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Case 1:10-cv-00373-RBW Document 128 Filed 01/04/13 Page 1 of 2

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA __________________________________________ KENNETH BERGE, ET. AL, ) ) Plaintiffs, ) ) vs. ) ) UNITED STATES OF AMERICA, ET. AL , ) ) Defendant. ) __________________________________________)

Civil Action No. 10-373 (RBW)

DEFENDANTS’ NOTICE OF SUPPLEMENTAL AUTHORITY Defendants hereby notify the Court of the National Defense Authorization Act for Fiscal Year 2013 signed into law on January 2, 2013.

Under this Act, Congress

established a 1-year pilot program for the Department of Defense (“DOD”) to “provide for the treatment of autism spectrum disorders, including applied behavior analysis, for all TRICARE beneficiaries covered under the basic TRICARE program.”

See

Conference Report, Congressional Record, H7134 (December 18, 2012) (Attached). “The conferees have provided DOD this 1-year authority in order to allow DOD to assess such coverage independent from litigation proceedings” in this Court. See id. Given that Congress has recognized that DOD is to further assess the scope of applied behavior analysis coverage, and rejected mandating coverage beyond this pilot program, defendants renew their request that the injunction be vacated. See Dkt. #s 122, 126.

Dated: January 4, 2012

Respectfully submitted, STUART F. DELERY Principal Deputy Assistant Attorney General

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Case 1:10-cv-00373-RBW Document 128 Filed 01/04/13 Page 2 of 2

RONALD C. MACHEN JR. United States Attorney for the District of Columbia JOSEPH H. HUNT Director, Federal Programs Branch _/s/_______________________________ ADAM D. KIRSCHNER Trial Attorney U.S. Department of Justice Civil Division, Federal Programs Branch Mailing Address P.O. Box 883 Washington, D.C., 20044 Delivery Address 20 Massachusetts Ave., NW., Room 7126 Washington, DC 20001 Telephone: (202) 353-9265 Fax: (202) 616-8470 Adam.Kirschner@usdoj.gov COUNSEL FOR DEFENDANTS

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H7134

Case 1:10-cv-00373-RBW Document 128-1 — Filed 01/04/13 Page December 1 of 1 CONGRESSIONAL RECORD HOUSE 18, 2012

the-counter drugs with no beneficiary copayment under demonstration authority for several years, and that the pilot program has resulted in significant savings to the Department. The conferees encourage the Department to continue to implement the authority provided by this section in a similar manner. Modification of requirements on mental health assessments for members of the Armed Forces deployed in connection with a contingency operation (sec. 703) The Senate amendment contained a provision (sec. 713) that would amend section 1074m(a) of title 10, United States Code, to align mandatory post-deployment person-toperson mental health assessments for certain service members with other existing health assessments. The provision would also limit the pre-deployment mental health assessments required under this section to those service members who will be subjected or exposed to operational risk factors during deployment in a contingency operation. The House bill contained no similar provision. The House recedes with an amendment that would amend section 1074m(a) of title 10, United States Code, to align mandatory post-deployment person-to-person mental health assessments for certain service members with other existing health assessments by changing the required assessment period from between 180 days after deployment to 1 year after deployment, to between 180 days after deployment to 18 months after deployment. Use of Department of Defense funds for abortions in cases of rape and incest (sec. 704) The Senate amendment contained a provision (sec. 711) that would authorize the use of Department of Defense funds for abortions in cases of rape or incest. The House bill contained no similar provision. The House recedes.

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Pilot program on certain treatments of autism under the TRICARE program (sec. 705) The House bill contained a provision (sec. 704) that would authorize behavioral health treatment, including applied behavior analysis therapy, for autism spectrum disorders when prescribed by a physician to be covered under the basic TRICARE program for certain beneficiaries. The Senate amendment contained a provision (sec. 705) that would authorize behavioral health treatment, including applied behavior analysis therapy, for all developmental disabilities as defined by section 15002(8) of title 42, United States Code, including autism spectrum disorders, when prescribed by a physician to be covered under the basic TRICARE program for certain beneficiaries. The Senate recedes with an amendment that would require the Secretary of Defense to conduct a 1-year pilot program to provide for the treatment of autism spectrum disorders, including applied behavior analysis, for all TRICARE beneficiaries covered under the basic program. The conferees are aware that the Department of Defense (DOD) has been ordered by the District Court for the District of Columbia to provide coverage under the basic TRICARE benefit for applied behavior analysis. The conferees understand that the plaintiffs and DOD have each submitted motions to reconsider the court order. The conferees have provided DOD this 1-year authority in order to allow DOD to assess such coverage independent from litigation proceedings.

