The purpose of this chapter is to create and maintain high morale in the uniformed services by providing an improved and uniform program of medical and dental care for members and certain former members of those services, and for their dependents.
(Added Pub. L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1445; amended Pub. L. 89–614, § 2(1), Sept. 30, 1966, 80 Stat. 862; Pub. L. 96–513, title V, § 511(34)(A), (B), Dec. 12, 1980, 94 Stat. 2922.)
Historical and Revision Notes
Revised sectionSource (U.S. Code)Source (Statutes at Large)
107137:401.June 7, 1956, ch. 374, § 101, 70 Stat. 250.
The words “and certain former members” are inserted to reflect the fact that many of the persons entitled to retired pay are former members only. The words “and dental” are inserted to reflect the fact that members and, in certain limited situations, dependents are entitled to dental care under sections 1071–1085 of this title.
Editorial Notes
Prior ProvisionsA prior section 1071, act Aug. 10, 1956, ch. 1041, 70A Stat. 81, which stated the purpose of former sections 1071 to 1086 of this title, and provided for their construction, was repealed by Pub. L. 85–861, § 36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which was classified to subchapter I–D (§ 1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare, prior to repeal by Pub. L. 99–410, title II, § 203, Aug. 28, 1986, 100 Stat. 930.
Amendments1980—Pub. L. 96–513 substituted “Purpose of this chapter” for “Purpose of sections 1071–1087 of this title” in section catchline, and substituted reference to this chapter for reference to sections 1071–1087 of this title in text.
1966—Pub. L. 89–614 substituted “1087” for “1085” in section catchline and text.
Statutory Notes and Related Subsidiaries
Effective Date of 1980 AmendmentAmendment by Pub. L. 96–513 effective Dec. 12, 1980, see section 701(b)(3) of Pub. L. 96–513, set out as a note under section 101 of this title.
Effective Date of 1966 AmendmentPub. L. 89–614, § 3, Sept. 30, 1966, 80 Stat. 866, provided that: “The amendments made by this Act [see Short Title of 1966 Amendment note below] shall become effective January 1, 1967, except that those amendments relating to outpatient care in civilian facilities for spouses and children of members of the uniformed services who are on active duty for a period of more than 30 days shall become effective on October 1, 1966.”
Short Title of 2008 AmendmentPub. L. 110–181, div. A, title XVI, § 1601, Jan. 28, 2008, 122 Stat. 431, provided that: “This title [enacting sections 1074l, 1216a, and 1554a of this title, amending sections 1074, 1074f, 1074i, 1145, 1201, 1203, 1212, and 1599c of this title and section 6333 of Title 5, Government Organization and Employees, and enacting provisions set out as notes under this section, sections 1074, 1074f, 1074i, 1074l, 1212, and 1554a of this title, and section 6333 of Title 5] may be cited as the ‘Wounded Warrior Act’.”
Short Title of 1987 AmendmentPub. L. 100–180, div. A, title VII, § 701, Dec. 4, 1987, 101 Stat. 1108, provided that: “This title [enacting sections 1103, 2128 to 2130 [now 16201 to 16203], and 6392 of this title, amending sections 533, 591, 1079, 1086, 1251, 2120, 2122, 2123, 2124, 2127, 2172 [now 16302], 3353, 3855, 5600, 8353, and 8855 of this title, section 302 of Title 37, Pay and Allowances of the Uniformed Services, and section 3809 of Title 50, War and National Defense, enacting provisions set out as notes under sections 1073, 1074, 1079, 1092, 1103, 2121, 2124, 12201, and 16201 of this title, amending provisions set out as notes under sections 1073 and 1101 of this title, and repealing provisions set out as notes under sections 2121 and 2124 of this title] may be cited as the ‘Military Health Care Amendments of 1987’.”
Short Title of 1966 AmendmentPub. L. 89–614, § 1, Sept. 30, 1966, 80 Stat. 862, provided: “That this Act [enacting sections 1086 and 1087 of this title, amending this section and sections 1072 to 1074, 1076 to 1079, 1082, and 1084 of this title, and enacting provisions set out as a note under this section] may be cited as the ‘Military Medical Benefits Amendments of 1966’.”
Pilot Program on Wastewater Surveillance System of Department of DefensePub. L. 119–60, div. A, title VII, § 733, Dec. 18, 2025, 139 Stat. 932, provided that:
“(a) Pilot Program Required.—Commencing not later than 180 days after the date of the enactment of this Act [Dec. 18, 2025], the Secretary of Defense shall carry out a pilot program under which the Secretary shall develop and implement a comprehensive wastewater surveillance system at not fewer than four installations of a military department at which the Secretary seeks to identify the prevalence of infectious diseases among members of the Armed Forces at the installation (in this section referred to as the ‘pilot program’).
“(b) Technologies and Data System Used.—In carrying out the pilot program, the Secretary shall ensure the system developed and implemented under subsection (a) is comprised of appropriate technologies and a uniform data system across the Department of Defense.
“(c) Duration.—The pilot program shall be carried out during a two-year period beginning on the date of the commencement of the pilot program.
“(d) Report.—Not later than 90 days after the termination of the pilot program, the Secretary shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report that includes the following:“(1) A summary of the findings from the wastewater surveillance system under the pilot program.
“(2) Recommendations for interventions or policy changes based on trends observed under the pilot program.
“(3) An assessment of the effectiveness of the pilot program in enhancing force health protection and readiness.”
Pilot Program To Assist Certain Members of the Armed Forces and Dependents With Additional Supplemental Coverage Relating to CancerPub. L. 119–60, div. A, title VII, § 734, Dec. 18, 2025, 139 Stat. 933, provided that:
“(a) Establishment.—Not later than September 30, 2027, the Secretary of Defense shall establish a pilot program under which a covered individual may obtain supplemental insurance for noncovered expenses under a fixed indemnity supplemental benefit plan described in subsection (b)(1) (in this section referred to as the ‘pilot program’). The Secretary shall carry out such program until the date on which the last agreement terminates pursuant to subsection (b)(2).
“(b) Agreement.—“(1) In general.—In carrying out the pilot program, the Secretary shall enter into an agreement with not fewer than two companies to each offer one or more fixed indemnity supplemental benefit plans that—“(A) meet the requirements for a supplemental insurance plan under section 199.2 of title 32, Code of Federal Regulations, and the exceptions under section 199.8(b)(4) of such title, as in effect on the date of the enactment of this Act [Dec. 18, 2025];
“(B) are provided under a separate policy, certificate, or contract; and
“(C) are designed to help participants pay noncovered expenses.
“(2) Duration of agreement.—An agreement entered into under paragraph (1) shall be for a period of not more than three years, and may not be renewed.
“(c) Provision of Information.—The Secretary shall provide information to covered individuals regarding the pilot program by making available on a publicly accessible internet website the following information:“(1) A notice of availability of a fixed indemnity supplemental benefit plan provided under the pilot program.
“(2) A description of how to enroll in such plan.
“(3) A description and explanation of such plan, including the diagnoses, screenings, and treatments covered by the plan.
“(4) A description of the costs to the individual through premiums and remittances to a company providing such plan.
“(5) A notice that—“(A) the availability of a fixed indemnity supplemental benefit plan provided under the pilot program does not affect the health care benefits provided to covered individuals under the TRICARE program; and
“(B) covered individuals are not required to purchase such a plan in order to receive health care benefits covered under the TRICARE program.
“(d) Enrollment.—“(1) Election.—A covered individual may elect to enroll in a fixed indemnity supplemental benefit plan provided under the pilot program.
“(2) Verification of eligibility.—The Secretary shall establish procedures to determine the eligibility of applicants seeking to enroll in a fixed indemnity supplemental benefit plan provided under the pilot program.
“(e) Limitations on Authorization of Appropriations.—None of the amounts authorized to be appropriated by this Act or otherwise made available for fiscal year 2026 or any fiscal year thereafter to carry out the pilot program may be used to subsidize the cost of a fixed indemnity supplemental benefit plan provided under the pilot program.
“(f) Briefing.—Not later than one year after the date on which the pilot program commences and annually thereafter during the life of the pilot program, the Secretary shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing regarding the pilot program, including the following:“(1) A description of the insurance products provided through a fixed indemnity supplemental benefit plan provided under the pilot program.
“(2) The number of covered individuals who enrolled in such a plan.
“(3) Feedback and examples of use cases by such individuals.
“(4) A determination by the Secretary with respect to whether the pilot program should be made permanent.
“(g) Definitions.—In this section:“(1) The term ‘covered individual’ means the following:“(A) A member of the regular component of the Army, Navy, Marine Corps, Air Force, or Space Force.
“(B) A dependent (as defined in section 1072 of title 10, United States Code) of such a member who is enrolled in the TRICARE program.
“(2) The term ‘noncovered expense’ means, with respect to a covered individual, any expenses relating to the screening for and diagnosis and treatment of cancer that are not otherwise covered by the health care benefits the individuals [sic] receives under chapter 55 of title 10, United States Code, or any other benefit provided by the Secretary of Defense.
“(3) The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10, United States Code.”
Program To Prevent Perinatal Mental Health Conditions in Pregnant and Postpartum Members of the Armed ForcesPub. L. 118–159, div. A, title VII, § 705, Dec. 23, 2024, 138 Stat. 1943, provided that:
“(a) Requirement.—The Secretary of Defense, acting through the Under Secretary of Defense for Personnel and Readiness, shall carry out a program to improve clinical and nonclinical services targeting mental health conditions in pregnant and postpartum members of the Armed Forces and spouses of members during the perinatal period.
“(b) Elements.—The Secretary shall ensure that the program under subsection (a) includes the following:“(1) Access to support resources during the perinatal period, including—“(A) identification of symptoms of perinatal mental health conditions, brief intervention by primary care providers, referral to care, and treatment;
“(B) targeted nonmedical counseling services through the Department of Defense Military and Family Life Counseling Program of the Office of Military Family Readiness Policy under section 1781 of title 10, United States Code;
“(C) existing parenting resiliency programs of the military departments;
“(D) adherence to clinical practice guidelines in military medical treatment facilities in support of members of the uniformed services and dependents with a diagnosed mental health condition requiring clinical intervention, including through primary care services and women’s health clinics, in collaboration with behavioral health services; and
“(E) prenatal and postnatal support programs at military medical treatment facilities that provide group counseling modeled after best clinical practices, such as the Centering Pregnancy program.
“(2) A process for informing pregnant and postpartum members of the Armed Forces and spouses of members of nonmedical and clinical support services during the perinatal period.
“(3) A communications strategy to increase awareness of the services available under the program.
“(c) Report.—Not later than December 31, 2025, the Secretary shall submit to the Committees on Armed Services of the Senate and House of Representatives a report on the program under subsection (a) that includes the following:“(1) A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities.
“(2) How resources are allocated for the purpose of establishing and maintaining perinatal support programs at military medical treatment facilities.
“(3) Measurements for adherence to evidence-based protocols at military medical treatment facilities with respect to identifying potential mental health issues.
“(4) Assessment of current training and credentials required for health care providers providing perinatal services and consideration for further certifications, such as the Perinatal Mental Health Certification.
“(5) Feasibility and advisability of adding specialized perinatal mental health support services via a helpline through Military One Source.
“(6) Recommendations for administrative or legislative changes to improve the effectiveness of the program.
“(d) Perinatal Period Defined.—In this section, the term ‘perinatal period’ means the period beginning with pregnancy through one year following childbirth.”
Establishment of Defense Intrepid Network for Traumatic Brain Injury and Brain Health as Program of RecordPub. L. 118–159, div. A, title VII, § 721, Dec. 23, 2024, 138 Stat. 1951, provided that:
“(a) In General.—Not later than January 1, 2026, the Secretary of Defense shall establish the Defense Intrepid Network for Traumatic Brain Injury and Brain Health (in this section referred to as the ‘Network’) headquartered at the National Intrepid Center of Excellence as a program of record subject to milestone reviews and compliance with the requirements under this section.
“(b) Duties.—The duties of the Network are as follows:“(1) To provide clinical care to prevent, diagnose, treat, and rehabilitate members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, symptoms from blast overpressure or blast exposure, and other mental health conditions.
“(2) To promote standardization of care among the 10 Intrepid Spirit Centers throughout the continental United States, brain health clinics in Alaska and Germany, and other sites as designated by the Director of the Defense Health Agency as being a part of the long-term brain health strategy of the Department of Defense.
“(3) To support and conduct research and education on traumatic brain injury, post-traumatic stress disorder, blast overpressure or blast exposure, and other mental health conditions.
“(c) Annual Briefing.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2024], and annually thereafter for a period of five years, the Secretary of Defense shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing that shall include, for the year covered by the briefing—“(1) the number of individuals to whom the Network has provided services;
“(2) the number of individuals who return to active duty in the Armed Forces after receiving services from the Network, and the stage in their career at which they seek treatment at the Network;
“(3) the number of individuals whose families are able to participate in programs provided by the Network; and
“(4) the number of individuals on a waitlist for treatment at the Network and the average period those individuals are on the waitlist.”
Brain Health and Trauma ProgramPub. L. 118–159, div. A, title VII, § 722, Dec. 23, 2024, 138 Stat. 1951, provided that:
“(a) Establishment.—The Secretary of Defense shall establish an intensive comprehensive brain health and trauma program to—“(1) provide multidisciplinary specialist evaluations, treatment initiation, and aftercare for members of the Armed Forces and dependents of members; and
“(2) make evidence-based improvements in such evaluations, treatment, and aftercare.
“(b) Program Elements.—The Secretary shall ensure that the program under subsection (a) includes the following:“(1) Initiatives of the Defense Health Agency that provide coordinated evaluations, treatment, and aftercare for traumatic brain injuries and related conditions, that incorporates specialized evaluations, innovative and evidence-based treatments, and comprehensive follow-up care.
“(2) Collaboration with private sector nonprofit health care organizations involved in innovative clinical activities in brain health and trauma care, including transitional and residential brain injury treatment programs.
“(3) One or more pilot programs for demonstrating the effectiveness of intensive outpatient multidisciplinary specialist treatment and care coordination.
“(4) Incorporation of evidence-based therapy with complementary and alternative medicine approaches.
“(5) Thorough evaluations of the effectiveness of innovative activities for diagnosis, treatment, and aftercare of brain trauma and promotion of brain health.
“(c) Briefing.—Not later than December 31, 2025, the Secretary shall provide to the Armed Services Committees of the Senate and House of Representatives a briefing on the program under subsection (a). Such briefing shall include the following:“(1) A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities.
“(2) The scope of each pilot program carried out under subsection (b)(3).
“(3) Recommendations for administrative or legislative changes to improve the effectiveness of the program.”
Blast Overpressure and Traumatic Brain Injury Oversight Strategy and Action PlanPub. L. 118–159, div. A, title VII, § 724, Dec. 23, 2024, 138 Stat. 1954, provided that:
“(a) Strategy and Plan Required.—The Secretary of Defense shall develop and implement a traumatic brain injury oversight strategy and action plan that includes, at a minimum, the following:“(1) Assigned roles and responsibilities for the components of the Office of the Secretary of Defense for the mitigation, identification, and treatment of traumatic brain injury and the monitoring and documentation of blast overpressure exposure.
“(2) Standardized monitoring, treatment, and referral guidelines for traumatic brain injury programs across all covered Armed Forces.
“(3) A review and update of the current brain injury diagnostic tools used by such programs.
“(4) Standardized, 72-hour follow-up requirements for all traumatic brain injury patients, including protocols for the treatment and observation during such follow-up appointments.
“(5) Oversight and documentation standards to aid in data collection.
“(b) Implementation.—The Secretary shall implement the oversight strategy and action plan under subsection (a) not later than one year after the date of the enactment of this Act [Dec. 23, 2024].
“(c) Submission to GAO.—Upon development of the oversight strategy and action plan under subsection (a), the Secretary shall submit to the Comptroller General of the United States the oversight strategy and action plan.
“(d) Covered Armed Forces Defined.—In this section, the term ‘covered Armed Forces’ means the Army, Navy, Marine Corps, Air Force, and Space Force.”
