CHAPTER 55 - MEDICAL AND DENTAL CARE

Title 10 > CHAPTER 55

Sections (128)

§ 1071 Purpose of this chapter

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 .)

“SEC. 1602 GENERAL DEFINITIONS.

“In this title [see Short Title of 2008 Amendment note above]: The term ‘appropriate committees of Congress’ means— the Committees on Armed Services, Veterans’ Affairs, and Appropriations of the Senate; and the Committees on Armed Services, Veterans’ Affairs, and Appropriations of the House of Representatives. The term ‘Benefits Delivery at Discharge Program’ means a program administered jointly by the Secretary of Defense and the Secretary of Veterans Affairs to provide information and assistance on available benefits and other transition assistance to members of the Armed Forces who are separating from the Armed Forces, including assistance to obtain any disability benefits for which such members may be eligible. The term ‘Disability Evaluation System’ means the following: A system or process of the Department of Defense for evaluating the nature and extent of disabilities affecting members of the Armed Forces that is operated by the Secretaries of the military departments and is comprised of medical evaluation boards, physical evaluation boards, counseling of members, and mechanisms for the final disposition of disability evaluations by appropriate personnel. A system or process of the Coast Guard for evaluating the nature and extent of disabilities affecting members of the Coast Guard that is operated by the Secretary of Homeland Security and is similar to the system or process of the Department of Defense described in subparagraph (A). The term ‘eligible family member’, with respect to a recovering service member, means a family member (as defined in [former] section 481h(b)(3)(B) of title 37 , United States Code) who is on invitational travel orders or serving as a non-medical attendee while caring for the recovering service member for more than 45 days during a one-year period. The term ‘medical care’ includes mental health care. The term ‘outpatient status’, with respect to a recovering service member, means the status of a recovering service member assigned to— a military medical treatment facility as an outpatient; or a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients. The term ‘recovering service member’ means a member of the Armed Forces, including a member of the National Guard or a Reserve, who is undergoing medical treatment, recuperation, or therapy and is in an outpatient status while recovering from a serious injury or illness related to the member’s military service. The term ‘serious injury or illness’, in the case of a member of the Armed Forces, means an injury or illness incurred by the member in line of duty on active duty in the Armed Forces that may render the member medically unfit to perform the duties of the member’s office, grade, rank, or rating. The term ‘TRICARE program’ has the meaning given that term in section 1072(7) of title 10 , United States Code. [As amended Pub. L. 110–417 , [div. A], title X, § 1061(b)(13), Oct. 14, 2008 , 122 Stat. 4613 ; Pub. L. 111–84, div. A, title VI, § 632(h) , Oct. 28, 2009 , 123 Stat. 2362 ; Pub. L. 112–81, div. A, title VI, § 631(f)(4)(B) , Dec. 31, 2011 , 125 Stat. 1465 .]

“SEC. 1603 CONSIDERATION OF GENDER-SPECIFIC NEEDS OF RECOVERING SERVICE MEMBERS AND VETERANS.

(“(a) In General.— In developing and implementing the policy required by section 1611(a), and in otherwise carrying out any other provision of this title [see Short Title of 2008 Amendment note above] or any amendment made by this title, the Secretary of Defense and the Secretary of Veterans Affairs shall take into account and fully address any unique gender-specific needs of recovering service members and veterans under such policy or other provision.

(“(b) Reports.— In submitting any report required by this title or an amendment made by this title, the Secretary of Defense and the Secretary of Veterans Affairs shall, to the extent applicable, include a description of the manner in which the matters covered by such report address the unique gender-specific needs of recovering service members and veterans.

“SEC. 1611 COMPREHENSIVE POLICY ON IMPROVEMENTS TO CARE, MANAGEMENT, AND TRANSITION OF RECOVERING SERVICE MEMBERS.

(“(a) Comprehensive Policy Required.— Not later than July 1, 2008 , the Secretary of Defense and the Secretary of Veterans Affairs shall, to the extent feasible, jointly develop and implement a comprehensive policy on improvements to the care, management, and transition of recovering service members. The policy shall cover each of the following: The care and management of recovering service members. The medical evaluation and disability evaluation of recovering service members. The return of service members who have recovered to active duty when appropriate. The transition of recovering service members from receipt of care and services through the Department of Defense to receipt of care and services through the Department of Veterans Affairs. The Secretary of Defense and the Secretary of Veterans Affairs shall develop the policy in consultation with the heads of other appropriate departments and agencies of the Federal Government and with appropriate non-governmental organizations having an expertise in matters relating to the policy. The Secretary of Defense and the Secretary of Veterans Affairs shall jointly update the policy on a periodic basis, but not less often than annually, in order to incorporate in the policy, as appropriate, the following: The results of the reviews required under subsections (b) and (c). Best practices identified through pilot programs carried out under this title. Improvements to matters under the policy otherwise identified and agreed upon by the Secretary of Defense and the Secretary of Veterans Affairs.

(“(b) Review of Current Policies and Procedures.— In developing the policy required by subsection (a), the Secretary of Defense and the Secretary of Veterans Affairs shall, to the extent necessary, jointly and separately conduct a review of all policies and procedures of the Department of Defense and the Department of Veterans Affairs that apply to, or shall be covered by, the policy. The purpose of the review shall be to identify the most effective and patient-oriented approaches to care and management of recovering service members for purposes of— incorporating such approaches into the policy; and extending such approaches, where applicable, to the care and management of other injured or ill members of the Armed Forces and veterans. In conducting the review, the Secretary of Defense and the Secretary of Veterans Affairs shall— identify among the policies and procedures described in paragraph (1) best practices in approaches to the care and management of recovering service members; identify among such policies and procedures existing and potential shortfalls in the care and management of recovering service members (including care and management of recovering service members on the temporary disability retired list), and determine means of addressing any shortfalls so identified; determine potential modifications of such policies and procedures in order to ensure consistency and uniformity, where appropriate, in the application of such policies and procedures— among the military departments; among the Veterans Integrated Services Networks (VISNs) of the Department of Veterans Affairs; and between the military departments and the Veterans Integrated Services Networks; and develop recommendations for legislative and administrative action necessary to implement the results of the review. The review shall be completed not later than 90 days after the date of the enactment of this Act [ Jan. 28, 2008 ].

(“(c) Consideration of Existing Findings, Recommendations, and Practices.— In developing the policy required by subsection (a), the Secretary of Defense and the Secretary of Veterans Affairs shall take into account the following: The findings and recommendations of applicable studies, reviews, reports, and evaluations that address matters relating to the policy, including, but not limited, to the following: The Independent Review Group on Rehabilitative Care and Administrative Processes at Walter Reed Army Medical Center and National Naval Medical Center, appointed by the Secretary of Defense. The Secretary of Veterans Affairs Task Force on Returning Global War on Terror Heroes, appointed by the President. The President’s Commission on Care for America’s Returning Wounded Warriors. The Veterans’ Disability Benefits Commission established by title XV of the National Defense Authorization Act for Fiscal Year 2004 ( Public Law 108–136 ; 117 Stat. 1676 ; 38 U.S.C. 1101 note). The President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans, of March 2003. The Report of the Congressional Commission on Servicemembers and Veterans Transition Assistance, of 1999, chaired by Anthony J. Principi. The President’s Commission on Veterans’ Pensions, of 1956, chaired by General Omar N. Bradley. The experience and best practices of the Department of Defense and the military departments on matters relating to the policy. The experience and best practices of the Department of Veterans Affairs on matters relating to the policy. Such other matters as the Secretary of Defense and the Secretary of Veterans Affairs consider appropriate.

(“(d) Training and Skills of Health Care Professionals, Recovery Care Coordinators, Medical Care Case Managers, and Non-Medical Care Managers for Recovering Service Members.— The policy required by subsection (a) shall provide for uniform standards among the military departments for the training and skills of health care professionals, recovery care coordinators, medical care case managers, and non-medical care managers for recovering service members under subsection (e) in order to ensure that such personnel are able to— detect early warning signs of post-traumatic stress disorder (PTSD), suicidal or homicidal thoughts or behaviors, and other behavioral health concerns among recovering service members; and promptly notify appropriate health care professionals following detection of such signs. In providing for uniform standards under paragraph (1), the policy shall include a mechanism or system to track the number of notifications made by recovery care coordinators, medical care case managers, and non-medical care managers to health care professionals under paragraph (1)(A) regarding early warning signs of post-traumatic stress disorder and suicide in recovering service members.

(“(e) Services for Recovering Service Members.— The policy required by subsection (a) shall provide for improvements as follows with respect to the care, management, and transition of recovering service members: The policy shall provide for uniform standards and procedures for the development of a comprehensive recovery plan for each recovering service member that covers the full spectrum of care, management, transition, and rehabilitation of the service member during recovery. The policy shall provide for a uniform program for the assignment to recovering service members of recovery care coordinators having the duties specified in subparagraph (B). The duties under the program of a recovery care coordinator for a recovering service member shall include, but not be limited to, overseeing and assisting the service member in the service member’s course through the entire spectrum of care, management, transition, and rehabilitation services available from the Federal Government, including services provided by the Department of Defense, the Department of Veterans Affairs, the Department of Labor, and the Social Security Administration. The maximum number of recovering service members whose cases may be assigned to a recovery care coordinator under the program at any one time shall be such number as the policy shall specify, except that the Secretary of the military department concerned may waive such limitation with respect to a given coordinator for not more than 120 days in the event of unforeseen circumstances (as specified in the policy). The policy shall specify standard training requirements and curricula for recovery care coordinators under the program, including a requirement for successful completion of the training program before a person may assume the duties of such a coordinator. The policy shall include mechanisms to ensure that recovery care coordinators under the program have the resources necessary to expeditiously carry out the duties of such coordinators under the program. The policy shall specify requirements for the appropriate rank or grade, and appropriate occupation, for persons appointed to head and supervise recovery care coordinators. The policy shall provide for a uniform program among the military departments for the assignment to recovering service members of medical care case managers having the duties specified in subparagraph (B). The duties under the program of a medical care case manager for a recovering service member (or the service member’s immediate family or other designee if the service member is incapable of making judgments about personal medical care) shall include, at a minimum, the following: Assisting in understanding the service member’s medical status during the care, recovery, and transition of the service member. Assisting in the receipt by the service member of prescribed medical care during the care, recovery, and transition of the service member. Conducting a periodic review of the medical status of the service member, which review shall be conducted, to the extent practicable, in person with the service member, or, whenever the conduct of the review in person is not practicable, with the medical care case manager submitting to the manager’s supervisor a written explanation why the review in person was not practicable (if the Secretary of the military department concerned elects to require such written explanations for purposes of the program). The maximum number of recovering service members whose cases may be assigned to a medical care case manager under the program at any one time shall be such number as the policy shall specify, except that the Secretary of the military department concerned may waive such limitation with respect to a given manager for not more than 120 days in the event of unforeseen circumstances (as specified in the policy). The policy shall specify standard training requirements and curricula for medical care case managers under the program, including a requirement for successful completion of the training program before a person may assume the duties of such a manager. The policy shall include mechanisms to ensure that medical care case managers under the program have the resources necessary to expeditiously carry out the duties of such managers under the program. The policy shall specify requirements for the appropriate rank or grade, and appropriate occupation, for persons appointed to head and supervise the medical care case managers at each medical facility of the Armed Forces. Persons so appointed may be appointed from the Army Medical Corps, Army Medical Service Corps, Army Nurse Corps, Navy Medical Corps, Navy Medical Service Corps, Navy Nurse Corps, Air Force Medical Service, or other corps or civilian health care professional, as applicable, at the discretion of the Secretary of Defense. The policy shall provide for a uniform program among the military departments for the assignment to recovering service members of non-medical care managers having the duties specified in subparagraph (B). The duties under the program of a non-medical care manager for a recovering service member shall include, at a minimum, the following: Communicating with the service member and with the service member’s family or other individuals designated by the service member regarding non-medical matters that arise during the care, recovery, and transition of the service member. Assisting with oversight of the service member’s welfare and quality of life. Assisting the service member in resolving problems involving financial, administrative, personnel, transitional, and other matters that arise during the care, recovery, and transition of the service member. The policy shall provide that a non-medical care manager shall perform duties under the program for a recovering service member until the service member is returned to active duty or retired or separated from the Armed Forces. The maximum number of recovering service members whose cases may be assigned to a non-medical care manager under the program at any one time shall be such number as the policy shall specify, except that the Secretary of the military department concerned may waive such limitation with respect to a given manager for not more than 120 days in the event of unforeseen circumstances (as specified in the policy). The policy shall specify standard training requirements and curricula among the military departments for non-medical care managers under the program, including a requirement for successful completion of the training program before a person may assume the duties of such a manager. The policy shall include mechanisms to ensure that non-medical care managers under the program have the resources necessary to expeditiously carry out the duties of such managers under the program. The policy shall specify requirements for the appropriate rank and occupational speciality for persons appointed to head and supervise the non-medical care managers at each medical facility of the Armed Forces. The policy shall provide for appropriate minimum standards for access of recovering service members to non-urgent medical care and other health care services as follows: In medical facilities of the Department of Defense. Through the TRICARE program. The standards for access under subparagraph (A) shall include such standards on maximum waiting times of recovering service members as the policy shall specify for care that includes, but is not limited to, the following: Follow-up care. Specialty care. Diagnostic referrals and studies. Surgery based on a physician’s determination of medical necessity. The policy shall permit any recovering service member to waive a standard for access under this paragraph under such circumstances and conditions as the policy shall specify. The policy shall provide for uniform guidelines among the military departments for the assignment of recovering service members to a location of care, including guidelines that provide for the assignment of recovering service members, when medically appropriate, to care and residential facilities closest to their duty station or home of record or the location of their designated care giver at the earliest possible time. The policy shall provide for uniform guidelines and procedures among the military departments for the reassignment of recovering service members from a medical or medical-related support facility determined by the Secretary of Defense to violate the standards required by section 1648 to another appropriate medical or medical-related support facility until the correction of violations of such standards at the medical or medical-related support facility from which such service members are reassigned. The policy shall provide for uniform standards among the military departments on the availability of appropriate transportation and subsistence for recovering service members to facilitate their obtaining needed medical care and services. The policy shall provide for uniform criteria among the military departments for the assignment of recovering service members to work and duty assignments that are compatible with their medical conditions. The policy shall provide for uniform standards among the military departments on the provision of educational and vocational training and rehabilitation opportunities for recovering service members at the earliest possible point in their recovery. The policy shall provide for uniform procedures among the military departments on tracking recovering service members to facilitate— locating each recovering service member; and tracking medical care appointments of recovering service members to ensure timeliness and compliance of recovering service members with appointments, and other physical and evaluation timelines, and to provide any other information needed to conduct oversight of the care, management, and transition of recovering service members. The policy shall provide for uniform policies, procedures, and criteria among the military departments on the referral of recovering service members to the Department of Veterans Affairs and other private and public entities (including universities and rehabilitation hospitals, centers, and clinics) in order to secure the most appropriate care for recovering service members, which policies, procedures, and criteria shall take into account, but not be limited to, the medical needs of recovering service members and the geographic location of available necessary recovery care services.

(“(f) Services for Families of Recovering Service Members.— The policy required by subsection (a) shall provide for improvements as follows with respect to services for families of recovering service members: The policy shall provide for uniform guidelines among the military departments on the provision by the military departments of support for family members of recovering service members who are not otherwise eligible for care under section 1672 in caring for such service members during their recovery. The policy shall provide for uniform requirements and standards among the military departments on the provision by the military departments of advice and training, as appropriate, to family members of recovering service members with respect to care for such service members during their recovery. The policy shall provide for uniform procedures among the military departments on the measurement of the satisfaction of family members of recovering service members with the quality of health care services provided to such service members during their recovery. The policy shall provide for procedures for application by eligible family members during a one-year period for job placement services otherwise offered by the Department of Defense.

(“(g) Outreach to Recovering Service Members and Their Families on Comprehensive Policy.— The policy required by subsection (a) shall include procedures and mechanisms to ensure that recovering service members and their families are fully informed of the policies required by this section, including policies on medical care for recovering service members, on the management and transition of recovering service members, and on the responsibilities of recovering service members and their family members throughout the continuum of care and services for recovering service members under this section.

(“(h) Applicability of Comprehensive Policy to Recovering Service Members on Temporary Disability Retired List.— Appropriate elements of the policy required by this section shall apply to recovering service members whose names are placed on the temporary disability retired list in such manner, and subject to such terms and conditions, as the Secretary of Defense shall prescribe in regulations for purposes of this subsection.

“SEC. 1612 MEDICAL EVALUATIONS AND PHYSICAL DISABILITY EVALUATIONS OF RECOVERING SERVICE MEMBERS.

(“(a) Medical Evaluations of Recovering Service Members.— Not later than July 1, 2008 , the Secretary of Defense shall develop a policy on improvements to the processes, procedures, and standards for the conduct by the military departments of medical evaluations of recovering service members. The policy on improvements to processes, procedures, and standards required under this subsection shall include and address the following: Processes for medical evaluations of recovering service members that— apply uniformly throughout the military departments; and apply uniformly with respect to recovering service members who are members of the regular components of the Armed Forces and recovering service members who are members of the National Guard and Reserve. Standard criteria and definitions for determining the achievement for recovering service members of the maximum medical benefit from treatment and rehabilitation. Standard timelines for each of the following: Determinations of fitness for duty of recovering service members. Specialty care consultations for recovering service members. Preparation of medical documents for recovering service members. Appeals by recovering service members of medical evaluation determinations, including determinations of fitness for duty. Procedures for ensuring that— upon request of a recovering service member being considered by a medical evaluation board, a physician or other appropriate health care professional who is independent of the medical evaluation board is assigned to the service member; and the physician or other health care professional assigned to a recovering service member under clause (i)— serves as an independent source for review of the findings and recommendations of the medical evaluation board; provides the service member with advice and counsel regarding the findings and recommendations of the medical evaluation board; and advises the service member on whether the findings of the medical evaluation board adequately reflect the complete spectrum of injuries and illness of the service member. Standards for qualifications and training of medical evaluation board personnel, including physicians, case workers, and physical disability evaluation board liaison officers, in conducting medical evaluations of recovering service members. Standards for the maximum number of medical evaluation cases of recovering service members that are pending before a medical evaluation board at any one time, and requirements for the establishment of additional medical evaluation boards in the event such number is exceeded. Standards for information for recovering service members, and their families, on the medical evaluation board process and the rights and responsibilities of recovering service members under that process, including a standard handbook on such information (which handbook shall also be available electronically).

(“(b) Physical Disability Evaluations of Recovering Service Members.— Not later than July 1, 2008 , the Secretary of Defense and the Secretary of Veterans Affairs shall develop a policy on improvements to the processes, procedures, and standards for the conduct of physical disability evaluations of recovering service members by the military departments and by the Department of Veterans Affairs. The policy on improvements to processes, procedures, and standards required under this subsection shall include and address the following: A clearly-defined process of the Department of Defense and the Department of Veterans Affairs for disability determinations of recovering service members. To the extent feasible, procedures to eliminate unacceptable discrepancies and improve consistency among disability ratings assigned by the military departments and the Department of Veterans Affairs, particularly in the disability evaluation of recovering service members, which procedures shall be subject to the following requirements and limitations: Such procedures shall apply uniformly with respect to recovering service members who are members of the regular components of the Armed Forces and recovering service members who are members of the National Guard and Reserve. Under such procedures, each Secretary of a military department shall, to the extent feasible, utilize the standard schedule for rating disabilities in use by the Department of Veterans Affairs, including any applicable interpretation of such schedule by the United States Court of Appeals for Veterans Claims, in making any determination of disability of a recovering service member, except as otherwise authorized by section 1216a of title 10 , United States Code (as added by section 1642 of this Act). Uniform timelines among the military departments for appeals of determinations of disability of recovering service members, including timelines for presentation, consideration, and disposition of appeals. Uniform standards among the military departments for qualifications and training of physical disability evaluation board personnel, including physical evaluation board liaison personnel, in conducting physical disability evaluations of recovering service members. Uniform standards among the military departments for the maximum number of physical disability evaluation cases of recovering service members that are pending before a physical disability evaluation board at any one time, and requirements for the establishment of additional physical disability evaluation boards in the event such number is exceeded. Uniform standards and procedures among the military departments for the provision of legal counsel to recovering service members while undergoing evaluation by a physical disability evaluation board. Uniform standards among the military departments on the roles and responsibilities of non-medical care managers under section 1611(e)(4) and judge advocates assigned to recovering service members undergoing evaluation by a physical disability board, and uniform standards on the maximum number of cases involving such service members that are to be assigned to judge advocates at any one time.

(“(c) Assessment of Consolidation of Department of Defense and Department of Veterans Affairs Disability Evaluation Systems.— The Secretary of Defense and the Secretary of Veterans Affairs shall jointly submit to the appropriate committees of Congress a report on the feasability [sic] and advisability of consolidating the disability evaluation systems of the military departments and the disability evaluation system of the Department of Veterans Affairs into a single disability evaluation system. The report shall be submitted together with the report required by section 1611(a). The report required by paragraph (1) shall include the following: An assessment of the feasability [sic] and advisability of consolidating the disability evaluation systems described in paragraph (1) as specified in that paragraph. If the consolidation of the systems is considered feasible and advisable— recommendations for various options for consolidating the systems as specified in paragraph (1); and recommendations for mechanisms to evaluate and assess any progress made in consolidating the systems as specified in that paragraph.

“SEC. 1613 RETURN OF RECOVERING SERVICE MEMBERS TO ACTIVE DUTY IN THE ARMED FORCES.

“The Secretary of Defense shall establish standards for determinations by the military departments on the return of recovering service members to active duty in the Armed Forces.

“SEC. 1614 TRANSITION OF RECOVERING SERVICE MEMBERS FROM CARE AND TREATMENT THROUGH THE DEPARTMENT OF DEFENSE TO CARE, TREATMENT, AND REHABILITATION THROUGH THE DEPARTMENT OF VETERANS AFFAIRS.

(“(a) In General.— Not later than July 1, 2008 , the Secretary of Defense and the Secretary of Veterans Affairs shall jointly develop and implement processes, procedures, and standards for the transition of recovering service members from care and treatment through the Department of Defense to care, treatment, and rehabilitation through the Department of Veterans Affairs.

(“(b) Elements.— The processes, procedures, and standards required under this section shall include the following: Uniform, patient-focused procedures to ensure that the transition described in subsection (a) occurs without gaps in medical care and in the quality of medical care, benefits, and services. Procedures for the identification and tracking of recovering service members during the transition, and for the coordination of care and treatment of recovering service members during the transition, including a system of cooperative case management of recovering service members by the Department of Defense and the Department of Veterans Affairs during the transition. Procedures for the notification of Department of Veterans Affairs liaison personnel of the commencement by recovering service members of the medical evaluation process and the physical disability evaluation process. Procedures and timelines for the enrollment of recovering service members in applicable enrollment or application systems of the Department of Veterans Affairs with respect to health care, disability, education, vocational rehabilitation, or other benefits. Procedures to ensure the access of recovering service members during the transition to vocational, educational, and rehabilitation benefits available through the Department of Veterans Affairs. Standards for the optimal location of Department of Defense and Department of Veterans Affairs liaison and case management personnel at military medical treatment facilities, medical centers, and other medical facilities of the Department of Defense. Standards and procedures for integrated medical care and management of recovering service members during the transition, including procedures for the assignment of medical personnel of the Department of Veterans Affairs to Department of Defense facilities to participate in the needs assessments of recovering service members before, during, and after their separation from military service. Standards for the preparation of detailed plans for the transition of recovering service members from care and treatment by the Department of Defense to care, treatment, and rehabilitation by the Department of Veterans Affairs, which plans shall— be based on standardized elements with respect to care and treatment requirements and other applicable requirements; and take into account the comprehensive recovery plan for the recovering service member concerned as developed under section 1611(e)(1). Procedures to ensure that each recovering service member who is being retired or separated under chapter 61 of title 10, United States Code, receives a written transition plan, prior to the time of retirement or separation, that— specifies the recommended schedule and milestones for the transition of the service member from military service; provides for a coordinated transition of the service member from the Department of Defense disability evaluation system to the Department of Veterans Affairs disability system; and includes information and guidance designed to assist the service member in understanding and meeting the schedule and milestones specified under subparagraph (A) for the service member’s transition. Procedures for the transmittal from the Department of Defense to the Department of Veterans Affairs of records and any other required information on each recovering service member described in paragraph (9), which procedures shall provide for the transmission from the Department of Defense to the Department of Veterans Affairs of records and information on the service member as follows: The address and contact information of the service member. The DD–214 discharge form of the service member, which shall be transmitted under such procedures electronically. A copy of the military service record of the service member, including medical records and any results of a physical evaluation board. Information on whether the service member is entitled to transitional health care, a conversion health policy, or other health benefits through the Department of Defense under section 1145 of title 10 , United States Code. A copy of any request of the service member for assistance in enrolling in, or completed applications for enrollment in, the health care system of the Department of Veterans Affairs for health care benefits for which the service member may be eligible under laws administered by the Secretary of Veterans Affairs. A copy of any request by the service member for assistance in applying for, or completed applications for, compensation and vocational rehabilitation benefits to which the service member may be entitled under laws administered by the Secretary of Veterans Affairs. A process to ensure that, before transmittal of medical records of a recovering service member to the Department of Veterans Affairs, the Secretary of Defense ensures that the service member (or an individual legally recognized to make medical decisions on behalf of the service member) authorizes the transfer of the medical records of the service member from the Department of Defense to the Department of Veterans Affairs pursuant to the Health Insurance Portability and Accountability Act of 1996 [ Pub. L. 104–191 , see Tables for classification]. Procedures to ensure that, with the consent of the recovering service member concerned, the address and contact information of the service member is transmitted to the department or agency for veterans affairs of the State in which the service member intends to reside after the retirement or separation of the service member from the Armed Forces. Procedures to ensure that, before the transmittal of records and other information with respect to a recovering service member under this section, a meeting regarding the transmittal of such records and other information occurs among the service member, appropriate family members of the service member, representatives of the Secretary of the military department concerned, and representatives of the Secretary of Veterans Affairs, with at least 30 days advance notice of the meeting being given to the service member unless the service member waives the advance notice requirement in order to accelerate transmission of the service member’s records and other information to the Department of Veterans Affairs. Procedures to ensure that the Secretary of Veterans Affairs gives appropriate consideration to a written statement submitted to the Secretary by a recovering service member regarding the transition. Procedures to provide access for the Department of Veterans Affairs to the military health records of recovering service members who are receiving care and treatment, or are anticipating receipt of care and treatment, in Department of Veterans Affairs health care facilities, which procedures shall be consistent with the procedures and requirements in paragraphs (11) and (13). A process for the utilization of a joint separation and evaluation physical examination that meets the requirements of both the Department of Defense and the Department of Veterans Affairs in connection with the medical separation or retirement of a recovering service member from military service and for use by the Department of Veterans Affairs in disability evaluations. Procedures for surveys and other mechanisms to measure patient and family satisfaction with the provision by the Department of Defense and the Department of Veterans Affairs of care and services for recovering service members, and to facilitate appropriate oversight by supervisory personnel of the provision of such care and services. Procedures to ensure the participation of recovering service members who are members of the National Guard or Reserve in the Benefits Delivery at Discharge Program, including procedures to ensure that, to the maximum extent feasible, services under the Benefits Delivery at Discharge Program are provided to recovering service members at— appropriate military installations; appropriate armories and military family support centers of the National Guard; appropriate military medical care facilities at which members of the Armed Forces are separated or discharged from the Armed Forces; and in the case of a member on the temporary disability retired list under section 1202 or 1205 of title 10, United States Code, who is being retired under another provision of such title or is being discharged, at a location reasonably convenient to the member.

“SEC. 1616 ESTABLISHMENT OF A WOUNDED WARRIOR RESOURCE CENTER.

(“(a) Establishment.— The Secretary of Defense shall establish a wounded warrior resource center (in this section referred to as the ‘center’) to provide wounded warriors, their families, and their primary caregivers with a single point of contact for assistance with reporting deficiencies in covered military facilities, obtaining health care services, receiving benefits information, receiving legal assistance referral information (where appropriate), receiving other appropriate referral information, and any other difficulties encountered while supporting wounded warriors. The Secretary shall widely disseminate information regarding the existence and availability of the center, including contact information, to members of the Armed Forces and their dependents. In carrying out this subsection, the Secretary may use existing infrastructure and organizations but shall ensure that the center has the ability to separately keep track of calls from wounded warriors.

(“(b) Access.— The center shall provide multiple methods of access, including at a minimum an Internet website and a toll-free telephone number (commonly referred to as a ‘hot line’) at which personnel are accessible at all times to receive reports of deficiencies or provide information about covered military facilities, health care services, or military benefits.

