,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #fadh  ,,in ,,the ,,house ,,of  
,,representatives  ,march #i1 #bjbj,mr4 
,cole 7for himself and ,mrs4 ,luria7    
introduced the following bill2 which was
 referred to the ,committee on ,armed   
,services  ,a ,,bill  ,to amend title   
#aj1 ,united ,states ,code1 to expand   
benefits available under the ,,tricare  
,extended ,health ,care ,option program1
 and for other purposes4  #a4 ,short    
title ,this ,act may be cited as the    
,,tricare ,,echo ,improvement ,act4  #b4
 ,findings ,congress finds the          
following3 7#a7 ,active duty members of 
the uniformed services encounter        
difficulties accessing ,home and        
,community-,based ,services 7,,hcbs7    
waivers under ,medicaid for the         
dependents of such members who have     
intellectual or developmental           
disabilities4  7#b7 ,state residency    
requirements create barriers to         
accessing such benefits for military    
families who move across ,state lines   

and are required to reenroll with each  
permanent change of station4  7#c7      
,enrollment caps for such waivers create
 additional barriers1 and often result  
in waiting lists due to the demand for  
such waivers1 including1 in #bjag1 an   
average #cj-month wait time4  7#d7 ,the 
,military ,compensation and ,retirement 
,modernization ,commission concluded    
that 8access to ,,hcbs waiver benefits  
is a substantial issue for military     
families ''' ,service members are       
required to re-apply for benefits each  
time they move to a new state4 ,many    
,service members encounter waiting lists
 that exceed their time assigned to a   
location404  7#e7 ,in #bjja1 the        
,,tricare ,extended ,care ,health       
,option program 7,,echo program7 was    
established as an alternative to ,,hcbs 
waivers for military families4 ,the     
,,echo program provides additional      
medical and non-medical services not    
covered by ,,tricare to eligible        
military dependents with special needs1 

for the purpose of assisting in the     
reduction of the disabling effects of   
the qualifying condition of the         
dependent4  7#f7 ,the ,military         
,compensation and ,retirement           
,modernization ,commission concluded    
that1 although ,,echo was created as an 
alternative to ,,hcbs waiver benefits1  
8,,echo benefits1 as currently          
implemented1 are not robust enough to   
replace state waiver programs when those
 programs are inaccessible40  7#g7      
,although the purpose of the ,,echo     
program is to provide supplemental      
services to dependents with special     
needs1 a #bjad study conducted by the   
,manpower ,data ,center of the          
,department of ,defense found that only 
#cg percent of military families that   
have a child with special needs were    
aware of the program4  7#h7 ,the        
,conference ,report accompanying the    
,national ,defense ,authorization ,act  
for ,fiscal ,year #bjaj stated that     
8expanding support for families with    

special needs is a critical requirement 
for the all-volunteer force404  #c4     
,sense of ,congress ,it is the sense of 
,congress that military families        
deserve-- 7#a7 equitable access to      
critical services that minimize the     
debilitating effects of a disabling     
condition2 and  7#b7 an evaluation of   
the effectiveness of current services   
under the ,,echo program4  #d4          
,expansion of benefits available under  
,,tricare ,extended ,health ,care       
,option program  7a7 ,extended benefits 
for eligible dependents ,subsection 7e7 
of section #ajgi of title #aj1 ,united  
,states ,code1 is amended to read as    
follows3  7e7 7#a7 ,extended benefits   
for eligible dependents under subsection
 7d7 may include comprehensive health   
care services 7including services       
necessary to maintain1 or minimize or   
prevent deterioration of1 function of   
the patient7 and case management        
services with respect to the qualifying 
condition of such a dependent1 and      

include1 to the extent such benefits are
 not provided under provisions of this  
chapter other than under this section1  
the following3 7,a7 ,diagnosis and      
screening4  7,b7 ,inpatient1 outpatient1
 and comprehensive home health care     
supplies and services which may include 
cost effective and medically appropriate
 services other than part-time or       
intermittent services 7within the       
meaning of such terms as used in the    
second sentence of section #ahfa7m7 of  
the ,social ,security ,act74  7,c7      
,rehabilitation and habilitation        
services and devices4  7,d7             
,institutional care in private          
nonprofit1 public1 and ,state           
institutions and facilities and1 if     
appropriate1 transportation to and from 
such institutions and facilities4  7,e7 
,custodial care1 notwithstanding the    
prohibition in section #ajgg7;b77#a7 of 
this title4  7,f7 ,in accordance with   
paragraph 7#b71 respite care for the    
primary caregiver of the eligible       