Establishment of Requirements Relating to Blast Overpressure ExposurePub. L. 118–159, div. A, title VII, § 725, Dec. 23, 2024, 138 Stat. 1955, provided that:
“Not later than two years after the date of the enactment of this Act [Dec. 23, 2024], the Secretary of Defense shall establish—
“(1) performance parameters to minimize exposure to blast overpressure when drafting requirements for new weapon systems for the Department of Defense, taking into account the thresholds for blast exposure and overpressure safety identified pursuant to section 735(b)(1) of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (Public Law 117–263; 10 U.S.C. 1071 note), as amended by section 723;
“(2) with respect to contractual agreements entered into by any entity and the Department of Defense as part of the defense weapon acquisition process on or after the date on which such parameters are established, a requirement that the entity shall provide to the Secretary blast overpressure measurements and safety data for a weapon system procured under such agreement that produces blast overpressure that exceeds such thresholds; and
“(3) a requirement that any test plan for a new weapon system shall incorporate testing for blast overpressure measurements and safety data.”
Medical Countermeasures for Overseas Personnel of the Department of Defense for Acute Radiation Syndrome and Thermal BurnsPub. L. 118–159, div. A, title VII, § 734, Dec. 23, 2024, 138 Stat. 1956, provided that:
“(a) Program Required.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2024], the Secretary of Defense shall establish a program to develop requirements for the procurement, pre-positioning, and maintenance of medical countermeasures approved, cleared, licensed, or authorized by the Food and Drug Administration to diagnose, prevent, and treat acute radiation syndrome and thermal burns for use by covered personnel.
“(b) Program Specifications.—In carrying out the program required by subsection (a), the Secretary of Defense shall consider, in coordination with the Chairman of the Joint Chiefs of Staff and the commanders of the combatant commands, the following:“(1) The number of covered personnel in areas in which the use of tactical nuclear weapons is a substantial threat.
“(2) Peer-reviewed and published scientific studies regarding safety and efficacy of the potential countermeasures described in subsection (a).
“(3) Operational requirements of the Department.
“(4) Appropriate doctrine, training, and operational plans for effective use of such countermeasures.
“(5) A feasible schedule for implementation of the program.
“(c) Covered Personnel Defined.—In this section, the term ‘covered personnel’ means—“(1) members of the Armed Forces deployed outside the United States; and
“(2) civilian employees of the Department of Defense deployed outside the United States.”
Accountability for Wounded Warriors Undergoing Disability EvaluationPub. L. 117–263, div. A, title VII, § 711, Dec. 23, 2022, 136 Stat. 2656, provided that:
“(a) Policy.—Not later than April 1, 2023, the Secretary of Defense, in consultation with the Secretaries concerned, shall establish a policy to ensure accountability for actions taken under the authorities of the Defense Health Agency and the Armed Forces, respectively, concerning wounded, ill, and injured members of the Armed Forces during the integrated disability evaluation system process. Such policy shall include the following:“(1) A restatement of the requirement that, in accordance with section 1216(b) of title 10, United States Code, a determination of fitness for duty of a member of the Armed Forces under chapter 61 of title 10, United States Code, is the responsibility of the Secretary concerned.
“(2) A description of the role of the Director of the Defense Health Agency in supporting the Secretaries concerned in carrying out determinations of fitness for duty as specified in paragraph (1).
“(3) A description of how the medical evaluation board processes of the Armed Forces are integrated with the Defense Health Agency, including with respect to case management, appointments, and other relevant matters.
“(4) A requirement that, in determining fitness for duty of a member of the Armed Forces under chapter 61 of title 10, United States Code, the Secretary concerned shall consider the results of any medical evaluation of the member provided under the authority of the Defense Health Agency pursuant to section 1073c of title 10, United States Code.
“(5) A description of how the Director of the Defense Health Agency adheres to the medical evaluation processes of the Armed Forces, including an identification of each applicable regulation or policy to which the Director is required to so adhere.
“(6) An assessment of the feasibility of affording various additional due process protections to members of the Armed Forces undergoing the medical evaluation board process.
“(7) A restatement of the requirement that wounded, ill, and injured members of the Armed Forces may not be denied any due process protection afforded under applicable law or regulation of the Department of Defense or the Armed Forces.
“(8) A description of the types of due process protections specified in paragraph (7), including an identification of each specific due process protection.
“(b) Clarification of Responsibilities Regarding Medical Evaluation Boards.—
[Amended section 1073c of this title.]
“(c) Briefing.—Not later than February 1, 2023, the Secretary of Defense shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the status of the implementation of subsections (a) and (b).
“(d) Report.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2022], the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a report on the implementation of subsections (a) and (b), lessons learned as a result of such implementation, and the recommendations of the Secretary relating to the policy on wounded, ill, and injured members of the Armed Forces undergoing the integrated disability evaluation system process.
“(e) Secretary Concerned Defined.—In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10, United States Code.”
Access to Certain Dependent Medical Records by Remarried Former SpousesPub. L. 117–263, div. A, title VII, § 721, Dec. 23, 2022, 136 Stat. 2663, provided that:
“(a) Access.—The Secretary of Defense may authorize a remarried former spouse who is a custodial parent of a dependent child to retain electronic access to the privileged medical records of such dependent child, notwithstanding that the former spouse is no longer a dependent under section 1072(2) of title 10, United States Code.
“(b) Definitions.—In this section:“(1) The term ‘dependent’ has the meaning given that term in section 1072 of title 10, United States Code.
“(2) The term ‘dependent child’ means a dependent child of a remarried former spouse and a member or former member of a uniformed service.
“(3) The term ‘remarried former spouse’ means a remarried former spouse of a member or former member of a uniformed service.”
Brain Health Initiative of Department of DefensePub. L. 117–263, div. A, title VII, § 735, Dec. 23, 2022, 136 Stat. 2668, as amended by Pub. L. 118–159, div. A, title VII, § 723, Dec. 23, 2024, 138 Stat. 1952, provided that:
“(a) In General.—The Secretary of Defense, in consultation with the Secretaries concerned, shall establish a comprehensive initiative for brain health to be known as the ‘Warfighter Brain Health Initiative’ (in this section referred to as the ‘Initiative’) for the purpose of unifying efforts and programs across the Department of Defense to improve the cognitive performance and brain health of members of the Armed Forces.
“(b) Objectives.—The objectives of the Initiative shall be the following:“(1) To enhance, maintain, and restore the cognitive performance of members of the Armed Forces through education, training, prevention, protection, monitoring, detection, diagnosis, treatment, and rehabilitation, including through the following activities:“(A) The establishment of a program to monitor cognitive brain health across the Department of Defense, with the goal of detecting any need for cognitive enhancement or restoration resulting from potential brain exposures of members of Armed Forces, to mitigate possible evolution of injury or disease progression.
“(B) In accordance with subsection (c), the identification and dissemination of thresholds for blast exposure and overpressure safety and associated emerging scientific evidence that—“(i) cover brain injury and impulse noise;
“(ii) measure impact over 24-hour, 72-hour to 96-hour, monthly, annual, and lifetime periods;
“(iii) are designed to prevent cognitive deficits after firing;
“(iv) account for the cumulative impact of firing multiple weapon systems during the same period;
“(v) include minimum safe distances and levels of exposure for observers and instructors; and
“(vi) address shoulder-fired heavy weapons.
“(C) The modification of high-risk training and operational activities to mitigate the negative effects of repetitive blast exposure.
“(D) The identification of individuals who perform high-risk training or occupational activities, for purposes of increased monitoring of the brain health of such individuals.
“(E) The development and operational fielding of non-invasive, portable, point-of-care medical devices, to inform the diagnosis and treatment of traumatic brain injury.
“(F) The establishment of a standardized monitoring program that documents and analyzes blast exposures that may affect the brain health of members of the Armed Forces.
“(G) The consideration of the findings and recommendations of the report of the National Academies of Science, Engineering, and Medicine titled ‘Traumatic Brain Injury: A Roadmap for Accelerating Progress’ and published in 2022 (relating to the acceleration of progress in traumatic brain injury research and care), or any successor report, in relation to the activities of the Department relating to brain health, as applicable.
“(H) The establishment of a standardized treatment program based on interventions that have shown benefit to individuals with brain health issues after a brain injury and the provision of that treatment program to individuals with brain health issues after a brain injury resulting from a potential brain exposure described in subparagraph (A) or high-risk training or occupational activities described in subparagraph (D).
“(I) The establishment of policies to encourage members of the Armed Forces to seek medical treatment for brain health when needed, prevent retaliation against such members who seek such medical treatment, and address other barriers to seeking medical treatment for brain health due to the impact of blast exposure, blast overpressure, or traumatic brain injury.
“(J) The modification of existing weapons systems to reduce blast exposure of the individual using the weapon and those within the minimum safe distance.
“(2) To harmonize and prioritize the efforts of the Department of Defense into a single approach to brain health.
“(c) Thresholds for Blast Exposure and Overpressure Safety.—“(1) Timing.—“(A) Initial thresholds.—Not later than January 1, 2027, the Secretary of Defense shall identify and disseminate the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B).
“(B) Periodic updates.—On a quinquennial basis, the Secretary shall review and, as necessary, update the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B).
“(2) Formal training requirement.—The Secretary shall ensure that training on the thresholds for blast exposure and overpressure safety is provided to members of the Armed Forces before training, deployment, or entering other high-risk environments where exposure to blast overpressure is likely.
“(3) Central repository.—Not later than January 1, 2027, the Secretary shall establish a central repository of blast-related characteristics, such as pressure profiles and common blast loads associated with specific systems and the environments in which the systems are used.
“(4) Waivers.—“(A) Protocols.—The Secretary may waive the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B) for operational or training requirements that the Secretary determines are essential to national security. The Secretary shall include in each such waiver a justification for exceeding such thresholds.
“(B) Tracking system.—The Secretary shall establish a Department of Defense-wide tracking system for waivers issued under subparagraph (A) that includes data contributed by the Secretary of each military department.
“(C) Report on waivers.—Not later than one year after issuing a waiver under subparagraph (A) and annually thereafter for a period of five years, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on such waivers that includes—“(i) the number of waivers issued, disaggregated by military department; and
“(ii) a description of actions taken by the Secretary concerned to track the health effects of exceeding thresholds for blast exposure and overpressure safety on members of the Armed Forces, document such effects in medical records, and provide care to such members.
“(d) Pilot Program Relating to Monitoring of Blast Coverage.—“(1) Authority.—The Director of the Defense Health Agency may conduct, as part of the Initiative, a pilot program under which the Director shall monitor blast overpressure exposure through the use of commercially available, off-the-shelf, wearable sensors or other remote measurement technology, and document and evaluate data collected as a result of such monitoring.
“(2) Locations.—Monitoring activities under a pilot program conducted pursuant to paragraph (1) shall be carried out in each training environment that the Director determines poses a risk for blast overpressure exposure.
“(3) Documentation and sharing of data.—If the Director conducts a pilot program pursuant to paragraph (1), the Director shall—“(A) ensure that any data collected pursuant to such pilot program that is related to the health effects of the blast overpressure exposure of a member of the Armed Forces who participated in the pilot program is documented and maintained by the Secretary of Defense in an electronic health record for the member; and
“(B) to the extent practicable, and in accordance with applicable provisions of law relating to data privacy, make data collected pursuant to such pilot program available to other academic and medical researchers for the purpose of informing future research and treatment options.
“(4) Weapons use.—Monitoring activities under a pilot program conducted pursuant to paragraph (1) shall be carried out for any member of the Armed Forces firing tier 1 weapons in training or combat, as identified by the Secretary of Defense.
“(e) Reports on Warfighter Brain Health Initiative.—Not later than December 31, 2025, and not less frequently than annually thereafter for a period of five years, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that includes the following:“(1) A description of the activities taken under the Initiative and resources expended under the Initiative during the prior fiscal year.
“(2) The number of members of the Armed Forces impacted by blast overpressure and blast exposure in the prior fiscal year, including—“(A) the number of members who reported adverse health effects from blast overpressure or blast exposure;
“(B) the number of members exposed to blast overpressure or blast exposure;
“(C) the number of members who received treatment for injuries related to blast overpressure or blast exposure, including at facilities of the Department of Defense and at facilities in the private sector; and
“(D) the type of care that members receive from facilities of the Department of Defense and the type of care that members receive from facilities in the private sector.
“(3) A summary of the progress made during the prior fiscal year with respect to the objectives of the Initiative under subsection (b).
“(4) A description of the steps the Secretary is taking to ensure that activities under the Initiative are being implemented across the Department of Defense and the military departments.
“(f) Secretary Concerned Defined.—In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10, United States Code.”
Establishment of Partnership Program Between United States and Ukraine for Military Trauma Care and ResearchPub. L. 117–263, div. A, title VII, § 736, Dec. 23, 2022, 136 Stat. 2670, as amended by Pub. L. 118–31, div. A, title VII, § 721, Dec. 22, 2023, 137 Stat. 305, provided that:
“Not later than February 24, 2023, the Secretary of Defense shall seek to enter into a partnership with the appropriate counterpart from the Government of Ukraine for the establishment of a joint program on military trauma care and research. Such program shall consist of the following:
“(1) The sharing of relevant lessons learned from the Russo-Ukraine War.
“(2) The conduct of relevant joint conferences and exchanges with military medical professionals from Ukraine and the United States.
“(3) Collaboration with the armed forces of Ukraine on matters relating to health policy, health administration, and medical supplies and equipment, including through knowledge exchanges.
“(4) The conduct of joint research and development on the health effects of new and emerging weapons.
“(5) The entrance into agreements with military medical schools of Ukraine for reciprocal education programs under which students at the Uniformed Services University of the Health Sciences receive specialized military medical instruction at the such military medical schools of Ukraine and military medical personnel of Ukraine receive specialized military medical instruction at the Uniformed Services University of the Health Sciences, pursuant to section 2114(f) of title 10, United States Code.
“(6) The provision of support to Ukraine for the purpose of facilitating the establishment in Ukraine of a program substantially similar to the Wounded Warrior Program in the United States.
“(7) The provision of training and support to Ukraine for the treatment of individuals with extremity trauma, amputations, post-traumatic stress disorder, traumatic brain injuries, and any other mental health conditions associated with post-traumatic stress disorder or traumatic brain injuries, including—“(A) the exchange of subject matter expertise;
“(B) training and support relating to advanced clinical skills development; and
“(C) training and support relating to clinical case management support.
“(8) The provision of training to the armed forces of Ukraine in the following areas:“(A) Health matters relating to chemical, biological, radiological, nuclear and explosive weapons.
“(B) Preventive medicine and infectious disease.
“(C) Post traumatic stress disorder.
“(D) Suicide prevention.
“(9) The maintenance of a list of medical supplies and equipment needed.
“(10) Such other elements as the Secretary of Defense may determine appropriate.”
Biennial Briefing on Individual Longitudinal Exposure RecordPub. L. 117–168, title VIII, § 802, Aug. 10, 2022, 136 Stat. 1801, provided that:
“(a) In General.—Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operational capability, as determined by the Secretary of Defense, and every two years thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall provide the appropriate committees of Congress a briefing on—“(1) the quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and
“(2) the usefulness of such Individual Longitudinal Exposure Record or system in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs.
“(b) Elements.—Each briefing required by subsection (a) shall include, for the period covered by the report, the following:“(1) An identification of potential exposures to occupational or environmental hazards captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems.
“(2) An analysis of the quality and accuracy of the location data used by the Department of Defense in determining potential exposures to occupational or environmental hazards by members of the Armed Forces and veterans, and recommendations for how to improve the quality of such data if necessary.
“(c) Definitions.—In this section:“(1) Appropriate committees of congress.—The term ‘appropriate committees of Congress’ means—“(A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and
“(B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives.
“(2) Individual longitudinal exposure record.—The term ‘Individual Longitudinal Exposure Record’ has the meaning given such term in section 1171 of title 38, United States Code, as added by section 202.”
Appeals to Physical Evaluation Board Determinations of Fitness for DutyPub. L. 117–81, div. A, title V, § 524, Dec. 27, 2021, 135 Stat. 1687, as amended by Pub. L. 119–60, div. A, title V, § 524(a), Dec. 18, 2025, 139 Stat. 865, provided that:
“The Secretary of Defense shall incorporate a formal appeals process (including timelines established by the Secretary of Defense) into the policies and procedures applicable to the implementation of the Integrated Disability Evaluation System of the Department of Defense. The appeals process shall include the following:
“(1) The Secretary concerned shall ensure that a member of the Armed Forces may submit a formal appeal made with respect to determinations of fitness for duty to a Physical Evaluation Board of such Secretary. The Secretary concerned may require submission of a statement of contention as part of the appeal submission.