(“(c) Confidentiality.— Individuals who seek to provide information through the center under subsection (a) shall be notified, immediately before they provide such information, of their option to elect, at their discretion, to have their identity remain confidential. In the case of information provided through use of the toll-free telephone number by an individual who elects to maintain the confidentiality of his or her identity, any individual who, by necessity, has had access to such information for purposes of investigating or responding to the call as required under subsection (d) may not disclose the identity of the individual who provided the information.

(“(d) Functions.— The center shall perform the following functions: The center shall be responsible for documenting receipt of a call, referring the call to the appropriate office within a military department for answer or investigation, and tracking the formulation and notification of the response to the call. The center shall be responsible for ensuring that, not later than 96 hours after a call— if a report of deficiencies is received in a call— any deficiencies referred to in the call are investigated; if substantiated, a plan of action for remediation of the deficiencies is developed and implemented; and if requested, the individual who made the report is notified of the current status of the report; or if a request for information is received in a call— the information requested by the caller is provided by the center; all requests for information from the call are referred to the appropriate office or offices of a military department for response; and the individual who made the report is notified, at a minimum, of the current status of the query. The center shall be responsible for ensuring that, if requested, the caller is notified when the deficiency has been corrected or when the request for information has been fulfilled to the maximum extent practicable, as determined by the Secretary.

(“(e) Definitions.— In this section: The term ‘covered military facility’ has the meaning provided in section 1648(b) of this Act. The term ‘call’ means any query or report that is received by the center by means of the toll-free telephone number or other source.

(“(f) Effective Dates.— The toll-free telephone number required to be established by subsection (a), shall be fully operational not later than April 1, 2008 . The Internet website required to be established by subsection (a), shall be fully operational not later than July 1, 2008 . [As amended Pub. L. 110–417 , [div. A], title VII, § 724, Oct. 14, 2008 , 122 Stat. 4509 .]

“SEC. 1618 COMPREHENSIVE PLAN ON PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF, AND RESEARCH ON, TRAUMATIC BRAIN INJURY, POST-TRAUMATIC STRESS DISORDER, AND OTHER MENTAL HEALTH CONDITIONS IN MEMBERS OF THE ARMED FORCES.

(“(a) Comprehensive Statement of Policy.— The Secretary of Defense and the Secretary of Veterans Affairs shall direct joint planning among the Department of Defense, the military departments, and the Department of Veterans Affairs for the prevention, diagnosis, mitigation, treatment, and rehabilitation of, and research on, traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces, including planning for the seamless transition of such members from care through the Department of Defense to care through the Department of Veterans Affairs.

(“(b) Comprehensive Plan Required.— Not later than 180 days after the date of the enactment of this Act [ Jan. 28, 2008 ], the Secretary of Defense shall, in consultation with the Secretary of Veterans Affairs, submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a comprehensive plan for programs and activities of the Department of Defense to prevent, diagnose, mitigate, treat, research, and otherwise respond to traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces, including— an assessment of the current capabilities of the Department for the prevention, diagnosis, mitigation, treatment, and rehabilitation of, and research on, traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces; the identification of gaps in current capabilities of the Department for the prevention, diagnosis, mitigation, treatment, and rehabilitation of, and research on, traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces; and the identification of the resources required for the Department in fiscal years 2009 through 2013 to address the gaps in capabilities identified under paragraph (2).

(“(c) Program Required.— One of the programs contained in the comprehensive plan submitted under subsection (b) shall be a Department of Defense program, developed in collaboration with the Department of Veterans Affairs, under which each member of the Armed Forces who incurs a traumatic brain injury or post-traumatic stress disorder during service in the Armed Forces— is enrolled in the program; and receives treatment and rehabilitation meeting a standard of care such that each individual who qualifies for care under the program shall— be provided the highest quality, evidence-based care in facilities that most appropriately meet the specific needs of the individual; and be rehabilitated to the fullest extent possible using up-to-date evidence-based medical technology, and physical and medical rehabilitation practices and expertise.

(“(d) Provision of Information Required.— The comprehensive plan submitted under subsection (b) shall require the provision of information by the Secretary of Defense to members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, or other mental health conditions and their families about their options with respect to the following: The receipt of medical and mental health care from the Department of Defense and the Department of Veterans Affairs. Additional options available to such members for treatment and rehabilitation of traumatic brain injury, post-traumatic stress disorder, and other mental health conditions. The options available, including obtaining a second opinion, to such members for a referral to an authorized provider under chapter 55 of title 10, United States Code, as determined under regulations prescribed by the Secretary of Defense.

(“(e) Additional Elements of Plan.— The comprehensive plan submitted under subsection (b) shall include comprehensive proposals of the Department on the following: The designation by the Secretary of Defense of a lead agent or executive agent for the Department to coordinate development and implementation of the plan. The improvement of methods and mechanisms for the detection and treatment of traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces in the field. The development of a plan for reducing post traumatic-stress disorder, incorporating evidence-based preventive and early-intervention measures, practices, or procedures that reduce the likelihood that personnel in combat will develop post-traumatic stress disorder or other stress-related conditions (including substance abuse conditions) into— basic and pre-deployment training for enlisted members of the Armed Forces, noncommissioned officers, and officers; combat theater operations; and post-deployment service. Requirements for research on traumatic brain injury, post-traumatic stress disorder, and other mental health conditions including (in particular) research on pharmacological and other approaches to treatment for traumatic brain injury, post-traumatic stress disorder, or other mental health conditions, as applicable, and the allocation of priorities among such research. The development, adoption, and deployment of joint Department of Defense-Department of Veterans Affairs evidence-based diagnostic criteria for the detection and evaluation of the range of traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces, which criteria shall be employed uniformly across the military departments in all applicable circumstances, including provision of clinical care and assessment of future deployability of members of the Armed Forces. The development and deployment of evidence-based means of assessing traumatic brain injury, post-traumatic stress disorder, and other mental health conditions in members of the Armed Forces, including a system of pre-deployment and post-deployment screenings of cognitive ability in members for the detection of cognitive impairment. The development and deployment of effective means of managing and monitoring members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, or other mental health conditions in the receipt of care for traumatic brain injury, post-traumatic stress disorder, or other mental health conditions, as applicable, including the monitoring and assessment of treatment and outcomes. The development and deployment of an education and awareness training initiative designed to reduce the negative stigma associated with traumatic brain injury, post-traumatic stress disorder, and other mental health conditions, and mental health treatment. The provision of education and outreach to families of members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, or other mental health conditions on a range of matters relating to traumatic brain injury, post-traumatic stress disorder, or other mental health conditions, as applicable, including detection, mitigation, and treatment. A requirement that exposure to a blast or blasts be recorded in the records of members of the Armed Forces. The development of clinical practice guidelines for the diagnosis and treatment of blast injuries in members of the Armed Forces, including, but not limited to, traumatic brain injury. The development of requirements, as appropriate, for gender- and ethnic group-specific medical care services and treatment for members of the Armed Forces who experience mental health problems and conditions, including post-traumatic stress disorder, with specific regard to the availability of, access to, and research and development requirements of such needs.

(“(f) Coordination in Development.— The comprehensive plan submitted under subsection (b) shall be developed in coordination with the Secretary of the Army (who was designated by the Secretary of Defense as executive agent for the prevention, mitigation, and treatment of blast injuries under section 256 of the National Defense Authorization Act for Fiscal Year 2006 ( Public Law 109–163 ; 119 Stat. 3181 ; 10 U.S.C. 1071 note)).

“SEC. 1621 CENTER OF EXCELLENCE IN THE PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF TRAUMATIC BRAIN INJURY.

(“(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 traumatic brain injury, including mild, moderate, and severe traumatic brain 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 Department 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.— The Center shall have responsibilities as follows: To implement the comprehensive plan and strategy for the Department of Defense, required by section 1618 of this Act, for the prevention, diagnosis, mitigation, treatment, and rehabilitation of traumatic brain injury, including research on gender and ethnic group-specific health needs related to traumatic brain injury. To provide for the development, testing, and dissemination within the Department of best practices for the treatment of traumatic brain injury. To provide guidance for the mental health system of the Department in determining the mental health and neurological health personnel required to provide quality mental health care for members of the Armed Forces with traumatic brain injury. To establish, implement, and oversee a comprehensive program to train mental health and neurological health professionals of the Department in the treatment of traumatic brain injury. To facilitate advancements in the study of the short-term and long-term psychological effects of traumatic brain injury. To disseminate within the military medical treatment facilities of the Department best practices for training mental health professionals, including neurological health professionals, with respect to traumatic brain injury. To conduct basic science and translational research on traumatic brain injury for the purposes of understanding the etiology of traumatic brain injury and developing preventive interventions and new treatments. To develop programs and outreach strategies for families of members of the Armed Forces with traumatic brain injury in order to mitigate the negative impacts of traumatic brain injury on such family members and to support the recovery of such members from traumatic brain injury. To conduct research on the mental health needs of families of members of the Armed Forces with traumatic brain injury and develop protocols to address any needs identified through such research. To conduct longitudinal studies (using imaging technology and other proven research methods) on members of the Armed Forces with traumatic brain injury to identify early signs of Alzheimer’s disease, Parkinson’s disease, or other manifestations of neurodegeneration, as well as epilepsy, in such members, in coordination with the studies authorized by section 721 of the John Warner National Defense Authorization Act for Fiscal Year 2007 ( Public Law 109–364 ; 120 Stat. 2294 ) [ 10 U.S.C. 1074 note] and other studies of the Department of Defense and the Department of Veterans Affairs that address the connection between exposure to combat and the development of Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative disorders, as well as epilepsy. To develop and oversee a long-term plan to increase the number of mental health and neurological health professionals within the Department in order to facilitate the meeting by the Department of the needs of members of the Armed Forces with traumatic brain injury until their transition to care and treatment from the Department of Veterans Affairs. To develop a program on comprehensive pain management, including management of acute and chronic pain, to utilize current and develop new treatments for pain, and to identify and disseminate best practices on pain management related to traumatic brain injury. Such other responsibilities as the Secretary shall specify.

“SEC. 1622 CENTER OF EXCELLENCE IN PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF POST-TRAUMATIC STRESS DISORDER AND OTHER MENTAL HEALTH CONDITIONS.

(“(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 post-traumatic stress disorder (PTSD) and other mental health conditions, including mild, moderate, and severe post-traumatic stress disorder and other mental health conditions, 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 National Center on Post-Traumatic Stress Disorder of the Department 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.— The center shall have responsibilities as follows: To implement the comprehensive plan and strategy for the Department of Defense, required by section 1618 of this Act, for the prevention, diagnosis, mitigation, treatment, and rehabilitation of post-traumatic stress disorder and other mental health conditions, including research on gender- and ethnic group-specific health needs related to post-traumatic stress disorder and other mental health conditions. To provide for the development, testing, and dissemination within the Department of best practices for the treatment of post-traumatic stress disorder. To provide guidance for the mental health system of the Department in determining the mental health and neurological health personnel required to provide quality mental health care for members of the Armed Forces with post-traumatic stress disorder and other mental health conditions. To establish, implement, and oversee a comprehensive program to train mental health and neurological health professionals of the Department in the treatment of post-traumatic stress disorder and other mental health conditions. To facilitate advancements in the study of the short-term and long-term psychological effects of post-traumatic stress disorder and other mental health conditions. To disseminate within the military medical treatment facilities of the Department best practices for training mental health professionals, including neurological health professionals, with respect to post-traumatic stress disorder and other mental health conditions. To conduct basic science and translational research on post-traumatic stress disorder for the purposes of understanding the etiology of post-traumatic stress disorder and developing preventive interventions and new treatments. To develop programs and outreach strategies for families of members of the Armed Forces with post-traumatic stress disorder and other mental health conditions in order to mitigate the negative impacts of post-traumatic stress disorder and other mental health conditions on such family members and to support the recovery of such members from post-traumatic stress disorder and other mental health conditions. To conduct research on the mental health needs of families of members of the Armed Forces with post-traumatic stress disorder and other mental health conditions and develop protocols to address any needs identified through such research. To develop and oversee a long-term plan to increase the number of mental health and neurological health professionals within the Department in order to facilitate the meeting by the Department of the needs of members of the Armed Forces with post-traumatic stress disorder and other mental health conditions until their transition to care and treatment from the Department of Veterans Affairs.

“SEC. 1623 CENTER OF EXCELLENCE IN PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF MILITARY EYE INJURIES.

(“(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 military eye injuries 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.— The center shall— 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 significant eye injury incurred by a member of the Armed Forces while serving on active duty; ensure the electronic exchange with the Secretary of Veterans Affairs of information obtained through tracking under subparagraph (A); and enable the Secretary of Veterans Affairs to access the registry and add information pertaining to additional treatments or surgical procedures and eventual visual outcomes for veterans who were entered into the registry and subsequently received treatment through the Veterans Health Administration. The registry under this subsection shall be known as the ‘Military Eye Injury Registry’ (hereinafter referred to as the ‘Registry’). The center shall develop the Registry in consultation with the ophthalmological specialist personnel and optometric specialist personnel of the Department of Defense and the ophthalmological specialist personnel and optometric specialist personnel of the Department of Veterans Affairs. The mechanisms and procedures of the Registry shall reflect applicable expert research on military and other eye injuries. 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 eye injury described in that paragraph as follows (to the extent applicable): 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. Not later than 180 days after the significant eye injury is reported or recorded in the medical record. The center shall provide notice to the Blind Rehabilitation Service of the Department of Veterans Affairs and to the eye care 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 eye care and visual rehabilitation benefits and services by the Department of Veterans Affairs after the separation or release of such member from the Armed Forces. A member of the Armed Forces described in this subparagraph is a member of the Armed Forces as follows: A member with a significant eye injury incurred while serving on active duty, including a member with visual dysfunction related to traumatic brain injury. A member with an eye injury incurred while serving on active duty who has a visual acuity of 20/200 or less in the injured eye. A member with an eye injury incurred while serving on active duty who has a loss of peripheral vision resulting in 20 degrees or less of visual field in the injured eye.

(“(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 ophthalmological and optometric 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 eye injuries 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 an eye 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.

(“(f) Traumatic Brain Injury Post Traumatic Visual Syndrome.— In carrying out the program at Walter Reed Army Medical Center, District of Columbia, on traumatic brain injury post traumatic visual syndrome, the Secretary of Defense and the Department of Veterans Affairs shall jointly provide for the conduct of a cooperative program for members of the Armed Forces and veterans with traumatic brain injury by military medical treatment facilities of the Department of Defense and medical centers of the Department of Veterans Affairs selected for purposes of this subsection for purposes of vision screening, diagnosis, rehabilitative management, and vision research, including research on prevention, on visual dysfunction related to traumatic brain injury. [As amended Pub. L. 110–417 , [div. A], title VII, § 722, Oct. 14, 2008 , 122 Stat. 4508 .]

“SEC. 1631 MEDICAL CARE AND OTHER BENEFITS FOR MEMBERS AND FORMER MEMBERS OF THE ARMED FORCES WITH SEVERE INJURIES OR ILLNESSES.

(“(a) Medical and Dental Care for Former Members.— Effective as of the date of the enactment of this Act [ Jan. 28, 2008 ] and subject to regulations prescribed by the Secretary of Defense, the Secretary may authorize that any former member of the Armed Forces with a serious injury or illness may receive the same medical and dental care as a member of the Armed Forces on active duty for medical and dental care not reasonably available to such former member in the Department of Veterans Affairs. The Secretary of Defense may not provide medical or dental care to a former member of the Armed Forces under this subsection after December 31, 2012 , if the Secretary has not provided medical or dental care to the former member under this subsection before that date.

(“(b) Rehabilitation and Vocational Benefits.— Effective as of the date of the enactment of this Act [ Jan. 28, 2008 ], a member of the Armed Forces with a severe injury or illness is entitled to such benefits (including rehabilitation and vocational benefits, but not including compensation) from the Secretary of Veterans Affairs to facilitate the recovery and rehabilitation of such member as the Secretary otherwise provides to veterans of the Armed Forces receiving medical care in medical facilities of the Department of Veterans Affairs facilities in order to facilitate the recovery and rehabilitation of such members.

(“(c) Rehabilitative Equipment for Members of the Armed Forces.— Subject to the availability of appropriations for such purpose, the Secretary of Defense may provide an active duty member of the Armed Forces with a severe injury or illness with rehabilitative equipment, including recreational sports equipment that provide an adaption or accommodation for the member, regardless of whether such equipment is intentionally designed to be adaptive equipment. In carrying out this subsection, the Secretary of Defense shall consult with the Secretary of Veterans Affairs regarding similar programs carried out by the Secretary of Veterans Affairs. [As amended Pub. L. 112–56, title II, § 231 , Nov. 21, 2011 , 125 Stat. 719 ; Pub. L. 112–81, div. A, title VII, § 707 , Dec. 31, 2011 , 125 Stat. 1474 ; Pub. L. 112–239, div. A, title X, § 1076(a)(9) , Jan. 2, 2013 , 126 Stat. 1948 ; Pub. L. 113–291, div. A, title VII, § 724 , Dec. 19, 2014 , 128 Stat. 3418 ; Pub. L. 114–58, title II, § 204 , Sept. 30, 2015 , 129 Stat. 533 ; Pub. L. 114–228, title II, § 204 , Sept. 29, 2016 , 130 Stat. 938 ; 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 .]

“SEC. 1635 FULLY INTEROPERABLE ELECTRONIC PERSONAL HEALTH INFORMATION FOR THE DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS.

(“(a) In General.— The Secretary of Defense and the Secretary of Veterans Affairs shall jointly— develop and implement electronic health record systems or capabilities that allow for full interoperability of personal health care information between the Department of Defense and the Department of Veterans Affairs; and accelerate the exchange of health care information between the Department of Defense and the Department of Veterans Affairs in order to support the delivery of health care by both Departments.

(“(b) Department of Defense-Department of Veterans Affairs Interagency Program Office.— There is hereby established an interagency program office of the Department of Defense and the Department of Veterans Affairs (in this section referred to as the ‘Office’) for the purposes described in paragraph (2). The Office shall carry out decision making authority delegated to the Office by the Secretary of Defense and the Secretary of Veterans Affairs with respect to the definition, coordination, and management of functional, technical, and programmatic activities that are jointly used, carried out, and shared by the Departments. The purposes of the Office shall be as follows: To act as a single point of accountability for the Department of Defense and the Department of Veterans Affairs in the rapid development and implementation of electronic health record systems or capabilities that allow for full interoperability of personal health care information between the Department of Defense and the Department of Veterans Affairs. To accelerate the exchange of health care information between the Department of Defense and the Department of Veterans Affairs in order to support the delivery of health care by both Departments. To develop and implement a comprehensive interoperability strategy, which shall include— the Electronic Health Record Modernization Program of the Department of Veterans Affairs; and the Healthcare Management System Modernization Program of the Department of Defense. To pursue the highest level of interoperability for the delivery of health care by the Department of Defense and the Department of Veterans Affairs. To accelerate the exchange of health care information between the Departments, and advances in the health information technology marketplace, in order to support the delivery of health care by the Departments. To collect the operational and strategic requirements of the Departments relating to the strategy under subsection (a) and communicate such requirements and activities to the Office of the National Coordinator for Health Information Technology of the Department of Health and Human Services for the purpose of implementing title IV of the 21st Century Cures Act (division A of Public Law 114–255 ) [see Tables for classification], and the amendments made by that title, and other objectives of the Office of the National Coordinator for Health Information Technology. To plan for and effectuate the broadest possible implementation of standards, specifically with respect to the Fast Healthcare Interoperability Resources standard or successor standard, the evolution of such standards, and the obsolescence of such standards. To actively engage with national and international health standards setting organizations, including by taking membership in such organizations, to ensure that standards established by such organizations meet the needs of the Departments pursuant to the strategy under subsection (a), and oversee and approve adoption of and mapping to such standards by the Departments. To express the content and format of health data of the Departments using a common language to improve the exchange of data between the Departments and with the private sector, and to ensure that clinicians of the Departments have access to integrated, computable, comprehensive health records of patients. To inform the Chief Information Officer of the Department of Defense and the Chief Information Officer of the Department of Veterans Affairs of any activities of the Office affecting or relevant to cybersecurity. To establish an environment that will enable and encourage the adoption by the Departments of innovative technologies for health care delivery. To leverage data integration to advance health research and develop an evidence base for the health care programs of the Departments. To prioritize the use of open systems architecture by the Departments. To ensure ownership and control by patients of personal health information and data in a manner consistent with applicable law. To prevent contractors of the Departments or other non-departmental entities from owning or having exclusive control over patient health data, for the purposes of protecting patient privacy and enhancing opportunities for innovation. To implement a single lifetime longitudinal personal health record between the Department of Defense and the Department of Veterans Affairs. To attain interoperability capabilities— sufficient to enable the provision of seamless health care by health care facilities and providers of the Departments, as well as private sector facilities and providers contracted by the Departments; and that are more adaptable and far reaching than those achievable through biodirectional information exchange between electronic health records of the exchange of read-only data alone. To make maximum use of open-application program interfaces and the Fast Healthcare Interoperability Resources standard (or successor standard).

(“(c) Leadership.— The Director of the Office shall be the head of the Office. The Deputy Director of the Office shall be the deputy head of the Office and shall assist the Director in carrying out the duties of the Director. The Director shall report directly to the Deputy Secretary of Defense and the Deputy Secretary of Veterans Affairs. The Director shall be appointed by the Secretary of Defense, with the concurrence of the Secretary of Veterans Affairs, for a fixed term of four years. For the subsequent term, the Secretary of Veterans Affairs, with the concurrence of the Secretary of Defense, shall appoint the Director for a fixed term of four years, and thereafter, the appointment of the Director for a fixed term of four years shall alternate between the Secretaries. The Deputy Director shall be appointed by the Secretary of Veterans Affairs, with the concurrence of the Secretary of Defense, for a fixed term of four years. For the subsequent term, the Secretary of Defense, with the concurrence of the Secretary of Veterans Affairs, shall appoint the Deputy Director for a fixed term of four years, and thereafter, the appointment of the Deputy Director for a fixed term of four years shall alternate between the Secretaries. The Secretary of Defense and the Secretary of Veterans Affairs shall jointly develop qualification requirements for the Director and the Deputy Director. Such requirements shall ensure that, at a minimum, the Director and Deputy Director, individually or together, meet the following qualifications: Significant experience at a senior management level fielding enterprise-wide technology in a health care setting, or business systems in the public or private sector. Credentials for enterprise-wide program management. Significant experience leading implementation of complex organizational change by integrating the input of experts from various disciplines, such as clinical, business, management, informatics, and technology. The Secretary of Defense and the Secretary of Veterans Affairs shall jointly develop a leadership succession process for the Office. The Department of Veterans Affairs-Department of Defense Joint Executive Committee may provide guidance in the discharge of the functions of the Office under this section. Upon request by any of the appropriate committees of Congress, the Director and the Deputy Director shall testify before such committee, or provide a briefing or otherwise provide requested information to such committee, regarding the discharge of the functions of the Office under this section.

(“(d) Function.— The function of the Office shall be to implement, by not later than September 30, 2009 , electronic health record systems or capabilities that allow for full interoperability of personal health care information between the Department of Defense and the Department of Veterans Affairs, which health records shall comply with applicable interoperability standards, implementation specifications, and certification criteria (including for the reporting of quality measures) of the Federal Government.

(“(e) Implementation Milestones.— With respect to the electronic health record systems of the Department of Defense and the Department of Veterans Affairs, the Office shall seek to enter into an agreement with an independent entity to conduct an evaluation by not later than October 1, 2021 [,] of the following: Whether a clinician of the Department of Defense, can access, and meaningfully interact with, a complete patient health record of a veteran, from a military medical treatment facility. Whether a clinician of the Department of Veterans Affairs can access, and meaningfully interact with, a complete patient health record of a member of the Armed Forces serving on active duty, from a medical center of the Department of Veterans Affairs. Whether clinicians of the Departments can access, and meaningfully interact with, the data elements of the health record of a patient who is a veteran or is a member of the Armed Forces which are generated when the individual receives health care from a community care provider of the Department of Veterans Affairs or a TRICARE program provider of the Department of Defense. Whether a community care provider of the Department of the Veterans Affairs and a TRICARE program provider of the Department of Defense on a Health Information Exchange-supported electronic health record can access patient health records of veterans and active-duty members of the Armed Forces from the system of the provider. An assessment of interoperability between the legacy electronic health record systems and the future electronic health record systems of the Department of Veterans Affairs and the Department of Defense. An assessment of the use of interoperable content between— the legacy electronic health record systems and the future electronic health record systems of the Department of Veterans Affairs and the Department of Defense; and third-party applications. The Office shall— maintain the common configuration baseline for the electronic health record systems of the Department of Defense and the Department of Veterans Affairs; and continually evaluate the state of configuration and the impacts on interoperability; and promote the enhancement of such electronic health records systems. Not less than once per year, the Office shall convene a meeting of clinical staff from the Department of Defense, the Department of Veterans Affairs, the Coast Guard, community providers, and other leading clinical experts, for the purpose of assessing the state of clinical use of the electronic health record systems and whether the systems are meeting clinical and patient needs. Clinical staff participating in a meeting under subparagraph (A) shall make recommendations to the Office on the need for any improvements or concerns with the electronic health record systems. Beginning October 1, 2021 , and on at least a biannual basis thereafter until 2025 at the earliest, the Office shall undertake a clinician and patient satisfaction survey regarding clinical use and patient experience with the electronic health record systems of the Department of Defense and the Department of Veterans Affairs.

(“(f) Pilot Projects.— In order to assist the Office in the discharge of its function under this section, the Secretary of Defense and the Secretary of Veterans Affairs may, acting jointly, carry out one or more pilot projects to assess the feasibility and advisability of various technological approaches to the achievement of the electronic health record systems or capabilities described in subsection (d). For purposes of each pilot project carried out under this subsection, the Secretary of Defense and the Secretary of Veterans Affairs shall, for purposes of the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 [ Pub. L. 104–191 ] ( 42 U.S.C. 1320d–2 note), ensure the effective sharing of protected health information between the health care system of the Department of Defense and the health care system of the Department of Veterans Affairs as needed to provide all health care services and other benefits allowed by law.

(“(g) Staff and Other Resources.— The Secretary of Defense and the Secretary of Veterans Affairs shall assign to the Office such personnel and other resources of the Department of Defense and the Department of Veterans Affairs as are required for the discharge of its function under this section, including the assignment of clinical or technical personnel of the Department of Defense or the Department of Veterans Affairs to the Office. Subject to the approval of the Secretary of Defense and the Secretary of Veterans Affairs, the Director may utilize the services of private individuals and entities as consultants to the Office in the discharge of its function under this section. Amounts available to the Office shall be available for payment for such services. The Secretary of Defense and the Secretary of Veterans shall enter into an agreement on cost sharing and providing resources for the operations and staffing of the Office. The Secretary of Defense and the Secretary of Veterans Affairs shall delegate to the Director the authority under title 5, United States Code, regarding appointments in the competitive service to hire personnel of the Office.

(“(h) Reports.— Not later than September 30, 2020 , and each year thereafter through 2024, the Director shall submit to the Secretary of Defense and the Secretary of Veterans Affairs, and to the appropriate committees of Congress, a report on the activities of the Office during the preceding calendar year. Each report shall include the following: A detailed description of the activities of the Office during the year covered by such report, including a detailed description of the amounts expended and the purposes for which expended. With respect to the objectives of the strategy under paragraph (2)(C) of subsection (b), and the purposes of the Office under such subsection— a discussion, description, and assessment of the progress made by the Department of Defense and the Department of Veterans Affairs during the preceding calendar year; and a discussion and description of the goals of the Department of Defense and the Department of Veterans Affairs for the following calendar year, including updates to strategies and plans. A detailed financial summary of the activities of the Office, including the funds allocated to the Office by each Department, the expenditures made, and an assessment as to whether the current funding is sufficient to carry out the activities of the Office. A detailed description of the status of each of the implementation milestones, including the nature of the evaluation, methodology for testing, and findings with respect to each milestone under subsection (e). A detailed description of the state of the configuration baseline, including any activities which decremented or enhanced the state of configuration under subsection (e). With respect to the annual meeting required under subsection (e)(3)— a detailed description of activities, assessments, and recommendations relating to such meeting; and the response of the Office to any such recommendations. Each report under this subsection shall be made publicly available.

(“(i) Comptroller General Assessment of Implementation.— Not later than six months after the date of the enactment of this Act [ Jan. 28, 2008 ] and every six months thereafter until the completion of the implementation of electronic health record systems or capabilities described in subsection (d), the Comptroller General of the United States shall submit to the appropriate committees of Congress a report setting forth the assessment of the Comptroller General of the progress of the Department of Defense and the Department of Veterans Affairs in implementing electronic health record systems or capabilities described in subsection (d).

