March 14, 2013 The Honorable Chuck Hagel Office of the Secretary of Defense 1400 Defense Pentagon Washington, DC 20301-1400 Dear Mr. Secretary: As organizations committed to the health and well-being of children and families in the Armed Services, we write to congratulate you on your confirmation as Secretary of Defense and look forward to working with you as you lead the Department of Defense. Your history of service to our country, through your years in uniform serving in Vietnam and your service at the Veteran’s Administration, gives you clear perspective and keen understanding of the bravery and dedication of the nation’s military families and the challenges they must sometimes face to access needed medical care. As you are well aware, the TRICARE program covers 9.6 million uniformed service members and their families, including about 2 million children. With TRICARE patterned after Medicare, a healthcare system for senior adults, it often adopts policies and practices from Medicare that do not address the unique health care needs of children. Moreover, military families with children with special health care needs and chronic conditions often have difficulty accessing and navigating resources and services offered by local or regionally specialized providers. This challenge is further exacerbated by the frequent relocations experienced by military families. As organizations who supported the TRICARE for Kids Act (H.R. 4341) in the 112th Congress, we were delighted to see that the final FY 2013 National Defense Authorization Act (FY13 NDAA) contained language directing the Secretary of Defense to conduct a study on the health care and related support provided by the Secretary to dependent children of members of the Armed Forces. Specifically, Section 735 directs the Secretary to conduct a study that includes the following:

(1) A comprehensive review of the policies of the Secretary and the TRICARE program with respect to providing pediatric care.

(2) An assessment of access to pediatric health care by dependent children in appropriate

settings.

(3) An assessment of access to specialty care by dependent children, including care for children with special health care needs.

(4) A comprehensive review and analysis of reimbursement under the TRICARE program

for pediatric care. (5) An assessment of the adequacy of the ECHO Program in meeting the needs of

dependent children with extraordinary health care needs.

(6) An assessment of the adequacy of care management for dependent children with special health care needs.

(7) An assessment of the support provided through other Department of Defense or

military department programs and policies that support the physical and behavioral health of dependent children, including children with special health care needs.

(8) Mechanisms for linking dependent children with special health care needs with State and

local community resources, including children¹s hospitals and providers of pediatric specialty care.

(9) Strategies to mitigate the impact of frequent relocations related to military service on the

continuity of health care services for dependent children, including children with special health and behavioral health care needs.

We are grateful that this language was included in the FY13 NDAA and look forward to working with the Secretary to ensure that a thorough study is indeed conducted by the end of 2013. In this spirit, we would like to recommend that you consider setting up a working group—like the one that was contained in the original TRICARE for Kids Act—to provide valuable input that is otherwise not available to the Department of Defense in conducting this study. The language in the original bill called for a 14-member working group consisting of:

(a) the Chief Medical Officer of the TRICARE program;

(b) the Chief Medical Officers of the North, South and West regions of the TRICARE program;

(c) one individual each appointed by the Surgeon Generals of the Army, Navy and Air

Force;

(d) one individual representing the regional managed care contractors from each of the North, South and West TRICARE regions;

(e) three individuals representing the Military Coalition;

(f) one individual representing the American Academy of Pediatrics;

(g) one individual representing the Children’s Hospital Association (formerly the National Association of Children’s Hospitals); (h) one individual representing military families who is not an employee of an organization representing such families; and (i) one individual as determined by the Chief Medical Officer of the TRICARE program.

This type of working group, comprised of people who administer TRICARE, military pediatricians and other providers who deliver care to beneficiaries, and families who participate in the program, would allow for a wide variety of views to be represented in the review of the program. It is imperative that military families receive the proper services and medical treatment that their children need. Ensuring that their children’s healthcare needs are appropriately met is one important way this country can demonstrate our gratitude, respect and honor to our military and their families. The study and subsequent recommendations by the Secretary can help to accomplish this goal. We thank you for your commitment to supporting the families of our nation's military, and urge you to reach out and work with our organizations as you conduct this important study. Sincerely, American Academy of Pediatrics Children’s Hospital Association March of Dimes Military Officers Association of America Military Special Needs Network National Military Family Association