“(2) The appeals process shall include, at the request of such member, an impartial hearing on a fitness for duty determination to be conducted by the Secretary concerned.
“(3) Such member shall have the option to be represented at a hearing by legal counsel.”
Improvement of Postpartum Care for Members of the Armed Forces and DependentsPub. L. 117–81, div. A, title VII, § 707, Dec. 27, 2021, 135 Stat. 1782, provided that:
“(a) Clinical Practice Guidelines for Postpartum Care in Military Medical Treatment Facilities.—Not later than 180 days after the date of the enactment of this Act [Dec. 27, 2021], the Secretary of Defense shall establish clinical practice guidelines for the provision of postpartum care in military medical treatment facilities. Such guidelines shall take into account the recommendations of established professional medical associations and address the following matters:“(1) Postpartum mental health assessments, including the appropriate intervals for furnishing such assessments and screening questions for such assessments (including questions relating to postpartum anxiety and postpartum depression).
“(2) Pelvic health evaluation and treatment, including the appropriate timing for furnishing a medical evaluation for pelvic health, considerations for providing consultations for physical therapy for pelvic health (including pelvic floor health), and the appropriate use of telehealth services.
“(3) Pelvic health rehabilitation services.
“(4) Obstetric hemorrhage treatment, including through the use of pathogen reduced resuscitative products.
“(b) Policy on Scheduling of Appointments for Postpartum Health Care Services.—“(1) Policy required.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a policy for the scheduling of appointments for postpartum health care services in military medical treatment facilities. In developing the policy, the Secretary shall consider the extent to which it is appropriate to facilitate concurrent scheduling of appointments for postpartum care with appointments for well-baby care.
“(2) Pilot program authorized.—The Secretary may carry out a pilot program in one or more military medical treatment facilities to evaluate the effect of concurrent scheduling, to the degree clinically appropriate, of the appointments specified in paragraph (1).
“(c) Policy on Postpartum Physical Fitness Tests and Body Composition Assessments.—Not later than 180 days after the date of enactment of this Act, the Secretary shall establish a policy, which shall be standardized across each Armed Force to the extent practicable, for the time periods after giving birth that a member of the Armed Forces (including the reserve components) may be excused from, or provided an alternative to, a physical fitness test or a body composition assessment.
“(d) Briefing.—Not later than 270 days after the date of enactment of this Act, the Secretary shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the implementation of the requirements under this section.”
Implementation of Integrated Product for Management of Population Health Across Military Health SystemPub. L. 117–81, div. A, title VII, § 722, Dec. 27, 2021, 135 Stat. 1792, provided that:
“(a) Integrated Product.—The Secretary of Defense shall develop and implement an integrated product for the management of population health across the military health system. Such integrated product shall serve as a repository for the health care, demographic, and other relevant data of all covered beneficiaries, including with respect to data on health care services furnished to such beneficiaries through the purchased care and direct care components of the TRICARE program, and shall—“(1) be compatible with the electronic health record system maintained by the Secretary for members of the Armed Forces;
“(2) enable the collection and stratification of data from multiple sources to measure population health goals, facilitate disease management programs of the Department, improve patient education, and integrate wellness services across the military health system; and
“(3) enable predictive modeling to improve health outcomes for patients and to facilitate the identification and correction of medical errors in the treatment of patients, issues regarding the quality of health care services provided, and gaps in health care coverage.
“(b) Considerations in Development.—In developing the integrated product under subsection (a), the Secretary shall harmonize such development with any policies of the Department relating to a digital health strategy (including the digital health strategy under section 723 [135 Stat. 1792]), coordinate with improvements to the electronic health record system specified in subsection (a)(1) to ensure the compatibility required under such subsection, and consider methods to improve beneficiary interface.
“(c) Definitions.—In this section:“(1) The terms ‘covered beneficiary’ and ‘TRICARE program’ have the meanings given such terms in section 1072 of title 10, United States Code.
“(2) The term ‘integrated product’ means an electronic system of systems (or solutions or products) that provides for the integration and sharing of data to meet the needs of an end user in a timely and cost-effective manner.”
Mandatory Training on Health Effects of Burn PitsPub. L. 117–81, div. A, title VII, § 725, Dec. 27, 2021, 135 Stat. 1795, provided that: “The Secretary of Defense shall provide to each medical provider of the Department of Defense mandatory training with respect to the potential health effects of burn pits.”
Access by Covered Individuals to Certain Facilities of Department of Defense for Assessment and Treatment of Anomalous Health ConditionsPub. L. 117–81, div. A, title VII, § 732, Dec. 27, 2021, 135 Stat. 1797, as amended by Pub. L. 117–263, div. A, title X, § 1044(b), Dec. 23, 2022, 136 Stat. 2772, provided that:
“(a) Assessment.—The Secretary of Defense shall provide to covered individuals whom the Secretary determines are experiencing symptoms of certain anomalous health conditions, as defined by the Secretary for purposes of this section, timely access for medical assessment, subject to space availability, to the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility, as determined by the Secretary.
“(b) Treatment.—With respect to an individual described in subsection (a) diagnosed with an anomalous health condition or a related affliction, whether diagnosed under an assessment under subsection (a) or otherwise, the Secretary of Defense shall furnish to the individual treatment for the condition or affliction, subject to space availability, at the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility, as determined by the Secretary.
“(c) Development of Process.—The Secretary of Defense, in consultation with the heads of such Federal agencies as the Secretary considers appropriate, shall develop a process to ensure that covered individuals are afforded timely access to the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility pursuant to subsection (a) by not later than 60 days after the date of the enactment of this Act [Dec. 27, 2021].
“(d) Modification of Department of Defense Trauma Registry.—The Secretary of Defense shall modify the Trauma Registry of the Department of Defense to include data on the demographics, condition-producing event, diagnosis and treatment, and outcomes of anomalous health conditions experienced by covered individuals assessed or treated under this section, subject to the consent of the covered individual and, if applicable, an agreement with the employing agency.
“(e) Covered Individuals Defined.—In this section, the term ‘covered individuals’ means—“(1) current and former employees of the United States Government and their family members; and
“(2) current and former members of the Armed Forces and their family members.”
Military Health System Clinical Quality Management ProgramPub. L. 116–283, div. A, title VII, § 744, Jan. 1, 2021, 134 Stat. 3708, provided that:
“(a) In General.—The Secretary of Defense, acting through the Director of the Defense Health Agency, shall implement a comprehensive program to be known as the ‘Military Health System Clinical Quality Management Program’ (in this section referred to as the ‘Program’).
“(b) Elements of Program.—The Program shall include, at a minimum, the following:“(1) The implementation of systematic procedures to eliminate, to the extent feasible, risk of harm to patients at military medical treatment facilities, including through identification, investigation, and analysis of events indicating a risk of patient harm and corrective action plans to mitigate such risks.
“(2) With respect to a potential sentinel event (including those involving members of the Armed Forces) at a military medical treatment facility—“(A) an analysis of such event, which shall occur and be documented as soon as possible after the event;
“(B) use of such analysis for clinical quality management; and
“(C) reporting of such event to the National Practitioner Data Bank in accordance with guidelines of the Secretary of Health and Human Services under the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.), giving special emphasis to the results of external peer reviews of the event.
“(3) Validation of provider credentials and granting of clinical privileges by the Director of the Defense Health Agency for all health care providers at a military medical treatment facility.
“(4) Accreditation of military medical treatment facilities by a recognized external accreditation body.
“(5) Systematic measurement of indicators of health care quality, emphasizing clinical outcome measures, comparison of such indicators with benchmarks from leading health care quality improvement organizations, and transparency with the public of appropriate clinical measurements for military medical treatment facilities.
“(6) Systematic activities emphasized by leadership at all organizational levels to use all elements of the Program to eliminate unwanted variance throughout the health care system of the Department of Defense and make constant improvements in clinical quality.
“(7) A full range of procedures for productive communication between patients and health care providers regarding actual or perceived adverse clinical events at military medical treatment facilities, including procedures—“(A) for full disclosure of such events (respecting the confidentiality of peer review information under a medical quality assurance program under section 1102 of title 10, United States Code);
“(B) providing an opportunity for the patient to be heard in relation to quality reviews; and
“(C) to resolve patient concerns by independent, neutral health care resolution specialists.
“(c) Additional Clinical Quality Management Activities.—“(1) In general.—In addition to the elements of the Program set forth in subsection (b), the Secretary shall establish and maintain clinical quality management activities in relation to functions of the health care system of the Department separate from delivery of health care services in military medical treatment facilities.
“(2) Health care delivery outside military medical treatment facilities.—In carrying out paragraph (1), the Secretary shall maintain policies and procedures to promote clinical quality in health care delivery on ships and planes, in deployed settings, and in all other circumstances not covered by subsection (b), with the objective of implementing standards and procedures comparable, to the extent practicable, to those under such subsection.
“(3) Purchased care system.—In carrying out paragraph (1), the Secretary shall maintain policies and procedures for health care services provided outside the Department but paid for by the Department, reflecting best practices by public and private health care reimbursement and management systems.”
Wounded Warrior Service Dog ProgramPub. L. 116–283, div. A, title VII, § 745, Jan. 1, 2021, 134 Stat. 3710, provided that:
“(a) Program.—The Secretary of Defense shall establish a program, to be known as the ‘Wounded Warrior Service Dog Program’, to provide assistance dogs to covered members and covered veterans.
“(b) Definitions.—In this section:“(1) The term ‘assistance dog’ means a dog specifically trained to perform physical tasks to mitigate the effects of a covered disability, except that the term does not include a dog specifically trained for comfort or personal defense.
“(2) The term ‘covered disability’ means any of the following:“(A) Blindness or visual impairment.
“(B) Loss of use of a limb, paralysis, or other significant mobility issues.
“(C) Loss of hearing.
“(D) Traumatic brain injury.
“(E) Post-traumatic stress disorder.
“(F) Any other disability that the Secretary of Defense considers appropriate.
“(3) The term ‘covered member’ means a member of the Armed Forces who is—“(A) receiving medical treatment, recuperation, or therapy under chapter 55 of title 10, United States Code;
“(B) in medical hold or medical holdover status; or
“(C) covered under section 1202 or 1205 of title 10, United States Code.
“(4) The term ‘covered veteran’ means a veteran who is enrolled in the health care system established under section 1705(a) of title 38, United States Code.”
Inclusion of Blast Exposure History in Medical Records of Members of the Armed ForcesPub. L. 116–92, div. A, title VII, § 717, Dec. 20, 2019, 133 Stat. 1453, provided that:
“(a) Requirement.—If a covered incident occurs with respect to a member of the Armed Forces, the Secretary of Defense, in coordination with the Secretaries of the military departments, shall document blast exposure history in the medical record of the member to assist in determining whether a future illness or injury of the member is service-connected and inform future blast exposure risk mitigation efforts of the Department of Defense.
“(b) Elements.—A blast exposure history under subsection (a) shall include, at a minimum, the following:“(1) The date of the exposure.
“(2) The duration of the exposure, and, if known, the measured blast pressure experienced by the individual during such exposure.
“(3) Whether the exposure occurred during combat or training.
“(c) Report.—Not later than one year after the date of the enactment of this Act [Dec. 20, 2019], the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the types of information included in a blast exposure history under subsection (a).
“(d) Covered Incident Defined.—In this section, the term ‘covered incident’ means a concussive event or injury that requires a military acute concussive evaluation by a skilled health care provider.”
Modification to Referrals for Mental Health ServicesPub. L. 116–92, div. A, title VII, § 722, Dec. 20, 2019, 133 Stat. 1457, provided that: “If the Secretary of Defense is unable to provide mental health services in a military medical treatment facility to a member of the Armed Forces within 15 days of the date on which such services are first requested by the member, the Secretary may refer the member to a provider under the TRICARE program (as that term is defined in section 1072 of title 10, United States Code) to receive such services.”
Medical Simulation Technology and Live Tissue TrainingPub. L. 115–232, div. A, title VII, § 718, Aug. 13, 2018, 132 Stat. 1816, provided that:
“(a) In General.—“(1) Use of simulation technology.—Except as provided by paragraph (2), the Secretary of Defense shall use medical simulation technology, to the maximum extent practicable, before the use of live tissue training to train medical professionals and combat medics of the Department of Defense.
“(2) Determination.—The use of live tissue training within the Department of Defense may be used as determined necessary by the medical chain of command.
“(b) Briefing.—Not later than 180 days after the date of the enactment of this Act [Aug. 13, 2018], the Secretary of Defense, in consultation with the Chairman of the Joint Chiefs of Staff and the Secretaries of the military departments, shall provide a briefing to the Committees on Armed Services of the House of Representatives and the Senate on the use and benefit of medical simulation technology and live tissue training within the Department of Defense to train medical professionals, combat medics, and members of the Special Operations Forces.
“(c) Elements.—The briefing under subsection (b) shall include the following:“(1) A discussion of the benefits and needs of both medical simulation technology and live tissue training.
“(2) Ways and means to enhance and advance the use of simulation technologies in training.
“(3) An assessment of current medical simulation technology requirements, gaps, and limitations.
“(4) An overview of Department of Defense medical training programs, as of the date of the briefing, that use live tissue training and medical simulation technologies.
“(5) Any other matters the Secretary determines appropriate.”
Inclusion of Gambling Disorder in Health Assessments of Members of the Armed Forces and Related Research EffortsPub. L. 115–232, div. A, title VII, § 733, Aug. 13, 2018, 132 Stat. 1818, provided that:
“(a) Inclusion in Next Annual Periodic Health Assessments.—The Secretary of Defense shall incorporate medical screening questions specific to gambling disorder into the Annual Periodic Health Assessments of members of the Armed Forces conducted by the Department of Defense during the one-year period beginning 180 days after the date of the enactment of this Act [Aug. 13, 2018].
“(b) Inclusion in Certain Surveys.—The Secretary shall incorporate into ongoing research efforts of the Department questions on gambling disorder, as appropriate, including by restoring such questions to the following:“(1) The first Health Related Behaviors Survey of Active Duty Military Personnel conducted after the date of the enactment of this Act.
“(2) The first Health Related Behaviors Survey of Reserve Component Personnel conducted after that date.
“(c) Reports.—Not later than one year after the date of the completion of the assessment referred to in subsection (a), and of each survey referred to in subsection (b), as modified pursuant to this section, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the findings of the assessment or survey in connection with the prevalence of gambling disorder among members of the Armed Forces.”
Joint Trauma SystemPub. L. 114–328, div. A, title VII, § 707, Dec. 23, 2016, 130 Stat. 2208, provided that:
“(a) Plan.—“(1) In general.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate an implementation plan to establish a Joint Trauma System within the Defense Health Agency that promotes improved trauma care to members of the Armed Forces and other individuals who are eligible to be treated for trauma at a military medical treatment facility.
“(2) Implementation.—The Secretary shall implement the plan under paragraph (1) after a 90-day period has elapsed following the date on which the Comptroller General of the United States is required to submit to the Committees on Armed Services of the House of Representatives and the Senate the review under subsection (c). In implementing such plan, the Secretary shall take into account any recommendation made by the Comptroller General under such review.
“(b) Elements.—The Joint Trauma System described in subsection (a)(1) shall include the following elements:“(1) Serve as the reference body for all trauma care provided across the military health system.
“(2) Establish standards of care for trauma services provided at military medical treatment facilities.
“(3) Coordinate the translation of research from the centers of excellence of the Department of Defense into standards of clinical trauma care.
“(4) Coordinate the incorporation of lessons learned from the trauma education and training partnerships pursuant to section 708 into clinical practice.
“(c) Review.—Not later than 180 days after the date on which the Secretary submits to the Committees on Armed Services of the House of Representatives and the Senate the implementation plan under subsection (a)(1), the Comptroller General of the United States shall submit to such committees a review of such plan to determine if each element under subsection (b) is included in such plan.