(“(j) Technology-Neutral Guidelines and Standards.— The Director, in consultation with industry and appropriate Federal agencies, shall develop, or shall adopt from industry, technology-neutral information technology infrastructure guidelines and standards for use by the Department of Defense and the Department of Veterans Affairs to enable those departments to effectively select and utilize information technologies to meet the requirements of this section.

(“(k) Definitions.— In this section: The term ‘appropriate congressional committees’ means— the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives]; and the Committees on Veterans’ Affairs of the House of Representatives and the Senate. The term ‘configuration baseline’ means a fixed reference in the development cycle or an agreed-upon specification of a product at a point in time that serves as a documented basis for defining incremental change in all aspects of an information technology product. The term ‘Electronic Health Record Modernization Program’ has the meaning given that term in section 503 of the Veterans Benefits and Transition Act of 2018 ( Public Law 115–407 ; 132 Stat. 5376 ) [38 U.S.C. note prec. 5701]. The term ‘interoperability’ means the ability of different information systems, devices, or applications to connect, regardless of the technology platform or the location where care is provided— in a coordinated and secure manner, within and across organizational boundaries, and across the complete spectrum of care, including all applicable care settings; with relevant stakeholders, including the person whose information is being shared, to access, exchange, integrate, and use computable data regardless of the origin or destination of the data or the applications employed; with the capability to reliably exchange information without error; with the ability to interpret and to make effective use of such exchanged information; with the ability for information that can be used to advance patient care to move between health care entities; and without additional intervention by the end user. The term ‘meaningfully interact’ means the ability to view, consume, act upon, and edit information in a clinical setting to facilitate high-quality clinical decision making. The term ‘seamless health care’ means health care which is optimized through access by patients and clinicians to integrated, relevant, and complete information about the clinical experiences of the patient, social and environmental determinants of health, and health trends over time, in order to enable patients and clinicians to— move efficiently within and across organizational boundaries; make high-quality decisions; and effectively carry out complete plans of care. The term ‘Secretary concerned’ means— the Secretary of Defense, with respect to matters concerning the Department of Defense; the Secretary of Veterans Affairs, with respect to matters concerning the Department of Veterans Affairs; and the Secretary of Homeland Security, with respect to matters concerning the Coast Guard when it is not operating as a service in the Department of the Navy. The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10 , United States Code. [As amended Pub. L. 110–417 , [div. A], title II, § 252, Oct. 14, 2008 , 122 Stat. 4400 ; Pub. L. 113–175, title I, § 105 , Sept. 26, 2014 , 128 Stat. 1903 ; Pub. L. 114–58, title IV, § 411 , Sept. 30, 2015 , 129 Stat. 536 ; Pub. L. 114–228, title IV, § 414 , Sept. 29, 2016 , 130 Stat. 941 ; Pub. L. 116–92, div. A, title VII, § 715(a) –(g), Dec. 20, 2019 , 133 Stat. 1446–1451 .]

“SEC. 1644 AUTHORIZATION OF PILOT PROGRAMS TO IMPROVE THE DISABILITY EVALUATION SYSTEM FOR MEMBERS OF THE ARMED FORCES.

(“(a) Pilot Programs.— For the purposes set forth in subsection (c), the Secretary of Defense may establish and conduct pilot programs with respect to the system of the Department of Defense for the evaluation of the disabilities of members of the Armed Forces who are being separated or retired from the Armed Forces for disability under chapter 61 of title 10, United States Code (in this section referred to as the ‘disability evaluation system’). In carrying out this section, the Secretary of Defense may conduct one or more of the pilot programs described in paragraphs (1) through (3) of subsection (b) or such other pilot programs as the Secretary of Defense considers appropriate. In establishing and conducting any pilot program under this section, the Secretary of Defense shall consult with the Secretary of Veterans Affairs.

(“(b) Scope of Pilot Programs.— Under one of the pilot programs authorized by subsection (a), for purposes of making a determination of disability of a member of the Armed Forces under section 1201(b) of title 10 , United States Code, for the retirement, separation, or placement of the member on the temporary disability retired list under chapter 61 of such title, upon a determination by the Secretary of the military department concerned that the member is unfit to perform the duties of the member’s office, grade, rank, or rating because of a physical disability as described in section 1201(a) of such title— the Secretary of Veterans Affairs may— conduct an evaluation of the member for physical disability; and assign the member a rating of disability in accordance with the schedule for rating disabilities utilized by the Secretary of Veterans Affairs based on all medical conditions (whether individually or collectively) that render the member unfit for duty; and the Secretary of the military department concerned may make the determination of disability regarding the member utilizing the rating of disability assigned under subparagraph (A)(ii). Under one of the pilot programs authorized by subsection (a), in making a determination of disability of a member of the Armed Forces under section 1201(b) of title 10 , United States Code, for the retirement, separation, or placement of the member on the temporary disability retired list under chapter 61 of such title, the Secretary of the military department concerned may, upon determining that the member is unfit to perform the duties of the member’s office, grade, rank, or rating because of a physical disability as described in section 1201(a) of such title— provide for the joint evaluation of the member for disability by the Secretary of the military department concerned and the Secretary of Veterans Affairs, including the assignment of a rating of disability for the member in accordance with the schedule for rating disabilities utilized by the Secretary of Veterans Affairs based on all medical conditions (whether individually or collectively) that render the member unfit for duty; and make the determination of disability regarding the member utilizing the rating of disability assigned under subparagraph (A). Under one of the pilot programs authorized by subsection (a), the Secretary of Defense may establish and operate a single Internet website for the disability evaluation system of the Department of Defense that enables participating members of the Armed Forces to fully utilize such system through the Internet, with such Internet website to include the following: The availability of any forms required for the utilization of the disability evaluation system by members of the Armed Forces under the system. Secure mechanisms for the submission of such forms by members of the Armed Forces under the system, and for the tracking of the acceptance and review of any forms so submitted. Secure mechanisms for advising members of the Armed Forces under the system of any additional information, forms, or other items that are required for the acceptance and review of any forms so submitted. The continuous availability of assistance to members of the Armed Forces under the system (including assistance through the caseworkers assigned to such members of the Armed Forces) in submitting and tracking such forms, including assistance in obtaining information, forms, or other items described by subparagraph (C). Secure mechanisms to request and receive personnel files or other personnel records of members of the Armed Forces under the system that are required for submission under the disability evaluation system, including the capability to track requests for such files or records and to determine the status of such requests and of responses to such requests. The pilot programs authorized by subsection (a) may also provide for the development, evaluation, and identification of such practices and procedures under the disability evaluation system as the Secretary considers appropriate for purposes set forth in subsection (c).

(“(c) Purposes.— A pilot program established under subsection (a) may have one or more of the following purposes: To provide for the development, evaluation, and identification of revised and improved practices and procedures under the disability evaluation system in order to— reduce the processing time under the disability evaluation system of members of the Armed Forces who are likely to be retired or separated for disability, and who have not requested continuation on active duty, including, in particular, members who are severely wounded; identify and implement or seek the modification of statutory or administrative policies and requirements applicable to the disability evaluation system that— are unnecessary or contrary to applicable best practices of civilian employers and civilian healthcare systems; or otherwise result in hardship, arbitrary, or inconsistent outcomes for members of the Armed Forces, or unwarranted inefficiencies and delays; eliminate material variations in policies, interpretations, and overall performance standards among the military departments under the disability evaluation system; and determine whether it enhances the capability of the Department of Veterans Affairs to receive and determine claims from members of the Armed Forces for compensation, pension, hospitalization, or other veterans benefits. In conjunction with the findings and recommendations of applicable Presidential and Department of Defense study groups, to provide for the eventual development of revised and improved practices and procedures for the disability evaluation system in order to achieve the objectives set forth in paragraph (1).

(“(d) Utilization of Results in Updates of Comprehensive Policy on Care, Management, and Transition of Recovering Service Members.— The Secretary of Defense and the Secretary of Veterans Affairs, acting jointly, may incorporate responses to any findings and recommendations arising under the pilot programs conducted under subsection (a) in updating the comprehensive policy on the care and management of covered service members under section 1611(a)(4).

(“(e) Construction With Other Authorities.— Subject to paragraph (2), in carrying out a pilot program under subsection (a)— the rules and regulations of the Department of Defense and the Department of Veterans Affairs relating to methods of determining fitness or unfitness for duty and disability ratings for members of the Armed Forces shall apply to the pilot program only to the extent provided in the report on the pilot program under subsection (g)(1); and the Secretary of Defense and the Secretary of Veterans Affairs may waive any provision of title 10, 37, or 38, United States Code, relating to methods of determining fitness or unfitness for duty and disability ratings for members of the Armed Forces if the Secretaries determine in writing that the application of such provision would be inconsistent with the purpose of the pilot program. Nothing in paragraph (1) shall be construed to authorize the waiver of any provision of section 1216a of title 10 , United States Code, as added by section 1642 of this Act.

(“(f) Duration.— Each pilot program conducted under subsection (a) shall be completed not later than one year after the date of the commencement of such pilot program under that subsection.

(“(g) Reports.— Not later than 90 days after the date of the enactment of this Act [ Jan. 28, 2008 ], the Secretary of Defense shall submit to the appropriate committees of Congress a report on each pilot program that has been commenced as of that date under subsection (a). The report shall include— a description of the scope and objectives of the pilot program; a description of the methodology to be used under the pilot program to ensure rapid identification under such pilot program of revised or improved practices under the disability evaluation system in order to achieve the objectives set forth in subsection (c)(1); and a statement of any provision described in subsection (e)(1)(B) that will not apply to the pilot program by reason of a waiver under that subsection. Not later than 180 days after the date of the submittal of the report required by paragraph (1) with respect to a pilot program, the Secretary shall submit to the appropriate committees of Congress a report describing the current status of the pilot program. Not later than 90 days after the completion of all of the pilot programs conducted under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report setting forth a final evaluation and assessment of the pilot programs. The report shall include such recommendations for legislative or administrative action as the Secretary considers appropriate in light of such pilot programs.

“SEC. 1648 STANDARDS FOR MILITARY MEDICAL TREATMENT FACILITIES, SPECIALTY MEDICAL CARE FACILITIES, AND MILITARY QUARTERS HOUSING PATIENTS AND ANNUAL REPORT ON SUCH FACILITIES.

(“(a) Establishment of Standards.— The Secretary of Defense shall establish for the military facilities of the Department of Defense and the military departments referred to in subsection (b) standards with respect to the matters set forth in subsection (c). To the maximum extent practicable, the standards shall— be uniform and consistent for all such facilities; and be uniform and consistent throughout the Department of Defense and the military departments.

(“(b) Covered Military Facilities.— The military facilities covered by this section are the following: Military medical treatment facilities. Specialty medical care facilities. Military quarters or leased housing for patients.

(“(c) Scope of Standards.— The standards required by subsection (a) shall include the following: Generally accepted standards for the accreditation of medical facilities, or for facilities used to quarter individuals that may require medical supervision, as applicable, in the United States. To the extent not inconsistent with the standards described in paragraph (1), minimally acceptable conditions for the following: Appearance and maintenance of facilities generally, including the structure and roofs of facilities. Size, appearance, and maintenance of rooms housing or utilized by patients, including furniture and amenities in such rooms. Operation and maintenance of primary and back-up facility utility systems and other systems required for patient care, including electrical systems, plumbing systems, heating, ventilation, and air conditioning systems, communications systems, fire protection systems, energy management systems, and other systems required for patient care. Compliance of facilities, rooms, and grounds, to the maximum extent practicable, with the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12101 et seq.). Such other matters relating to the appearance, size, operation, and maintenance of facilities and rooms as the Secretary considers appropriate.

(“(d) Compliance With Standards.— In establishing standards under subsection (a), the Secretary shall specify a deadline for compliance with such standards by each facility referred to in subsection (b). The deadline shall be at the earliest date practicable after the date of the enactment of this Act [ Jan. 28, 2008 ], and shall, to the maximum extent practicable, be uniform across the facilities referred to in subsection (b). In carrying out this section, the Secretary shall also establish guidelines for investment to be utilized by the Department of Defense and the military departments in determining the allocation of financial resources to facilities referred to in subsection (b) in order to meet the deadline specified under paragraph (1).

(“(e) Report on Development and Implementation of Standards.— Not later than March 1, 2008 , 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 on the actions taken to carry out subsection (a). The report under paragraph (1) shall include the following: The standards established under subsection (a). An assessment of the appearance, condition, and maintenance of each facility referred to in subsection (b), including— an assessment of the compliance of the facility with the standards established under subsection (a); and a description of any deficiency or noncompliance in each facility with the standards. A description of the investment to be allocated to address each deficiency or noncompliance identified under subparagraph (B)(ii). [As amended Pub. L. 114–92, div. A, title X, § 1072(e) , Nov. 25, 2015 , 129 Stat. 995 .]

“SEC. 1651 HANDBOOK FOR MEMBERS OF THE ARMED FORCES ON COMPENSATION AND BENEFITS AVAILABLE FOR SERIOUS INJURIES AND ILLNESSES.

(“(a) Information on Available Compensation and Benefits.— Not later than October 1, 2008 , the Secretary of Defense shall develop and maintain, in handbook and electronic form, a comprehensive description of the compensation and other benefits to which a member of the Armed Forces, and the family of such member, would be entitled upon the separation or retirement of the member from the Armed Forces as a result of a serious injury or illness. The handbook shall set forth the range of such compensation and benefits based on grade, length of service, degree of disability at separation or retirement, and such other factors affecting such compensation and benefits as the Secretary considers appropriate.

(“(b) Consultation.— The Secretary of Defense shall develop and maintain the comprehensive description required by subsection (a), including the handbook and electronic form of the description, in consultation with the Secretary of Veterans Affairs, the Secretary of Health and Human Services, and the Commissioner of Social Security.

(“(c) Update.— The Secretary of Defense shall update the comprehensive description required by subsection (a), including the handbook and electronic form of the description, on a periodic basis, but not less often than annually.

(“(d) Provision to Members.— The Secretary of the military department concerned shall provide the descriptive handbook under subsection (a) to each member of the Armed Forces described in that subsection as soon as practicable following the injury or illness qualifying the member for coverage under such subsection.

(“(e) Provision to Representatives.— If a member is incapacitated or otherwise unable to receive the descriptive handbook to be provided under subsection (a), the handbook shall be provided to the next of kin or a legal representative of the member, as determined in accordance with regulations prescribed by the Secretary of the military department concerned for purposes of this section.

“SEC. 1662 ACCESS OF RECOVERING SERVICE MEMBERS TO ADEQUATE OUTPATIENT RESIDENTIAL FACILITIES.

“All quarters of the United States and housing facilities under the jurisdiction of the Armed Forces that are occupied by recovering service members shall be inspected at least once every two years by the inspectors general of the regional medical commands. [As amended Pub. L. 113–291, div. A, title V, § 591 , Dec. 19, 2014 , 128 Stat. 3394 ; Pub. L. 114–92, div. A, title X, § 1072(f) , Nov. 25, 2015 , 129 Stat. 995 .]

“SEC. 1671 PROHIBITION ON TRANSFER OF RESOURCES FROM MEDICAL CARE.

“Neither the Secretary of Defense nor the Secretaries of the military departments may transfer funds or personnel from medical care functions to administrative functions within the Department of Defense in order to comply with the new administrative requirements imposed by this title [see Short Title of 2008 Amendment note above] or the amendments made by this title.

“SEC. 1672 MEDICAL CARE FOR FAMILIES OF MEMBERS OF THE ARMED FORCES RECOVERING FROM SERIOUS INJURIES OR ILLNESSES.

(“(a) Medical Care at Military Medical Facilities.— A family member of a recovering service member who is not otherwise eligible for medical care at a military medical treatment facility may be eligible for such care at such facilities, on a space-available basis, if the family member is— on invitational orders while caring for the service member; a non-medical attendee caring for the service member; or receiving per diem payments from the Department of Defense while caring for the service member. The Secretary of Defense may prescribe in regulations the family members of recovering service members who shall be considered to be a family member of a service member for purposes of this subsection. The Secretary of Defense shall prescribe in regulations the medical care that may be available to family members under this subsection at military medical treatment facilities. The United States may recover the costs of the provision of medical care under this subsection as follows (as applicable): From third-party payers, in the same manner as the United States may collect costs of the charges of health care provided to covered beneficiaries from third-party payers under section 1095 of title 10 , United States Code. As if such care was provided under the authority of section 1784 of title 38 , United States Code.

(“(b) Medical Care at Department of Veterans Affairs Medical Facilities.— When a recovering service member is receiving hospital care and medical services at a medical facility of the Department of Veterans Affairs, the Secretary of Veterans Affairs may provide medical care for eligible family members under this section when that care is readily available at that Department facility and on a space-available basis. The Secretary of Veterans Affairs shall prescribe in regulations the medical care that may be available to family members under this subsection at medical facilities of the Department of Veterans Affairs.

“SEC. 1676 MORATORIUM ON CONVERSION TO CONTRACTOR PERFORMANCE OF DEPARTMENT OF DEFENSE FUNCTIONS AT MILITARY MEDICAL FACILITIES.

(“(a) Moratorium.— No study or competition may be begun or announced pursuant to section 2461 of title 10 , United States Code, or otherwise pursuant to Office of Management and Budget circular A-76, relating to the possible conversion to performance by a contractor of any Department of Defense function carried out at a military medical facility until the Secretary of Defense— submits the certification required by subsection (b) to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives together with a description of the steps taken by the Secretary in accordance with the certification; and submits the report required by subsection (c).

(“(b) Certification.— The certification referred to in paragraph (a)(1) is a certification that the Secretary has taken appropriate steps to ensure that neither the quality of military medical care nor the availability of qualified personnel to carry out Department of Defense functions related to military medical care will be adversely affected by either— the process of considering a Department of Defense function carried out at a military medical facility for possible conversion to performance by a contractor; or the conversion of such a function to performance by a contractor.

(“(c) Report Required.— Not later than 180 days after the date of the enactment of this Act [ Jan. 28, 2008 ], the Secretary of Defense 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 public-private competitions being conducted for Department of Defense functions carried out at military medical facilities as of the date of the enactment of this Act by each military department and defense agency. Such report shall include— for each such competition— the cost of conducting the public-private competition; the number of military personnel and civilian employees of the Department of Defense affected; the estimated savings identified and the savings actually achieved; an evaluation whether the anticipated and budgeted savings can be achieved through a public-private competition; and the effect of converting the performance of the function to performance by a contractor on the quality of the performance of the function; and an assessment of whether any method of business reform or reengineering other than a public-private competition could, if implemented in the future, achieve any anticipated or budgeted savings.”

§ 1072 Definitions

In this chapter: The term “uniformed services” means the armed forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service. The term “dependent”, with respect to a member or former member of a uniformed service, means— the spouse; the unremarried widow; the unremarried widower; a child who— has not attained the age of 21; has not attained the age of 23, is enrolled in a full-time course of study at an institution of higher learning approved by the administering Secretary and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support; or is incapable of self-support because of a mental or physical incapacity that occurs while a dependent of a member or former member under clause (i) or (ii) and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support; a parent or parent-in-law who is, or was at the time of the member’s or former member’s death, in fact dependent on him for over one-half of his support and residing in his household; the unremarried former spouse of a member or former member who (i) on the date of the final decree of divorce, dissolution, or annulment, had been married to the member or former member for a period of at least 20 years during which period the member or former member performed at least 20 years of service which is creditable in determining that member’s or former member’s eligibility for retired or retainer pay, or equivalent pay, and (ii) does not have medical coverage under an employer-sponsored health plan; a person who (i) is the unremarried former spouse of a member or former member who performed at least 20 years of service which is creditable in determining the member or former member’s eligibility for retired or retainer pay, or equivalent pay, and on the date of the final decree of divorce, dissolution, or annulment before April 1, 1985 , had been married to the member or former member for a period of at least 20 years, at least 15 of which, but less than 20 of which, were during the period the member or former member performed service creditable in determining the member or former member’s eligibility for retired or retainer pay, and (ii) does not have medical coverage under an employer-sponsored health plan; a person who would qualify as a dependent under clause (G) but for the fact that the date of the final decree of divorce, dissolution, or annulment of the person is on or after April 1, 1985 , except that the term does not include the person after the end of the one-year period beginning on the date of that final decree; and an unmarried person who— is placed in the legal custody of the member or former member as a result of an order of a court of competent jurisdiction in the United States (or possession of the United States) for a period of at least 12 consecutive months; either— has not attained the age of 21; has not attained the age of 23 and is enrolled in a full time course of study at an institution of higher learning approved by the administering Secretary; or is incapable of self support because of a mental or physical incapacity that occurred while the person was considered a dependent of the member or former member under this subparagraph pursuant to subclause (I) or (II); is dependent on the member or former member for over one-half of the person’s support; resides with the member or former member unless separated by the necessity of military service or to receive institutional care as a result of disability or incapacitation or under such other circumstances as the administering Secretary may by regulation prescribe; and is not a dependent of a member or a former member under any other subparagraph. The term “administering Secretaries” means the Secretaries of executive departments specified in section 1073 of this title as having responsibility for administering this chapter. The term “Civilian Health and Medical Program of the Uniformed Services” means the program authorized under sections 1079 and 1086 of this title and includes contracts entered into under section 1091 or 1097 of this title and demonstration projects under section 1092 of this title . The term “covered beneficiary” means a beneficiary under this chapter other than a beneficiary under section 1074(a) of this title . The term “child”, with respect to a member or former member of a uniformed service, means the following: An unmarried legitimate child. An unmarried adopted child. An unmarried stepchild. An unmarried person— who is placed in the home of the member or former member by a placement agency (recognized by the Secretary of Defense), or by any other source authorized by State or local law to provide adoption placement, in anticipation of the legal adoption of the person by the member or former member; and who otherwise meets the requirements specified in paragraph (2)(D). The term “TRICARE program” means the various programs carried out by the Secretary of Defense under this chapter and any other provision of law providing for the furnishing of medical and dental care and health benefits to members and former members of the uniformed services and their dependents, including the following health plan options: TRICARE Prime. TRICARE Select. TRICARE for Life. The term “custodial care” means treatment or services, regardless of who recommends such treatment or services or where such treatment or services are provided, that— can be rendered safely and reasonably by a person who is not medically skilled; or is or are designed mainly to help the patient with the activities of daily living. The term “domiciliary care” means care provided to a patient in an institution or homelike environment because— providing support for the activities of daily living in the home is not available or is unsuitable; or members of the patient’s family are unwilling to provide the care. The term “health care” includes mental health care. The term “TRICARE Extra” means the preferred-provider option of the TRICARE program made available prior to January 1, 2018 , under which TRICARE Standard beneficiaries may obtain discounts on cost sharing as a result of using TRICARE network providers. The term “TRICARE Select” means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of this title . The term “TRICARE for Life” means the Medicare wraparound coverage option of the TRICARE program made available to the beneficiary by reason of section 1086(d) of this title . The term “TRICARE Prime” means the managed care option of the TRICARE program. The term “TRICARE Standard” means the TRICARE program made available prior to January 1, 2018 , covering health benefits contracted for under the authority of section 1079(a) or 1086(a) of this title and subject to the same rates and conditions as apply to persons covered under those sections. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1446 ; amended Pub. L. 89–614, § 2(1) , Sept. 30, 1966 , 80 Stat. 862 ; Pub. L. 89–718, § 8(a) , Nov. 2, 1966 , 80 Stat. 1117 ; Pub. L. 96–513, title I, § 115(b) , title V, § 511(34)(A), (35), (36), Dec. 12, 1980 , 94 Stat. 2877 , 2922, 2923; Pub. L. 97–252, title X, § 1004(a) , Sept. 8, 1982 , 96 Stat. 737 ; Pub. L. 98–525, title VI, § 645(a) , Oct. 19, 1984 , 98 Stat. 2548 ; Pub. L. 98–557, § 19(1) , Oct. 30, 1984 , 98 Stat. 2869 ; Pub. L. 99–661, div. A, title VII, § 701(b) , Nov. 14, 1986 , 100 Stat. 3898 ; Pub. L. 101–189, div. A, title VII, § 731(a) , Nov. 29, 1989 , 103 Stat. 1481 ; Pub. L. 102–484, div. A, title VII, § 706 , Oct. 23, 1992 , 106 Stat. 2433 ; Pub. L. 103–160, div. A, title VII, § 702(a) , Nov. 30, 1993 , 107 Stat. 1686 ; Pub. L. 103–337, div. A, title VII, § 701(a) , Oct. 5, 1994 , 108 Stat. 2797 ; Pub. L. 105–85, div. A, title VII, § 711 , Nov. 18, 1997 , 111 Stat. 1808 ; Pub. L. 107–107, div. A, title VII, § 701(c) , Dec. 28, 2001 , 115 Stat. 1160 ; Pub. L. 109–163, div. A, title V, § 592(b) , title X, § 1057(a)(2), Jan. 6, 2006 , 119 Stat. 3280 , 3440; Pub. L. 110–181, div. A, title VII, § 708(a) , Jan. 28, 2008 , 122 Stat. 190 ; Pub. L. 114–328, div. A, title VII, § 701(j)(1)(A) , Dec. 23, 2016 , 130 Stat. 2191 ; Pub. L. 115–91, div. A, title VII, § 739(a) , Dec. 12, 2017 , 131 Stat. 1446 .)

§ 1073 Administration of this chapter

(a) Responsible Officials.— Except as otherwise provided in this chapter, the Secretary of Defense shall administer this chapter for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy, and the Secretary of Health and Human Services shall administer this chapter for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997 ( 42 U.S.C. 14401 et seq.). Except as otherwise provided in this chapter, the Secretary of Defense shall have responsibility for administering the TRICARE program and making any decision affecting such program.

(b) Stability in Program of Benefits.— The Secretary of Defense shall, to the maximum extent practicable, provide a stable program of benefits under this chapter throughout each fiscal year. To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense may implement any such change prior to the next fiscal quarter if the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter.

“SEC. 721 DEFINITIONS.

“In this subtitle: The term ‘administering Secretaries’ means the Secretary of Defense, the Secretary of Homeland Security, and the Secretary of Health and Human Services. The term ‘agreement’ means the agreement required under section 722(b) between the Secretary of Defense and a designated provider. The term ‘capitation payment’ means an actuarially sound payment for a defined set of health care services that is established on a per enrollee per month basis. The term ‘covered beneficiary’ means a beneficiary under chapter 55 of title 10, United States Code, other than a beneficiary under section 1074(a) of such title. The term ‘designated provider’ means a public or nonprofit private entity that was a transferee of a Public Health Service hospital or other station under section 987 of the Omnibus Budget Reconciliation Act of 1981 ( Public Law 97–35 ; 42 U.S.C. 248b ) and that, before the date of the enactment of this Act [ Sept. 23, 1996 ], was deemed to be a facility of the uniformed services for the purposes of chapter 55 of title 10, United States Code. The term includes any legal successor in interest of the transferee. The term ‘enrollee’ means a covered beneficiary who enrolls with a designated provider. The term ‘health care services’ means the health care services provided under the health plan known as the ‘TRICARE PRIME’ option under the TRICARE program. The term ‘Secretary’ means the Secretary of Defense. The term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter 55 of title 10, United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services.

“SEC. 722 INCLUSION OF DESIGNATED PROVIDERS IN UNIFORMED SERVICES HEALTH CARE DELIVERY SYSTEM.

(“(a) Inclusion in System.— The health care delivery system of the uniformed services shall include the designated providers.

(“(b) Agreements to Provide Managed Health Care Services.— After consultation with the other administering Secretaries, the Secretary of Defense shall negotiate and enter into an agreement with each designated provider under which the designated provider will provide health care services in or through managed care plans to covered beneficiaries who enroll with the designated provider. The agreement shall be entered into on a sole source basis. The Federal Acquisition Regulation, except for those requirements regarding competition, issued pursuant to section 1303(a) of title 41 , United States Code[,] shall apply to the agreements as acquisitions of commercial items. The implementation of an agreement is subject to availability of funds for such purpose.

(“(c) Effective Date of Agreements.— Unless an earlier effective date is agreed upon by the Secretary and the designated provider, the agreement shall take effect upon the later of the following: The date on which a managed care support contract under the TRICARE program is implemented in the service area of the designated provider. October 1, 1997 . The Secretary may modify the effective date established under paragraph (1) for an agreement to permit a transition period of not more than six months between the date on which the agreement is executed by the parties and the date on which the designated provider commences the delivery of health care services under the agreement.

(“(d) Temporary Continuation of Existing Participation Agreements.— The Secretary shall extend the participation agreement of a designated provider in effect immediately before the date of the enactment of this Act [ Sept. 23, 1996 ] under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 ( Public Law 101–510 ; [former] 42 U.S.C. 248c [note]) until the agreement required by this section takes effect under subsection (c), including any transitional period provided by the Secretary under paragraph (2) of such subsection.