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Pilot program on enhancements of Department of Defense efforts on mental health in the National Guard and Reserves through community partnerships (sec. 706) The House bill contained a provision (sec. 725) that would authorize the Secretary of Defense to carry out a pilot program to enhance the efforts of the Department of Defense (DOD) in research, treatment, education, and outreach on mental health, substance use disorders, and traumatic brain injury in members of the National Guard and reserves, their family members, and their caregivers through community partners. The provision would also authorize the Secretary to award grants to these community partners. The Senate amendment contained a provision (sec. 722) that would authorize the Secretary of Defense to carry out a research program to assess the feasibility and advisability of enhancing the efforts of the DOD in research, treatment, education, and outreach on mental health, substance use disorders, and traumatic brain injury in reserve component members, their families, and their caregivers. The Senate recedes with an amendment that would authorize the Secretary to carry out a pilot program to enhance the efforts of DOD in research, treatment, education, and outreach on mental health, substance use disorders, and traumatic brain injury in members of the National Guard and reserves, their family members, and their caregivers through agreements with community partners. Sense of Congress on health care for retired members of the uniformed services (sec. 707) The House bill contained a provision (sec. 701) that would express the sense of Congress that career members of the uniformed services and their families endure unique and extraordinary demands and make extraordinary sacrifices over the course of a 20–30 year military career, and that those decades of sacrifice constitute a pre-paid premium for health care during retirement. The Senate amendment contained a provision (sec. 706) that would express the sense of Congress that career members of the uniformed services and those who are medically retired, and their families, endure unique and extraordinary demands and make extraordinary sacrifices in protecting freedom for all Americans, and that access to quality health care services is an earned benefit during retirement in acknowledgment of their contributions of service and sacrifice. The House recedes. Subtitle B—Health Care Administration Authority for automatic enrollment in TRICARE Prime of dependents of members in pay grades above pay grade E–4 (sec. 711) The House bill contained a provision (sec. 712) that would require all dependents of members in pay grade E–4 or below to be automatically enrolled in TRICARE Prime, and would authorize the Secretary of Defense to automatically enroll dependents of members in pay grade E–5 or higher in TRICARE Prime. The Senate amendment contained no similar provision. The Senate recedes. Cost-sharing rates for the pharmacy benefits program of the TRICARE program (sec. 712) The House bill contained a provision (sec. 718) that would establish cost-sharing rates under the TRICARE pharmacy benefits program for fiscal year 2013 in statute, and in fiscal years 2014 and beyond, would limit annual increases in pharmacy copayments to the amount equal to the cost of living adjustment percentage increase in retiree pay. The Senate amendment contained no similar provision.

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The Senate recedes with an amendment that would establish cost-sharing rates under the TRICARE pharmacy benefits program for fiscal year 2013 in statute, and would in fiscal years 2014 through 2022 limit any annual increases in pharmacy copayments to increases in retiree cost of living adjustments. The provision would also enable the Department of Defense to delay increasing copayments until the aggregate increase amounts to at least 1 dollar. Beyond fiscal year 2022, the Secretary of Defense would be authorized to increase copayments as the Secretary considers appropriate. Clarification of applicability of certain authority and requirements to subcontractors employed to provide health care services to the Department of Defense (sec. 713) The House bill contained a provision (sec. 715) that would amend section 1089(a) of title 10, United States Code, to clarify that subcontractors providing health care under personal services contracts are covered for medical malpractice purposes under the Federal Tort Claims Act (28 U.S.C. 1346(b), 2671–2680) in the same manner as government employees providing the same services, as requested by the Department of Defense. The Senate amendment contained a similar provision (sec. 721). The House recedes. Expansion of evaluation of the effectiveness of the TRICARE program (sec. 714) The Senate amendment contained a provision (sec. 703) that would amend section 717(a) of the National Defense Authorization Act for Fiscal Year 1996 (Public Law 104–106) to update the reporting requirements of the Department of Defense report, ‘‘Evaluation of the TRICARE Program: Access, Cost, and Quality,’’ to reflect the Department’s practice of reporting on access, cost, and quality broadly for the military health care system, not solely for retirees as required by current law. The provision would also require the Department to evaluate access, cost, and quality for military dependent children under the age of 21 and for dependents of active-duty members with severe disabilities and special needs. The House bill contained no similar provision. The House recedes with a clarifying amendment. Requirement to ensure the effectiveness and efficiency of health engagements (sec. 715) The House bill contained a provision (sec. 714) that would require the Secretary of Defense, in coordination with the Assistant Secretary of Defense for Health Affairs and the Uniformed Services University of the Health Sciences (USUHS) to develop a process to ensure that health engagements conducted by the Department of Defense (DOD) are effective and efficient in meeting the national security goals of the United States. The provision would also authorize the Secretary of Defense, in coordination with USUHS, to conduct pilot programs to assess the effectiveness of the processes developed to ensure the efficiency and effectiveness of health engagements. The Senate amendment contained no similar provision. The Senate recedes with an amendment that would require the Secretary of Defense, in coordination with the Under Secretary of Defense for Policy and the Assistant Secretary of Defense for Health Affairs, to develop a process to ensure that health engagements conducted by DOD are effective and efficient in meeting the national security goals of the United States. The provision would also authorize the Assistant Secretary of Defense for Health Affairs to establish a measure of effectiveness learning tool to assess the effectiveness of processes developed

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DoD Filing in Berge Case Post NDAA