“(d) Review of Military Trauma System.—In establishing a Joint Trauma System, the Secretary of Defense may seek to enter into an agreement with a non-governmental entity with subject matter experts to—“(1) conduct a system-wide review of the military trauma system, including a comprehensive review of combat casualty care and wartime trauma systems during the period beginning on January 1, 2001, and ending on the date of the review, including an assessment of lessons learned to improve combat casualty care in future conflicts; and
“(2) make publicly available a report containing such review and recommendations to establish a comprehensive trauma system for the Armed Forces.”
Joint Trauma Education and Training DirectoratePub. L. 116–92, div. A, title VII, § 721, Dec. 20, 2019, 133 Stat. 1456, provided that:
“(a) Partnerships.—“(1) In general.—The Secretary of Defense, through the Joint Trauma Education and Training Directorate established under section 708 of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114–328; 10 U.S.C. 1071 note), may develop partnerships with civilian academic medical centers and large metropolitan teaching hospitals to improve combat casualty care for personnel of the Armed Forces.
“(2) Partnerships with level i trauma centers.—In carrying out partnerships under paragraph (1), trauma surgeons and physicians of the Department of Defense may partner with level I civilian trauma centers to provide training and readiness for the next generation of medical providers to treat critically injured burn patients.
“(b) Support of Partnerships.—The Secretary of Defense may make every effort to support partnerships under the Joint Trauma Education and Training Directorate with academic institutions that have level I civilian trauma centers, specifically those centers with a burn center, that offer burn rotations and clinical experience to provide training and readiness for the next generation of medical providers to treat critically injured burn patients.
“(c) Level I Civilian Trauma Center Defined.—In this section, the term ‘level I civilian trauma center’ has the meaning given that term in section 708 of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114–328; 10 U.S.C. 1071 note).”
Pub. L. 114–328, div. A, title VII, § 708, Dec. 23, 2016, 130 Stat. 2209, as amended by Pub. L. 115–232, div. A, title VII, § 719, Aug. 13, 2018, 132 Stat. 1817; Pub. L. 117–81, div. A, title III, § 373(b), Dec. 27, 2021, 135 Stat. 1667, provided that:
“(a) Establishment.—The Secretary of Defense shall establish a Joint Trauma Education and Training Directorate (in this section referred to as the ‘Directorate’) to ensure that the traumatologists of the Armed Forces maintain readiness and are able to be rapidly deployed for future armed conflicts. The Secretary shall carry out this section in collaboration with the Secretaries of the military departments.
“(b) Duties.—The duties of the Directorate are as follows:“(1) To enter into and coordinate the partnerships under subsection (c).
“(2) To establish the goals of such partnerships necessary for trauma teams led by traumatologists to maintain professional competency in trauma care.
“(3) To establish metrics for measuring the performance of such partnerships in achieving such goals.
“(4) To develop methods of data collection and analysis for carrying out paragraph (3).
“(5) To communicate and coordinate lessons learned from such partnerships with the Joint Trauma System established under section 707 [set out as a note above].
“(6) To develop standardized combat casualty care instruction for all members of the Armed Forces, including the use of standardized trauma training platforms.
“(7) To develop a comprehensive trauma care registry to compile relevant data from point of injury through rehabilitation with respect to both members of the Armed Forces and military working dogs.
“(8) To develop quality of care outcome measures for combat casualty care.
“(9) To inform and advise the conduct of research on the leading causes of morbidity and mortality of members of the Armed Forces and military working dogs in combat.
“(c) Partnerships.—“(1) In general.—The Secretary may enter into partnerships with civilian academic medical centers and trauma centers to provide integrated combat trauma teams, including forward surgical teams, with maximum exposure to a high volume of patients with critical injuries.
“(2) Trauma teams.—Under the partnerships entered into under paragraph (1), trauma teams of the Armed Forces led by traumatologists of the Armed Forces shall embed within trauma centers on an enduring basis.
“(3) Selection.—The Secretary shall select civilian academic medical centers and trauma centers to enter into partnerships under paragraph (1) based on patient volume, acuity, and other factors the Secretary determines necessary to ensure that the traumatologists of the Armed Forces and the associated clinical support teams have adequate and continuous exposure to critically injured patients.
“(4) Consideration.—In entering into partnerships under paragraph (1), the Secretary may consider the experiences and lessons learned by the military departments that have entered into memoranda of understanding with civilian medical centers for trauma care.
“(d) Personnel Management Plan.—“(1) Plan.—The Secretary shall establish a personnel management plan for the following wartime medical specialties:“(A) Emergency medical services and prehospital care.
“(B) Trauma surgery.
“(C) Critical care.
“(D) Anesthesiology.
“(E) Emergency medicine.
“(F) Other wartime medical specialties the Secretary determines appropriate for purposes of the plan.
“(2) Elements.—The elements of the plan established under paragraph (1) shall include, at a minimum, the following:“(A) An accession plan for the number of qualified medical personnel to maintain wartime medical specialties on an annual basis in order to maintain the required number of trauma teams as determined by the Secretary.
“(B) The number of positions required in each such medical specialty.
“(C) Crucial organizational and operational assignments for personnel in each such medical specialty.
“(D) Career pathways for personnel in each such medical specialty.
“(3) Implementation.—The Secretaries of the military departments shall carry out the plan established under paragraph (1).
“(e) Implementation Plan.—Not later than July 1, 2017, the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate an implementation plan for establishing the Joint Trauma Education and Training Directorate under subsection (a), entering into partnerships under subsection (c), and establishing the plan under subsection (d).
“(f) Level I Civilian Trauma Center Defined.—In this section, the term ‘level I civilian trauma center’ means a comprehensive regional resource that is a tertiary care facility central to the trauma system and is capable of providing total care for every aspect of injury from prevention through rehabilitation.”
Standardized System for Scheduling Medical Appointments at Military Treatment FacilitiesPub. L. 114–328, div. A, title VII, § 709, Dec. 23, 2016, 130 Stat. 2211, provided that:
“(a) Standardized System.—“(1) In general.—Not later than January 1, 2018, the Secretary of Defense shall implement a system for scheduling medical appointments at military treatment facilities that is standardized throughout the military health system to enable timely access to care for covered beneficiaries.
“(2) Lack of variance.—The system implemented under paragraph (1) shall ensure that the appointment scheduling processes and procedures used within the military health system do not vary among military treatment facilities.
“(b) Sole System.—Upon implementation of the system under subsection (a), no military treatment facility may use an appointment scheduling process other than such system.
“(c) Scheduling of Appointments.—“(1) In general.—Under the system implemented under subsection (a), each military treatment facility shall use a centralized appointment scheduling capability for covered beneficiaries that includes the ability to schedule appointments manually via telephone as described in paragraph (2) or automatically via a device that is connected to the Internet through an online scheduling system described in paragraph (3).
“(2) Telephone appointment process.—“(A) In general.—In the case of a covered beneficiary who contacts a military treatment facility via telephone to schedule an appointment under the system implemented under subsection (a), the Secretary shall implement standard processes to ensure that the needs of the covered beneficiary are met during the first such telephone call.
“(B) Matters included.—The standard processes implemented under subparagraph (A) shall include the following:“(i) The ability of a covered beneficiary, during the telephone call to schedule an appointment, to also schedule wellness visits or follow-up appointments during the 180-day period beginning on the date of the request for the visit or appointment.
“(ii) The ability of a covered beneficiary to indicate the process through which the covered beneficiary prefers to be reminded of future appointments, which may include reminder telephone calls, emails, or cellular text messages to the covered beneficiary at specified intervals prior to appointments.
“(3) Online system.—“(A) In general.—The Secretary shall implement an online scheduling system that is available 24 hours per day, seven days per week, for purposes of scheduling appointments under the system implemented under subsection (a).
“(B) Capabilities of online system.—The online scheduling system implemented under subparagraph (A) shall have the following capabilities:“(i) An ability to send automated email and text message reminders, including repeat reminders, to patients regarding upcoming appointments.
“(ii) An ability to store appointment records to ensure rapid access by medical personnel to appointment data.
“(d) Standards for Productivity of Health Care Providers.—“(1) In general.—The Secretary shall implement standards for the productivity of health care providers at military treatment facilities.
“(2) Matters considered.—In developing standards under paragraph (1), the Secretary shall consider—“(A) civilian benchmarks for measuring the productivity of health care providers;
“(B) the optimal number of medical appointments for each health care provider that would be required, as determined by the Secretary, to maintain access of covered beneficiaries to health care from the Department; and
“(C) the readiness requirements of the Armed Forces.
“(e) Plan.—“(1) In general.—Not later than January 1, 2017, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a comprehensive plan to implement the system required under subsection (a).
“(2) Elements.—The plan required under paragraph (1) shall include the following:“(A) A description of the manual appointment process to be used at military treatment facilities under the system required under subsection (a).
“(B) A description of the automated appointment process to be used at military treatment facilities under such system.
“(C) A timeline for the full implementation of such system throughout the military health system.
“(f) Briefing.—Not later than February 1, 2018, the Secretary shall brief the Committees on Armed Services of the Senate and the House of Representatives on the implementation of the system required under subsection (a) and the standards for the productivity of health care providers required under subsection (d).
“(g) Report on Missed Appointments.—“(1) In general.—Not later than March 1 each year, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the total number of medical appointments at military treatment facilities for which a covered beneficiary failed to appear without prior notification during the one-year period preceding the submittal of the report.
“(2) Elements.—Each report under paragraph (1) shall include for each military treatment facility the following:“(A) An identification of the top five reasons for a covered beneficiary missing an appointment.
“(B) A comparison of the number of missed appointments for specialty care versus primary care.
“(C) An estimate of the cost to the Department of Defense of missed appointments.
“(D) An assessment of strategies to reduce the number of missed appointments.
“(h) Covered Beneficiary Defined.—In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10, United States Code.”
[For termination, effective Dec. 30, 2021, of reporting requirements in section 709(g) of Pub. L. 114–328, set out above, see section 1702(a), (b), of Pub. L. 116–92, set out as a Termination of Reporting Requirements note under section 111 of this title.]
Evaluation and Treatment of Veterans and Civilians at Military Treatment FacilitiesPub. L. 114–328, div. A, title VII, § 717, Dec. 23, 2016, 130 Stat. 2223, as amended by Pub. L. 115–91, div. A, title VII, § 712, Dec. 12, 2017, 131 Stat. 1437, provided that:
“(a) In General.—The Secretary of Defense shall authorize a veteran (in consultation with the Secretary of Veterans Affairs) or civilian to be evaluated and treated at a military treatment facility if the Secretary of Defense determines that—“(1) the evaluation and treatment of the individual is necessary to attain the relevant mix and volume of medical casework required to maintain medical readiness skills and competencies of health care providers at the facility;
“(2) the health care providers at the facility have the competencies, skills, and abilities required to treat the individual; and
“(3) the facility has available space, equipment, and materials to treat the individual.
“(b) Priority of Covered Beneficiaries.—“(1) In general.—Except as provided in paragraph (2), the evaluation and treatment of covered beneficiaries at military treatment facilities shall be prioritized ahead of the evaluation and treatment of veterans and civilians at such facilities under subsection (a).
“(2) Waiver.—The Secretary may waive the requirement under paragraph (1) in order to provide timely evaluation and treatment for individuals who are—“(A) severely wounded or injured by acts of terror that occur in the United States; or
“(B) residents of the United States who are severely wounded or injured by acts of terror outside the United States.
“(c) Reimbursement for Treatment.—“(1) Civilians.—A military treatment facility that evaluates or treats an individual (other than an individual described in paragraph (2)) under subsection (a) shall bill the individual and accept reimbursement from the individual or a third-party payer (as that term is defined in section 1095(h) of title 10, United States Code) on behalf of such individual for the costs of any health care services provided to the individual under such subsection.
“(2) Veterans.—The Secretary of Defense shall enter into a memorandum of agreement with the Secretary of Veterans Affairs under which the Secretary of Veterans Affairs will pay a military treatment facility using a prospective payment methodology (including interagency transfers of funds or obligational authority and similar transactions) for the costs of any health care services provided at the facility under subsection (a) to individuals eligible for such health care services from the Department of Veterans Affairs.
“(3) Use of amounts.—The Secretary of Defense shall make available to a military treatment facility any amounts collected by such facility under paragraph (1) or (2) for health care services provided to an individual under subsection (a).
“(d) Covered Beneficiary Defined.—In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10, United States Code.”
Enhancement of Use of Telehealth Services in Military Health SystemPub. L. 114–328, div. A, title VII, § 718, Dec. 23, 2016, 130 Stat. 2224, provided that:
“(a) Incorporation of Telehealth.—“(1) In general.—Not later than 18 months after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense shall incorporate, throughout the direct care and purchased care components of the military health system, the use of telehealth services, including mobile health applications—“(A) to improve access to primary care, urgent care, behavioral health care, and specialty care;
“(B) to perform health assessments;
“(C) to provide diagnoses, interventions, and supervision;
“(D) to monitor individual health outcomes of covered beneficiaries with chronic diseases or conditions;
“(E) to improve communication between health care providers and patients; and
“(F) to reduce health care costs for covered beneficiaries and the Department of Defense.
“(2) Types of telehealth services.—The telehealth services required to be incorporated under paragraph (1) shall include those telehealth services that—“(A) maximize the use of secure messaging between health care providers and covered beneficiaries to improve the access of covered beneficiaries to health care and reduce the number of visits to medical facilities for health care needs;
“(B) allow covered beneficiaries to schedule appointments; and
“(C) allow health care providers, through video conference, telephone or tablet applications, or home health monitoring devices—“(i) to assess and evaluate disease signs and symptoms;
“(ii) to diagnose diseases;
“(iii) to supervise treatments; and
“(iv) to monitor health outcomes.
“(b) Coverage of Items or Services.—An item or service furnished to a covered beneficiary via a telecommunications system shall be covered under the TRICARE program to the same extent as the item or service would be covered if furnished in the location of the covered beneficiary.
“(c) Reimbursement Rates for Telehealth Services.—The Secretary shall develop standardized payment methods to reimburse health care providers for telehealth services provided to covered beneficiaries in the purchased care component of the TRICARE program, including by using reimbursement rates that incentivize the provision of telehealth services.
“(d) Reduction or Elimination of Copayments.—The Secretary shall reduce or eliminate, as the Secretary considers appropriate, copayments or cost shares for covered beneficiaries in connection with the receipt of telehealth services under the purchased care component of the TRICARE program.
“(e) Reports.—“(1) Initial report.—“(A) In general.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report describing the full range of telehealth services to be available in the direct care and purchased care components of the military health system and the copayments and cost shares, if any, associated with those services.
“(B) Reimbursement plan.—The report required under subparagraph (A) shall include a plan to develop standardized payment methods to reimburse health care providers for telehealth services provided to covered beneficiaries in the purchased care component of the TRICARE program, as required under subsection (c).
“(2) Final report.—“(A) In general.—Not later than three years after the date on which the Secretary begins incorporating, throughout the direct care and purchased care components of the military health system, the use of telehealth services as required under subsection (a), the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report describing the impact made by the use of telehealth services, including mobile health applications, to carry out the actions specified in subparagraphs (A) through (F) of subsection (a)(1).
“(B) Elements.—The report required under subparagraph (A) shall include an assessment of the following:“(i) The satisfaction of covered beneficiaries with telehealth services furnished by the Department of Defense.
“(ii) The satisfaction of health care providers in providing telehealth services furnished by the Department.
“(iii) The effect of telehealth services furnished by the Department on the following: “(I) The ability of covered beneficiaries to access health care services in the direct care and purchased care components of the military health system.
“(II) The frequency of use of telehealth services by covered beneficiaries.
“(III) The productivity of health care providers providing care furnished by the Department.
“(IV) The reduction, if any, in the use by covered beneficiaries of health care services in military treatment facilities or medical facilities in the private sector.
“(V) The number and types of appointments for the receipt of telehealth services furnished by the Department.
“(VI) The savings, if any, realized by the Department by furnishing telehealth services to covered beneficiaries.
“(f) Regulations.—“(1) Interim final rule.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary shall prescribe an interim final rule to implement this section.
“(2) Final rule.—Not later than 180 days after prescribing the interim final rule under paragraph (1) and considering public comments with respect to such interim final rule, the Secretary shall prescribe a final rule to implement this section.