(“(e) Service Area.— The Secretary may not reduce the size of the service area of a designated provider below the size of the service area in effect as of September 30, 1996 .

(“(f) Compliance With Administrative Requirements.— Unless otherwise agreed upon by the Secretary and a designated provider, the designated provider shall comply with necessary and appropriate administrative requirements established by the Secretary for other providers of health care services and requirements established by the Secretary of Health and Human Services for risk-sharing contractors under section 1876 of the Social Security Act ( 42 U.S.C. 1395mm ). The Secretary and the designated provider shall determine and apply only such administrative requirements as are minimally necessary and appropriate. A designated provider shall not be required to comply with a law or regulation of a State government requiring licensure as a health insurer or health maintenance organization. A designated provider may not contract out more than five percent of its primary care enrollment without the approval of the Secretary, except in the case of primary care contracts between a designated provider and a primary care contractor in force on the date of the enactment of this Act [ Sept. 23, 1996 ].

(“(g) Continued Acquisition of Reduced-Cost Drugs.— A designated provider shall be treated as part of the Department of Defense for purposes of section 8126 of title 38 , United States Code, in connection with the provision by the designated provider of health care services to covered beneficiaries pursuant to the participation agreement of the designated provider under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 ( Public Law 101–510 ; [former] 42 U.S.C. 248c note) or pursuant to the agreement entered into under subsection (b).

“SEC. 723 PROVISION OF UNIFORM BENEFIT BY DESIGNATED PROVIDERS.

(“(a) Uniform Benefit Required.— A designated provider shall offer to enrollees the health benefit option prescribed and implemented by the Secretary under section 731 of the National Defense Authorization Act for Fiscal Year 1994 ( Public Law 103–160 ; 10 U.S.C. 1073 note), including accompanying cost-sharing requirements.

(“(b) Time for Implementation of Benefit.— A designated provider shall offer the health benefit option described in subsection (a) to enrollees upon the later of the following: The date on which health care services within the health care delivery system of the uniformed services are rendered through the TRICARE program in the region in which the designated provider operates. October 1, 1997 .

(“(c) Adjustments.— The Secretary may establish a later date under subsection (b)(2) or prescribe reduced cost-sharing requirements for enrollees.

“SEC. 724 ENROLLMENT OF COVERED BENEFICIARIES.

(“(a) Fiscal Year 1997 Limitation.— During fiscal year 1997, the number of covered beneficiaries who are enrolled in managed care plans offered by designated providers may not exceed the number of such enrollees as of October 1, 1995 . The Secretary may waive the limitation under paragraph (1) if the Secretary determines that additional enrollment authority for a designated provider is required to accommodate covered beneficiaries who are dependents of members of the uniformed services entitled to health care under section 1074(a) of title 10 , United States Code.

(“(b) Permanent Limitation.— For each fiscal year beginning after September 30, 1997 , the number of enrollees in managed care plans offered by designated providers may not exceed 110 percent of the number of such enrollees as of the first day of the immediately preceding fiscal year. The Secretary may waive this limitation as provided in subsection (a)(2).

(“(c) Retention of Current Enrollees.— An enrollee in the managed care plan of a designated provider as of September 30, 1997 , or such earlier date as the designated provider and the Secretary may agree upon, shall continue receiving services from the designated provider pursuant to the agreement entered into under section 722 unless the enrollee disenrolls from the designated provider. Except as provided in subsection (e), the administering Secretaries may not disenroll such an enrollee unless the disenrollment is agreed to by the Secretary and the designated provider.

(“(d) Additional Enrollment Authority.— Subject to paragraph (2), other covered beneficiaries may also receive health care services from a designated provider. The designated provider may market such services to, and enroll, covered beneficiaries who— do not have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; subject to the limitation in subparagraph (B), have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; or are enrolled in the direct care system under the TRICARE program, regardless of whether the covered beneficiaries were users of the health care delivery system of the uniformed services in prior years. For each fiscal year beginning after September 30, 2003 , the number of covered beneficiaries newly enrolled by designated providers pursuant to clause (ii) of subparagraph (A) during such fiscal year may not exceed 10 percent of the total number of the covered beneficiaries who are newly enrolled under such subparagraph during such fiscal year. For purposes of this subsection, a covered beneficiary who has other primary health insurance coverage includes any covered beneficiary who has primary health insurance coverage— on the date of enrollment with a designated provider pursuant to paragraph (2)(A)(i); or on such date of enrollment and during the period after such date while the beneficiary is enrolled with the designated provider.

(“(e) Special Rule for Medicare-Eligible Beneficiaries.— Except as provided in paragraph (2), if a covered beneficiary who desires to enroll in the managed care program of a designated provider is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.), the covered beneficiary shall elect whether to receive health care services as an enrollee or under part A of title XVIII of the Social Security Act. The Secretary may disenroll an enrollee who subsequently violates the election made under this subsection and receives benefits under part A of title XVIII of the Social Security Act. After September 30, 2012 , a covered beneficiary (other than a beneficiary under section 1079 of title 10 , United States Code) who is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act [ 42 U.S.C. 1395c et seq.] due to age may not enroll in the managed care program of a designated provider unless the beneficiary was enrolled in that program on September 30, 2012 .

(“(f) Information Regarding Eligible Covered Beneficiaries.— The Secretary shall provide, in a timely manner, a designated provider with an accurate list of covered beneficiaries within the marketing area of the designated provider to whom the designated provider may offer enrollment.

(“(g) Open Enrollment Demonstration Program.— The Secretary of Defense shall conduct a demonstration program under which covered beneficiaries shall be permitted to enroll at any time in a managed care plan offered by a designated provider consistent with the enrollment requirements for the TRICARE Prime option under the TRICARE program, but without regard to the limitation in subsection (b). The demonstration program under this subsection shall cover designated providers, selected by the Secretary of Defense, and the service areas of the designated providers. The demonstration program carried out under this section shall commence on October 1, 1999 , and end on September 30, 2001 . Not later than March 15, 2001 , the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the demonstration program carried out under this subsection. The report shall include, at a minimum, an evaluation of the benefits of the open enrollment opportunity to covered beneficiaries and a recommendation on whether to authorize open enrollments in the managed care plans of designated providers permanently.

“SEC. 725 APPLICATION OF CHAMPUS PAYMENT RULES.

(“(a) Application of Payment Rules.— Subject to subsection (b), the Secretary shall require a private facility or health care provider that is a health care provider under the Civilian Health and Medical Program of the Uniformed Services to apply the payment rules described in section 1074(c) of title 10 , United States Code, in imposing charges for health care that the private facility or provider provides to enrollees of a designated provider.

(“(b) Authorized Adjustments.— The payment rules imposed under subsection (a) shall be subject to such modifications as the Secretary considers appropriate. The Secretary may authorize a lower rate than the maximum rate that would otherwise apply under subsection (a) if the lower rate is agreed to by the designated provider and the private facility or health care provider.

(“(c) Regulations.— The Secretary shall prescribe regulations to implement this section after consultation with the other administering Secretaries.

(“(d) Conforming Amendment.—

“SEC. 726 PAYMENTS FOR SERVICES.

(“(a) Form of Payment.— Unless otherwise agreed to by the Secretary and a designated provider, the form of payment for health care services provided by a designated provider shall be on a full risk capitation payment basis. The capitation payments shall be negotiated and agreed upon by the Secretary and the designated provider. In addition to such other factors as the parties may agree to apply, the capitation payments shall be based on the utilization experience of enrollees and competitive market rates for equivalent health care services for a comparable population to such enrollees in the area in which the designated provider is located.

(“(b) Limitation on Total Payments.— Total capitation payments for health care services to a designated provider shall not exceed an amount equal to the cost that would have been incurred by the Government if the enrollees had received such health care services through a military treatment facility, the TRICARE program, or the Medicare program, as the case may be. In establishing the ceiling rate for enrollees with the designated providers who are also eligible for the Civilian Health and Medical Program of the Uniformed Services, the Secretary of Defense shall take into account the health status of the enrollees.

(“(c) Establishment of Payment Rates on Annual Basis.— The Secretary and a designated provider shall establish capitation payments on an annual basis, subject to periodic review for actuarial soundness and to adjustment for any adverse or favorable selection reasonably anticipated to result from the design of the program under this subtitle.

(“(d) Alternative Basis for Calculating Payments.— After September 30, 1999 , the Secretary and a designated provider may mutually agree upon a new basis for calculating capitation payments.

“SEC. 727 REPEAL OF SUPERSEDED AUTHORITIES.

(“(a) Repeals.—

(“(b) Effective Date.— The amendments made by paragraphs (1), (2), and (3) of subsection (a) shall take effect on October 1, 1997 .”

§ 1073a Contracts for health care: best value contracting

(a) Authority.— Under regulations prescribed by the administering Secretaries, health care contracts shall be awarded in the administration of this chapter to the offeror or offerors that will provide the best value to the United States to the maximum extent consistent with furnishing high-quality health care in a manner that protects the fiscal and other interests of the United States.

(b) Factors Considered.— In the determination of best value under subsection (a)— consideration shall be given to the factors specified in the regulations; and greater weight shall be accorded to technical and performance-related factors than to cost and price-related factors.

(c) Applicability.— The authority under the regulations prescribed under subsection (a) shall apply to any contract in excess of $5,000,000.

§ 1073b Recurring reports and publication of certain data

(a) Annual Report on Recording of Health Assessment Data in Military Health Records.— The Secretary of Defense shall issue each year a report on the compliance by the military departments with applicable law and policies on the recording of health assessment data in military health records, including compliance with section 1074f(c) of this title . The report shall cover the calendar year preceding the year in which the report is submitted and include a discussion of the extent to which immunization status and predeployment and postdeployment health care data are being recorded in such records.

(b) Publication of Data on Patient Safety, Quality of Care, Satisfaction, and Health Outcome Measures.— The Secretary of Defense shall publish on a publically available Internet website of the Department of Defense data on all measures that the Secretary considers appropriate that are used by the Department to assess patient safety, quality of care, patient satisfaction, and health outcomes for health care provided under the TRICARE program at each military medical treatment facility. Such data shall include the core quality performance metrics adopted by the Secretary under section 728 of the National Defense Authorization Act for Fiscal Year 2017. The Secretary shall publish an update to the data published under paragraph (1) not less frequently than once each quarter during each fiscal year. The Secretary may not include data relating to risk management activities of the Department in any publication under paragraph (1) or update under paragraph (2). The Secretary shall ensure that the data published under paragraph (1) and updated under paragraph (2) is accessible to the public through the primary Internet website of the Department and the primary Internet website of the military medical treatment facility with respect to which such data applies.

§ 1073c Administration of Defense Health Agency and military medical treatment facilities

(a) Director of the Defense Health Agency.— There is in the Defense Health Agency a Director. The Director of the Defense Health Agency shall— be a military officer and hold a rank that is the same or greater than the rank of any officer serving as the Surgeon General of a military department under section 7036, 8031, or 9036 of this title; and have joint experience.

(b) Administration of Military Medical Treatment Facilities.— In accordance with paragraph (5), the Director of the Defense Health Agency shall be responsible for the administration of each military medical treatment facility, including with respect to— provision and delivery of health care within each such facility; management of privileging, scope of practice, and quality of health care provided within each such facility; budgetary matters; information technology; health care administration and management; supply and equipment; administrative policy and procedure; military medical construction; and any other matters the Secretary of Defense determines appropriate. In addition to the responsibilities set forth in paragraph (1), the Director of the Defense Health Agency shall have the authority— to direct, control, and serve as the primary rater of the performance of commanders or directors of military medical treatment facilities; to direct and control any intermediary organizations between the Defense Health Agency and military medical treatment facilities; to determine the scope of medical care provided at each military medical treatment facility to meet the military personnel readiness requirements of the senior military operational commander of the military installation; to identify the capacity of each military medical treatment facility to support clinical readiness standards of health care providers established by the Secretary of a military department or the Assistant Secretary of Defense for Health Affairs; to determine total workforce requirements at each military medical treatment facility; to determine, in coordination with each Secretary of a military department, manning, including joint manning, assigned to military medical treatment facilities and intermediary organizations; to select, after considering nominations from the Secretaries of the military departments, commanders or directors of military medical treatment facilities; to address personnel staffing shortages at military medical treatment facilities; and to select among service nominations for commanders or directors of military medical treatment facilities. The military commander or director of each military medical treatment facility shall be responsible for— on behalf of the military departments, ensuring the readiness of the members of the armed forces at such facility; and on behalf of the Defense Health Agency, furnishing the health care and medical treatment provided at such facility. If the Secretary of Defense determines it appropriate, a military director (or any other senior military officer or officers) of a military medical treatment facility may be a commanding officer for purposes of chapter 47 of this title (the Uniform Code of Military Justice) with respect to military personnel assigned to the military medical treatment facility. The Secretary of Defense shall establish a timeline to ensure that each Secretary of a military department transitions the administration of military medical treatment facilities from such Secretary to the Director of the Defense Health Agency pursuant to paragraph (1) by the date specified in such paragraph. The Secretary of Defense shall establish within the Defense Health Agency a professional staff to provide policy, oversight, and direction to carry out paragraphs (1) and (2). The Secretary shall carry out this paragraph by appointing the positions specified in subsections (c) and (d).

(c) DHA Assistant Director.— There is in the Defense Health Agency an Assistant Director for Health Care Administration. The Assistant Director shall— be a career appointee within the Department; and report directly to the Director of the Defense Health Agency. The Assistant Director shall be appointed from among individuals who have the education and experience to perform the responsibilities of the position. The Assistant Director shall be responsible for the following: Establishing priorities for health care administration and management. Establishing policies, procedures, and direction for the provision of direct care at military medical treatment facilities. Establishing priorities for budgeting matters with respect to the provision of direct care at military medical treatment facilities. Establishing policies, procedures, and direction for clinic management and operations at military medical treatment facilities. Establishing priorities for information technology at and between the military medical treatment facilities.

(d) DHA Deputy Assistant Directors.— There is in the Defense Health Agency a Deputy Assistant Director for Information Operations. The Deputy Assistant Director for Information Operations shall be responsible for policies, management, and execution of information technology operations at and between the military medical treatment facilities. There is in the Defense Health Agency a Deputy Assistant Director for Financial Operations. The Deputy Assistant Director for Financial Operations shall be responsible for the policy, procedures, and direction of budgeting matters and financial management with respect to the provision of direct care at military medical treatment facilities. There is in the Defense Health Agency a Deputy Assistant Director for Health Care Operations. The Deputy Assistant Director for Health Care Operations shall be responsible for the policy, procedures, and direction of health care administration in the military medical treatment facilities. There is in the Defense Health Agency a Deputy Assistant Director for Medical Affairs. The Deputy Assistant Director for Medical Affairs shall be responsible for policy, procedures, and direction of clinical quality and process improvement, patient safety, infection control, graduate medical education, clinical integration, utilization review, risk management, patient experience, and civilian physician recruiting at military medical treatment facilities. Each Deputy Assistant Director appointed under paragraph (3) or (4) shall report directly to the Assistant Director for Health Care Administration.

(e) Certain Responsibilities of DHA Director.— In addition to the other duties of the Director of the Defense Health Agency, the Director shall coordinate with the Joint Staff Surgeon to ensure that the Director most effectively carries out the responsibilities of the Defense Health Agency as a combat support agency under section 193 of this title . The responsibilities of the Director shall include the following: Ensuring that the Defense Health Agency meets the operational needs of the commanders of the combatant commands. Coordinating with the military departments to ensure that the staffing at the military medical treatment facilities supports readiness requirements for members of the armed forces and health care personnel. Ensuring that the Defense Health Agency meets the military medical readiness requirements of the senior military operational commanders of the military installations.

(f) Additional DHA Organizations.— Subject to subsection (g), the Secretary of Defense shall, acting though the Director of the Defense Health Agency, establish within the Defense Health Agency the following: A subordinate organization, to be called the Defense Health Agency Research and Development— led, at the election of the Director, by a director or commander (to be called the Director or Commander of Defense Health Agency Research and Development); comprised of the Army Medical Research and Materiel Command and such other medical research organizations and activities of the armed forces as the Secretary considers appropriate; and responsible for coordinating funding for Defense Health Program Research, Development, Test, and Evaluation, the Congressionally Directed Medical Research Program, and related Department of Defense medical research. A subordinate organization, to be called the Defense Health Agency Public Health— led, at the election of the Director, by a director or commander (to be called the Director or Commander of Defense Health Agency Public Health); and comprised of the Army Public Health Center, the Navy–Marine Corps Public Health Center, Air Force public health programs, and any other related defense health activities that the Secretary considers appropriate, including overseas laboratories focused on preventive medicine, environmental health, and similar matters.

(g) Exception to Establishment of Additional DHA Organizations.— At the discretion of the Secretary of Defense, a military department may retain a function that would otherwise be transferred to the Defense Health Agency under subsection (f) if the Secretary of Defense determines the function— addresses a need that is unique to the military department; and is in direct support of operating forces and necessary to execute strategies relating to national security and defense.

(h) Consultations on Medical Research of Military Departments.— In establishing the Defense Health Agency Research and Development pursuant to subsection (f)(1), and on a basis that is not less frequent than semiannually thereafter, the Secretary of Defense shall carry out recurring consultations with each military department regarding the plans and requirements for military medical research organizations and activities of the military department.

(i) Treatment of Department of Defense for Purposes of Personnel Assignment.— In implementing this section— the Department of Defense shall be considered a single agency for purposes of civilian personnel assignment under title 5; and the Secretary of Defense may reassign any employee of a component of the Department of Defense or a military department in a position in the civil service (as defined in section 2101 of title 5 ) to any other component of the Department of Defense or military department.

(j) Rule of Construction Regarding Secretaries Concerned and Medical Evaluation Boards.— Nothing in this section shall be construed as transferring to the Director of the Defense Health Agency, or otherwise revoking, any authority or responsibility of the Secretary concerned under chapter 61 of this title with respect to a member of the armed forces (including with respect to the administration of morale and welfare and the determination of fitness for duty for the member) while the member is being considered by a medical evaluation board.

(k) Definitions.— In this section: The term “career appointee” has the meaning given that term in section 3132(a)(4) of title 5 . The term “Defense Health Agency” means the Defense Agency established pursuant to Department of Defense Directive 5136.13, or such successor Defense Agency. The term “military medical treatment facility” means— any fixed facility of the Department of Defense that is outside of a deployed environment and used primarily for health care; and any other location used for purposes of providing health care services as designated by the Secretary of Defense.

§ 1073d Military medical treatment facilities

(a) In General.— To support the medical readiness of the armed forces and the readiness of medical personnel, the Secretary of Defense, in consultation with the Secretaries of the military departments, shall maintain the military medical treatment facilities described in subsections (b), (c), and (d).

(b) Medical Centers.— The Secretary of Defense shall maintain medical centers in areas with a large population of members of the armed forces and covered beneficiaries. Medical centers shall serve as referral facilities for members and covered beneficiaries who require comprehensive health care services that support medical readiness. Medical centers shall consist of the following: Inpatient and outpatient tertiary care facilities that incorporate specialty and subspecialty care. Graduate medical education programs. Residency training programs. Level one, level two, or level three trauma care capabilities. The Secretary shall designate certain major medical centers as regional centers of excellence for the provision of specialty care services in the areas of specialty care described in subparagraph (D). A major medical center may be designated as a center of excellence under this subparagraph for more than one such area of specialty care. The Secretary may designate certain medical centers as satellite centers of excellence for the provision of specialty care services for specific conditions, such as the following: Post-traumatic stress. Traumatic brain injury. Such other conditions as the Secretary determines appropriate. Centers of excellence designated under this paragraph shall serve the purposes of— ensuring the military medical force readiness of the Department of Defense and the medical readiness of the armed forces; improving the quality of health care furnished by the Secretary to eligible beneficiaries; and improving health outcomes for eligible beneficiaries. The areas of specialty care described in this subparagraph are as follows: Oncology. Burn injuries and wound care. Rehabilitation medicine. Psychological health and traumatic brain injury. Amputations and prosthetics. Neurosurgery. Orthopedic care. Substance abuse. Infectious diseases and preventive medicine. Cardiothoracic surgery. Such other areas of specialty care as the Secretary determines appropriate. Centers of excellence designated under this paragraph shall be the primary source within the military health system for the receipt by eligible beneficiaries of specialty care. Eligible beneficiaries seeking a specialty care service through the military health system shall be referred to a center of excellence designated under subparagraph (A) for that area of specialty care or, if the specialty care service sought is unavailable at such center, to an appropriate specialty care provider in the private sector. Not later than 90 days prior to the designation of a center of excellence under this paragraph, the Secretary shall notify the Committees on Armed Services of the House of Representatives and the Senate of such designation. In this paragraph, the term “eligible beneficiary” means any beneficiary under this chapter. The Secretary of Defense shall designate and maintain certain military medical treatment facilities as core casualty receiving facilities, to ensure the medical capability and capacity required to diagnose, treat, and rehabilitate large volumes of combat casualties and, as may be directed by the President or the Secretary, provide a medical response to events the President determines or declares as natural disasters, mass casualty events, or other national emergencies. The Secretary shall ensure that the military medical treatment facilities selected for designation pursuant to subparagraph (A) are geographically located to facilitate the aeromedical evacuation of casualties from theaters of operations. The Secretary— shall ensure that the Secretaries of the military departments assign military personnel to core casualty receiving facilities designated under subparagraph (A) at not less than 90 percent of the staffing level required to maintain the operating bed capacity necessary to support operation planning requirements; may augment the staffing of military personnel at core casualty receiving facilities under subparagraph (A) with civilian employees of the Department of Defense to fulfill the staffing requirement under clause (i); and shall ensure that each core casualty receiving facility under subparagraph (A) is staffed with a civilian Chief Financial Officer and a civilian Chief Operating Officer with experience in the management of civilian hospital systems, for the purpose of ensuring continuity in the management of the facility. In this paragraph: The term “core casualty receiving facility” means a Role 4 medical treatment facility that serves as a medical hub for the receipt and treatment of casualties, including civilian casualties, that may result from combat or from an event the President determines or declares as a natural disaster, mass casualty event, or other national emergency. The term “Role 4 medical treatment facility” means a medical treatment facility that provides the full range of preventative, curative, acute, convalescent, restorative, and rehabilitative care.

(c) Hospitals.— The Secretary of Defense shall maintain hospitals in areas where civilian health care facilities are unable to support the health care needs of members of the armed forces and covered beneficiaries. Hospitals shall provide— inpatient and outpatient health services to maintain medical readiness; and such other programs and functions as the Secretary determines appropriate. Hospitals shall consist of inpatient and outpatient care facilities with limited specialty care that the Secretary determines— is cost effective; or is not available at civilian health care facilities in the area of the hospital.

(d) Ambulatory Care Centers.— The Secretary of Defense shall maintain ambulatory care centers in areas where civilian health care facilities are able to support the health care needs of members of the armed forces and covered beneficiaries. Ambulatory care centers shall provide the outpatient health services required to maintain medical readiness, including with respect to partnerships established pursuant to section 706 of the National Defense Authorization Act for Fiscal Year 2017. Ambulatory care centers shall consist of outpatient care facilities with limited specialty care that the Secretary determines— is cost effective; or is not available at civilian health care facilities in the area of the ambulatory care center.

(e) Maintenance of Inpatient Capabilities at Military Medical Treatment Facilities Located Outside the United States.— In carrying out subsection (a), the Secretary of Defense shall ensure that each covered facility maintains, at a minimum, inpatient capabilities that the Secretary determines are similar to the inpatient capabilities of such facility on September 30, 2016 . The Secretary may not eliminate the inpatient capabilities of a covered facility until the day that is 180 days after the Secretary provides a briefing to the Committees on Armed Services of the Senate and the House of Representatives regarding the proposed elimination. During any such briefing, the Secretary shall certify the following: The Secretary has entered into agreements with hospitals or medical centers in the host nation of such covered facility that— replace the inpatient capabilities the Secretary proposes to eliminate; and ensure members of the armed forces and covered beneficiaries who receive health care from such covered facility, have, within a distance the Secretary determines is reasonable, access to quality health care, including case management and translation services. The Secretary has consulted with the commander of the geographic combatant command in which such covered facility is located to ensure that the proposed elimination would have no impact on the operational plan for such geographic combatant command. Before the Secretary eliminates the inpatient capabilities of such covered facility, the Secretary shall provide each member of the armed forces or covered beneficiary who receives health care from the covered facility with— a transition plan for continuity of health care for such member or covered beneficiary; and a public forum to discuss the concerns of the member or covered beneficiary regarding the proposed reduction. In this subsection, the term “covered facility” means a military medical treatment facility located outside the United States.

(f) Notification Required to Modify Scope of Services Provided at Military Medical Treatment Facilities.— The Secretary of Defense may not modify the scope of medical care provided at a military medical treatment facility, or the beneficiary population served at the facility, unless— the Secretary submits to the Committees on Armed Services of the House of Representatives and the Senate a notification of the proposed modification in scope; a period of 180 days has elapsed following the date on which the Secretary submits such notification; and if the proposed modification in scope involves the termination or reduction of inpatient capabilities at a military medical treatment facility located outside the United States, the Secretary has provided to each member of the armed forces or covered beneficiary receiving services at such facility a transition plan for the continuity of health care for such member or covered beneficiary. Each notification under paragraph (1) shall contain, with respect to the military medical treatment facility for which the modification in scope has been proposed, the following: An endorsement from the Chairman of the Joint Chiefs of Staff that the proposed modification will have no effect on operational requirements of the armed forces. An endorsement from the Surgeon General of the military department concerned that the proposed modification will have no effect on the training or readiness of military medical personnel in the military department concerned. An assessment from the Director of the Defense Health Agency that explains how members of the armed forces and covered beneficiaries receiving services at the facility will continue to receive care.

§ 1073e Protection of armed forces from infectious diseases

(a) Protection.— The Secretary of Defense shall develop and implement a plan to ensure that the armed forces have the diagnostic equipment, testing capabilities, and personal protective equipment necessary to protect members of the armed forces from the threat of infectious diseases and to treat members who contract infectious diseases.

(b) Requirements.— In carrying out subsection (a), the Secretary shall ensure the following: Each military medical treatment facility has the testing capabilities described in such subsection, as appropriate for the mission of the facility. Each deployed naval vessel has access to the testing capabilities described in such subsection. Members of the armed forces deployed in support of a contingency operation outside of the United States have access to the testing capabilities described in such subsection, including at field hospitals, combat support hospitals, field medical stations, and expeditionary medical facilities. The Department of Defense maintains— a 30-day supply of personal protective equipment in a quantity sufficient for each member of the armed forces, including the reserve components thereof; and the capability to rapidly resupply such equipment.

(c) Research and Development.— The Secretary shall include with the defense budget materials (as defined by section 231(f) 1 of this title) for a fiscal year a plan to research and develop vaccines, diagnostics, and therapeutics for infectious diseases. The Secretary shall ensure that the medical laboratories of the Department of Defense are equipped with the technology needed to facilitate rapid research and development of vaccines, diagnostics, and therapeutics in the case of a pandemic.

§ 1073f Health care fraud and abuse prevention program

(a) Program Authorized.— The Secretary of Defense may carry out a program under this section to prevent and remedy fraud and abuse in the health care programs of the Department of Defense. At the discretion of the Secretary, such program may be administered jointly by the Inspector General of the Department of Defense and the Director of the Defense Health Agency. In carrying out such program, the authorities granted to the Secretary of Defense and the Inspector General of the Department of Defense under section 1128A(m) of the Social Security Act ( 42 U.S.C. 1320a–7a(m) ) shall be available to the Secretary and the Inspector General.

(b) Civil Monetary Penalties.— Except as provided in paragraph (2), the provisions of section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7a ) shall apply with respect to any civil monetary penalty imposed in carrying out the program authorized under subsection (a). Consistent with section 1079a of this title , amounts recovered in connection with any such civil monetary penalty imposed— shall be credited to appropriations available as of the time of the collection for expenses of the health care program of the Department of Defense affected by the fraud and abuse for which such penalty was imposed; and may be used to support the administration of the program authorized under subsection (a), including to support any interagency agreements entered into under subsection (d).

(c) Interagency Agreements.— The Secretary of Defense may enter into agreements with the Secretary of Health and Human Services, the Attorney General, or the heads of other Federal agencies, for the effective and efficient implementation of the program authorized under subsection (a).

(d) Rule of Construction.— Joint administration of the program authorized under subsection (a) may not be construed as limiting the authority of the Inspector General of the Department of Defense under any other provision of law.

(e) Fraud and Abuse Defined.— In this section, the term “fraud and abuse” means any conduct specified in subsection (a) or (b) of section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7a ).