dependent4  7,g7 ,in accordance with    
paragraph 7#c71 service and modification
 of durable equipment and assistive     
technology devices4  7,h7 ,special      
education4  7,i7 ,vocational training1  
which may be furnished to an eligible   
dependent in the residence of the       
eligible dependent or at a facility in  
which such training is provided4  7,j7  
,in accordance with paragraph 7#d71     
adaptations to the private residence and
 vehicle of the eligible dependent4     
7,k7 ,such other services and supplies  
as determined appropriate by the        
,secretary1 notwithstanding the         
limitations in subsection 7a77#ab74     
7#b7 ,respite care under paragraph      
7#a77;,f7 shall be provided subject to  
the following conditions3 7,a7 ,such    
respite care shall be limited to #ej    
hours in each month4  7,b7 ,unused hours
 of respite care may not be carried over
 to another month4  7,c7 ,such respite  
care may be provided to an eligible     
beneficiary regardless of whether the   

eligible beneficiary is receiving       
another benefit under this subsection4  
7#c7 7,a7 ,service and modification of  
durable equipment and assistive         
technology devices under paragraph      
7#a77;,g7 may be provided only upon     
determination by the ,secretary that the
 service or modification is necessary   
for the use of such equipment or device 
by the eligible dependent4  7,b7        
,service and modification of durable    
equipment and assistive technology      
devices under such paragraph may not be 
provided-- 7i7 in the case of misuse1   
loss1 or theft of the equipment or      
device2 or  7ii7 for a deluxe1 luxury1  
or immaterial feature of the equipment  
or device1 as determined by the         
,secretary4  7,c7 ,service and          
modification of durable equipment and   
assistive technology devices under such 
paragraph may include training of the   
eligible dependent and immediate family 
members of the eligible dependent on the
 use of the equipment or device4  7#d7  

7,a7 ,adaptations to the private        
residence and vehicle of the eligible   
dependent under paragraph 7#a77;,j7 may 
be provided if such adaptations-- 7i7   
are determined to be medically necessary
 by the provider responsible for the    
care of the eligible dependent with     
respect to the qualifying condition2 and
  7ii7 are necessary to assist in-- 7,i7
 the reduction of the disabling effects 
of the qualifying condition2 or  7,,ii7 
maintenance of the present functionality
 of the eligible dependent4  7,b7 ,with 
respect to a vehicle1 adaptations may be
 provided under such paragraph if the   
vehicle is the primary means of         
transportation of the eligible          
dependent4  4  #e4 ,additional          
requirements in ,office of ,special     
,needs annual report ,section           
#agha;c7g77#b7 of title #aj1 ,united    
,states ,code1 is amended-- 7#a7 by     
redesignating subparagraph 7,c7 as      
subparagraph 7,d72 and  7#b7 by         
inserting after subparagraph 7,b7 the   

following new subparagraph 7,c73  7,c7  
,with respect to the ,extended ,care    
,health ,option program under section   
#ajgi7;d7 of this title-- 7i7 the       
utilization rates of services under such
 program by eligible dependents 7as such
 term is defined in such section7 during
 the prior year2  7ii7 a description of 
gaps in such services1 as ascertained by
 the ,secretary from information        
provided by families of eligible        
dependents2  7iii7 an assessment of     
factors that prevent knowledge of and   
access to such program1 including a     
discussion of actions the ,secretary may
 take to address these factors2 and     
7iv7 an assessment of the average wait  
time for an eligible dependent enrolled 
in the program to access alternative    
health coverage for a qualifying        
condition 7as such term is defined in   
such section71 including a discussion of
 any adverse health outcomes associated 
with such wait4  4  #f4 ,effective date 
,the amendments made by this ,act shall 

take effect ,october #a1 #bjbj4