“(3) Objectives.—The regulations prescribed under paragraphs (1) and (2) shall accomplish the objectives set forth in subsection (a) and ensure quality of care, patient safety, and the integrity of the TRICARE program.
“(g) Definitions.—In this section, the terms ‘covered beneficiary’ and ‘TRICARE program’ have the meaning given those terms in section 1072 of title 10, United States Code.”
Program To Eliminate Variability in Health Outcomes and Improve Quality of Health Care Services Delivered in Military Medical Treatment FacilitiesPub. L. 114–328, div. A, title VII, § 726, Dec. 23, 2016, 130 Stat. 2231, provided that:
“(a) Program.—Beginning not later than January 1, 2018, the Secretary of Defense shall implement a program—“(1) to establish best practices for the delivery of health care services for certain diseases or conditions at military medical treatment facilities, as selected by the Secretary;
“(2) to incorporate such best practices into the daily operations of military medical treatment facilities selected by the Secretary for purposes of the program, with priority in selection given to facilities that provide specialty care; and
“(3) to eliminate variability in health outcomes and to improve the quality of health care services delivered at military medical treatment facilities selected by the Secretary for purposes of the program.
“(b) Use of Clinical Practice Guidelines.—In carrying out the program under subsection (a), the Secretary shall develop, implement, monitor, and update clinical practice guidelines reflecting the best practices established under paragraph (1) of such subsection.
“(c) Development.—In developing the clinical practice guidelines under subsection (b), the Secretary shall ensure that such development includes a baseline assessment of health care delivery and outcomes at military medical treatment facilities to evaluate and determine evidence-based best practices, within the direct care component of the military health system and the private sector, for treating the diseases or conditions selected by the Secretary under subsection (a)(1).
“(d) Implementation.—The Secretary shall implement the clinical practice guidelines under subsection (b) in military medical treatment facilities selected by the Secretary under subsection (a)(2) using means determined appropriate by the Secretary, including by communicating with the relevant health care providers of the evidence upon which the guidelines are based and by providing education and training on the most appropriate implementation of the guidelines.
“(e) Monitoring.—The Secretary shall monitor the implementation of the clinical practice guidelines under subsection (b) using appropriate means, including by monitoring the results in clinical outcomes based on specific metrics included as part of the guidelines.
“(f) Updating.—The Secretary shall periodically update the clinical practice guidelines under subsection (b) based on the results of monitoring conducted under subsection (e) and by continuously assessing evidence-based best practices within the direct care component of the military health system and the private sector.
“(g) Continuous Cycle.—The Secretary shall establish a continuous cycle of carrying out subsections (c) through (f) with respect to the clinical practice guidelines established under subsection (a).”
Adoption of Core Quality Performance MetricsPub. L. 114–328, div. A, title VII, § 728(a), Dec. 23, 2016, 130 Stat. 2233, provided that:
“(a) Adoption.—“(1) In general.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense shall adopt, to the extent appropriate, the core quality performance metrics agreed upon by the Core Quality Measures Collaborative for use by the military health system and in contracts awarded to carry out the TRICARE program.
“(2) Core measures.—The core quality performance metrics described in paragraph (1) shall include the following sets:“(A) Accountable care organizations, patient centered medical homes, and primary care.
“(B) Cardiology.
“(C) Gastroenterology.
“(D) HIV and hepatitis C.
“(E) Medical oncology.
“(F) Obstetrics and gynecology.
“(G) Orthopedics.
“(H) Such other sets of core quality performance metrics released by the Core Quality Measures Collaborative as the Secretary considers appropriate.”
[For definitions of terms used in section 728(a) of Pub. L. 114–328, set out above, see section 728(c) of Pub. L. 114–328, set out below.]
Accountability for the Performance of the Military Health System of Certain Leaders Within the SystemPub. L. 114–328, div. A, title VII, § 730, Dec. 23, 2016, 130 Stat. 2235, provided that:
“(a) In General.—Commencing not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense, in consultation with the Secretaries of the military departments, shall incorporate into the annual performance review of each military and civilian leader in the military health system, as determined by the Secretary of Defense, measures of accountability for the performance of the military health system described in subsection (b).
“(b) Measures of Accountability for Performance.—The measures of accountability for the performance of the military health system incorporated into the annual performance review of an individual pursuant to this section shall include measures to assess performance and assure accountability for the following:“(1) Quality of care.
“(2) Access of beneficiaries to care.
“(3) Improvement in health outcomes for beneficiaries.
“(4) Patient safety.
“(5) Such other matters as the Secretary of Defense, in consultation with the Secretaries of the military departments, considers appropriate.
“(c) Report on Implementation.—“(1) In general.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the incorporation of measures of accountability for the performance of the military health system into the annual performance reviews of individuals as required by this section.
“(2) Elements.—The report required by paragraph (1) shall include the following:“(A) A comprehensive plan for the use of measures of accountability for performance in annual performance reviews pursuant to this section as a means of assessing and assuring accountability for the performance of the military health system.
“(B) The identification of each leadership position in the military health system determined under subsection (a) and a description of the specific measures of accountability for performance to be incorporated into the annual performance reviews of each such position pursuant to this section.”
Establishment of Advisory Committees for Military Treatment FacilitiesPub. L. 114–328, div. A, title VII, § 731, Dec. 23, 2016, 130 Stat. 2236, provided that:
“(a) In General.—The Secretary of Defense shall establish, under such regulations as the Secretary may prescribe, an advisory committee for each military treatment facility.
“(b) Status of Certain Members of Advisory Committees.—A member of an advisory committee established under subsection (a) who is not a member of the Armed Forces on active duty or an employee of the Federal Government shall, with the approval of the commanding officer or director of the military treatment facility concerned, be treated as a volunteer under section 1588 of title 10, United States Code, in carrying out the duties of the member under this section.
“(c) Duties.—Each advisory committee established under subsection (a) for a military treatment facility shall provide to the commanding officer or director of such facility advice on the administration and activities of such facility as it relates to the experience of care for beneficiaries at such facility.”
Provision of Information to Members of the Armed Forces on Privacy Rights Relating to Receipt of Mental Health ServicesPub. L. 113–291, div. A, title V, § 523, Dec. 19, 2014, 128 Stat. 3361, provided that:
“(a) Provision of Information Required.—The Secretaries of the military departments shall ensure that the information described in subsection (b) is provided—“(1) to each officer candidate during initial training;
“(2) to each recruit during basic training; and
“(3) to other members of the Armed Forces at such times as the Secretary of Defense considers appropriate.
“(b) Required Information.—The information required to be provided under subsection (a) shall include information on the applicability of the Department of Defense Instruction on Privacy of Individually Identifiable Health Information in DoD Health Care Programs and other regulations regarding privacy prescribed pursuant to the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191) to records regarding a member of the Armed Forces seeking and receiving mental health services.”
Antimicrobial Stewardship Program at Medical Facilities of the Department of DefensePub. L. 113–291, div. A, title VII, § 727, Dec. 19, 2014, 128 Stat. 3420, required the Secretary of Defense, no later than 180 days after Dec. 19, 2014, to carry out and report to Congress on an antimicrobial stewardship program at medical facilities of the Department of Defense.
Comprehensive Policy on Improvements to Care and Transition of Members of the Armed Forces With UrotraumaPub. L. 113–66, div. A, title VII, § 703, Dec. 26, 2013, 127 Stat. 791, required development and implementation of a comprehensive policy on improvements to the care, management, and transition of recovering Armed Forces members with urotrauma no later than 180 days after Dec. 26, 2013, with a report to Congress no later than one year after the implementation of the policy.
Electronic Health Records of the Department of Defense and the Department of Veterans AffairsPub. L. 113–66, div. A, title VII, § 713, Dec. 26, 2013, 127 Stat. 794, which required the Secretaries of Defense and Veterans Affairs to ensure that the electronic health records systems of their departments were interoperable and met certain standards and requirements and adhered to certain principles, was repealed by Pub. L. 116–92, div. A, title VII, § 715(i), Dec. 20, 2019, 133 Stat. 1453. See section 1635 of Pub. L. 110–181, set out in a note below.
Research and Medical Practice on Mental Health ConditionsPub. L. 112–239, div. A, title VII, § 725, Jan. 2, 2013, 126 Stat. 1806, required the Secretary of Defense to create a policy on medical practices from research on the diagnosis and treatment of mental health conditions and to submit a report to Congress no later than 180 days after Jan. 2, 2013.
Plan for Reform of the Administration of the Military Health SystemPub. L. 112–239, div. A, title VII, § 731, Jan. 2, 2013, 126 Stat. 1815, required the Secretary of Defense to develop a detailed plan to carry out reforms to the governance of the military health system and to submit a series of reports to Congress, with the final report due on Sept. 30, 2013.
Performance Metrics and Reports on Warriors in Transition Programs of the Military DepartmentsPub. L. 112–239, div. A, title VII, § 738, Jan. 2, 2013, 126 Stat. 1820, as amended by Pub. L. 115–91, div. A, title X, § 1051(r)(3), Dec. 12, 2017, 131 Stat. 1565, provided that:
“(a) Metrics Required.—The Secretary of Defense shall establish a policy containing uniform performance outcome measurements to be used by each Secretary of a military department in tracking and monitoring members of the Armed Forces in Warriors in Transition programs.
“(b) Elements.—The policy established under subsection (a) shall identify outcome measurements with respect to the following:“(1) Physical health and behavioral health.
“(2) Rehabilitation.
“(3) Educational and vocational preparation.
“(4) Such other matters as the Secretary considers appropriate.
“(c) Milestones.—In establishing the policy under subsection (a), the Secretary of Defense shall establish metrics and milestones for members in Warriors in Transition programs. Such metrics and milestones shall cover members throughout the course of care and rehabilitation in Warriors in Transitions programs by applying to the following occasions:“(1) When the member commences participation in the program.
“(2) At least once each year the member participates in the program.
“(3) When the member ceases participation in the program or is transferred to the jurisdiction of the Secretary of Veterans Affairs.
“(d) Cohort Groups and Parameters.—The policy established under subsection (a)—“(1) may differentiate among cohort groups within the population of members in Warriors in Transition programs, as appropriate; and
“(2) shall include parameters for specific outcome measurements in each element under subsection (b) and each metric and milestone under subsection (c).
“(e) Warriors in Transition Program Defined.—In this section, the term ‘Warriors in Transition program’ means any major support program of the Armed Forces for members of the Armed Forces with severe wounds, illnesses, or injuries that is intended to provide such members with nonmedical case management service and care coordination services, and includes the programs as follows:“(1) Warrior Transition Units and the Wounded Warrior Program of the Army.
“(2) The Wounded Warrior Safe Harbor program of the Navy.
“(3) The Wounded Warrior Regiment of the Marine Corps.
“(4) The Recovery Care Program and the Wounded Warrior programs of the Air Force.
“(5) The Care Coalition of the United States Special Operations Command.”
Suicide Prevention Policies and ProgramsPub. L. 114–92, div. A, title V, § 591, Nov. 25, 2015, 129 Stat. 832, provided that:
“(a) Development of Policy.—The Secretary of Defense, in consultation with the Secretaries of the military departments, may develop a policy to coordinate the efforts of the Department of Defense and non-government suicide prevention organizations regarding—“(1) the use of such non-government organizations to reduce the number of suicides among members of the Armed Forces by comprehensively addressing the needs of members of the Armed Forces who have been identified as being at risk of suicide;
“(2) the delineation of the responsibilities within the Department of Defense regarding interaction with such organizations;
“(3) the collection of data regarding the efficacy and cost of coordinating with such organizations; and
“(4) the preparation and preservation of any reporting material the Secretary determines necessary to carry out the policy.
“(b) Suicide Prevention Efforts.—The Secretary of Defense is authorized to take any necessary measures to prevent suicides by members of the Armed Forces, including by facilitating the access of members of the Armed Forces to successful non-governmental treatment regimen.”
Pub. L. 113–291, div. A, title V, § 567, Dec. 19, 2014, 128 Stat. 3385, provided that:
“(a) Policy for Standard Suicide Data Collection, Reporting, and Assessment.—“(1) Policy required.—The Secretary of Defense shall prescribe a policy for the development of a standard method for collecting, reporting, and assessing information regarding—“(A) any suicide or attempted suicide involving a member of the Armed Forces, including reserve components thereof; and
“(B) any death that is reported as a suicide involving a dependent of a member of the Armed Forces.
“(2) Purpose of policy.—The purpose of the policy required by this subsection is to improve the consistency and comprehensiveness of—“(A) the suicide prevention policy developed pursuant to section 582 of the National Defense Authorization Act for Fiscal Year 2013 (Public Law 112–239; 10 U.S.C. 1071 note); and
“(B) the suicide prevention and resilience program for the National Guard and Reserves established pursuant to section 10219 of title 10, United States Code.
“(3) Consultation.—The Secretary of Defense shall develop the policy required by this subsection in consultation with the Secretaries of the military departments and the Chief of the National Guard Bureau.
“(b) Submission and Implementation of Policy.—“(1) Submission.—Not later than 180 days after the date of the enactment of this Act [Dec. 19, 2014], the Secretary of Defense shall submit the policy developed under subsection (a) to the Committees on Armed Services of the Senate and the House of Representatives.
“(2) Implementation.—The Secretaries of the military departments shall implement the policy developed under subsection (a) not later than 180 days after the date of the submittal of the policy under paragraph (1).
“(c) Dependent Defined.—In this section, the term ‘dependent’, with respect to a member of the Armed Forces, means a person described in section 1072(2) of title 10, United States Code, except that, in the case of a parent or parent-in-law of the member, the income requirements of subparagraph (E) of such section do not apply.”
Pub. L. 112–239, div. A, title V, § 580, Jan. 2, 2013, 126 Stat. 1764, provided that:
“(a) In General.—The Secretary of Defense shall, acting through the Under Secretary of Defense for Personnel and Readiness, establish within the Office of the Secretary of Defense a position with responsibility for oversight of all suicide prevention and resilience programs of the Department of Defense (including those of the military departments and the Armed Forces).
“(b) Scope of Responsibilities.—The individual serving in the position established under subsection (a) shall have the responsibilities as follows:“(1) To establish a uniform definition of resiliency for use in the suicide prevention and resilience programs and preventative behavioral health programs of the Department of Defense (including those of the military departments and the Armed Forces).
“(2) To oversee the implementation of the comprehensive policy on the prevention of suicide among members of the Armed Forces required by section 582.”
Pub. L. 112–239, div. A, title V, § 582, Jan. 2, 2013, 126 Stat. 1766, provided that:
“(a) Comprehensive Policy Required.—Not later than 180 days after the date of the enactment of this Act [Jan. 2, 2013], the Secretary of Defense shall, acting through the Under Secretary of Defense for Personnel and Readiness, develop within the Department of Defense a comprehensive policy on the prevention of suicide among members of the Armed Forces. In developing the policy, the Secretary shall consider recommendations from the operational elements of the Armed Forces regarding the feasibility of the implementation and execution of particular elements of the policy.
“(b) Elements.—The policy required by subsection (a) shall cover each of the following:“(1) Increased awareness among members of the Armed Forces about mental health conditions and the stigma associated with mental health conditions and mental health care.
“(2) The means of identifying members who are at risk for suicide (including enhanced means for early identification and treatment of such members).
“(3) The continuous access by members to suicide prevention services, including suicide crisis services.
“(4) The means to evaluate and assess the effectiveness of the suicide prevention and resilience programs and preventative behavioral health programs of the Department of Defense (including those of the military departments and the Armed Forces), including the development of metrics for that purpose.
“(5) The means to evaluate and assess the current diagnostic tools and treatment methods in the programs referred to in paragraph (4) to ensure clinical best practices are used in such programs.
“(6) The standard of care for suicide prevention to be used throughout the Department.
“(7) The training of mental health care providers on suicide prevention.
“(8) The training standards for behavioral health care providers to ensure that such providers receive training on clinical best practices and evidence-based treatments as information on such practices and treatments becomes available.
“(9) The integration of mental health screenings and suicide risk and prevention for members into the delivery of primary care for such members.
“(10) The standards for responding to attempted or completed suicides among members, including guidance and training to assist commanders in addressing incidents of attempted or completed suicide within their units.