§ 1074 Medical and dental care for members and certain former members

(a) Under joint regulations to be prescribed by the administering Secretaries, a member of a uniformed service described in paragraph (2) is entitled to medical and dental care in any facility of any uniformed service. Members of the uniformed services referred to in paragraph (1) are as follows: A member of a uniformed service on active duty. A member of a reserve component of a uniformed service who has been commissioned as an officer if— the member has requested orders to active duty for the member’s initial period of active duty following the commissioning of the member as an officer; the request for orders has been approved; the orders are to be issued but have not been issued or the orders have been issued but the member has not entered active duty; and the member does not have health care insurance and is not covered by any other health benefits plan.

(b) Under joint regulations to be prescribed by the administering Secretaries, a member or former member of a uniformed service who is entitled to retired or retainer pay, or equivalent pay may, upon request, be given medical and dental care in any facility of any uniformed service, subject to the availability of space and facilities and the capabilities of the medical and dental staff. The administering Secretaries may, with the agreement of the Secretary of Veterans Affairs, provide care to persons covered by this subsection in facilities operated by the Secretary of Veterans Affairs and determined by him to be available for this purpose on a reimbursable basis at rates approved by the President. Paragraph (1) does not apply to a member or former member entitled to retired pay for non-regular service under chapter 1223 of this title who is under 60 years of age.

(c) Funds appropriated to a military department, the Department of Homeland Security (with respect to the Coast Guard when it is not operating as a service in the Navy), or the Department of Health and Human Services (with respect to the National Oceanic and Atmospheric Administration and the Public Health Service) may be used to provide medical and dental care to persons entitled to such care by law or regulations, including the provision of such care (other than elective private treatment) in private facilities for members of the uniformed services. If a private facility or health care provider providing care under this subsection is a health care provider under the Civilian Health and Medical Program of the Uniformed Services, the Secretary of Defense, after consultation with the other administering Secretaries, may by regulation require the private facility or health care provider to provide such care in accordance with the same payment rules (subject to any modifications considered appropriate by the Secretary) as apply under that program. Subject to such exceptions as the Secretary of Defense considers necessary, coverage for medical care for members of the uniformed services under this subsection, and standards with respect to timely access to such care, shall be comparable to coverage for medical care and standards for timely access to such care under the managed care option of the TRICARE program known as TRICARE Prime. The Secretary of Defense shall enter into arrangements with contractors under the TRICARE program or with other appropriate contractors for the timely and efficient processing of claims under this subsection. The Secretary of Defense shall consult with the other administering Secretaries in the administration of this paragraph. A member of the uniformed services described in subparagraph (B) may not be required to receive routine primary medical care at a military medical treatment facility. A member referred to in subparagraph (A) is a member of the uniformed services on active duty who is entitled to medical care under this subsection and who— receives a duty assignment described in subparagraph (C); and pursuant to the assignment of such duty, resides at a location that is more than 50 miles, or approximately one hour of driving time, from the nearest military medical treatment facility adequate to provide the needed care. A duty assignment referred to in subparagraph (B) means any of the following: Permanent duty as a recruiter. Permanent duty at an educational institution to instruct, administer a program of instruction, or provide administrative services in support of a program of instruction for the Reserve Officers’ Training Corps. Permanent duty as a full-time adviser to a unit of a reserve component. Any other permanent duty designated by the Secretary concerned for purposes of this paragraph. Subject to such terms and conditions as the Secretary of Defense considers appropriate, coverage comparable to that provided by the Secretary under subsections (d) and (e) of section 1079 of this title shall be provided under this subsection to members of the uniformed services who incur a serious injury or illness on active duty as defined by regulations prescribed by the Secretary. The Secretary of Defense shall prescribe in regulations— the individuals who shall be treated as the primary caregivers of a member of the uniformed services for purposes of this paragraph; and the definition of serious injury or illness for the purposes of this paragraph.

(d) For the purposes of this chapter, a member of a reserve component of the armed forces who is issued a delayed-effective-date active-duty order, or is covered by such an order, shall be treated as being on active duty for a period of more than 30 days beginning on the later of the date that is— the date of the issuance of such order; or 180 days before the date on which the period of active duty is to commence under such order for that member. In this subsection, the term “delayed-effective-date active-duty order” means an order to active duty for a period of more than 30 days under section 12304b of this title or a provision of law referred to in section 101(a)(13)(B) of this title that provides for active-duty service to begin under such order on a date after the date of the issuance of the order.

“SEC. 761 DEFINITIONS.

“For purposes of this subtitle [subtitle F (§§ 761–771) of title VII of Pub. L. 105–85 , enacting sections 1074e, 1074f, and 1107 of this title and this note]: The term ‘Gulf War illness’ means any one of the complex of illnesses and symptoms that might have been contracted by members of the Armed Forces as a result of service in the Southwest Asia theater of operations during the Persian Gulf War. The term ‘Persian Gulf War’ has the meaning given that term in section 101 of title 38 , United States Code. The term ‘Persian Gulf veteran’ means an individual who served on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War. The term ‘contingency operation’ has the meaning given that term in section 101(a) of title 10 , United States Code, and includes a humanitarian operation, peacekeeping operation, or similar operation.

“SEC. 762 PLAN FOR HEALTH CARE SERVICES FOR PERSIAN GULF VETERANS.

(“(a) Plan Required.— The Secretary of Defense and the Secretary of Veterans Affairs, acting jointly, shall prepare a plan to provide appropriate health care to Persian Gulf veterans (and dependents eligible by law) who suffer from a Gulf War illness.

(“(b) Contents of Plan.— In preparing the plan, the Secretaries shall— use the presumptions of service connection and illness specified in paragraphs (1) and (2) of section 721(d) of the National Defense Authorization Act for Fiscal Year 1995 ( Public Law 103–337 ; 10 U.S.C. 1074 note) to determine the Persian Gulf veterans (and dependents eligible by law) who should be covered by the plan; consider the need and methods available to provide health care services to Persian Gulf veterans who are no longer on active duty in the Armed Forces, such as Persian Gulf veterans who are members of the reserve components and Persian Gulf veterans who have been separated from the Armed Forces; and estimate the costs to the Government of providing full or partial health care services under the plan to covered Persian Gulf veterans (and covered dependents eligible by law).

(“(c) Follow-up Treatment.— The plan required by subsection (a) shall specifically address the measures to be used to monitor the quality, appropriateness, and effectiveness of, and patient satisfaction with, health care services provided to Persian Gulf veterans after their initial medical examination as part of registration in the Persian Gulf War Veterans Health Registry or the Comprehensive Clinical Evaluation Program.

(“(d) Submission of Plan.— Not later than March 1, 1998 , the Secretaries shall submit to Congress the plan required by subsection (a).

“SEC. 770 PERSIAN GULF ILLNESS CLINICAL TRIALS PROGRAM.

(“(a) Findings.— Congress finds the following: There are many ongoing studies that investigate risk factors which may be associated with the health problems experienced by Persian Gulf veterans; however, there have been no studies that examine health outcomes and the effectiveness of the treatment received by such veterans. The medical literature and testimony presented in hearings on Gulf War illnesses indicate that there are therapies, such as cognitive behavioral therapy, that have been effective in treating patients with symptoms similar to those seen in many Persian Gulf veterans.

(“(b) Establishment of Program.— The Secretary of Defense and the Secretary of Veterans Affairs, acting jointly, shall establish a program of cooperative clinical trials at multiple sites to assess the effectiveness of protocols for treating Persian Gulf veterans who suffer from ill-defined or undiagnosed conditions. Such protocols shall include a multidisciplinary treatment model, of which cognitive behavioral therapy is a component.

(“(c) Funding.— Of the funds authorized to be appropriated in section 201(1) [ 111 Stat. 1655 ] for research, development, test, and evaluation for the Army, the sum of $4,500,000 shall be available for program element 62787A (medical technology) in the budget of the Department of Defense for fiscal year 1998 to carry out the clinical trials program established pursuant to subsection (b).”

“SEC. 721 PROGRAMS RELATED TO DESERT STORM MYSTERY ILLNESS.

(“(a) Outreach Program to Persian Gulf Veterans and Families.— The Secretary of Defense shall institute a comprehensive outreach program to inform members of the Armed Forces who served in the Southwest Asia theater of operations during the Persian Gulf Conflict, and the families of such members, of illnesses that may result from such service. The program shall be carried out through both medical and command channels, as well as any other means the Secretary considers appropriate. Under the program, the Secretary shall— inform such individuals regarding— common disease symptoms reported by Persian Gulf veterans that may be due to service in the Southwest Asia theater of operations; blood donation policy; available counseling and medical care for such members; and possible health risks to children of Persian Gulf veterans; inform such individuals of the procedures for registering in either the Persian Gulf Veterans Health Surveillance System of the Department of Defense or the Persian Gulf War Health Registry of the Department of Veterans Affairs; and encourage such members to report any symptoms they may have and to register in the appropriate health surveillance registry.

(“(b) Incentives to Persian Gulf Veterans To Register.— In order to encourage Persian Gulf veterans to register any symptoms they may have in one of the existing health registries, the Secretary of Defense shall provide the following: For any Persian Gulf veteran who is on active duty and who registers with the Department of Defense’s Persian Gulf War Veterans Health Surveillance System, a full medical evaluation and any required medical care. For any Persian Gulf War veteran who is, as of the date of the enactment of this Act [ Oct. 5, 1994 ], a member of a reserve component, opportunity to register at a military medical facility in the Persian Gulf Veterans Health Care Surveillance System and, in the case of a Reserve who registers in that registry, a full medical evaluation by the Department of Defense. Depending on the results of the evaluation and on eligibility status, reserve personnel may be provided medical care by the Department of Defense. For a Persian Gulf veteran who is not, as of the date of the enactment of this Act [ Oct. 5, 1994 ], on active duty or a member of a reserve component, assistance and information at a military medical facility on registering with the Persian Gulf War Registry of the Department of Veterans Affairs and information related to support services provided by the Department of Veterans Affairs.

(“(c) Compatibility of Department of Defense and Department of Veterans Affairs Registries.— The Secretary of Defense shall take appropriate actions to ensure— that the data collected by and the testing protocols of the Persian Gulf War Health Surveillance System maintained by the Department of Defense are compatible with the data collected by and the testing protocols of the Persian Gulf War Veterans Health Registry maintained by the Department of Veterans Affairs; and that all information on individuals who register with the Department of Defense for purposes of the Persian Gulf War Health Surveillance System is provided to the Secretary of Veterans Affairs for incorporation into the Persian Gulf War Veterans Health Registry.

(“(d) Presumptions on Behalf of Service Member.— A member of the Armed Forces who is a Persian Gulf veteran, who has symptoms of illness, and who the Secretary concerned finds may have become ill as a result of serving on active duty in the Southwest Asia theater of operations during the Persian Gulf War shall be considered for Department of Defense purposes to have become ill as a result of serving in that theater of operations. A member of the Armed Forces who is a Persian Gulf veteran and who reports being ill as a result of serving on active duty in the Southwest Asia theater of operations during the Persian Gulf War shall be considered for Department of Defense purposes to have become ill as a result of serving in that theater of operations until such time as the weight of medical evidence establishes other cause or causes of the member’s illness. The Secretary concerned shall ensure that, for the purposes of health care treatment by the Department of Defense, health care and personnel administration, and disability evaluation by the Department of Defense, the symptoms of any member of the Armed Forces covered by paragraph (1) or (2) are examined in light of the member’s service in the Persian Gulf War and in light of the reported symptoms of other Persian Gulf veterans. The Secretary shall ensure that, in providing health care diagnosis and treatment of the member, a broad range of potential causes of the member’s symptoms are considered and that the member’s symptoms are considered collectively, as well as by type of symptom or medical specialty, and that treatment across medical specialties is coordinated appropriately. The Secretary of Defense shall ensure that the presumptions of service connection and illness specified in paragraphs (1) and (2) are incorporated in appropriate service medical and personnel regulations and are widely disseminated throughout the Department of Defense.

(“(e) Revision of the Physical Evaluation Board Criteria.— The Secretary of Defense, in consultation with the Secretary of Veterans Affairs and the Secretary of Health and Human Services, shall ensure that case definitions of Persian Gulf related illnesses, as well as the Physical Evaluation Board criteria used to set disability ratings for members no longer medically qualified for continuation on active duty, are established as soon as possible to permit accurate disability ratings related to a diagnosis of Persian Gulf illnesses. Until revised disability criteria can be implemented and members of the Armed Forces can be rated against those criteria, the Secretary of Defense shall ensure— that any member of the Armed Forces on active duty who may be suffering from a Persian Gulf-related illness is afforded continued military medical care; and that any member of the Armed Forces on active duty who is found by a Physical Evaluation Board to be unfit for continuation on active duty as a result of a Persian Gulf-related illness for which the board has no rating criteria (or inadequate rating criteria) for the illness or condition from which the member suffers is placed on the temporary disability retired list.

(“(f) Review of Records and Rerating of Previously Discharged Gulf War Veterans.— The Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall ensure that a review is made of the health and personnel records of each Persian Gulf veteran who before the date of the enactment of this Act [ Oct. 5, 1994 ] was discharged from active duty, or was medically retired, as a result of a Physical Evaluation Board process. The review under paragraph (1) shall be carried out to ensure that former Persian Gulf veterans who may have been suffering from a Persian Gulf-related illness at the time of discharge or retirement from active duty as a result of the Physical Evaluation Board process are reevaluated in accordance with the criteria established under subsection (e)(1) and, if appropriate, are rerated.

(“(g) Persian Gulf Illness Medical Referral Centers.— The Secretary of Defense shall evaluate the feasibility of establishing one or more medical referral centers to provide uniform, coordinated medical care for Persian Gulf veterans on active duty who are or may be suffering from a Persian Gulf-related illness. The Secretary shall submit a report on such feasibility to the Committees on Armed Services of the Senate and House of Representatives not later than six months after the date of the enactment of this Act [ Oct. 5, 1994 ].

(“[(h) Repealed. Pub. L. 108–136, div. A, title X, § 1031(e) , Nov. 24, 2003 , 117 Stat. 1604 .]

(“(i) Persian Gulf Veteran.— For purposes of this section, a Persian Gulf veteran is an individual who served on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf Conflict.

“SEC. 722 STUDIES OF HEALTH CONSEQUENCES OF MILITARY SERVICE OR EMPLOYMENT IN SOUTHWEST ASIA DURING THE PERSIAN GULF WAR.

(“(a) In General.— The Secretary of Defense, in coordination with the Secretary of Veterans Affairs and the Secretary of Health and Human Services, shall conduct studies and administer grants for studies to determine— the nature and causes of illnesses suffered by individuals as a consequence of service or employment by the United States in the Southwest Asia theater of operations during the Persian Gulf War; and the appropriate treatment for those illnesses.

(“(b) Nature of the Studies.— Studies under subsection (a)— shall include consideration of the range of potential exposure of individuals to environmental, battlefield, and other conditions incident to service in the theater; shall be conducted so as to provide assessments of both short-term and long-term effects to the health of individuals as a result of those exposures; and shall include, at a minimum, the following types of studies: An epidemiological study or studies on the incidence, prevalence, and nature of the illness and symptoms and the risk factors associated with symptoms or illnesses. Studies to determine the health consequences of the use of pyridostigmine bromide as a pretreatment antidote enhancer during the Persian Gulf War, alone or in combination with exposure to pesticides, environmental toxins, and other hazardous substances. Clinical research and other studies on the causes, possible transmission, and treatment of Persian Gulf-related illnesses. The first project carried out under paragraph (1)(C)(ii) shall be a retrospective study of members of the Armed Forces who served in the Southwest Asia theater of operations during the Persian Gulf War. The second project carried out under paragraph (1)(C)(ii) shall consist of animal research and nonanimal research, including in vitro systems, as required, designed to determine whether the use of pyridostigmine bromide in combination with exposure to pesticides or other organophosphates, carbamates, or relevant chemicals will result in increased toxicity in animals and is likely to have a similar effect on humans.

(“(c) Individuals Covered by the Studies.— Studies conducted pursuant to subsections [sic] (a) shall apply to the following individuals: Individuals who served as members of the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War. Individuals who were civilian employees of the Department of Defense in that theater during that period. To the extent appropriate, individuals who were employees of contractors of the Department of Defense in that theater during that period. To the extent appropriate, the spouses and children of individuals described in paragraph (1).

(“(d) Plan for the Studies.— The Secretary of Defense shall prepare a coordinated plan for the studies to be conducted pursuant to subsection (a). The plan shall include plans and requirements for research grants in support of the studies. The Secretary shall submit the plan to the National Academy of Sciences for review and comment. The plan for studies pursuant to subsection (a) shall be updated annually. The Secretary of Defense shall request an annual review by the National Academy of Sciences of the updated plan and study progress and results achieved during the preceding year. The plan, and annual updates to the plan, shall be prepared in coordination with the Secretary of Veterans Affairs and the Secretary of Health and Human Services.

(“(e) Funding.— From the amount authorized to be appropriated pursuant to section 201 [ 108 Stat. 2690 ] for Defense-wide activities, the Secretary of Defense shall make available such funds as the Secretary considers necessary to support the studies conducted pursuant to subsection (a). For each year in which activities continue in support of the studies conducted pursuant to subsection (a), the Secretary of Defense shall include in the budget request for the Department of Defense a request for such funds as the Secretary determines necessary to continue the activities during that fiscal year.

(“(f) Reports.— Not later than March 31, 1995 , the Secretary of Defense shall submit to Congress the coordinated plan for the studies to be conducted pursuant to subsection (a) and the results of the review of that plan by the National Academy of Sciences. Not later than October 1 of each year through 1998, the Secretary shall submit to Congress a report on the results of the studies conducted pursuant to subsection (a), plans for continuation of the studies, and the results of the annual review of the studies by the National Academy of Sciences. Each report under this section shall be prepared in coordination with the Secretary of Veterans Affairs and the Secretary of Health and Human Services.

(“(g) Definition.— In this section, the term ‘Persian Gulf War’ has the meaning given such term in section 101 of title 38 , United States Code.”

§ 1074a Medical and dental care: members on duty other than active duty for a period of more than 30 days

(a) Under joint regulations prescribed by the administering Secretaries, the following persons are entitled to the benefits described in subsection (b): Each member of a uniformed service who incurs or aggravates an injury, illness, or disease in the line of duty while performing— active duty for a period of 30 days or less; inactive-duty training; or service on funeral honors duty under section 12503 of this title or section 115 of title 32 . Each member of a uniformed service who incurs or aggravates an injury, illness, or disease while traveling directly to or from the place at which that member is to perform or has performed— active duty for a period of 30 days or less; inactive-duty training; or service on funeral honors duty under section 12503 of this title or section 115 of title 32 . Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before the commencement of inactive-duty training, or while remaining overnight, between successive periods of inactive-duty training, at or in the vicinity of the site of the inactive-duty training. Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before serving on funeral honors duty under section 12503 of this title or section 115 of title 32 at or in the vicinity of the place at which the member was to so serve, if the place is outside reasonable commuting distance from the member’s residence.

(b) A person described in subsection (a) is entitled to— the medical and dental care appropriate for the treatment of the injury, illness, or disease of that person until the resulting disability cannot be materially improved by further hospitalization or treatment; and subsistence during hospitalization.

(c) A member is not entitled to benefits under subsection (b) if the injury, illness, or disease, or aggravation of an injury, illness, or disease described in subsection (a)(2), is the result of the gross negligence or misconduct of the member.

(d) The Secretary concerned shall provide to members of the Selected Reserve who are assigned to units scheduled for deployment within 75 days after mobilization the following medical and dental services: An annual medical screening. For members who are over 40 years of age, a full physical examination not less often than once every two years. An annual dental screening. The dental care identified in an annual dental screening as required to ensure that a member meets the dental standards required for deployment in the event of mobilization. The services provided under this subsection shall be provided at no cost to the member.

(e) A member of a uniformed service on active duty for health care or recuperation reasons, as described in paragraph (2), is entitled to medical and dental care on the same basis and to the same extent as members covered by section 1074(a) of this title while the member remains on active duty. Paragraph (1) applies to a member described in paragraph (1) or (2) of subsection (a) who, while being treated for (or recovering from) an injury, illness, or disease incurred or aggravated in the line of duty, is continued on active duty pursuant to a modification or extension of orders, or is ordered to active duty, so as to result in active duty for a period of more than 30 days.

(f) At any time after the Secretary concerned notifies members of the Ready Reserve that the members are to be called or ordered to active duty for a period of more than 30 days, the administering Secretaries may provide to each such member any medical and dental screening and care that is necessary to ensure that the member meets the applicable medical and dental standards for deployment. The notification to members of the Ready Reserve described in paragraph (1) shall include notice that the members are eligible for screening and care under this section. A member provided medical or dental screening or care under paragraph (1) may not be charged for the screening or care.

(g) The Secretary concerned may provide to any member of the Selected Reserve not described in subsection (d)(1) or (f), and to any member of the Individual Ready Reserve described in section 10144(b) of this title the medical and dental services specified in subsection (d)(1) if the Secretary determines that the receipt of such services by such member is necessary to ensure that the member meets applicable standards of medical and dental readiness. Services may not be provided to a member under this subsection for a condition that is the result of the member’s own misconduct. The services provided under this subsection shall be provided at no cost to the member.

(h) The Secretary of Defense may provide to any member of the reserve components performing inactive-duty training during scheduled unit training assemblies access to mental health assessments with a licensed mental health professional who shall be available for referrals during duty hours on the premises of the principal duty location of the member’s unit. Mental health services provided to a member under this subsection shall be at no cost to the member.

(i) Amounts available for operation and maintenance of a reserve component of the armed forces may be available for purposes of this section to ensure the medical, dental, and behavioral health readiness of members of such reserve component.

§ 1074b Medical and dental care: Academy cadets and midshipmen; members of, and designated applicants for membership in, Senior ROTC

(a) Eligibility.— Under joint regulations prescribed by the administering Secretaries, the following persons are, except as provided in subsection (c), entitled to the benefits described in subsection (b): A cadet at the United States Military Academy, the United States Air Force Academy, or the Coast Guard Academy, and a midshipman at the United States Naval Academy, who incurs or aggravates an injury, illness, or disease in the line of duty. A member of, and a designated applicant for membership in, the Senior Reserve Officers’ Training Corps who incurs or aggravates an injury, illness, or disease— in the line of duty while performing duties under section 2109 of this title ; while traveling directly to or from the place at which that member or applicant is to perform or has performed duties pursuant to section 2109 of this title ; or in the line of duty while remaining overnight immediately before the commencement of duties performed pursuant to section 2109 of this title or, while remaining overnight, between successive periods of performing duties pursuant to section 2109 of this title , at or in the vicinity of the site of the duties performed pursuant to section 2109 of this title , if the site is outside reasonable commuting distance from the residence of the member or designated applicant.

(b) Benefits.— A person eligible for benefits under subsection (a) for an injury, illness, or disease is entitled to— the medical and dental care under this chapter that is appropriate for the treatment of the injury, illness, or disease until the injury, illness, disease, or any resulting disability cannot be materially improved by further hospitalization or treatment; and meals during hospitalization.

(c) Exception for Gross Negligence or Misconduct.— A person is not entitled to benefits under subsection (b) for an injury, illness, or disease, or the aggravation of an injury, illness, or disease that is a result of the gross negligence or the misconduct of that person.

§ 1074c Medical care: authority to provide a wig

A person entitled to medical care under this chapter who has alopecia resulting from the treatment of a malignant disease may be furnished a wig if the person has not previously been furnished one at the expense of the United States. (Added Pub. L. 98–525, title XIV, § 1401(e)(2)(A) , Oct. 19, 1984 , 98 Stat. 2616 , § 1074b; renumbered § 1074c, Pub. L. 102–190, div. A, title VI, § 640(a)(1) , Dec. 5, 1991 , 105 Stat. 1385 .)

§ 1074d Certain primary and preventive health care services

(a) Services Available.— Female members and former members of the uniformed services entitled to medical care under section 1074 or 1074a of this title shall also be entitled to primary and preventive health care services for women as part of such medical care. The services described in paragraphs (1) and (2) of subsection (b) shall be provided under such procedures and at such intervals as the Secretary of Defense shall prescribe. Male members and former members of the uniformed services entitled to medical care under section 1074 or 1074a of this title shall also be entitled to preventive health care screening for colon or prostate cancer at such intervals and using such screening methods as the administering Secretaries consider appropriate.

(b) Definition.— In this section, the term “primary and preventive health care services for women” means health care services, including related counseling services, provided to women with respect to the following: Cervical cancer screening. Breast cancer screening, including through the use of digital breast tomosynthesis. Comprehensive obstetrical and gynecological care, including care related to pregnancy and the prevention of pregnancy. Infertility and sexually transmitted diseases, including prevention. Menopause, including hormone replacement therapy and counseling regarding the benefits and risks of hormone replacement therapy. Physical or psychological conditions arising out of acts of sexual violence. Gynecological cancers. Colon cancer screening, at the intervals and using the screening methods prescribed under subsection (a)(2).

§ 1074e Medical care: certain Reserves who served in Southwest Asia during the Persian Gulf Conflict

(a) Entitlement to Medical Care.— A member of the armed forces described in subsection (b) is entitled to medical care for a qualifying Persian Gulf symptom or illness to the same extent and under the same conditions (other than the requirement that the member be on active duty) as a member of a uniformed service who is entitled to such care under section 1074(a) of this title .

(b) Covered Members.— Subsection (a) applies to a member of a reserve component who— is a Persian Gulf veteran; has a qualifying Persian Gulf symptom or illness; and is not otherwise entitled to medical care for such symptom or illness under this chapter and is not otherwise eligible for hospital care and medical services for such symptom or illness under section 1710 of title 38 .

(c) Definitions.— In this section: The term “Persian Gulf veteran” means a member of the armed forces who served on active duty in the Southwest Asia theater of operations during the Persian Gulf Conflict. The term “qualifying Persian Gulf symptom or illness” means, with respect to a member described in subsection (b), a symptom or illness— that the member registered before September 1, 1997 , in the Comprehensive Clinical Evaluation Program of the Department of Defense and that is presumed under section 721(d) of the National Defense Authorization Act for Fiscal Year 1995 ( 10 U.S.C. 1074 note) to be a result of service in the Southwest Asia theater of operations during the Persian Gulf Conflict; or that the member registered before September 1, 1997 , in the Persian Gulf War Veterans Health Registry maintained by the Department of Veterans Affairs pursuant to section 702 of the Persian Gulf War Veterans’ Health Status Act ( 38 U.S.C. 527 note).

§ 1074f Medical tracking system for members deployed overseas

(a) System Required.— The Secretary of Defense shall establish a system to assess the medical condition of members of the armed forces (including members of the reserve components) who are deployed outside the United States or its territories or possessions as part of a contingency operation (including a humanitarian operation, peacekeeping operation, or similar operation) or combat operation.

(b) Elements of System.— The system described in subsection (a) shall include the use of predeployment medical examinations and postdeployment medical examinations (including the assessment of mental health and the drawing of blood samples) and postdeployment health reassessments to— accurately record the health status of members before their deployment; accurately record any changes in their health status during the course of their deployment; identify health concerns, including mental health concerns, that may become manifest several months following their deployment; and accurately record any exposure to occupational and environmental health risks during the course of their deployment. The postdeployment medical examination shall be conducted when the member is redeployed or otherwise leaves an area in which the system is in operation (or as soon as possible thereafter). The postdeployment health reassessment shall be conducted at an appropriate time during the period beginning 90 days after the member is redeployed and ending 180 days after the member is redeployed. The predeployment medical examination, postdeployment medical examination, and postdeployment health reassessment of a member of the armed forces required under paragraph (1) shall include the following: An assessment of the current treatment of the member and any use of psychotropic medications by the member for a mental health condition or disorder. An assessment of traumatic brain injury. An assessment of post-traumatic stress disorder. An assessment of whether the member was— based or stationed at a location where an open burn pit, as defined in subsection (c) of section 201 of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 ( Public Law 112–260 ; 38 U.S.C. 527 note), was used; or exposed to toxic airborne chemicals or other airborne contaminants, including any information recorded as part of the registry established by the Secretary of Veterans Affairs under such section 201. The Secretary shall establish for purposes of subparagraphs (B) and (C) of paragraph (2) a protocol for the predeployment assessment and documentation of the cognitive (including memory) functioning of a member who is deployed outside the United States in order to facilitate the assessment of the postdeployment cognitive (including memory) functioning of the member. The protocol under subparagraph (A) shall include appropriate mechanisms to permit the differential diagnosis of traumatic brain injury in members returning from deployment in a combat zone.

