Key Tricare for Kids Provisions in FY17 NDAA

The TFK Coalition continued to express its concerns to Congress about the significant “gaps,” “areas for clarification” and considerable deficiencies the Defense Health Agency noted in its July 2014 report, in response to Section 735 of the 2013 NDAA. While that report concluded that the military health system provides adequate coverage for military children, including children with special health care needs, the conclusion was unsubstantiated, lacking meaningful data and comparisons in support of some of its claims. Additionally, even with its broad “conclusions” it still identified concerns with coverage of preventive health services, behavioral health services, determining medical necessity, data collection and data utilization, to name a few. In addition, the report did not make any recommendations or plans to address any of these issues, as required by Congress.

That is why the Coalition is so pleased that the Senate included section 762 of its FY 2017 NDAA at our request, which requires the Department of Defense to issue a report that outlines its plan to improve pediatric care and related services, and that additional provisions in the legislation and accompanying committee reports support and promote addressing the specific needs of children including families impacted by special, chronic and complex health needs.

A couple of the key provisions in the bills are as follows:

Senate Sec. 762. Report on Plan to Improve the Pediatric Care and Related Services for Children of Members of the Armed Forces

House report language, Improving Pediatric Coverage Under TRICARE

Section 762 of S. 2943 directs the Secretary of Defense to specifically address points identified in the original Tricare for Kids legislation and submit a report setting forth the plan of the Department of Defense. In particular, the new report would require the Department of Defense to prepare and disclose its plan to align preventive pediatric care under the TRICARE program with preventive standards required by the Patient Protection and Affordable Care Act (AAP’s Bright Futures for children), guidelines established for such care by the Early and Periodic Screening, Diagnosis, and Treatment program under the Medicaid program and recommendations by organizations that specialize in pediatrics. Additionally, the provision directs the DoD to develop a uniform definition of ‘‘pediatric medical necessity;” revise certification requirements for residential treatment centers; develop measures to evaluate and improve access to pediatric care; improve the quality of and access to behavioral health care; mitigate the impact of permanent changes of station and develop and implement pediatric specific reporting, data measures, outcome measures, data collection, pediatric specialty care understanding, and other areas identified as gaps in the Tricare for Kids report.

This requirement will help to improve pediatric care and related services for children of members of the Armed Forces and all children covered by Tricare, which is greatly needed. The Congressional direction to the Secretary is much appreciated.

H.R. 4909 includes report language similar in spirit to section 762 of the Senate bill, as it shares the concern of the House Armed Services Committee that the Department has not completed addressing the deficiencies noted in the report required by sec. 735 of the NDAA for FY13. As such, this section directs the Secretary of Defense to provide a briefing to the House Committee on Armed Services on the actions taken and the plan to correct the remaining deficiencies identified in the pediatric health care report. Our coalition is also supportive of this requirement, in tandem with the report required by the Senate bill.

Both houses have passed their respective bills, and the legislation will go to conference committee to resolve differences.