“(11) The means to ensure the protection of the privacy of members seeking or receiving treatment relating to suicide.
“(12) Such other matters as the Secretary considers appropriate in connection with the prevention of suicide among members.”
Pub. L. 112–81, div. A, title V, § 533(a), (b), Dec. 31, 2011, 125 Stat. 1404, provided that:
“(a) Program Enhancement.—The Secretary of Defense shall take appropriate actions to enhance the suicide prevention program of the Department of Defense through the provision of suicide prevention information and resources to members of the Armed Forces from their initial enlistment or appointment through their final retirement or separation.
“(b) Cooperative Effort.—The Secretary of Defense shall develop suicide prevention information and resources in consultation with—“(1) the Secretary of Veterans Affairs, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; and
“(2) to the extent appropriate, institutions of higher education and other public and private entities, including international entities, with expertise regarding suicide prevention.”
Treatment of Wounded WarriorsPub. L. 112–81, div. A, title VII, § 722, Dec. 31, 2011, 125 Stat. 1479, provided that: “The Secretary of Defense may establish a program to enter into partnerships to enable coordinated, rapid clinical evaluation and the application of evidence-based treatment strategies for wounded service members, with an emphasis on the most common musculoskeletal injuries, that will address the priorities of the Armed Forces with respect to retention and readiness.”
Comprehensive Plan on Prevention, Diagnosis, and Treatment of Substance Use Disorders and Disposition of Substance Abuse Offenders in the Armed ForcesPub. L. 111–84, div. A, title V, § 596, Oct. 28, 2009, 123 Stat. 2339, provided for a comprehensive review of programs and policies regarding substance abuse disorders in members of the Armed Forces and the development of a plan for improvement and enhancement of such programs and policies by the Secretary of Defense and for a report to Congress on modification and improvements made following an independent study of the programs that was to be completed no later than two years after Oct. 28, 2009.
Comprehensive Policy on Pain Management by the Military Health Care SystemPub. L. 111–84, div. A, title VII, § 711, Oct. 28, 2009, 123 Stat. 2378, provided that:
“(a) Comprehensive Policy Required.—Not later than March 31, 2011, the Secretary of Defense shall develop and implement a comprehensive policy on pain management by the military health care system.
“(b) Scope of Policy.—The policy required by subsection (a) shall cover each of the following:“(1) The management of acute and chronic pain.
“(2) The standard of care for pain management to be used throughout the Department of Defense.
“(3) The consistent application of pain assessments throughout the Department of Defense.
“(4) The assurance of prompt and appropriate pain care treatment and management by the Department when medically necessary.
“(5) Programs of research related to acute and chronic pain, including pain attributable to central and peripheral nervous system damage characteristic of injuries incurred in modern warfare, brain injuries, and chronic migraine headache.
“(6) Programs of pain care education and training for health care personnel of the Department.
“(7) Programs of patient education for members suffering from acute or chronic pain and their families.
“(c) Updates.—The Secretary shall revise the policy required by subsection (a) on a periodic basis in accordance with experience and evolving best practice guidelines.
“(d) Annual Report.—“(1) In general.—Not later than 180 days after the date of the commencement of the implementation of the policy required by subsection (a), and on October 1 each year thereafter through 2018, the Secretary shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report on the policy.
“(2) Elements.—Each report required by paragraph (1) shall include the following:“(A) A description of the policy implemented under subsection (a), and any revisions to such policy under subsection (c).
“(B) A description of the performance measures used to determine the effectiveness of the policy in improving pain care for beneficiaries enrolled in the military health care system.
“(C) An assessment of the adequacy of Department pain management services based on a current survey of patients managed in Department clinics.
“(D) An assessment of the research projects of the Department relevant to the treatment of the types of acute and chronic pain suffered by members of the Armed Forces and their families.
“(E) An assessment of the training provided to Department health care personnel with respect to the diagnosis, treatment, and management of acute and chronic pain.
“(F) An assessment of the pain care education programs of the Department.
“(G) An assessment of the dissemination of information on pain management to beneficiaries enrolled in the military health care system.”
Plan To Increase the Mental Health Capabilities of the Department of DefensePub. L. 111–84, div. A, title VII, § 714, Oct. 28, 2009, 123 Stat. 2381, as amended by Pub. L. 111–383, div. A, title X, § 1075(d)(8), Jan. 7, 2011, 124 Stat. 4373, directed each military department to increase by a specified amount the number of active duty mental health personnel no later than 180 days after Oct. 28, 2009, and required the Secretary of Defense to report on the appropriate number of mental health personnel required to meet the mental health care needs of members of the Armed Forces, retired members, and dependents; to develop and implement a plan to significantly increase the number of military and civilian mental health personnel by Sept. 30, 2013; and to report on an assessment of the feasibility and advisability of establishing one or more military mental health specialties for officers or enlisted members of the Armed Forces.
Study and Plan To Improve Military Health CarePub. L. 111–84, div. A, title VII, § 721, Oct. 28, 2009, 123 Stat. 2385, provided that:
“(a) Study and Report Required.—Not later than one year after the date of the enactment of this Act [Oct. 28, 2009], the Secretary of Defense shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report on the health care needs of dependents (as defined in section 1072(2) of title 10, United States Code). The report shall include, at a minimum, the following:“(1) With respect to both the direct care system and the purchased care system, an analysis of the type of health care facility in which dependents seek care.
“(2) The 10 most common medical conditions for which dependents seek care.
“(3) The availability of and access to health care providers to treat the conditions identified under paragraph (2), both in the direct care system and the purchased care system.
“(4) Any shortfalls in the ability of dependents to obtain required health care services.
“(5) Recommendations on how to improve access to care for dependents.
“(6) With respect to dependents accompanying a member stationed at a military installation outside of the United States, the need for and availability of mental health care services.
“(b) Enhanced Military Health System and Improved TRICARE.—“(1) In general.—The Secretary of Defense, in consultation with the other administering Secretaries, shall undertake actions to enhance the capability of the military health system and improve the TRICARE program.
“(2) Elements.—In undertaking actions to enhance the capability of the military health system and improve the TRICARE program under paragraph (1), the Secretary shall consider the following actions:“(A) Actions to guarantee the availability of care within established access standards for eligible beneficiaries, based on the results of the study required by subsection (a).
“(B) Actions to expand and enhance sharing of health care resources among Federal health care programs, including designated providers (as that term is defined in section 721(5) of the National Defense Authorization Act for Fiscal Year 1997 (Public Law 104–201; 110 Stat. 2593; 10 U.S.C. 1073 note)).
“(C) Actions using medical technology to speed and simplify referrals for specialty care.
“(D) Actions to improve regional or national staffing capabilities in order to enhance support provided to military medical treatment facilities facing staff shortages.
“(E) Actions to improve health care access for members of the reserve components and their families, including such access with respect to mental health care and consideration of access issues for members and their families located in rural areas.
“(F) Actions to ensure consistency throughout the TRICARE program to comply with access standards, which are applicable to both commanders of military treatment facilities and managed care support contractors.
“(G) Actions to create new budgeting and resource allocation methodologies to fully support and incentivize care provided by military treatment facilities.
“(H) Actions regarding additional financing options for health care provided by civilian providers.
“(I) Actions to reduce administrative costs.
“(J) Actions to control the cost of health care and pharmaceuticals.
“(K) Actions to audit the Defense Enrollment Eligibility Reporting System to improve system checks on the eligibility of TRICARE beneficiaries.
“(L) Actions, including a comprehensive plan, for the enhanced availability of prevention and wellness care.
“(M) Actions using technology to improve direct communication with beneficiaries regarding health and preventive care.
“(N) Actions to create performance metrics by which to measure improvement in the TRICARE program.
“(O) Such other actions as the Secretary, in consultation with the other administering Secretaries, considers appropriate.
“(c) Quality Assurance.—In undertaking actions under this section, the Secretary of Defense and the other administering Secretaries shall continue or enhance the current level of quality health care provided by the Department of Defense and the military departments with no adverse impact to cost, access, or care.
“(d) Consultation.—In considering actions to be undertaken under this section, and in undertaking such actions, the Secretary shall consult with a broad range of national health care and military advocacy organizations.
“(e) Reports Required.—“(1) Initial report.—Not later than 180 days after the date of the enactment of this Act [Oct. 28, 2009], the Secretary shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] an initial report on the progress made in undertaking actions under this section and future plans for improvement of the military health system.
“(2) Report required with fiscal year 2012 budget proposal.—Together with the budget justification materials submitted to Congress in support of the Department of Defense budget for fiscal year 2012 (as submitted with the budget of the President under section 1105(a) of title 31, United States Code), the Secretary shall submit to the congressional defense committees a report setting forth the following:“(A) Updates on the progress made in undertaking actions under this section.
“(B) Future plans for improvement of the military health system.
“(C) An explanation of how the budget submission may reflect such progress and plans.
“(3) Periodic reports.—The Secretary shall, on a periodic basis, submit to the congressional defense committees a report on the progress being made in the improvement of the TRICARE program under this section.
“(4) Elements.—Each report under this subsection shall include the following:“(A) A description and assessment of the progress made as of the date of such report in the improvement of the TRICARE program.
“(B) Such recommendations for administrative or legislative action as the Secretary considers appropriate to expedite and enhance the improvement of the TRICARE program.
“(f) Definitions.—In this section:“(1) The term ‘administering Secretaries’ has the meaning given that term in section 1072(3) of title 10, United States Code.
“(2) The term ‘TRICARE program’ has the meaning given that term in section 1072(7) of title 10, United States Code.”
Program for Health Care Delivery at Military Installations With Projected GrowthPub. L. 110–417, [div. A], title VII, § 705, Oct. 14, 2008, 122 Stat. 4499, provided that:
“(a) Program.—The Secretary of Defense is authorized to develop a plan to establish a program to build cooperative health care arrangements and agreements between military installations projected to grow and local and regional non-military health care systems.
“(b) Requirements of Plan.—In developing the plan, the Secretary of Defense shall—“(1) identify and analyze health care delivery options involving the private sector and health care services in military facilities located on military installations;
“(2) develop methods for determining the cost avoidance or savings resulting from innovative partnerships between the Department of Defense and the private sector;
“(3) develop requirements for Department of Defense health care providers to deliver health care in civilian community hospitals; and
“(4) collaborate with State and local authorities to create an arrangement to share and exchange, between the Department of Defense and nonmilitary health care systems, personal health information, and data of military personnel and their families.
“(c) Coordination With Other Entities.—The plan shall include requirements for coordination with Federal, State, and local entities, TRICARE managed care support contractors, and other contracted assets around installations selected for participation in the program.
“(d) Consultation Requirements.—The Secretary of Defense shall develop the plan in consultation with the Secretaries of the military departments.
“(e) Selection of Military Installations.—Each selected military installation shall meet the following criteria:“(1) The military installation has members of the Armed Forces on active duty and members of reserve components of the Armed Forces that use the installation as a training and operational base, with members routinely deploying in support of the global war on terrorism.
“(2) The military population of an installation will significantly increase by 2013 due to actions related to either Grow the Force initiatives or recommendations of the Defense Base Realignment and Closure Commission.
“(3) There is a military treatment facility on the installation that has—“(A) no inpatient or trauma center care capabilities; and
“(B) no current or planned capacity that would satisfy the proposed increase in military personnel at the installation.
“(4) There is a civilian community hospital near the military installation, and the military treatment facility has—“(A) no inpatient services or limited capability to expand inpatient care beds, intensive care, and specialty services; and
“(B) limited or no capability to provide trauma care.
“(f) Reports.—Not later than one year after the date of the enactment of this Act [Oct. 14, 2008], and every year thereafter, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and House of Representatives an annual report on any plan developed under subsection (a).”
Center of Excellence in Prevention, Diagnosis, Mitigation, Treatment, and Rehabilitation of Hearing Loss and Auditory System InjuriesPub. L. 110–417, [div. A], title VII, § 721, Oct. 14, 2008, 122 Stat. 4506, provided that:
“(a) In General.—The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of hearing loss and auditory system injury to carry out the responsibilities specified in subsection (c).
“(b) Partnerships.—The Secretary shall ensure that the center collaborates to the maximum extent practicable with the Secretary of Veterans Affairs, institutions of higher education, and other appropriate public and private entities (including international entities) to carry out the responsibilities specified in subsection (c).
“(c) Responsibilities.—“(1) In general.—The center shall—“(A) implement a comprehensive plan and strategy for the Department of Defense, as developed by the Secretary of Defense, for a registry of information for the tracking of the diagnosis, surgical intervention or other operative procedure, other treatment, and follow up for each case of hearing loss and auditory system injury incurred by a member of the Armed Forces while serving on active duty;
“(B) ensure the electronic exchange with the Secretary of Veterans Affairs of information obtained through tracking under subparagraph (A); and
“(C) enable the Secretary of Veterans Affairs to access the registry and add information pertaining to additional treatments or surgical procedures and eventual hearing outcomes for veterans who were entered into the registry and subsequently received treatment through the Veterans Health Administration.
“(2) Designation of registry.—The registry under this subsection shall be known as the ‘Hearing Loss and Auditory System Injury Registry’ (hereinafter referred to as the ‘Registry’).
“(3) Consultation in development.—The center shall develop the Registry in consultation with audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Defense and the audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Veterans Affairs. The mechanisms and procedures of the Registry shall reflect applicable expert research on military and other hearing loss.
“(4) Mechanisms.—The mechanisms of the Registry for tracking under paragraph (1)(A) shall ensure that each military medical treatment facility or other medical facility shall submit to the center for inclusion in the Registry information on the diagnosis, surgical intervention or other operative procedure, other treatment, and follow up for each case of hearing loss and auditory system injury described in that paragraph as follows (to the extent applicable):“(A) Not later than 30 days after surgery or other operative intervention, including a surgery or other operative intervention carried out as a result of a follow-up examination.
“(B) Not later than 180 days after the hearing loss and auditory system injury is reported or recorded in the medical record.
“(5) Coordination of care and benefits.—(A) The center shall provide notice to the National Center for Rehabilitative Auditory Research (NCRAR) of the Department of Veterans Affairs and to the auditory system impairment services of the Veterans Health Administration on each member of the Armed Forces described in subparagraph (B) for purposes of ensuring the coordination of the provision of ongoing auditory system rehabilitation benefits and services by the Department of Veterans Affairs after the separation or release of such member from the Armed Forces.
“(B) A member of the Armed Forces described in this subparagraph is a member of the Armed Forces with significant hearing loss or auditory system injury incurred while serving on active duty, including a member with auditory dysfunction related to traumatic brain injury.
“(d) Utilization of Registry Information.—The Secretary of Defense and the Secretary of Veterans Affairs shall jointly ensure that information in the Registry is available to appropriate audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Defense and the Department of Veterans Affairs for purposes of encouraging and facilitating the conduct of research, and the development of best practices and clinical education, on hearing loss or auditory system injury incurred by members of the Armed Forces.
“(e) Inclusion of Records of OIF/OEF Veterans.—The Secretary of Defense shall take appropriate actions to include in the Registry such records of members of the Armed Forces who incurred a hearing loss or auditory system injury while serving on active duty on or after September 11, 2001, but before the establishment of the Registry, as the Secretary considers appropriate for purposes of the Registry.”
Wounded Warrior Health Care ImprovementsPub. L. 115–232, div. A, title VII, § 717, Aug. 13, 2018, 132 Stat. 1815, provided that:
“(a) In General.—Not later than 180 days after the date of the enactment of this Act [Aug. 13, 2018], the Secretary of Defense shall review and update policies and procedures relating to the care and management of recovering service members. In conducting such review, the Secretary shall consider best practices—“(1) in the care of recovering service members;
“(2) in the administrative management relating to such care;
“(3) to carry out applicable provisions of Federal law; and
“(4) recommended by the Comptroller General of the United States in the report titled ‘Army Needs to Improve Oversight of Warrior Transition Units’.
“(b) Scope of Policy.—In carrying out subsection (a), the Secretary shall update policies of the Department of Defense with respect to each of the following:“(1) The case management coordination of members of the Armed Forces between the military departments and the military medical treatment facilities administered by the Director of the Defense Health Agency pursuant to section 1073c of title 10, United States Code, including with respect to the coordination of—“(A) appointments;
“(B) rehabilitative services;
“(C) recuperation in an outpatient status;
“(D) contract care provided by a private health care provider outside of a military medical treatment facility;
“(E) the disability evaluation system; and
“(F) other administrative functions relating to the military department.