(c) Recordkeeping.— The results of all medical examinations and reassessments conducted under the system, records of all health care services (including immunizations and the prescription and administration of psychotropic medications) received by members described in subsection (a) in anticipation of their deployment or during the course of their deployment, and records of events occurring in the deployment area (including the results of any assessment performed by the Secretary of occupational and environmental health risks for such area) that may affect the health of such members shall be retained and maintained in a centralized location to improve future access to the records.

(d) Quality Assurance.— The Secretary of Defense shall establish a quality assurance program to evaluate the success of the system in ensuring that members described in subsection (a) receive predeployment medical examinations, postdeployment medical examinations, and postdeployment health reassessments and that the recordkeeping requirements with respect to the system are met. The quality assurance program established under paragraph (1) shall also include the following elements: The types of healthcare providers conducting postdeployment health assessments and reassessments. The training received by such providers applicable to the conduct of such assessments and reassessments, including training on assessments and referrals relating to mental health. The guidance available to such providers on how to apply the clinical practice guidelines developed under subsection (e)(1) in determining whether to make a referral for further evaluation of a member of the armed forces relating to mental health. The effectiveness of the tracking mechanisms required under this section in ensuring that members who receive referrals for further evaluations relating to mental health receive such evaluations and obtain such care and services as are warranted. Programs established for monitoring the mental health of each member who, after deployment to a combat operation or contingency operations, is known— to have a mental health condition or disorder; or to be receiving treatment, including psychotropic medications, for a mental health condition or disorder. The diagnosis and treatment of traumatic brain injury and post-traumatic stress disorder.

(e) Criteria for Referral for Further Evaluations.— The system described in subsection (a) shall include— development of clinical practice guidelines to be utilized by healthcare providers in determining whether to refer a member of the armed forces for further evaluation relating to mental health (including traumatic brain injury); mechanisms to ensure that healthcare providers are trained in the application of such clinical practice guidelines; and mechanisms for oversight to ensure that healthcare providers apply such guidelines consistently.

(f) Minimum Standards for Deployment.— The Secretary of Defense shall prescribe in regulations minimum standards for mental health for the eligibility of a member of the armed forces for deployment to a combat operation or contingency operation. The standards required by paragraph (1) shall include the following: A specification of the mental health conditions, treatment for such conditions, and receipt of psychotropic medications for such conditions that preclude deployment of a member of the armed forces to a combat operation or contingency operation, or to a specified type of such operation. Guidelines for the deployability and treatment of members of the armed forces diagnosed with a severe mental illness, traumatic brain injury, or post traumatic stress disorder. The Secretary shall take appropriate actions to ensure the utilization of the standards prescribed under paragraph (1) in the making of determinations regarding the deployability of members of the armed forces to a combat operation or contingency operation.

(g) Additional Requirements for Postdeployment Medical Examinations and Health Reassessments.— The Secretary of Defense shall standardize and make available to a provider that conducts a postdeployment medical examination or reassessment under the system described in subsection (a) questions relating to occupational and environmental health exposure. The Secretary, to the extent practicable, shall ensure that the medical record of a member includes information on the external cause relating to a diagnosis of the member, including by associating an external cause code (as issued under the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (or any successor revision)).

§ 1074g Pharmacy benefits program

(a) Pharmacy Benefits.— The Secretary of Defense, after consulting with the other administering Secretaries, shall establish an effective, efficient, integrated pharmacy benefits program under this chapter (hereinafter in this section referred to as the “pharmacy benefits program”). The pharmacy benefits program shall include a uniform formulary of pharmaceutical agents, which shall assure the availability of pharmaceutical agents in the complete range of therapeutic classes. The selection for inclusion on the uniform formulary of particular pharmaceutical agents in each therapeutic class shall be based on the relative clinical and cost effectiveness of the agents in such class. With respect to members of the uniformed services, such uniform formulary shall include pharmaceutical agents on the joint uniform formulary established under section 715 of the National Defense Authorization Act for Fiscal Year 2016. In considering the relative clinical effectiveness of agents under subparagraph (A), the Secretary shall presume inclusion in a therapeutic class of a pharmaceutical agent, unless the Pharmacy and Therapeutics Committee established under subsection (b) finds that a pharmaceutical agent does not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness, or clinical outcome over the other drugs included on the uniform formulary. In considering the relative cost effectiveness of agents under subparagraph (A), the Secretary shall rely on the evaluation by the Pharmacy and Therapeutics Committee of the costs of agents in a therapeutic class in relation to the safety, effectiveness, and clinical outcomes of such agents. The Secretary shall establish procedures for the selection of particular pharmaceutical agents for the uniform formulary. Such procedures shall be established so as best to accomplish, in the judgment of the Secretary, the objectives set forth in paragraph (1). Except as provided in subparagraph (F), no pharmaceutical agent may be excluded from the uniform formulary except upon the recommendation of the Pharmacy and Therapeutics Committee. Pharmaceutical agents included on the uniform formulary shall be available to eligible covered beneficiaries through— facilities of the uniformed services, consistent with the scope of health care services offered in such facilities and additional determinations by the Pharmacy and Therapeutics Committee of the relative clinical and cost effectiveness of the agents; retail pharmacies designated or eligible under the TRICARE program or the Civilian Health and Medical Program of the Uniformed Services to provide pharmaceutical agents to covered beneficiaries; or the national mail-order pharmacy program. The Secretary may implement procedures to place selected over-the-counter drugs on the uniform formulary and to make such drugs available to eligible covered beneficiaries. An over-the-counter drug may be included on the uniform formulary only if the Pharmacy and Therapeutics Committee established under subsection (b) finds that the over-the-counter drug is cost effective and clinically effective. If the Pharmacy and Therapeutics Committee recommends an over-the-counter drug for inclusion on the uniform formulary, the drug shall be considered to be in the same therapeutic class of pharmaceutical agents, as determined by the Committee, as similar prescription drugs. Regulations prescribed by the Secretary to carry out clause (i) shall include the following with respect to over-the-counter drugs included on the uniform formulary: A determination of the means and conditions under paragraphs (5) and (6) through which over-the-counter drugs will be available to eligible covered beneficiaries and the amount of cost sharing that such beneficiaries will be required to pay for over-the-counter drugs, if any, except that no such cost sharing may be required for a member of a uniformed service on active duty. Any terms and conditions for the dispensing of over-the-counter drugs to eligible covered beneficiaries. The pharmacy benefits program shall assure the availability of clinically appropriate pharmaceutical agents to members of the armed forces, including, where appropriate, agents not included on the uniform formulary described in paragraph (2). The pharmacy benefits program may provide that prior authorization be required for certain pharmaceutical agents to assure that the use of such agents is clinically appropriate. The pharmacy benefits program shall assure the availability to eligible covered beneficiaries of pharmaceutical agents not included on the uniform formulary. Such pharmaceutical agents shall be available through the national mail-order pharmacy program under terms and conditions that shall include cost-sharing by the eligible covered beneficiary as specified in paragraph (6). In the case of any of the years 2018 through 2027, the cost-sharing amounts under this subsection for eligible covered beneficiaries shall be determined in accordance with the following table: For: The cost-sharing amount for a 30-day supply of a retail generic is: The cost-sharing amount for a 30-day supply of a retail formulary is: The cost-sharing amount for a 90-day supply of a mail order generic is: The cost-sharing amount for a 90-day supply of a mail order formulary is: The cost-sharing amount for a 90-day supply of a mail order non-formulary is: 2018 $11$28 $7$24 $532019$11 $28$7 $24$53 2020 $13$33 $10$29 $602021$13 $33$10 $29$60 2022 $14$38 $12$34 $682023$14 $38$12 $34$68 2024 $16$43 $13$38 $762025$16 $43$13 $38$76 2026 $16$48 $14$44 $852027$16 $48$14 $44$85 For any year after 2027, the cost-sharing amounts under this subsection for eligible covered beneficiaries shall be equal to the cost-sharing amounts for the previous year adjusted by an amount, if any, determined by the Secretary to reflect changes in the costs of pharmaceutical agents and prescription dispensing, rounded to the nearest dollar. Notwithstanding subparagraphs (A) and (B), the cost-sharing amounts under this subsection for a dependent of a member of the uniformed services who dies while on active duty, a member retired under chapter 61 of this title, or a dependent of a member retired under such chapter shall be equal to the cost-sharing amounts, if any, for 2017. Notwithstanding subparagraphs (A), (B), and (C), the Secretary may selectively waive or reduce cost-sharing amounts under this subsection for a dependent of a member of the uniformed services described in section 1074(c)(3)(B) of this title if the dependent is enrolled in the TRICARE Prime Remote program and accompanies the member to the duty assignment of the member at the expense of the Federal Government. Notwithstanding subparagraphs (A), (B), and (C), the cost-sharing amount under this subsection for any prescription contraceptive on the uniform formulary provided through a retail pharmacy described in paragraph (2)(E)(ii) or through the national mail-order pharmacy program is $0. The Secretary shall establish procedures for eligible covered beneficiaries to receive pharmaceutical agents that are not included on the uniform formulary but that are considered to be clinically necessary. Such procedures shall include peer review procedures under which the Secretary may determine that there is a clinical justification for the use of a pharmaceutical agent that is not on the uniform formulary, in which case the pharmaceutical agent shall be provided under the same terms and conditions as an agent on the uniform formulary. Such procedures shall also include an expeditious appeals process for an eligible covered beneficiary, or a network or uniformed provider on behalf of the beneficiary, to establish clinical justification for the use of a pharmaceutical agent that is not on the uniform formulary. In carrying out this subsection, the Secretary shall ensure that an eligible covered beneficiary may continue to receive coverage for any maintenance pharmaceutical that is not on the uniform formulary and that was prescribed for the beneficiary before October 5, 1999 , and stabilized the medical condition of the beneficiary. Beginning on October 1, 2015 , the pharmacy benefits program shall require eligible covered beneficiaries generally to refill non-generic prescription maintenance medications through military treatment facility pharmacies or the national mail-order pharmacy program. The Secretary shall determine the maintenance medications subject to the requirement under subparagraph (A). The Secretary shall ensure that— such medications are generally available to eligible covered beneficiaries through retail pharmacies only for an initial filling of a 30-day or less supply; and any refills of such medications are obtained through a military treatment facility pharmacy or the national mail-order pharmacy program. The Secretary may exempt the following prescription maintenance medications from the requirement of subparagraph (A): Medications that are for acute care needs. Such other medications as the Secretary determines appropriate. Notwithstanding paragraphs (2), (5), and (6), in order to encourage the use by covered beneficiaries of pharmaceutical agents that provide the best clinical effectiveness to covered beneficiaries and the Department of Defense (as determined by the Secretary, including considerations of better care, healthier people, and smarter spending), the Secretary may, upon the recommendation of the Pharmacy and Therapeutics Committee established under subsection (b) and review by the Uniform Formulary Beneficiary Advisory Panel established under subsection (c)— exclude from the pharmacy benefits program any pharmaceutical agent that the Secretary determines provides very little or no clinical effectiveness to covered beneficiaries and the Department under the program; and give preferential status to any non-generic pharmaceutical agent on the uniform formulary by treating it, for purposes of cost-sharing under paragraph (6), as a generic product under the TRICARE retail pharmacy program and mail order pharmacy program.

(b) Establishment of Committee.— The Secretary of Defense shall, in consultation with the Secretaries of the military departments, establish a Pharmacy and Therapeutics Committee for the purpose of developing the uniform formulary of pharmaceutical agents required by subsection (a), reviewing such formulary on a periodic basis, and making additional recommendations regarding the formulary as the committee determines necessary and appropriate. The committee shall include representatives of pharmacies of the uniformed services facilities and representatives of providers in facilities of the uniformed services. Committee members shall have expertise in treating the medical needs of the populations served through such entities and in the range of pharmaceutical and biological medicines available for treating such populations. The committee shall function under procedures established by the Secretary under the regulations prescribed under subsection (j). The committee shall meet at least quarterly and shall, during meetings, consider for inclusion on the uniform formulary under the standards established in subsection (a) any drugs newly approved by the Food and Drug Administration.

(c) Advisory Panel.— Concurrent with the establishment of the Pharmacy and Therapeutics Committee under subsection (b), the Secretary shall establish a Uniform Formulary Beneficiary Advisory Panel to review and comment on the development of the uniform formulary. The Secretary shall consider the comments of the panel before implementing the uniform formulary or implementing changes to the uniform formulary. The Secretary shall determine the size and membership of the panel established under paragraph (1), which shall include members that represent— nongovernmental organizations and associations that represent the views and interests of a large number of eligible covered beneficiaries; contractors responsible for the TRICARE retail pharmacy program; contractors responsible for the national mail-order pharmacy program; and TRICARE network providers.

(d) Procedures.— In the operation of the pharmacy benefits program under subsection (a), the Secretary of Defense shall assure through management and new contractual arrangements that financial resources are aligned such that the cost of prescriptions is borne by the organization that is financially responsible for the health care of the eligible covered beneficiary. The Secretary shall use a modification to the bid price adjustment methodology in the managed care support contracts current as of October 5, 1999 , to ensure equitable and timely reimbursement to the TRICARE managed care support contractors for pharmaceutical products delivered in the nonmilitary environments. The methodology shall take into account the “at-risk” nature of the contracts as well as managed care support contractor pharmacy costs attributable to changes to pharmacy service or formulary management at military medical treatment facilities, and other military activities and policies that affect costs of pharmacy benefits provided through the Civilian Health and Medical Program of the Uniformed Services. The methodology shall also account for military treatment facility costs attributable to the delivery of pharmaceutical products in the military facility environment which were prescribed by a network provider. With respect to the TRICARE retail pharmacy program described in subsection (a)(2)(E)(ii), the Secretary shall ensure that a contract entered into with a TRICARE pharmacy program contractor includes requirements described in section 1860D–12(b)(6) of the Social Security Act ( 42 U.S.C. 1395w–112(b)(6) ) to ensure the provision of information regarding the pricing standard for prescription drugs.

(e) Pharmacy Data Transaction Service.— The Secretary of Defense shall implement the use of the Pharmacy Data Transaction Service in all fixed facilities of the uniformed services under the jurisdiction of the Secretary, in the TRICARE retail pharmacy program, and in the national mail-order pharmacy program.

(f) Procurement of Pharmaceuticals by TRICARE Retail Pharmacy Program.— With respect to any prescription filled after January 28, 2008 , the TRICARE retail pharmacy program shall be treated as an element of the Department of Defense for purposes of the procurement of drugs by Federal agencies under section 8126 of title 38 to the extent necessary to ensure that pharmaceuticals paid for by the Department of Defense that are provided by pharmacies under the program to eligible covered beneficiaries under this section are subject to the pricing standards in such section 8126.

(g) Sharing of Information With State Prescription Drug Monitoring Programs.— The Secretary of Defense shall establish and maintain a program (to be known as the “Military Health System Prescription Drug Monitoring Program”) in accordance with this subsection. The program shall include a special emphasis on drugs provided through facilities of the uniformed services. The program shall be— comparable to prescription drug monitoring programs operated by States, including such programs approved by the Secretary of Health and Human Services under section 399O of the Public Health Service Act ( 42 U.S.C. 280g–3 ); and applicable to designated controlled substance prescriptions under the pharmacy benefits program. The Secretary shall establish appropriate procedures for the bi-directional sharing of patient-specific information regarding prescriptions for designated controlled substances between the program and State prescription drug monitoring programs. The purpose of sharing of information under this paragraph shall be to prevent misuse and diversion of opioid medications and other designated controlled substances. Any disclosure of patient-specific information by the Secretary under this paragraph is an authorized disclosure for purposes of the health information privacy regulations promulgated under the Health Insurance Portability and Accountability Act of 1996 ( Public Law 104–191 ). Any procedures developed pursuant to paragraph (3)(A) shall include appropriate safeguards, as determined by the Secretary, concerning cyber security of Department of Defense systems and operational security of Department personnel. To the extent the Secretary considers appropriate, the program may be treated as comparable to a State program for purposes of bi-directional sharing of controlled substance prescription information. For purposes of this subsection, any reference to a program operated by a State includes any program operated by a county, municipality, or other subdivision within that State.

(h) Labeling.— The Secretary of Defense shall ensure that drugs made available through the facilities of the armed forces under the jurisdiction of the Secretary include labels and other labeling that are in compliance with the requirements of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 301 et seq.).

(i) Definitions.— In this section: The term “eligible covered beneficiary” means a covered beneficiary for whom eligibility to receive pharmacy benefits through the means described in subsection (a)(2)(E) is established under this chapter or another provision of law. The term “pharmaceutical agent” means drugs, biological products, and medical devices under the regulatory authority of the Food and Drug Administration. The term “over-the-counter drug” means a drug that is not subject to section 503(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 353(b) ). The term “prescription drug” means a drug that is subject to section 503(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 353(b) ).

(j) Regulations.— The Secretary of Defense shall, after consultation with the other administering Secretaries, prescribe regulations to carry out this section.

§ 1074h Medical and dental care: medal of honor recipients; dependents

(a) Medal of Honor Recipients.— A former member of the armed forces who is a Medal of Honor recipient and who is not otherwise entitled to medical and dental benefits under this chapter may, upon request, be given medical and dental care provided by the administering Secretaries in the same manner as if entitled to retired pay.

(b) Immediate Dependents.— A person who is an immediate dependent of a Medal of Honor recipient and who is not otherwise entitled to medical and dental benefits under this chapter may, upon request, be given medical and dental care provided by the administering Secretaries in the same manner as if the Medal of Honor recipient were, or (if deceased) was at the time of death, entitled to retired pay.

(c) Definitions.— In this section: The term “Medal of Honor recipient” means a person who has been awarded a medal of honor under section 7271, 8291, or 9271 of this title or section 2732 of title 14 . The term “immediate dependent” means a dependent described in subparagraph (A), (B), (C), or (D) of section 1072(2) of this title .

§ 1074i Reimbursement for certain travel expenses

(a) In General.— Except as provided by subsection (b), in any case in which a covered beneficiary is referred by a primary care physician to a specialty care provider who provides services more than 100 miles from the location in which the primary care provider provides services to the covered beneficiary, the Secretary of Defense shall provide travel and transportation allowances as specified in regulations prescribed under section 464 of title 37 for the covered beneficiary and, when accompaniment by an adult is necessary, for a parent or guardian of the covered beneficiary or another member of the covered beneficiary’s family who is at least 21 years of age.

(b) Special Rules for Certain Members and Dependents.— The Secretary of Defense may provide travel and transportation allowances as specified in the regulations referred to in subsection (a) for travel of members of the armed forces on active duty and their dependents, and accompaniment, to a specialty care provider not otherwise authorized by subsection (a) under such exceptional circumstances as the Secretary considers appropriate for purposes of this section. With respect to members of the armed forces on active duty and their dependents, the Secretary shall administer subsection (a) by substituting “75 miles” for “100 miles”.

(c) Outreach Program and Travel Reimbursement for Follow-on Specialty Care and Related Services.— The Secretary concerned shall ensure that an outreach program is implemented for each member of the uniformed services who incurred a combat-related disability and is entitled to retired or retainer pay, or equivalent pay, so that— the progress of the member is closely monitored; and the member receives the travel reimbursement authorized by subsection (a) whenever the member requires follow-on specialty care, services, or supplies.

(d) Definitions.— In this section: The term “specialty care provider” includes a dental specialist. The term “dental specialist” means an oral surgeon, orthodontist, prosthodontist, periodontist, endodontist, or pediatric dentist, and includes such other providers of dental care and services as determined appropriate by the Secretary of Defense. The term “combat-related disability” has the meaning given that term in section 1413a of this title .

§ 1074j Sub-acute care program

(a) Establishment.— The Secretary of Defense shall establish an effective, efficient, and integrated sub-acute care benefits program under this chapter (hereinafter referred to in this section as the “program”). Except as otherwise provided in this section, the types of health care authorized under the program shall be the same as those provided under section 1079 of this title . The Secretary, after consultation with the other administering Secretaries, shall promulgate regulations to carry out this section.

(b) Benefits.— The program shall include a uniform skilled nursing facility benefit that shall be provided in the manner and under the conditions described in section 1861 (h) and (i) of the Social Security Act ( 42 U.S.C. 1395x (h) and (i)), except that the limitation on the number of days of coverage under section 1812 (a) and (b) of such Act ( 42 U.S.C. 1395d (a) and (b)) shall not be applicable under the program. Skilled nursing facility care for each spell of illness shall continue to be provided for as long as medically necessary and appropriate. In this subsection: The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act ( 42 U.S.C. 1395i–3(a) ). The term “spell of illness” has the meaning given such term in section 1861(a) of such Act ( 42 U.S.C. 1395x(a) ). The program shall include a comprehensive, part-time or intermittent home health care benefit that shall be provided in the manner and under the conditions described in section 1861(m) of the Social Security Act ( 42 U.S.C. 1395x(m) ). The Secretary of Defense may take such actions as are necessary to ensure that there is an effective transition in the furnishing of part-time or intermittent home health care benefits for covered beneficiaries who were receiving such benefits before the establishment of the program under this section. The actions taken under this paragraph may include the continuation of such benefits on an extended basis for such time as the Secretary determines appropriate.

§ 1074k Long-term care insurance

Provisions regarding long-term care insurance for members and certain former members of the uniformed services and their families are set forth in chapter 90 of title 5. (Added Pub. L. 107–107, div. A, title VII, § 701(f)(1) , Dec. 28, 2001 , 115 Stat. 1161 .)

§ 1074l Notification to Congress of hospitalization of combat wounded members

(a) Notification Required.— The Secretary concerned shall provide notification of the hospitalization of any member of the armed forces evacuated from a theater of combat and admitted to any military medical treatment facility to the appropriate Members of Congress.

(b) Appropriate Members.— In this section, the term “appropriate Members of Congress”, with respect to the member of the armed forces about whom notification is being made, means the Senators representing the State, and the Member, Delegate, or Resident Commissioner of the House of Representatives representing the district, that includes the member’s home of record or a different location as provided by the member.

(c) Consent of Member Required.— The notification under subsection (a) may be provided only with the consent of the member of the armed forces about whom notification is to be made. In the case of a member who is unable to provide consent, information and consent may be provided by next of kin.

§ 1074m Mental health assessments for members of the armed forces deployed in support of a contingency operation

(a) Mental Health Assessments.— The Secretary of Defense shall provide a person-to-person mental health assessment for each member of the armed forces who is deployed in support of a contingency operation as follows: Once during the period beginning 120 days before the date of the deployment. Once during each 180-day period during which a member is deployed. Subject to paragraph (3) and subsection (d), once during the period beginning on the date of redeployment from the contingency operation and ending on the date that is 21 days after the date on which the post-deployment leave of the member terminates. Subject to subsection (d), not less than once annually— beginning 21 days after the date on which the post-deployment leave of the member terminates; or if the assessment required by subparagraph (C) is performed during the period specified in paragraph (3), beginning 180 days after the date of redeployment from the contingency operation. A mental health assessment is not required for a member of the armed forces under subparagraphs (C) and (D) of paragraph (1) (including an assessment performed pursuant to paragraph (3)) if the Secretary determines that providing such assessment to the member during the time periods under such subparagraphs would remove the member from forward deployment or put members or operational objectives at risk. A mental health assessment required under subparagraph (C) of paragraph (1) may be provided during the period beginning 90 days after the date of redeployment from the contingency operation and ending 180 days after such redeployment date if the Secretary determines that— an insufficient number of personnel are available to perform the assessment during the time period under such subparagraph; or an administrative processing issue exists upon the return of the member to the home unit or duty station that would prohibit the effective performance of the assessment during such time period.

(b) Purpose.— The purpose of the mental health assessments provided pursuant to this section shall be to identify post-traumatic stress disorder, suicidal tendencies, and other behavioral health conditions identified among members described in subsection (a) in order to determine which such members are in need of additional care and treatment for such health conditions.

(c) Elements.— The mental health assessments provided pursuant to this section shall— be performed by personnel trained and certified to perform such assessments and may be performed— by licensed mental health professionals if such professionals are available and the use of such professionals for the assessments would not impair the capacity of such professionals to perform higher priority tasks; by personnel in deployed units whose responsibilities include providing unit health care services if such personnel are available and the use of such personnel for the assessments would not impair the capacity of such personnel to perform higher priority tasks; and by personnel at private facilities in accordance with section 1074(c) of this title ; include a person-to-person dialogue between members described in subsection (a) and the professionals or personnel described by subparagraph (A), as applicable, on such matters as the Secretary shall specify in order that the assessments achieve the purpose specified in subsection (b) for such assessments; be conducted in a private setting to foster trust and openness in discussing sensitive health concerns; be provided in a consistent manner across the military departments; and include a review of the health records of the member that are related to each previous deployment of the member or other relevant activities of the member while serving in the armed forces, as determined by the Secretary. The Secretary may treat periodic health assessments and other person-to-person assessments that are provided to members of the armed forces, including examinations under section 1074f of this title , as meeting the requirements for mental health assessments required under this section if the Secretary determines that such assessments and person-to-person assessments meet the requirements for mental health assessments established by this section.

(d) Cessation of Assessments.— No mental health assessment is required to be provided to an individual under subparagraph (C) or (D) of subsection (a)(1) after the individual’s discharge or release from the armed forces.

(e) Sharing of Information.— The Secretary of Defense shall share with the Secretary of Veterans Affairs such information on members of the armed forces that is derived from confidential mental health assessments, including mental health assessments provided pursuant to this section and section 1074n of this title and health assessments and other person-to-person assessments provided before the date of the enactment of this section, as the Secretary of Defense and the Secretary of Veterans Affairs jointly consider appropriate to ensure continuity of mental health care and treatment of members of the armed forces during the transition from health care and treatment provided by the Department of Defense to health care and treatment provided by the Department of Veterans Affairs. Any sharing of information under paragraph (1) shall occur pursuant to a protocol jointly established by the Secretary of Defense and the Secretary of Veterans Affairs for purposes of this subsection. Any such protocol shall be consistent with the following: Applicable provisions of the Wounded Warrior Act (title XVI of Public Law 110–181 ; 10 U.S.C. 1071 note), including section 1614 of such Act ( 122 Stat. 443 ; 10 U.S.C. 1071 note). Section 1720F of title 38 . Before each mental health assessment is conducted under subsection (a), the Secretary of Defense shall ensure that the member is notified of the sharing of information with the Secretary of Veterans Affairs under this subsection.

(f) Regulations.— The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section. Not later than 270 days after the date of the issuance of the regulations prescribed under paragraph (1), the Secretary shall notify the congressional defense committees of the implementation of the regulations by the military departments.

§ 1074n Annual mental health assessments for members of the armed forces

(a) Mental Health Assessments.— Subject to subsection (c), not less frequently than once each calendar year (and before separation from active duty pursuant to section 1145(a)(5)(A) of this title ), the Secretary of Defense shall provide a person-to-person mental health assessment for— each member of a regular component of the armed forces; and each member of the Selected Reserve of an armed force.

(b) Elements.— The mental health assessments provided pursuant to this section shall— be conducted in accordance with the requirements of subsection (c)(1) of section 1074m of this title with respect to a mental health assessment provided pursuant to such section; and include a review of the health records of the member that are related to each previous health assessment or other relevant activities of the member while serving in the armed forces, as determined by the Secretary.

(c) Sufficiency of Other Mental Health Assessments.— The Secretary is not required to provide a mental health assessment pursuant to this section to an individual in a calendar year in which the individual has received a mental health assessment pursuant to section 1074m of this title . The Secretary may treat periodic health assessments and other person-to-person assessments that are provided to members of the armed forces, including examinations under section 1074f of this title , as meeting the requirements for mental health assessments required under this section if the Secretary determines that such assessments and person-to-person assessments meet the requirements for mental health assessments established by this section.

(d) Privacy Matters.— Any medical or other personal information obtained under this section shall be protected from disclosure or misuse in accordance with the laws on privacy applicable to such information.

(e) Regulations.— The Secretary of Defense shall, in consultation with the other administering Secretaries, prescribe regulations for the administration of this section.

§ 1074o Provision of hyperbaric oxygen therapy for certain members

(a) In General.— The Secretary may furnish hyperbaric oxygen therapy available at a military medical treatment facility to a covered member if such therapy is prescribed by a physician to treat post-traumatic stress disorder or traumatic brain injury.

(b) Covered Member Defined.— In this section, the term “covered member” means a member of the armed forces who is— serving on active duty; and diagnosed with post-traumatic stress disorder or traumatic brain injury.

§ 1075 TRICARE Select

(a) Establishment.— Not later than January 1, 2018 , the Secretary of Defense shall establish a self-managed, preferred-provider network option under the TRICARE program. Such option shall be known as “TRICARE Select”. The Secretary shall establish TRICARE Select in all areas. Under TRICARE Select, eligible beneficiaries will not have restrictions on the freedom of choice of the beneficiary with respect to health care providers.

(b) Enrollment Eligibility.— The beneficiary categories for purposes of eligibility to enroll in TRICARE Select and cost-sharing requirements applicable to such category are as follows: An “active-duty family member” category that consists of beneficiaries who are covered by section 1079 of this title (as dependents of active duty members). A “retired” category that consists of beneficiaries covered by subsection (c) of section 1086 of this title , other than Medicare-eligible beneficiaries described in subsection (d)(2) of such section. A “reserve and young adult” category that consists of beneficiaries who are covered by— section 1076d of this title ; section 1076e; or section 1110b. A covered beneficiary who elects to participate in TRICARE Select shall enroll in such option under section 1099 of this title .

(c) Cost-sharing Requirements.— The cost-sharing requirements under TRICARE Select are as follows: With respect to beneficiaries in the active-duty family member category or the retired category by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018 , or by reason of being a dependent of such a member, the cost-sharing requirements shall be calculated pursuant to subsection (d)(1). Except as provided by subsection (e), with respect to beneficiaries described in subparagraph (B) in the active-duty family member category or the retired category, the cost-sharing requirements shall be calculated as if the beneficiary were enrolled in TRICARE Extra or TRICARE Standard as if TRICARE Extra or TRICARE Standard, as the case may be, were still being carried out by the Secretary. Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018 , or by reason of being a dependent of such a member. With respect to beneficiaries in the reserve and young adult category, the cost-sharing requirements shall be calculated pursuant to subsection (d)(1) as if the beneficiary were in the active-duty family member category or the retired category, as applicable, except that the premiums calculated pursuant to section 1076d, 1076e, or 1110b of this title, as the case may be, shall apply instead of any enrollment fee required under this section.

(d) Cost-sharing Amounts for Certain Beneficiaries.— Beneficiaries described in subsection (c)(1) enrolled in TRICARE Select shall be subject to cost-sharing requirements in accordance with the amounts and percentages under the following table during calendar year 2018 and as such amounts are adjusted under paragraph (2) for subsequent years: TRICARE Select Active-Duty Family Member (Individual/Family) Retired (Individual/Family) Annual Enrollment $0$450 / 900 Annual deductible E4 & below: 50 / $100$150 / 300 Network ..................... E5 & above: 150 / $300$300 / $600outofnetworkAnnualcatastrophiccap$1,000 $3,500Outpatientvisitciviliannetwork$15 primary care $25primarycare.....................$25 specialty care $40specialtycare..........................................Outofnetwork:20$40 network $80network.....................20$20 network $40network.....................20$25 network $95network.....................20$15 $60Durablemedicalequipmentciviliannetwork10$60 per network admission $175peradmissionnetwork..........................................20$25 per day network $50perdaynetwork.....................$50 per day out of network Lesser of $300perdayor20$1. The remaining amount above such multiple of $1shallbecarriedoverto,andaccumulatedwith,theamountoftheincreaseforthesubsequentyearoryearsandmadewhentheaggregateamountofincreasescarriedoverunderthisclauseforayearis$1 or more. Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. The cost-sharing requirements applicable to services not specifically addressed in the table set forth in paragraph (1) shall be established by the Secretary.

(e) Exceptions to Certain Cost-sharing Amounts for Certain Beneficiaries Eligible Prior to 2018.— Subject to paragraph (4), and in accordance with subsection (d)(2), the Secretary shall establish an annual enrollment fee for beneficiaries described in subsection (c)(2)(B) in the retired category who enroll in TRICARE Select (other than such beneficiaries covered by paragraph (3)). Such enrollment fee shall be $150foranindividualand$300 for a family. For the calendar year for which the Secretary first establishes the annual enrollment fee under paragraph (1), the Secretary shall adjust the catastrophic cap amount to be $3,500 for beneficiaries described in subsection (c)(2)(B) in the retired category who are enrolled in TRICARE Select (other than such beneficiaries covered by paragraph (3)). The enrollment fee established pursuant to paragraph (1) and the catastrophic cap adjusted under paragraph (2) for beneficiaries described in subsection (c)(2)(B) in the retired category shall not apply with respect to the following beneficiaries: Retired members and the family members of such members covered by paragraph (1) of section 1086(c) of this title by reason of being retired under chapter 61 of this title or being a dependent of such a member. Survivors covered by paragraph (2) of such section 1086(c). The Secretary may not establish an annual enrollment fee under paragraph (1) until 90 days has elapsed following the date on which the Comptroller General of the United States is required to submit the review under paragraph (5). Not later than February 1, 2020 , the Comptroller General of the United States shall submit to the Committees on Armed Services of the House of Representatives and the Senate a review of the following: Whether health care coverage for covered beneficiaries has changed since the enactment of this section. Whether covered beneficiaries are able to obtain appointments for health care according to the access standards established by the Secretary of Defense. The percent of network providers that accept new patients under the TRICARE program. The satisfaction of beneficiaries under TRICARE Select.

(f) Other Exceptions to Cost-sharing Requirements.— A beneficiary enrolled in TRICARE for Life is subject to cost-sharing requirements pursuant to section 1086(d)(3) of this title and calculated as if the beneficiary were enrolled in TRICARE Standard as if TRICARE Standard were still being carried out by the Secretary. Notwithstanding any other provision of this section, the cost-sharing amount under this section for any beneficiary enrolled in TRICARE Select for a service described in subparagraph (B) that is provided by a network provider is $0. A service described in this subparagraph is any contraceptive method approved, cleared, or authorized under section 505, 510(k), 513(f)(2), or 515 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 , 360(k), 360c(f)(2), 360e), any contraceptive care (including with respect to insertion, removal, and follow up), any sterilization procedure, or any patient education or counseling service provided in connection with any such contraceptive, care, or procedure. Consistent with other provisions of this chapter and subject to requirements to be prescribed by the Secretary, the Secretary may waive cost-sharing requirements for the first three outpatient mental health visits each year of any of the following beneficiaries: Beneficiaries in the active-duty family member category. Beneficiaries covered by section 1110b of this title . This paragraph shall terminate on the date that is five years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2024.

(g) Construction.— Nothing in this section may be construed as affecting the availability of TRICARE Prime and TRICARE for Life or the cost-sharing requirements for TRICARE for Life under section 1086(d)(3) of this title .

(h) Authority for Multiple Networks in the Same Geographic Area.— The Secretary may establish a system of multiple networks of providers under TRICARE Select in the same geographic area or areas. Under a system established under paragraph (1), the Secretary may— require a covered beneficiary enrolling in TRICARE Select to enroll in a specific provider network established pursuant to such system, in which case any provider not in that specific provider network shall be deemed an out-of-network provider with respect to the covered beneficiary (regardless of whether the provider is in a different TRICARE Select provider network) for purposes of this section or any other provision of law limiting the coverage or provision of health care services to those provided by network providers under the TRICARE program; and include beneficiaries covered by subsection (c)(2).

(i) Definitions.— In this section: The terms “active-duty family member category”, “retired category”, and “reserve and young adult category” mean the respective categories of TRICARE Select enrollment described in subsection (b). The term “network” means— with respect to health care services, such services provided to beneficiaries by TRICARE-authorized civilian health care providers who have entered into a contract under this chapter with a contractor under the TRICARE program; and with respect to providers, civilian health care providers who have agreed to accept a pre-negotiated rate as the total charge for services provided by the provider and to file claims for beneficiaries. The term “out-of-network” means, with respect to health care services, such services provided by TRICARE-authorized civilian providers who have not entered into a contract under this chapter with a contractor under the TRICARE program.

§ 1075a TRICARE Prime: cost sharing

(a) Cost-sharing Requirements.— The cost-sharing requirements under TRICARE Prime are as follows: There are no cost-sharing requirements for beneficiaries who are covered by section 1074(a) of this title . With respect to beneficiaries in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title ) by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018 , or by reason of being a dependent of such a member, the cost-sharing requirements shall be calculated pursuant to subsection (b)(1). With respect to beneficiaries described in subparagraph (B) in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title ), the cost-sharing requirements shall be calculated in accordance with the other provisions of this chapter without regard to subsection (b). Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018 , or by reason of being a dependent of such a member.

(b) Cost-sharing Amounts.— Beneficiaries described in subsection (a)(2) enrolled in TRICARE Prime shall be subject to cost-sharing requirements in accordance with the amounts and percentages under the following table during calendar year 2018 and as such amounts are adjusted under paragraph (2) for subsequent years: TRICARE Prime Active-Duty Family Member (Individual/Family) Retired (Individual/Family) Annual Enrollment $0$350 / $700AnnualdeductibleNoNoAnnualcatastrophiccap$1,000 $3,500Outpatientvisitciviliannetwork$0 $20primarycare.....................$30 specialty care ER visit civilian network $0$60 network Urgent care civilian network $0$30 network Ambulatory surgery civilian network $0$60 network Ground ambulance civilian network $0$40 Durable medical equipment civilian network $020$0 $150peradmissionInpatientskillednursing/rehabcivilian$0 $30perdaynetworkEachdollaramountexpressedasafixeddollaramountinthetablesetforthinparagraph(1)shallbeannuallyindexedtotheamountbywhichretiredpayisincreasedundersection1401aofthistitle,roundedtothenextlowermultipleof$1. The remaining amount above such multiple of $1shallbecarriedoverto,andaccumulatedwith,theamountoftheincreaseforthesubsequentyearoryearsandmadewhentheaggregateamountofincreasescarriedoverunderthisclauseforayearis$1 or more. Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. The cost-sharing requirements applicable to services not specifically addressed in the table set forth in paragraph (1) shall be established by the Secretary.

(c) Special Rule for Amounts Without Referrals.— Notwithstanding subsection (b)(1), the cost-sharing amount for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph (1) of section 1095f(a) of this title (or a waiver pursuant to paragraph (2) of such section for such care) shall be an amount equal to 50 percent of the allowed point-of-service charge for such care.

(d) Prohibition on Cost-sharing for Certain Services.— Notwithstanding any other provision of this section, the cost-sharing amount under this section for any beneficiary enrolled in TRICARE Prime for a service described in subparagraph (B) that is provided under TRICARE Prime is $0. A service described in this subparagraph is any contraceptive method approved, cleared, or authorized under section 505, 510(k), 513(f)(2), or 515 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 , 360(k), 360c(f)(2), 360e), any contraceptive care (including with respect to insertion, removal, and follow up), any sterilization procedure, or any patient education or counseling service provided in connection with any such contraceptive, care, or procedure. Consistent with other provisions of this chapter and subject to requirements to be prescribed by the Secretary, the Secretary may waive cost-sharing requirements for the first three outpatient mental health visits each year of a beneficiary in the active-duty family member category (as described in section 1075(b)(1)(A) of this title ). This paragraph shall terminate on the date that is five years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2024.

§ 1076 Medical and dental care for dependents: general rule

(a) A dependent described in paragraph (2) is entitled, upon request, to the medical and dental care prescribed by section 1077 of this title in facilities of the uniformed services, subject to the availability of space and facilities and the capabilities of the medical and dental staff. A dependent referred to in paragraph (1) is a dependent of a member of a uniformed service described in one of the following subparagraphs: A member who is on active duty for a period of more than 30 days or died while on that duty. A member who died from an injury, illness, or disease incurred or aggravated— while the member was on active duty under a call or order to active duty of 30 days or less, on active duty for training, or on inactive-duty training; or while the member was traveling to or from the place at which the member was to perform, or had performed, such active duty, active duty for training, or inactive-duty training. A member who died from an injury, illness, or disease incurred or aggravated in the line of duty while the member remained overnight immediately before the commencement of inactive-duty training, or while the member remained overnight between successive periods of inactive-duty training, at or in the vicinity of the site of the inactive-duty training. A member on active duty who is entitled to benefits under subsection (e) of section 1074a of this title by reason of paragraph (1), (2), or (3) of subsection (a) of such section. A member who died from an injury, illness, or disease incurred or aggravated while the member— was serving on funeral honors duty under section 12503 of this title or section 115 of title 32 ; was traveling to or from the place at which the member was to so serve; or remained overnight at or in the vicinity of that place immediately before so serving, if the place is outside reasonable commuting distance from the member’s residence.

(b) Under regulations to be prescribed jointly by the administering Secretaries, a dependent of a member or former member— who is, or (if deceased) was at the time of his death, entitled to retired or retainer pay or equivalent pay; or who died before attaining age 60 and at the time of his death would have been eligible for retired pay under chapter 1223 of this title (or under chapter 67 of this title as in effect before December 1, 1994 ) but for the fact that he was under 60 years of age; may, upon request, be given the medical and dental care prescribed by section 1077 of this title in facilities of the uniformed services, subject to the availability of space and facilities and the capabilities of the medical and dental staff, except that a dependent of a member or former member described in paragraph (2) may not be given such medical or dental care until the date on which such member or former member would have attained age 60.

(c) A determination by the medical or dental officer in charge, or the contract surgeon in charge, or his designee, as to the availability of space and facilities and to the capabilities of the medical and dental staff is conclusive. Care under this section may not be permitted to interfere with the primary mission of those facilities.

(d) To utilize more effectively the medical and dental facilities of the uniformed services, the administering Secretaries shall prescribe joint regulations to assure that dependents entitled to medical or dental care under this section will not be denied equal opportunity for that care because the facility concerned is that of a uniformed service other than that of the member.

(e) Subject to paragraph (3), the administering Secretary shall furnish an abused dependent of a former member of a uniformed service described in paragraph (4), during that period that the abused dependent is in receipt of transitional compensation under section 1059 of this title , with medical and dental care, including mental health services, in facilities of the uniformed services in accordance with the same eligibility and benefits as were applicable for that abused dependent during the period of active service of the former member. Subject to paragraph (3), upon request of any dependent of a former member of a uniformed service punished for an abuse described in paragraph (4), the administering Secretary for such uniformed service may furnish medical care in facilities of the uniformed services to the dependent for the treatment of any adverse health condition resulting from such dependent’s knowledge of (A) the abuse, or (B) any injury or illness suffered by the abused person as a result of such abuse. Medical and dental care furnished to a dependent of a former member of the uniformed services in facilities of the uniformed services under paragraph (1) or (2)— shall be limited to the health care prescribed by section 1077 of this title ; and shall be subject to the availability of space and facilities and the capabilities of the medical and dental staff. A former member of a uniformed service referred to in paragraph (1) is a member who— received a dishonorable or bad-conduct discharge or was dismissed from a uniformed service as a result of a court-martial conviction for an offense, under either military or civil law, involving abuse of a dependent of the member; or was administratively discharged from a uniformed service as a result of such an offense. A determination of whether an offense involved abuse of a dependent of the member shall be made in accordance with regulations prescribed by the administering Secretary for such uniformed service.

(f) The administering Secretaries shall furnish an eligible dependent a physical examination that is required by a school in connection with the enrollment of the dependent as a student in that school. A dependent is eligible for a physical examination under paragraph (1) if the dependent— is entitled to receive medical care under subsection (a) or is authorized to receive medical care under subsection (b); and is at least 5 years of age and less than 12 years of age. Nothing in paragraph (2) may be construed to prohibit the furnishing of a school-required physical examination to any dependent who, except for not satisfying the age requirement under that paragraph, would otherwise be eligible for a physical examination required to be furnished under this subsection.

§ 1076a TRICARE dental program

(a) Establishment of Dental Plans.— The Secretary of Defense may establish, and in the case of the dental plan described in paragraph (1) shall establish, the following voluntary enrollment dental plans: A dental insurance plan for members of the Selected Reserve of the Ready Reserve and for members of the Individual Ready Reserve described in sub section 10144(b) of this title . A dental insurance plan for members of the Individual Ready Reserve not eligible to enroll in the plan established under paragraph (1). Dental benefits plans for eligible dependents of members of the uniformed services who are on active duty for a period of more than 30 days. A dental benefits plan for eligible dependents of members of the Ready Reserve of the reserve components who are not on active duty for more than 30 days.

(b) Administration of Plans.— The plans established under this section shall be administered under regulations prescribed by the Secretary of Defense in consultation with the other administering Secretaries. Effective as of January 1, 2027 , the regulations prescribed pursuant to paragraph (1) shall include, with respect to premium sharing plans referred to in subsection (d)(1), the following elements: A third party administrator shall manage the administrative features of such plans, including eligibility, enrollment, plan change and premium payment processes, submission of qualifying life events changes, and address changes. Such plans shall include the following three enrollment options: Self. Self plus one. Family. In the United States, to the extent practicable, individuals eligible to enroll in such a plan shall be offered options to enroll in plans of not fewer than two and not more than four dental insurance carriers. To the extent practicable, each carrier described in subparagraph (C)— shall manage dental care delivery matters, including claims adjudication (with required electronic submission of claims), coordination of benefits, covered services, enrollment verification, and provider networks; shall, in addition to offering a standard option plan, offer a non-standard option plan; may offer a non-standard option plan managed as a dental health maintenance organization plan; shall establish and operate dental provider networks that provide— accessible care with a prevention or wellness focus; continuity of care; coordinated care (including appropriate dental and medical referrals); patient-centered care (including effective communications, individualized care, and shared decision-making); and high-quality, safe care; shall develop and implement adult and pediatric dental quality measures, including effective measurements for— access to care; continuity of care; cost; adverse patient events; oral health outcomes; and patient experience; and may conduct in the provider networks established and operated by the carrier under clause (iv), to the extent practicable, pilot programs on the development of a model of care based on the model of care commonly referred to as patient-centered dental homes.

(c) Care Available Under Plans.— Dental plans established under subsection (a) may provide for the following dental care: Diagnostic, oral examination, and preventive services and palliative emergency care. Basic restorative services of amalgam and composite restorations, stainless steel crowns for primary teeth, and dental appliance repairs. Orthodontic services, crowns, gold fillings, bridges, complete or partial dentures, and such other services as the Secretary of Defense considers to be appropriate.

(d) Premiums.— The dental insurance plan established under subsection (a)(1) and the dental benefits plans established under subsection (a)(3) are premium sharing plans. Members enrolled in a premium sharing plan for themselves or for their dependents shall be required to pay a share of the premium charged for the benefits provided under the plan. During the period preceding January 1, 2027 , the member’s share of the premium charge may not exceed $20 per month for the enrollment. Effective as of January 1 of each year during the period preceding January 1, 2027 , the amount of the premium required under subparagraph (A) shall be increased by the percent equal to the lesser of— the percent by which the rates of basic pay of members of the uniformed services are increased on such date; or the sum of one-half percent and the percent computed under section 5303(a) of title 5 for the increase in rates of basic pay for statutory pay systems for pay periods beginning on or after such date. During the period preceding January 1, 2027 , the Secretary of Defense may reduce the monthly premium required to be paid under paragraph (1) in the case of enlisted members in pay grade E–1, E–2, E–3, or E–4 if the Secretary determines that such a reduction is appropriate to assist such members to participate in a dental plan referred to in subparagraph (A). Beginning on January 1, 2027 , the amount of the premium required under subparagraph (A)— for standard option plans, shall be established by the Secretary annually such that in the aggregate (taking into account the adjustments under subparagraph (F) and subsection (e)(3)), the Secretary’s share of each premium is 60 percent of the premium for each enrollment category (self, self plus one, and family, respectively) of each standard option plan; and for non-standard option plans, shall be equal to the amount determined under clause (i) plus 100 percent of the additional premium amount applicable to such non-standard option plan. Beginning on January 1, 2027 , the Secretary of Defense shall reduce the monthly premium required to be paid under paragraph (1) in the case of enlisted members in pay grade E–1, E–2, E–3, or E–4. The dental insurance plan established under subsection (a)(2) and the dental benefits plan established under subsection (a)(4) are full premium plans. Members enrolled in a full premium plan for themselves or for their dependents shall be required to pay the entire premium charged for the benefits provided under the plan. A member’s share of the premium for a plan established under subsection (a) may be paid by deductions from the basic pay of the member and from compensation paid under section 206 of title 37 , as the case may be. The regulations prescribed under subsection (b) shall specify the procedures for payment of the premiums by enrollees who do not receive such pay.

(e) Copayments Under Premium Sharing Plans.— Except as provided pursuant to paragraph (2), a member or dependent who receives dental care under a premium sharing plan referred to in subsection (d)(1) shall— in the case of care described in subsection (c)(1), pay no charge for the care; in the case of care described in subsection (c)(2), pay 20 percent of the charges for the care; and in the case of care described in subsection (c)(3), pay a percentage of the charges for the care that is determined appropriate by the Secretary of Defense, after consultation with the other administering Secretaries. During a national emergency declared by the President or Congress and subject to regulations prescribed by the Secretary of Defense, the Secretary may waive, in whole or in part, the charges otherwise payable by a member of the Selected Reserve of the Ready Reserve or a member of the Individual Ready Reserve under paragraph (1) for the coverage of the member alone under the dental insurance plan established under subsection (a)(1) if the Secretary determines that such waiver of the charges would facilitate or ensure the readiness of a unit or individual for deployment. The waiver under subparagraph (A) may apply only with respect to charges for coverage of dental care required for readiness. Beginning on January 1, 2027 , the Secretary of Defense shall reduce copayments required to be paid under paragraph (1) in the case of enlisted members in pay grade E–1, E–2, E–3, or E–4.

(f) Transfer of Members.— If a member whose dependents are enrolled in the plan established under subsection (a)(3) is transferred to a duty station where dental care is provided to the member’s eligible dependents under a program other than that plan, the member may discontinue participation under the plan. If the member is later transferred to a duty station where dental care is not provided to such member’s eligible dependents except under the plan established under subsection (a)(3), the member may re-enroll the dependents in that plan.

(g) Care Outside the United States.— The Secretary of Defense may exercise the authority provided under subsection (a) to establish dental insurance plans and dental benefits plans for dental benefits provided outside the United States for the eligible members and dependents of members of the uniformed services. In the case of such an overseas dental plan, the Secretary may waive or reduce any copayments required by subsection (e) to the extent the Secretary determines appropriate for the effective and efficient operation of the plan.

(h) Waiver of Requirements for Surviving Dependents.— The Secretary of Defense may waive (in whole or in part) any requirements of a dental plan established under this section as the Secretary determines necessary for the effective administration of the plan for a dependent who is an eligible dependent described in subsection (k)(2).

(i) Authority Subject to Appropriations.— The authority of the Secretary of Defense to enter into a contract under this section for any fiscal year is subject to the availability of appropriations for that purpose.

(j) Limitation on Reduction of Benefits.— During the period preceding January 1, 2027 , the Secretary of Defense may not reduce benefits provided under a plan established under this section, and on or after January 1, 2027 , the Secretary may not reduce benefits provided under a standard option plan under this section, until— the Secretary provides notice of the Secretary’s intent to reduce such benefits to the Committees on Armed Services of the Senate and the House of Representatives; and one year has elapsed following the date of such notice.

(k) Eligible Dependent Defined.— In this section, the term “eligible dependent” means a dependent described in subparagraph (A), (D), or (I) of section 1072(2) of this title . Such term includes any such dependent of a member who dies— while on active duty for a period of more than 30 days; or while such member is a member of the Ready Reserve. Such term does not include a dependent by reason of paragraph (2) after the end of the three-year period beginning on the date of the member’s death, except that, in the case of a dependent of the deceased who is described by subparagraph (D) or (I) of section 1072(2) of this title , the period of continued eligibility shall be the longer of the following periods beginning on such date: Three years. The period ending on the date on which such dependent attains 21 years of age. In the case of such dependent who, at 21 years of age, is enrolled in a full-time course of study in a secondary school or in a full-time course of study in an institution of higher education approved by the administering Secretary and was, at the time of the member’s death, in fact dependent on the member for over one-half of such dependent’s support, the period ending on the earlier of the following dates: The date on which such dependent ceases to pursue such a course of study, as determined by the administering Secretary. The date on which such dependent attains 23 years of age.

(l) Definitions.— In this section: The term “non-standard option plan” means a high option dental insurance plan that includes covered services in addition to, or provides greater coverage with respect to, services covered under a standard option plan. The term “standard option plan” means a dental insurance plan that provides for the coverage of preventive services, basic restorative services, and specialty dental care services at a level that is at least commensurate with the coverage of the same services provided under the premium sharing plans under this section during the period preceding January 1, 2027 .

[§ 1076b Repealed. Pub. L. 109–364, div. A, title VII, § 706(d), Oct. 17, 2006, 120 Stat. 2282]

§ 1076c Dental insurance plan: certain retirees and their surviving spouses and other dependents

(a) Requirement for Plan.— The Secretary of Defense shall establish a dental insurance plan for retirees of the uniformed services, certain unremarried surviving spouses, and dependents in accordance with this section. The Secretary may satisfy the requirement under paragraph (1) by entering into an agreement with the Director of the Office of Personnel Management to allow persons described in subsection (b) to enroll in an insurance plan under chapter 89A of title 5 that provides benefits similar to those benefits required to be provided under subsection (d).

(b) Persons Eligible for Plan.— The following persons are eligible to enroll in the dental insurance plan established under subsection (a): Members of the uniformed services who are entitled to retired pay. Members of the Retired Reserve who would be entitled to retired pay under chapter 1223 of this title but for being under 60 years of age. Eligible dependents of a member described in paragraph (1) or (2) who are covered by the enrollment of the member in the plan. Eligible dependents of a member described in paragraph (1) or (2) who is not enrolled in the plan and who— is enrolled under section 1705 of title 38 to receive dental care from the Secretary of Veterans Affairs; is enrolled in a dental plan that— is available to the member as a result of employment by the member that is separate from the military service of the member; and is not available to dependents of the member as a result of such separate employment by the member; or is prevented by a medical or dental condition from being able to obtain benefits under the plan. The unremarried surviving spouse and eligible child dependents of a deceased member— who died while in a status described in paragraph (1) or (2); who is described in section 1448(d)(1) of this title ; or who died while on active duty for a period of more than 30 days and whose eligible dependents are not eligible, or no longer eligible, for dental benefits under section 1076a of this title .

(c) Premiums.— A member enrolled in the dental insurance plan established under subsection (a) shall pay the premiums charged for the insurance coverage. The Secretary of Defense shall establish procedures for the collection of the premiums charged for coverage by the dental insurance plan. To the maximum extent practicable, the premiums payable by a member entitled to retired pay shall be deducted and withheld from the retired pay of the member (if pay is available to the member).

(d) Benefits Available Under the Plan.— The dental insurance plan established under subsection (a) shall provide benefits for dental care and treatment which may be comparable to the benefits authorized under section 1076a of this title for plans established under that section and shall include diagnostic services, preventative services, endodontics and other basic restorative services, surgical services, and emergency services.

(e) Coverage.— The Secretary shall prescribe a minimum required period for enrollment by a member or surviving spouse in the dental insurance plan established under subsection (a). The dental insurance plan shall provide for voluntary enrollment of participants and shall authorize a member or eligible unremarried surviving spouse to enroll for self only or for self and eligible dependents.

(f) Required Terminations of Enrollment.— The Secretary shall terminate the enrollment of any enrollee, and any eligible dependents of the enrollee covered by the enrollment, in the dental insurance plan established under subsection (a) upon the occurrence of the following: In the case of an enrollment under subsection (b)(1), termination of the member’s entitlement to retired pay. In the case of an enrollment under subsection (b)(2), termination of the member’s status as a member of the Retired Reserve. In the case of an enrollment under subsection (b)(5), remarriage of the surviving spouse.

(g) Continuation of Dependents’ Enrollment Upon Death of Enrollee.— Coverage of a dependent in the dental insurance plan established under subsection (a) under an enrollment of a member or a surviving spouse who dies during the period of enrollment shall continue until the end of that period and may be renewed by (or for) the dependent, so long as the premium paid is sufficient to cover continuation of the dependent’s enrollment. The Secretary may terminate coverage of the dependent when the premiums paid are no longer sufficient to cover continuation of the enrollment. The Secretary shall prescribe in regulations under subsection (h) the parties responsible for paying the remaining premiums due on the enrollment and the manner for collection of the premiums.

(h) Regulations.— The dental insurance plan established under subsection (a) shall be administered under regulations prescribed by the Secretary of Defense, in consultation with the other administering Secretaries.

(i) Voluntary Disenrollment.— With respect to enrollment in the dental insurance plan established under subsection (a), the Secretary of Defense— shall allow for a period of up to 30 days at the beginning of the prescribed minimum enrollment period during which an enrollee may disenroll; and shall provide for limited circumstances under which disenrollment shall be permitted during the prescribed enrollment period, without jeopardizing the fiscal integrity of the dental program. The circumstances described in paragraph (1)(B) shall include— a case in which a retired member, surviving spouse, or dependent of a retired member who is also a Federal employee is assigned to a location outside the jurisdiction of the dental insurance plan established under subsection (a) that prevents utilization of dental benefits under the plan; a case in which a retired member, surviving spouse, or dependent of a retired member is prevented by a serious medical condition from being able to obtain benefits under the plan; a case in which severe financial hardship would result; and any other circumstances which the Secretary considers appropriate. The Secretary shall establish procedures for timely decisions on requests for disenrollment under this section and for appeal to the TRICARE Management Activity of adverse decisions.