“(2) The transition of a member of the Armed Forces who is retired under chapter 61 of title 10, United States Code, from receiving treatment furnished by the Secretary of Defense to treatment furnished by the Secretary of Veterans Affairs.
“(3) Facility standards related to lodging and accommodations for recovering service members and the family members and non-medical attendants of recovering service members.
“(c) Report.—Not later than one year after the date of the enactment of this Act [Aug. 13, 2018], the Secretary of Defense and Secretaries of the military departments shall jointly submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the review conducted under subsection (a), including a description of the policies updated pursuant to subsection (b).
“(d) Definitions.—In this section, the terms ‘disability evaluation system’, ‘outpatient status’, and ‘recovering service members’ have the meaning given those terms in section 1602 of the Wounded Warrior Act (title XVI of Public Law 110–181; 10 U.S.C. 1071 note).”
Pub. L. 110–181, div. A, title XVI, §§ 1602, 1603, 1611–1614, 1616, 1618, 1621–1623, 1631, 1635, 1644, 1648, 1651, 1662, 1671, 1672, 1676, Jan. 28, 2008, 122 Stat. 431–443, 447, 450–455, 458, 460, 467, 473, 476, 479, 481, 484, as amended by Pub. L. 110–417, [div. A], title II, § 252, title VII, §§ 722, 724, title X, § 1061(b)(13), Oct. 14, 2008, 122 Stat. 4400, 4508, 4509, 4613; Pub. L. 111–84, div. A, title VI, § 632(h), Oct. 28, 2009, 123 Stat. 2362; Pub. L. 112–56, title II, § 231, Nov. 21, 2011, 125 Stat. 719; Pub. L. 112–81, div. A, title VI, § 631(f)(4)(B), title VII, § 707, Dec. 31, 2011, 125 Stat. 1465, 1474; Pub. L. 112–239, div. A, title X, § 1076(a)(9), Jan. 2, 2013, 126 Stat. 1948; Pub. L. 113–175, title I, § 105, Sept. 26, 2014, 128 Stat. 1903; Pub. L. 113–291, div. A, title V, § 591, title VII, § 724, Dec. 19, 2014, 128 Stat. 3394, 3418; Pub. L. 114–58, title II, § 204, title IV, § 411, Sept. 30, 2015, 129 Stat. 533, 536; Pub. L. 114–92, div. A, title X, § 1072(e), (f), Nov. 25, 2015, 129 Stat. 995; Pub. L. 114–228, title II, § 204, title IV, § 414, Sept. 29, 2016, 130 Stat. 938, 941; Pub. L. 115–62, title II, § 203, Sept. 29, 2017, 131 Stat. 1162; Pub. L. 115–251, title I, § 126, Sept. 29, 2018, 132 Stat. 3169; Pub. L. 116–92, div. A, title VII, § 715(a)–(g), Dec. 20, 2019, 133 Stat. 1446–1451, provided that:
Disease and Chronic Care ManagementPub. L. 109–364, div. A, title VII, § 734, Oct. 17, 2006, 120 Stat. 2299, required the Secretary of Defense to develop a fully integrated program on disease and chronic care management for the military health care system with uniform policies and practices throughout the system and an implementation plan for the program and to report to Congress no later than Mar. 1, 2008.
Prevention, Mitigation, and Treatment of Blast InjuriesPub. L. 109–163, div. A, title II, § 256, Jan. 6, 2006, 119 Stat. 3181, as amended by Pub. L. 112–239, div. A, title X, § 1076(c)(2)(C), Jan. 2, 2013, 126 Stat. 1950, provided for medical research efforts and programs of the Department of Defense relating to the prevention, mitigation, and treatment of blast injuries, including the designation of an executive agent to coordinate and manage such efforts and programs, conduct studies, and develop training protocols, and required an annual report to Congress through 2008.
Access to Health Care Services for Beneficiaries Eligible for TRICARE and Department of Veterans Affairs Health CarePub. L. 107–314, div. A, title VII, § 708, Dec. 2, 2002, 116 Stat. 2585, provided that:
“(a) Requirement To Establish Process.—(1) The Secretary of Defense shall prescribe in regulations a process for resolving issues relating to patient safety and continuity of care for covered beneficiaries who are concurrently entitled to health care under the TRICARE program and eligible for health care services provided by the Department of Veterans Affairs. The Secretary shall—“(A) ensure that the process provides for coordination of, and access to, health care from the two sources in a manner that prevents diminution of access to health care from either source; and
“(B) in consultation with the Secretary of Veterans Affairs, prescribe a clear definition of an ‘episode of care’ for use in the resolution of patient safety and continuity of care issues under such process.
“(2) Not later than May 1, 2003, the Secretary shall submit to the Committees on Armed Services of the Senate and of the House of Representatives a report describing the process prescribed under paragraph (1).
“(3) While prescribing the process under paragraph (1) and upon completion of the report under paragraph (2), the Secretary shall provide to the Comptroller General information that would be relevant in carrying out the study required by subsection (b).
“(b) Comptroller General Study and Report.—(1) The Comptroller General shall conduct a study of the health care issues of covered beneficiaries described in subsection (a). The study shall include the following:“(A) An analysis of whether covered beneficiaries who seek services through the Department of Veterans Affairs are receiving needed health care services in a timely manner from the Department of Veterans Affairs, as compared to the timeliness of the care available to covered beneficiaries under TRICARE Prime (as set forth in access to care standards under TRICARE program policy that are applicable to the care being sought).
“(B) An evaluation of the quality of care for covered beneficiaries who do not receive needed services from the Department of Veterans Affairs within a time period that is comparable to the time period provided for under such access to care standards and who then must seek alternative care under the TRICARE program.
“(C) Recommendations to improve access to, and timeliness and quality of, care for covered beneficiaries described in subsection (a).
“(D) An evaluation of the feasibility and advisability of making access to care standards applicable jointly under the TRICARE program and the Department of Veterans Affairs health care system.
“(E) A review of the process prescribed by the Secretary of Defense under subsection (a) to determine whether the process ensures the adequacy and quality of the health care services provided to covered beneficiaries under the TRICARE program and through the Department of Veterans Affairs, together with timeliness of access to such services and patient safety.
“(2) Not later than 60 days after the congressional committees specified in subsection (a)(2) receive the report required under that subsection, the Comptroller General shall submit to those committees a report on the study conducted under this subsection.
“(c) Definitions.—In this section:“(1) The term ‘covered beneficiary’ has the meaning provided by section 1072(5) of title 10, United States Code.
“(2) The term ‘TRICARE program’ has the meaning provided by section 1072(7) of such title.
“(3) The term ‘TRICARE Prime’ has the meaning provided by section 1097a(f) of such title.”
Pilot Program Providing for Department of Veterans Affairs Support in the Performance of Separation Physical ExaminationsPub. L. 107–107, div. A, title VII, § 734, Dec. 28, 2001, 115 Stat. 1170, authorized the Secretary of Defense and the Secretary of Veterans Affairs to jointly carry out a pilot program, to begin not later than July 1, 2002, and terminate on Dec. 31, 2005, under which the Secretary of Veterans Affairs, in one or more geographic areas, could perform the physical examinations required for separation of members from the uniformed services, and directed the Secretaries to jointly submit to Congress interim and final reports not later than Mar. 1, 2005.
Health Care Management Demonstration ProgramPub. L. 106–398, § 1 [[div. A], title VII, § 733], Oct. 30, 2000, 114 Stat. 1654, 1654A–191, as amended by Pub. L. 107–107, div. A, title VII, § 737, Dec. 28, 2001, 115 Stat. 1173, directed the Secretary of Defense to carry out a demonstration program on health care management, to begin not later than 180 days after Oct. 30, 2000, and terminate on Dec. 31, 2003, to explore opportunities for improving the planning, programming, budgeting systems, and management of the Department of Defense health care system, and directed the Secretary to submit a report on such program to committees of Congress not later than Mar. 15, 2004.
Processes for Patient Safety in Military and Veterans Health Care SystemsPub. L. 106–398, § 1 [[div. A], title VII, § 742], Oct. 30, 2000, 114 Stat. 1654, 1654A–192, provided that:
“(a) Error Tracking Process.—The Secretary of Defense shall implement a centralized process for reporting, compilation, and analysis of errors in the provision of health care under the defense health program that endanger patients beyond the normal risks associated with the care and treatment of such patients. To the extent practicable, that process shall emulate the system established by the Secretary of Veterans Affairs for reporting, compilation, and analysis of errors in the provision of health care under the Department of Veterans Affairs health care system that endanger patients beyond such risks.
“(b) Sharing of Information.—The Secretary of Defense and the Secretary of Veterans Affairs—“(1) shall share information regarding the designs of systems or protocols established to reduce errors in the provision of health care described in subsection (a); and
“(2) shall develop such protocols as the Secretaries consider necessary for the establishment and administration of effective processes for the reporting, compilation, and analysis of such errors.”
Cooperation in Developing Pharmaceutical Identification TechnologyPub. L. 106–398, § 1 [[div. A], title VII, § 743], Oct. 30, 2000, 114 Stat. 1654, 1654A–192, provided that: “The Secretary of Defense and the Secretary of Veterans Affairs shall cooperate in developing systems for the use of bar codes for the identification of pharmaceuticals in the health care programs of the Department of Defense and the Department of Veterans Affairs. In any case in which a common pharmaceutical is used in such programs, the bar codes for those pharmaceuticals shall, to the maximum extent practicable, be identical.”
Patient Care Reporting and Management SystemPub. L. 106–398, § 1 [[div. A], title VII, § 754], Oct. 30, 2000, 114 Stat. 1654, 1654A–196, as amended by Pub. L. 109–163, div. A, title VII, § 741, Jan. 6, 2006, 119 Stat. 3360, provided that:
“(a) Establishment.—The Secretary of Defense shall establish a patient care error reporting and management system.
“(b) Purposes of System.—The purposes of the system are as follows:“(1) To study the occurrences of errors in the patient care provided under chapter 55 of title 10, United States Code.
“(2) To identify the systemic factors that are associated with such occurrences.
“(3) To provide for action to be taken to correct the identified systemic factors.
“(c) Requirements for System.—The patient care error reporting and management system shall include the following:“(1) A hospital-level patient safety center, within the quality assurance department of each health care organization of the Department of Defense, to collect, assess, and report on the nature and frequency of errors related to patient care.
“(2) For each health care organization of the Department of Defense and for the entire Defense health program, patient safety standards that are necessary for the development of a full understanding of patient safety issues in each such organization and the entire program, including the nature and types of errors and the systemic causes of the errors.
“(3) Establishment of a Department of Defense Patient Safety Center, which shall have the following missions:“(A) To analyze information on patient care errors that is submitted to the Center by each military health care organization.
“(B) To develop action plans for addressing patterns of patient care errors.
“(C) To execute those action plans to mitigate and control errors in patient care with a goal of ensuring that the health care organizations of the Department of Defense provide highly reliable patient care with virtually no error.
“(D) To provide, through the Assistant Secretary of Defense for Health Affairs, to the Agency for Healthcare Research and Quality of the Department of Health and Human Services any reports that the Assistant Secretary determines appropriate.
“(E) To review and integrate processes for reducing errors associated with patient care and for enhancing patient safety.
“(F) To contract with a qualified and objective external organization to manage the national patient safety database of the Department of Defense.
“(d) Medical Team Training Program.—The Secretary shall expand the health care team coordination program to integrate that program into all Department of Defense health care operations. In carrying out this subsection, the Secretary shall take the following actions:“(1) Establish not less than two Centers of Excellence for the development, validation, proliferation, and sustainment of the health care team coordination program, one of which shall support all fixed military health care organizations, the other of which shall support all combat casualty care organizations.
“(2) Deploy the program to all fixed and combat casualty care organizations of each of the Armed Forces, at the rate of not less than 10 organizations in each fiscal year.
“(3) Expand the scope of the health care team coordination program from a focus on emergency department care to a coverage that includes care in all major medical specialties, at the rate of not less than one specialty in each fiscal year.
“(4) Continue research and development investments to improve communication, coordination, and team work in the provision of health care.
“(e) Consultation.—The Secretary shall consult with the other administering Secretaries (as defined in section 1072(3) of title 10, United States Code) in carrying out this section.”
Confidentiality of Communications With Professionals Providing Therapeutic or Related Services Regarding Sexual or Domestic AbusePub. L. 106–65, div. A, title V, § 585, Oct. 5, 1999, 113 Stat. 636, required the Secretary of Defense to prescribe in regulations policies and procedures to provide maximum protections for the confidentiality of communications between dependents of Armed Forces members and professionals providing therapeutic or related services regarding sexual or domestic abuse and to report to Congress no later than Jan. 21, 2000.
Health Care Quality Information and Technology EnhancementPub. L. 106–65, div. A, title VII, § 723, Oct. 5, 1999, 113 Stat. 695, as amended by Pub. L. 106–398, § 1 [[div. A], title VII, § 753(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–195; Pub. L. 109–163, div. A, title VII, § 742, Jan. 6, 2006, 119 Stat. 3360; Pub. L. 109–364, div. A, title X, § 1046(e), Oct. 17, 2006, 120 Stat. 2394; Pub. L. 112–81, div. A, title X, § 1062(j)(1), Dec. 31, 2011, 125 Stat. 1585; Pub. L. 117–286, § 4(a)(47), Dec. 27, 2022, 136 Stat. 4310, provided that:
“(a) Purpose.—The purpose of this section is to ensure that the Department of Defense addresses issues of medical quality surveillance and implements solutions for those issues in a timely manner that is consistent with national policy and industry standards.
“(b) Department of Defense Program for Medical Informatics and Data.—The Secretary of Defense shall establish a Department of Defense program, the purposes of which shall be the following:“(1) To develop parameters for assessing the quality of health care information.
“(2) To develop the defense digital patient record.
“(3) To develop a repository for data on quality of health care.
“(4) To develop capability for conducting research on quality of health care.
“(5) To conduct research on matters of quality of health care.
“(6) To develop decision support tools for health care providers.
“(7) To refine medical performance report cards.
“(8) To conduct educational programs on medical informatics to meet identified needs.
“(c) Automation and Capture of Clinical Data.—(1) Through the program established under subsection (b), the Secretary of Defense shall accelerate the efforts of the Department of Defense to automate, capture, and exchange controlled clinical data and present providers with clinical guidance using a personal information carrier, clinical lexicon, or digital patient record.
“(2) The program shall serve as a primary resource for the Department of Defense for matters concerning the capture, processing, and dissemination of data on health care quality.
“(d) Medical Informatics Advisory Committee.—(1) The Secretary of Defense shall establish a Medical Informatics Advisory Committee (hereinafter referred to as the ‘Committee’), the members of which shall be the following:“(A) The Assistant Secretary of Defense for Health Affairs.
“(B) The Director of the TRICARE Management Activity of the Department of Defense.
“(C) The Surgeon General of the Army.
“(D) The Surgeon General of the Navy.
“(E) The Surgeon General of the Air Force.
“(F) Representatives of the Department of Veterans Affairs, designated by the Secretary of Veterans Affairs.
“(G) Representatives of the Department of Health and Human Services, designated by the Secretary of Health and Human Services.
“(H) Any additional members appointed by the Secretary of Defense to represent health care insurers and managed care organizations, academic health institutions, health care providers (including representatives of physicians and representatives of hospitals), and accreditors of health care plans and organizations.
“(2) The primary mission of the Committee shall be to advise the Secretary on the development, deployment, and maintenance of health care informatics systems that allow for the collection, exchange, and processing of health care quality information for the Department of Defense in coordination with other Federal departments and agencies and with the private sector.
“(3) Specific areas of responsibility of the Committee shall include advising the Secretary on the following:“(A) The ability of the medical informatics systems at the Department of Defense and Department of Veterans Affairs to monitor, evaluate, and improve the quality of care provided to beneficiaries.
“(B) The coordination of key components of medical informatics systems, including digital patient records, both within the Federal Government and between the Federal Government and the private sector.
“(C) The development of operational capabilities for executive information systems and clinical decision support systems within the Department of Defense and Department of Veterans Affairs.
“(D) Standardization of processes used to collect, evaluate, and disseminate health care quality information.
“(E) Refinement of methodologies by which the quality of health care provided within the Department of Defense and Department of Veterans Affairs is evaluated.
“(F) Protecting the confidentiality of personal health information.
“(4) The Assistant Secretary of Defense for Health Affairs shall consult with the Committee on the issues described in paragraph (3).
“(5) Members of the Committee shall not be paid by reason of their service on the Committee.
“(6) Chapter 10 of title 5, United States Code, shall not apply to the Committee.”
[Section 1062(j)(1)(A) of Pub. L. 112–81, which directed the redesignation of pars. (6) and (7) as (5) and (6) of section 723(d) of Pub. L. 106–65, set out above, could not be executed due to the prior identical amendment by section 1046(e) of Pub. L. 109–364.]
Joint Department of Defense and Department of Veterans Affairs Reports Relating to Interdepartmental Cooperation in Delivery of Medical CarePub. L. 105–261, div. A, title VII, § 745, Oct. 17, 1998, 112 Stat. 2075, as amended by Pub. L. 106–65, div. A, title X, § 1067(3), Oct. 5, 1999, 113 Stat. 774; Pub. L. 108–136, div. A, title X, § 1031(g)(1), Nov. 24, 2003, 117 Stat. 1604, (1) directed the Secretary of Defense and the Secretary of Veterans Affairs to jointly conduct a survey of their respective medical care beneficiary populations to identify the expectations of, requirements for, and behavior patterns of the beneficiaries with respect to medical care, and to submit a report on the results of the survey to committees of Congress not later than Jan. 1, 2000; (2) directed the same Secretaries to jointly conduct a review to identify impediments to cooperation between the Department of Defense and the Department of Veterans Affairs regarding the delivery of medical care and to submit a report on the results of the review to committees of Congress not later than Mar. 1, 1999; (3) directed the Secretary of Defense to review the TRICARE program to identify opportunities for increased participation by the Department of Veterans Affairs in that program; (4) directed the Department of Defense-Department of Veterans Affairs Federal Pharmacy Executive Steering Committee to examine existing pharmaceutical benefits and programs for beneficiaries and review existing methods for contracting for and distributing medical supplies and services and to submit a report on the results of the examination to committees of Congress not later than 60 days after its completion; and (5) directed the Secretary of Defense and the Secretary of Veterans Affairs to jointly submit to committees of Congress a report, not later than Mar. 1, 1999, on the status of the efforts of the Department of Defense and the Department of Veterans Affairs to standardize physical examinations administered by the two departments for the purpose of determining or rating disabilities.
External Peer Review for Defense Health Program Extramural Medical Research Involving Human SubjectsPub. L. 104–201, div. A, title VII, § 742, Sept. 23, 1996, 110 Stat. 2600, provided that:
“(a) Establishment of External Peer Review Process.—The Secretary of Defense shall establish a peer review process that will use persons who are not officers or employees of the Government to review the research protocols of medical research projects.
“(b) Peer Review Requirements.—Funds of the Department of Defense may not be obligated or expended for any medical research project unless the research protocol for the project has been approved by the external peer review process established under subsection (a).
“(c) Medical Research Project Defined.—For purposes of this section, the term ‘medical research project’ means a research project that—“(1) involves the participation of human subjects;
“(2) is conducted solely by a non-Federal entity; and
“(3) is funded through the Defense Health Program account.
“(d) Effective Date.—The peer review requirements of subsection (b) shall take effect on October 1, 1996, and, except as provided in subsection (e), shall apply to all medical research projects proposed funded on or after that date, including medical research projects funded pursuant to any requirement of law enacted before, on, or after that date.
“(e) Exceptions.—Only the following medical research projects shall be exempt from the peer review requirements of subsection (b):“(1) A medical research project that the Secretary determines has been substantially completed by October 1, 1996.
“(2) A medical research project funded pursuant to any provision of law enacted on or after that date if the provision of law specifically refers to this section and specifically states that the peer review requirements do not apply.”
Annual Beneficiary SurveyPub. L. 102–484, div. A, title VII, § 724, Oct. 23, 1992, 106 Stat. 2440, as amended by Pub. L. 103–337, div. A, title VII, § 717, Oct. 5, 1994, 108 Stat. 2804, provided that:
“(a) Survey Required.—The administering Secretaries shall conduct annually a formal survey of persons receiving health care under chapter 55 of title 10, United States Code, in order to determine the following:“(1) The availability of health care services to such persons through the health care system provided for under that chapter, the types of services received, and the facilities in which the services were provided.
“(2) The familiarity of such persons with the services available under that system and with the facilities in which such services are provided.
“(3) The health of such persons.
“(4) The level of satisfaction of such persons with that system and the quality of the health care provided through that system.
“(5) Such other matters as the administering Secretaries determine appropriate.
“(b) Exemption.—An annual survey under subsection (a) shall be treated as not a collection of information for the purposes for which such term is defined in section 3502(4) of title 44, United States Code.
“(c) Definition.—For purposes of this section, the term ‘administering Secretaries’ has the meaning given such term in section 1072(3) of title 10, United States Code.”
Comprehensive Study of Military Medical Care SystemPub. L. 102–190, div. A, title VII, § 733, Dec. 5, 1991, 105 Stat. 1408, as amended by Pub. L. 102–484, div. A, title VII, § 723, Oct. 23, 1992, 106 Stat. 2440, directed Secretary of Defense to conduct a comprehensive study of the military medical care system, not later than Dec. 15, 1992, to submit to congressional defense committees a detailed accounting on progress of the study, including preliminary results of the study, and not later than Dec. 15, 1993, submit to congressional defense committees a final report on the study.
Identification and Treatment of Drug and Alcohol Dependent Persons in the Armed ForcesPub. L. 92–129, title V, § 501, Sept. 28, 1971, 85 Stat. 361, which directed Secretary of Defense to devise ways to identify, treat, and rehabilitate drug and alcohol dependent members of the armed forces, to identify, refuse admission to, and refer to civilian treatment facilities such persons seeking entrance to the armed forces, and to report to Congress on and suggest additional legislation concerning these matters, was repealed and restated as sections 978 and 1090 of this title by Pub. L. 97–295, §§ 1(14)(A), (15)(A), 6(b), Oct. 12, 1982, 96 Stat. 1289, 1290, 1314.
Definitions
Pub. L. 114–328, div. A, title VII, § 728(c), Dec. 23, 2016, 130 Stat. 2234, provided that:
“In this section [amending section 1073b of this title and enacting provisions set out as a note under this section]:
“(1) The term ‘Core Quality Measures Collaborative’ means the collaboration between the Centers for Medicare & Medicaid Services, major health insurance companies, national physician organizations, and other entities to reach consensus on core performance measures reported by health care providers.
“(2) The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10, United States Code.”
Executive Documents
Ex. Ord. No. 13625. Improving Access to Mental Health Services for Veterans, Service Members, and Military Families
Ex. Ord. No. 13625, Aug. 31, 2012, 77 F.R. 54783, provided:
By the authority vested in me as President by the Constitution and the laws of the United States of America, I hereby order as follows:
Section 1. Policy. Since September 11, 2001, more than two million service members have deployed to Iraq or Afghanistan. Long deployments and intense combat conditions require optimal support for the emotional and mental health needs of our service members and their families. The need for mental health services will only increase in the coming years as the Nation deals with the effects of more than a decade of conflict. Reiterating and expanding upon the commitment outlined in my Administration’s 2011 report, entitled “Strengthening Our Military Families,” we have an obligation to evaluate our progress and continue to build an integrated network of support capable of providing effective mental health services for veterans, service members, and their families. Our public health approach must encompass the practices of disease prevention and the promotion of good health for all military populations throughout their lifespans, both within the health care systems of the Departments of Defense and Veterans Affairs and in local communities. Our efforts also must focus on both outreach to veterans and their families and the provision of high quality mental health treatment to those in need. Coordination between the Departments of Veterans Affairs and Defense during service members’ transition to civilian life is essential to achieving these goals.
Ensuring that all veterans, service members (Active, Guard, and Reserve alike), and their families receive the support they deserve is a top priority for my Administration. As part of our ongoing efforts to improve all facets of military mental health, this order directs the Secretaries of Defense, Health and Human Services, Education, Veterans Affairs, and Homeland Security to expand suicide prevention strategies and take steps to meet the current and future demand for mental health and substance abuse treatment services for veterans, service members, and their families.
Sec. 2. Suicide Prevention. (a) By December 31, 2012, the Department of Veterans Affairs, in continued collaboration with the Department of Health and Human Services, shall expand the capacity of the Veterans Crisis Line by 50 percent to ensure that veterans have timely access, including by telephone, text, or online chat, to qualified, caring responders who can help address immediate crises and direct veterans to appropriate care. Further, the Department of Veterans Affairs shall ensure that any veteran identifying him or herself as being in crisis connects with a mental health professional or trained mental health worker within 24 hours. The Department of Veterans Affairs also shall expand the number of mental health professionals who are available to see veterans beyond traditional business hours.
(b) The Departments of Veterans Affairs and Defense shall jointly develop and implement a national suicide prevention campaign focused on connecting veterans and service members to mental health services. This 12-month campaign, which shall begin on September 1, 2012, will focus on the positive benefits of seeking care and encourage veterans and service members to proactively reach out to support services.
(c) To provide the best mental health and substance abuse prevention, education, and outreach support to our military and their family members, the Department of Defense shall review all of its existing mental health and substance abuse prevention, education, and outreach programs across the military services and the Defense Health Program to identify the key program areas that produce the greatest impact on quality and outcomes, and rank programs within each of these program areas using metrics that assess their effectiveness. By the end of Fiscal Year 2014, existing program resources shall be realigned to ensure that highly ranked programs are implemented across all of the military services and less effective programs are replaced.
Sec. 3. Enhanced Partnerships Between the Department of Veterans Affairs and Community Providers. (a) Within 180 days of the date of this order, in those service areas where the Department of Veterans Affairs has faced challenges in hiring and placing mental health service providers and continues to have unfilled vacancies or long wait times, the Departments of Veterans Affairs and Health and Human Services shall establish pilot projects whereby the Department of Veterans Affairs contracts or develops formal arrangements with community-based providers, such as community mental health clinics, community health centers, substance abuse treatment facilities, and rural health clinics, to test the effectiveness of community partnerships in helping to meet the mental health needs of veterans in a timely way. Pilot sites shall ensure that consumers of community-based services continue to be integrated into the health care systems of the Department of Veterans Affairs. No fewer than 15 pilot projects shall be established.
(b) The Department of Veterans Affairs shall develop guidance for its medical centers and service networks that supports the use of community mental health services, including telehealth services and substance abuse services, where appropriate, to meet demand and facilitate access to care. This guidance shall include recommendations that medical centers and service networks use community-based providers to help meet veterans’ mental health needs where objective criteria, which the Department of Veterans Affairs shall define in the form of specific metrics, demonstrate such needs. Such objective criteria should include estimates of wait-times for needed care that exceed established targets.
(c) The Departments of Health and Human Services and Veterans Affairs shall develop a plan for a rural mental health recruitment initiative to promote opportunities for the Department of Veterans Affairs and rural communities to share mental health providers when demand is insufficient for either the Department of Veterans Affairs or the communities to independently support a full-time provider.
Sec. 4. Expanded Department of Veterans Affairs Mental Health Services Staffing. The Secretary of Veterans Affairs shall, by December 31, 2013, hire and train 800 peer-to-peer counselors to empower veterans to support other veterans and help meet mental health care needs. In addition, the Secretary shall continue to use all appropriate tools, including collaborative arrangements with community-based providers, pay-setting authorities, loan repayment and scholarships, and partnerships with health care workforce training programs to accomplish the Department of Veterans Affairs’ goal of recruiting, hiring, and placing 1,600 mental health professionals by June 30, 2013. The Department of Veterans Affairs also shall evaluate the reporting requirements associated with providing mental health services and reduce paperwork requirements where appropriate. In addition, the Department of Veterans Affairs shall update its management performance evaluation system to link performance to meeting mental health service demand.
Sec. 5. Improved Research and Development. (a) The lack of full understanding of the underlying mechanisms of Post-Traumatic Stress Disorder (PTSD), other mental health conditions, and Traumatic Brain Injury (TBI) has hampered progress in prevention, diagnosis, and treatment. In order to improve the coordination of agency research into these conditions and reduce the number of affected men and women through better prevention, diagnosis, and treatment, the Departments of Defense, Veterans Affairs, Health and Human Services, and Education, in coordination with the Office of Science and Technology Policy, shall establish a National Research Action Plan within 8 months of the date of this order.
(b) The National Research Action Plan shall include strategies to establish surrogate and clinically actionable biomarkers for early diagnosis and treatment effectiveness; develop improved diagnostic criteria for TBI; enhance our understanding of the mechanisms responsible for PTSD, related injuries, and neurological disorders following TBI; foster development of new treatments for these conditions based on a better understanding of the underlying mechanisms; improve data sharing between agencies and academic and industry researchers to accelerate progress and reduce redundant efforts without compromising privacy; and make better use of electronic health records to gain insight into the risk and mitigation of PTSD, TBI, and related injuries. In addition, the National Research Action Plan shall include strategies to support collaborative research to address suicide prevention.
(c) The Departments of Defense and Health and Human Services shall engage in a comprehensive longitudinal mental health study with an emphasis on PTSD, TBI, and related injuries to develop better prevention, diagnosis, and treatment options. Agencies shall continue ongoing collaborative research efforts, with an aim to enroll at least 100,000 service members by December 31, 2012, and include a plan for long-term follow-up with enrollees through a coordinated effort with the Department of Veterans Affairs.
Sec. 6. Military and Veterans Mental Health Interagency Task Force. There is established an Interagency Task Force on Military and Veterans Mental Health (Task Force), to be co-chaired by the Secretaries of Defense, Veterans Affairs, and Health and Human Services, or their designated representatives.
(a) Membership. In addition to the Co-Chairs, the Task Force shall consist of representatives from:
(i) the Department of Education;
(ii) the Office of Management and Budget;
(iii) the Domestic Policy Council;
(iv) the National Security Staff;
(v) the Office of Science and Technology Policy;
(vi) the Office of National Drug Control Policy; and
(vii) such other executive departments, agencies, or offices as the Co-Chairs may designate.
A member agency of the Task Force shall designate a full-time officer or employee of the Federal Government to perform the Task Force functions.
(b) Mission. Member agencies shall review relevant statutes, policies, and agency training and guidance to identify reforms and take actions that facilitate implementation of the strategies outlined in this order. Member agencies shall work collaboratively on these strategies and also create an inventory of mental health and substance abuse programs and activities to inform this work.
(c) Functions.
(i) Not later than 180 days after the date of this order, the Task Force shall submit recommendations to the President on strategies to improve mental health and substance abuse treatment services for veterans, service members, and their families. Every year thereafter, the Task Force shall provide to the President a review of agency actions to enhance mental health and substance abuse treatment services for veterans, service members, and their families consistent with this order, as well as provide additional recommendations for action as appropriate. The Task Force shall define specific goals and metrics that will aid in measuring progress in improving mental health strategies. The Task Force will include cost analysis in the development of all recommendations, and will ensure any new requirements are supported within existing resources.
(ii) In addition to coordinating and reviewing agency efforts to enhance veteran and military mental health services pursuant to this order, the Task Force shall evaluate:
(1) agency efforts to improve care quality and ensure that the Departments of Defense and Veterans Affairs and community-based mental health providers are trained in the most current evidence-based methodologies for treating PTSD, TBI, depression, related mental health conditions, and substance abuse;
(2) agency efforts to improve awareness and reduce stigma for those needing to seek care; and
(3) agency research efforts to improve the prevention, diagnosis, and treatment of TBI, PTSD, and related injuries, and explore the need for an external research portfolio review.
(iii) In performing its functions, the Task Force shall consult with relevant nongovernmental experts and organizations as necessary.
Sec. 7. General Provisions. (a) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(b) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
Barack Obama.
[Reference to the National Security Staff deemed to be a reference to the National Security Council Staff, see Ex. Ord. No. 13657, set out as a note under section 3021 of Title 50, War and National Defense.]