(j) Definitions.— In this section: The term “eligible dependent” means a dependent described in subparagraph (A), (D), or (I) of section 1072(2) of this title . The term “eligible child dependent” means a dependent described in subparagraph (D) or (I) of section 1072(2) of this title . The term “retired pay” includes retainer pay.

§ 1076d TRICARE program: TRICARE Reserve Select coverage for members of the Selected Reserve

(a) Eligibility.— Except as provided in paragraph (2), a member of the Selected Reserve of the Ready Reserve of a reserve component of the armed forces is eligible for health benefits under TRICARE Reserve Select as provided in this section. During the period preceding January 1, 2030 , paragraph (1) does not apply to a member who is enrolled, or is eligible to enroll, in a health benefits plan under chapter 89 of title 5.

(b) Termination of Eligibility Upon Termination of Service.— Except as provided in paragraph (2), eligibility for TRICARE Reserve Select coverage of a member under this section shall terminate upon the termination of the member’s service in the Selected Reserve. During the period beginning on the date of the enactment of this paragraph and ending December 31, 2018 , eligibility for a member under this section who is involuntarily separated from the Selected Reserve under other than adverse conditions, as characterized by the Secretary concerned, shall terminate 180 days after the date on which the member is separated.

(c) Family Members.— While a member of a reserve component is covered by TRICARE Reserve Select under the section, the members of the immediate family of such member are eligible for TRICARE Reserve Select coverage as dependents of the member. If a member of a reserve component dies while in a period of coverage under this section, the eligibility of the members of the immediate family of such member for TRICARE Reserve Select coverage shall continue for three years beyond the date of death of the member.

(d) Premiums.— A member of a reserve component covered by TRICARE Reserve Select under this section shall pay a premium for that coverage. Such premium shall apply instead of any enrollment fees required under section 1075 of this title . The Secretary of Defense shall prescribe for the purposes of this section one premium for TRICARE Reserve Select coverage of members without dependents and one premium for TRICARE Reserve Select coverage of members with dependents referred to in subsection (f)(1). The premium prescribed for a coverage shall apply uniformly to all covered members of the reserve components. The monthly amount of the premium in effect for a month for TRICARE Reserve Select coverage under this section shall be the amount equal to 28 percent of the total monthly amount determined on an appropriate actuarial basis as being reasonable for that coverage. The appropriate actuarial basis for purposes of subparagraph (A) shall be determined, for each calendar year after calendar year 2009, by utilizing the actual cost of providing benefits under this section to members and their dependents during the calendar years preceding such calendar year. The premiums payable by a member of a reserve component under this subsection may be deducted and withheld from basic pay payable to the member under section 204 of title 37 or from compensation payable to the member under section 206 of such title. The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums. Amounts collected as premiums under this subsection shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title , shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section for such fiscal year.

(e) Regulations.— The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section.

(f) Definitions.— In this section: The term “immediate family”, with respect to a member of a reserve component, means all of the member’s dependents described in subparagraphs (A), (D), and (I) of section 1072(2) of this title . The term “TRICARE Reserve Select” means— medical care at facilities of the uniformed services to which a dependent described in section 1076(a)(2) of this title is entitled; and health benefits under the TRICARE Select self-managed, preferred provider network option under section 1075 of this title made available to beneficiaries by reason of this section and subject to the cost-sharing requirements set forth in such section 1075.

§ 1076e TRICARE program: TRICARE Retired Reserve coverage for certain members of the Retired Reserve who are qualified for a non-regular retirement but are not yet age 60

(a) Eligibility.— Except as provided in paragraph (2), a member of the Retired Reserve of a reserve component of the armed forces who is qualified for a non-regular retirement at age 60 under chapter 1223 of this title, but is not age 60, is eligible for health benefits under TRICARE Retired Reserve as provided in this section. Paragraph (1) does not apply to a member who is enrolled, or is eligible to enroll, in a health benefits plan under chapter 89 of title 5.

(b) Termination of Eligibility Upon Obtaining Other TRICARE Coverage.— Eligibility for TRICARE Retired Reserve coverage of a member under this section shall terminate upon the member becoming eligible for TRICARE coverage at age 60 under section 1086 of this title .

(c) Family Members.— While a member of a reserve component is covered by TRICARE Retired Reserve under this section, the members of the immediate family of such member are eligible for TRICARE Retired Reserve coverage as dependents of the member. If a member of a reserve component dies while in a period of coverage under this section, the eligibility of the members of the immediate family of such member for TRICARE Retired Reserve coverage under this section shall continue for the same period of time that would be provided under section 1086 of this title if the member had been eligible at the time of death for TRICARE coverage under such section (instead of under this section).

(d) Premiums.— A member of a reserve component covered by TRICARE Retired Reserve under this section shall pay a premium for that coverage. Such premium shall apply instead of any enrollment fees required under section 1075 of this title . The Secretary of Defense shall prescribe for the purposes of this section one premium for TRICARE Retired Reserve coverage of members without dependents and one premium for TRICARE Retired Reserve coverage of members with dependents referred to in subsection (f)(1). The premium prescribed for a coverage shall apply uniformly to all members of the reserve components covered under this section. The monthly amount of the premium in effect for a month for TRICARE Retired Reserve coverage under this section shall be the amount equal to the cost of coverage that the Secretary determines on an appropriate actuarial basis. The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums under this subsection. Amounts collected as premiums under this subsection shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title , shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section for such fiscal year.

(e) Regulations.— The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section.

(f) Definitions.— In this section: The term “immediate family”, with respect to a member of a reserve component, means all of the member’s dependents described in subparagraphs (A), (D), and (I) of section 1072(2) of this title . The term “TRICARE Retired Reserve” means— medical care at facilities of the uniformed services to which a dependent described in section 1076(a)(2) of this title is entitled; and health benefits under the TRICARE Select self-managed, preferred provider network option under section 1075 of this title made available to beneficiaries by reason of this section and subject to the cost-sharing requirements set forth in such section 1075.

§ 1076f TRICARE program: extension of coverage for certain members of the National Guard and dependents during certain disaster response duty

(a) Extended Coverage.— During a period in which a member of the National Guard is performing disaster response duty, the member may be treated as being on active duty for a period of more than 30 days for purposes of the eligibility of the member and dependents of the member for health care benefits under the TRICARE program if such period immediately follows a period in which the member served on full-time National Guard duty under section 502(f) of title 32 , including pursuant to chapter 9 of such title, unless the Governor of the State (or, with respect to the District of Columbia, the mayor of the District of Columbia) determines that such extended eligibility is not in the best interest of the member or the State.

(b) Contribution by State.— The Secretary shall charge a State for the costs of providing coverage under the TRICARE program to members of the National Guard of the State and the dependents of the members pursuant to subsection (a). Such charges shall be paid from the funds of the State or from any other non-Federal funds. Any amounts received by the Secretary under paragraph (1) shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title , shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section, including to carry out subsection (a) of this section.

(c) Definitions.— In this section: The term “disaster response duty” means duty performed by a member of the National Guard in State status pursuant to an emergency declaration by the Governor of the State (or, with respect to the District of Columbia, the mayor of the District of Columbia) in response to a disaster or in preparation for an imminent disaster. The term “State” means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, and any territory or possession of the United States.

§ 1077 Medical care for dependents: authorized care in facilities of uniformed services

(a) Only the following types of health care may be provided under section 1076 of this title : Hospitalization. Outpatient care. Drugs, including, in accordance with subsection (h), medically necessary vitamins. Treatment of medical and surgical conditions. Treatment of nervous, mental, and chronic conditions. Treatment of contagious diseases. Physical examinations, including eye examinations, and immunizations. Maternity and infant care, including well-baby care that includes one screening of an infant for the level of lead in the blood of the infant. Diagnostic tests and services, including laboratory and X-ray examinations. Dental care. Ambulance service and home calls when medically necessary. Durable equipment, which may be provided on a loan basis. Primary and preventive health care services for women (as defined in section 1074d(b) of this title ). Preventive health care screening for colon or prostate cancer, at the intervals and using the screening methods prescribed under section 1074d(a)(2) of this title . Prosthetic devices, as determined by the Secretary of Defense to be necessary because of significant conditions resulting from trauma, congenital anomalies, or disease. Except as provided by subsection (g), a hearing aid, but only if the dependent has a profound hearing loss, as determined under standards prescribed in regulations by the Secretary of Defense in consultation with the administering Secretaries, and only for the following dependents: A dependent of a member of the uniformed services on active duty. A dependent under subparagraph (D) or (I) of section 1072(2) of this title of a former member of the uniformed services who— is entitled to retired or retainer pay, or equivalent pay; and is enrolled in family coverage under TRICARE Prime. Any rehabilitative therapy to improve, restore, or maintain function, or to minimize or prevent deterioration of function, of a patient when prescribed by a physician. In accordance with subsection (h), medically necessary food and the medical equipment and supplies necessary to administer such food (other than durable medical equipment and supplies).

(b) The following types of health care may not be provided under section 1076 of this title : Domiciliary or custodial care. Orthopedic footwear and spectacles, except that, outside of the United States and at stations inside the United States where adequate civilian facilities are unavailable, such items may be sold to dependents at cost to the United States. The elective correction of minor dermatological blemishes and marks or minor anatomical anomalies.

(c) Except as specified in paragraphs (2) and (3), a dependent participating under a dental plan established under section 1076a of this title may not be provided dental care under section 1076(a) of this title except for emergency dental care, dental care provided outside the United States, and dental care that is not covered by such plan. Dependents who are 12 years of age or younger and are covered by a dental plan established under section 1076a of this title may be treated by postgraduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association if— treatment of pediatric dental patients is necessary in order to satisfy an accreditation standard of the American Dental Association that is applicable to such program, or training in pediatric dental care is necessary for the residents to be professionally qualified to provide dental care for dependent children accompanying members of the uniformed services outside the United States; and the number of pediatric patients at such facility is insufficient to support satisfaction of the accreditation or professional requirements in pediatric dental care that apply to such program or students. The total number of dependents treated in all facilities of the uniformed services under subparagraph (A) in a fiscal year may not exceed 2,000. Dependents who reside within a specified geographic area and are covered by a dental plan established under section 1076a may receive dental care in a dental treatment facility of the uniformed services on a space available basis if the Secretary of Defense determines that— civilian dental care within the specified geographic area is inadequate or is not sufficiently available; and adequate resources exist to provide space available dental care to the dependents at the facility. Care under subparagraph (A) shall be provided on a reimbursable basis.

(d) Notwithstanding subsection (b)(1), hospice care may be provided under section 1076 of this title in facilities of the uniformed services to a terminally ill patient who chooses (pursuant to regulations prescribed by the Secretary of Defense in consultation with the other administering Secretaries) to receive hospice care rather than continuing hospitalization or other health care services for treatment of the patient’s terminal illness. In this section, the term “hospice care” means the items and services described in section 1861(dd) of the Social Security Act ( 42 U.S.C. 1395x(dd) ).

(e) Authority to provide a prosthetic device under subsection (a)(15) includes authority to provide the following: Any accessory or item of supply that is used in conjunction with the device for the purpose of achieving therapeutic benefit and proper functioning. Services necessary to train the recipient of the device in the use of the device. Repair of the device for normal wear and tear or damage. Replacement of the device if the device is lost or irreparably damaged or the cost of repair would exceed 60 percent of the cost of replacement. An augmentative communication device may be provided as a voice prosthesis under subsection (a)(15). A prosthetic device customized for a patient may be provided under this section only by a prosthetic practitioner who is qualified to customize the device, as determined under regulations prescribed by the Secretary of Defense in consultation with the administering Secretaries.

(f) Items that may be provided to a patient under subsection (a)(12) include the following: Any durable medical equipment that can improve, restore, or maintain the function of a malformed, diseased, or injured body part, or can otherwise minimize or prevent the deterioration of the patient’s function or condition. Any durable medical equipment that can maximize the patient’s function consistent with the patient’s physiological or medical needs. Wheelchairs. Iron lungs. Hospital beds. In addition to the authority to provide durable medical equipment under subsection (a)(12), any customization of equipment owned by the patient that is durable medical equipment authorized to be provided to the patient under this section or section 1079(a)(5) of this title , and any accessory or item of supply for any such equipment, may be provided to the patient if the customization, accessory, or item of supply is essential for— achieving therapeutic benefit for the patient; making the equipment serviceable; or otherwise assuring the proper functioning of the equipment.

(g) In addition to the authority to provide a hearing aid under subsection (a)(16), hearing aids may be sold under this section to dependents eligible for care under this section at cost to the United States. For purposes of selling hearing aids at cost to the United States under paragraph (1), a dependent of a member of the reserve components who is enrolled in the TRICARE program under section 1076d of this title shall be deemed to be a dependent eligible for care under this section.

(h) Vitamins that may be provided under subsection (a)(3) are vitamins used for the management of a covered disease or condition pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation. Medically necessary food that may be provided under subsection (a)(18)— is food, including a low protein modified food product or an amino acid preparation product, that is— furnished pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation, for the dietary management of a covered disease or condition; a specially formulated and processed product (as opposed to a naturally occurring foodstuff used in its natural state) for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube; intended for the dietary management of an individual who, because of therapeutic or chronic medical needs, has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone; intended to be used under medical supervision, which may include in a home setting; and intended only for an individual receiving active and ongoing medical supervision under which the individual requires medical care on a recurring basis for, among other things, instructions on the use of the food; and may not include— food taken as part of an overall diet designed to reduce the risk of a disease or medical condition or as weight-loss products, even if the food is recommended by a physician or other health care professional; food marketed as gluten-free for the management of celiac disease or non-celiac gluten sensitivity; food marketed for the management of diabetes; or such other products as the Secretary determines appropriate. In this subsection, the term “covered disease or condition” means— inborn errors of metabolism; medical conditions of malabsorption; pathologies of the alimentary tract or the gastrointestinal tract; a neurological or physiological condition; and such other diseases or conditions the Secretary determines appropriate.

§ 1077a Access to military medical treatment facilities and other facilities

(a) Urgent Care.— The Secretary of Defense shall ensure that military medical treatment facilities, at locations the Secretary determines appropriate, provide urgent care services for members of the armed forces and covered beneficiaries until 11:00 p.m. each day. With respect to areas in which a military medical treatment facility covered by paragraph (1) is not located, the Secretary shall ensure that members of the armed forces and covered beneficiaries may access urgent care clinics through the health care provider network under the TRICARE program. A covered beneficiary may access urgent care services without the need for preauthorization for such services. The Secretary shall— publish information about changes in access to urgent care under the TRICARE program— on the primary publicly available Internet website of the Department; and on the primary publicly available Internet website of each military medical treatment facility; and ensure that such information is made available on the publicly available Internet website of each current managed care support contractor that has established a health care provider network under the TRICARE program.

(b) Nurse Advice Line.— The Secretary shall ensure that the nurse advice line of the Department directs covered beneficiaries seeking access to care to the source of the most appropriate level of health care required to treat the medical conditions of the beneficiaries, including urgent care services described in subsection (a).

(c) Primary Care Clinics.— The Secretary shall ensure that primary care clinics at military medical treatment facilities are available for members of the armed forces and covered beneficiaries between the hours determined appropriate under paragraph (2), including with respect to expanded hours described in subparagraph (B) of such paragraph. The Secretary shall determine the hours that each primary care clinic at a military medical treatment facility is available for members of the armed forces and covered beneficiaries based on— the needs of the military medical treatment facility to meet the access standards under the TRICARE Prime program; and the primary care utilization patterns of members and covered beneficiaries at such military medical treatment facility. The primary care clinic hours at a military medical treatment facility determined under subparagraph (A) shall include expanded hours beyond regular business hours during weekdays and the weekend if the Secretary determines under such subparagraph that sufficient demand exists at the military medical treatment facility for such expanded primary care clinic hours.

§ 1078 Medical and dental care for dependents: charges

(a) The Secretary of Defense, after consulting the other administering Secretaries, shall prescribe fair charges for inpatient medical and dental care given to dependents under section 1076 of this title . The charge or charges prescribed shall be applied equally to all classes of dependents.

(b) As a restraint on excessive demands for medical and dental care under section 1076 of this title , uniform minimal charges may be imposed for outpatient care. Charges may not be more than such amounts, if any, as the Secretary of Defense may prescribe after consulting the other administering Secretaries, and after a finding that such charges are necessary.

(c) Amounts received for subsistence and medical and dental care given under section 1076 of this title shall be deposited to the credit of the appropriation supporting the maintenance and operation of the facility furnishing the care.

§ 1078a Continued health benefits coverage

(a) Provision of Continued Health Coverage.— The Secretary of Defense shall implement and carry out a program of continued health benefits coverage in accordance with this section to provide persons described in subsection (b) with temporary health benefits comparable to the health benefits provided for former civilian employees of the Federal Government and other persons under section 8905a of title 5 .

(b) Eligible Persons.— The persons referred to in subsection (a) are the following: A member of the uniformed services who— is discharged or released from active duty (or full-time National Guard duty), whether voluntarily or involuntarily, under other than adverse conditions, as characterized by the Secretary concerned; immediately preceding that discharge or release, is entitled to medical and dental care under section 1074(a) of this title (except in the case of a member discharged or released from full-time National Guard duty); and after that discharge or release and any period of transitional health care provided under section 1145(a) of this title , would not otherwise be eligible for any benefits under this chapter. A member of the Selected Reserve of the Ready Reserve of a reserve component of the armed forces who— is discharged or released from service in the Selected Reserve, whether voluntarily or involuntarily, under other than adverse conditions, as characterized by the Secretary concerned; immediately preceding that discharge or release, is enrolled in TRICARE Reserve Select; and after that discharge or release, would not otherwise be eligible for any benefits under this chapter. A person who— ceases to meet the requirements for being considered an unmarried dependent child of a member or former member of the uniformed services under section 1072(2)(D) of this title or ceases to meet the requirements for being considered an unmarried dependent under section 1072(2)(I) of this title ; on the day before ceasing to meet those requirements, was covered under a health benefits plan under this chapter or transitional health care under section 1145(a) of this title as a dependent of the member or former member; and would not otherwise be eligible for any benefits under this chapter. A person who— is an unremarried former spouse of a member or former member of the uniformed services; and on the day before the date of the final decree of divorce, dissolution, or annulment was covered under a health benefits plan under this chapter or transitional health care under section 1145(a) of this title as a dependent of the member or former member; and is not a dependent of the member or former member under subparagraph (F) or (G) of section 1072(2) of this title or ends a one-year period of dependency under subparagraph (H) of such section. Any other person specified in regulations prescribed by the Secretary of Defense for purposes of this paragraph who loses entitlement to health care services under this chapter or section 1145 of this title , subject to such terms and conditions as the Secretary shall prescribe in the regulations.

(c) Notification of Eligibility.— The Secretary of Defense shall prescribe regulations to provide for persons described in subsection (b) to be notified of eligibility to receive health benefits under this section. In the case of a member who becomes (or will become) eligible for continued coverage under subsection (b)(1) or subsection (b)(2), the regulations shall provide for the Secretary concerned to notify the member of the member’s rights under this section as part of preseparation counseling conducted under section 1142 of this title or any other provision of other law. In the case of a dependent of a member or former member who becomes eligible for continued coverage under subsection (b)(3), the regulations shall provide that— the member or former member may submit to the Secretary concerned a written notice of the dependent’s change in status (including the dependent’s name, address, and such other information as the Secretary of Defense may require); and the Secretary concerned shall, within 14 days after receiving that notice, inform the dependent of the dependent’s rights under this section. In the case of a former spouse of a member or former member who becomes eligible for continued coverage under subsection (b)(4), the regulations shall provide appropriate notification provisions and a 60-day election period under subsection (d)(3). 1

(d) Election of Coverage.— In order to obtain continued coverage under this section, an appropriate written election (submitted in such manner as the Secretary of Defense may prescribe) shall be made as follows: In the case of a member described in subsection (b)(1), the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the later of— the date of the discharge or release of the member from active duty or full-time National Guard duty; the date on which the period of transitional health care applicable to the member under section 1145(a) of this title ends; or the date the member receives the notification required pursuant to subsection (c). In the case of a member described in subsection (b)(2), the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the later of— the date of the discharge or release of the member from service in the Selected Reserve; and the date the member receives the notification required pursuant to subsection (c). In the case of a dependent of a member or former member who becomes eligible for continued coverage under subsection (b)(3), the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the later of— the date on which the dependent first ceases to meet the requirements for being considered a dependent under subparagraph (D) or (I) of section 1072(2) of this title ; or the date the dependent receives the notification pursuant to subsection (c). Notwithstanding subparagraph (A), if the Secretary concerned determines that the dependent’s parent has failed to provide the notice referred to in subsection (c)(3)(A) with respect to the dependent in a timely fashion, the 60-day period under this paragraph shall be based only on the date under subparagraph (A)(i). In the case of a former spouse of a member or a former member who becomes eligible for continued coverage under subsection (b)(4), the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the later of— the date as of which the former spouse first ceases to meet the requirements for being considered a dependent under section 1072(2) of this title ; or such other date as the Secretary of Defense may prescribe. In the case of a person described in subsection (b)(5), by such date as the Secretary shall prescribe in the regulations required for purposes of that subsection.

(e) Coverage of Dependents.— A person eligible under subsection (b)(1) or subsection (b)(2) to elect to receive coverage may elect coverage either as an individual or, if appropriate, for self and dependents. A person eligible under subsection (b)(3) or subsection (b)(4) may elect only individual coverage.

(f) Charges.— Under arrangements satisfactory to the Secretary of Defense, a person receiving continued coverage under this section shall be required to pay into the Military Health Care Account or other appropriate account an amount equal to the sum of— the employee and agency contributions which would be required in the case of a similarly situated employee enrolled in a comparable health benefits plan under section 8905a(d)(1)(A)(i) of title 5 ; and an amount, not to exceed 10 percent of the amount determined under subparagraph (A), determined under regulations prescribed by the Secretary of Defense to be necessary for administrative expenses; and If a person elects to continue coverage under this section before the end of the applicable period under subsection (d), but after the person’s coverage under this chapter (and any transitional extension of coverage under section 1145(a) of this title ) expires, coverage shall be restored retroactively, with appropriate contributions (determined in accordance with paragraph (1)) and claims (if any), to the same extent and effect as though no break in coverage had occurred.

(g) Period of Continued Coverage.— Continued coverage under this section may not extend beyond— in the case of a member described in subsection (b)(1), the date which is 18 months after the date the member ceases to be entitled to care under section 1074(a) of this title and any transitional care under section 1145 of this title , as the case may be; in the case of a member described in subsection (b)(2), the date which is 18 months after the date the member ceases to be eligible to enroll in TRICARE Reserve Select; in the case of a person described in subsection (b)(3), the date which is 36 months after the date on which the person first ceases to meet the requirements for being considered a dependent under subparagraph (D) or (I) of section 1072(2) of this title ; in the case of a person described in subsection (b)(4), except as provided in paragraph (4), the date which is 36 months after the later of— the date on which the final decree of divorce, dissolution, or annulment occurs; and if applicable, the date the one-year extension of dependency under section 1072(2)(H) of this title expires; and in the case of a person described in subsection (b)(5), the date that is 36 months after the date on which the person loses entitlement to health care services as described in that subsection. Notwithstanding paragraph (1)(C), if a dependent of a member becomes eligible for continued coverage under subsection (b)(3) during a period of continued coverage of the member for self and dependents under this section, extended coverage of the dependent under this section may not extend beyond the date which is 36 months after the date the member became ineligible for medical and dental care under section 1074(a) of this title and any transitional health care under section 1145(a) of this title . Notwithstanding paragraph (1)(D), if a person becomes eligible for continued coverage under subsection (b)(4) as the former spouse of a member during a period of continued coverage of the member for self and dependents under this section, extended coverage of the former spouse under this section may not extend beyond the date which is 36 months after the date the member became ineligible for medical and dental care under section 1074(a) of this title and any transitional health care under section 1145(a) of this title . Notwithstanding paragraph (1), in the case of a former spouse described in subparagraph (B), continued coverage under this section shall continue for such period as the former spouse may request. A former spouse referred to in subparagraph (A) is a former spouse of a member or former member (other than a former spouse whose marriage was dissolved after the separation of the member from the service unless such separation was by retirement)— who has not remarried before age 55 after the marriage to the employee, former employee, or annuitant was dissolved; who was enrolled in an approved health benefits plan under this chapter as a family member at any time during the 18-month period before the date of the divorce, dissolution, or annulment; and who is receiving any portion of the retired or retainer pay of the member or former member or an annuity based on the retired or retainer pay of the member; or for whom a court order (as defined in section 1408(a)(2) of this title ) has been issued for payment of any portion of the retired or retainer pay or for whom a court order (as defined in section 1447(13) of this title ) or a written agreement (whether voluntary or pursuant to a court order) provides for an election by the member or former member to provide an annuity to the former spouse.

(h) TRICARE Reserve Select Defined.— In this section, the term “TRICARE Reserve Select” means TRICARE Standard coverage provided under section 1076d of this title .

§ 1078b Provision of food to certain members and dependents not receiving inpatient care in military medical treatment facilities

(a) In General.— Under regulations prescribed by the Secretary of Defense, the Secretary may provide food and beverages to an individual described in paragraph (2) at no cost to the individual. An individual described in this paragraph is the following: A member or former member of the uniformed services or dependent— who is receiving outpatient medical care at a military medical treatment facility; and whom the Secretary determines is unable to purchase food and beverages while at such facility by virtue of receiving such care. A member or former member of the uniformed services or dependent— who is a family member of an infant receiving inpatient medical care at a military medical treatment facility; who provides care to the infant while the infant receives such inpatient medical care; and whom the Secretary determines is unable to purchase food and beverages while at such facility by virtue of providing such care to the infant. A member or former member of the uniformed services or dependent whom the Secretary determines is under similar circumstances as a member, former member, or dependent described in subparagraph (A) or (B).

(b) Regulations.— The Secretary shall ensure that regulations prescribed under this section are consistent with generally accepted practices in private medical treatment facilities.

§ 1079 Contracts for medical care for spouses and children: plans

(a) To assure that medical care is available for dependents, as described in subparagraphs (A), (D), and (I) of section 1072(2) of this title , of members of the uniformed services who are on active duty for a period of more than 30 days, the Secretary of Defense, after consulting with the other administering Secretaries, shall contract, under the authority of this section, for medical care for those persons under such insurance, medical service, or health plans as he considers appropriate. The types of health care authorized under this section shall be the same as those provided under section 1076 of this title , except as follows: With respect to dental care— except as provided in subparagraph (B), only that care required as a necessary adjunct to medical or surgical treatment may be provided; and in connection with dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under, only institutional and anesthesia services may be provided. Consistent with such regulations as the Secretary of Defense may prescribe regarding the content of health promotion and disease prevention visits, the schedule and method of cervical cancer screenings and breast cancer screenings, the schedule and method of colon and prostate cancer screenings, and the types and schedule of immunizations— for dependents under six years of age, both health promotion and disease prevention visits and immunizations may be provided; and for dependents six years of age or older, health promotion and disease prevention visits may be provided in connection with immunizations or with diagnostic or preventive cervical and breast cancer screenings or colon and prostate cancer screenings. Not more than one eye examination may be provided to a patient in any calendar year. Under joint regulations to be prescribed by the administering Secretaries, the services of Christian Science practitioners and nurses and services obtained in Christian Science sanatoriums may be provided. Durable equipment provided under this section may be provided on a rental basis. Services in connection with nonemergency inpatient hospital care may not be provided if such services are available at a facility of the uniformed services located within a 40-mile radius of the residence of the patient, except that those services may be provided in any case in which another insurance plan or program provides primary coverage for those services. Services of pastoral counselors, family and child counselors, or marital counselors (other than certified marriage and family therapists) may not be provided unless the patient has been referred to the counselor by a medical doctor for treatment of a specific problem with the results of that treatment to be communicated back to the medical doctor who made the referral and services of certified marriage and family therapists may be provided consistent with such rules as may be prescribed by the Secretary of Defense, including credentialing criteria and a requirement that the therapists accept payment under this section as full payment for all services provided. Special education may not be provided, except when provided as secondary to the active psychiatric treatment on an institutional inpatient basis. Therapy or counseling for sexual dysfunctions or sexual inadequacies may not be provided. Treatment of obesity may not be provided if obesity is the sole or major condition treated. Surgery which improves physical appearance but is not expected to significantly restore functions (including mammary augmentation, face lifts, and sex gender changes) may not be provided, except that— breast reconstructive surgery following a mastectomy may be provided; reconstructive surgery to correct serious deformities caused by congenital anomalies or accidental injuries may be provided; and neoplastic surgery may be provided. Any service or supply which is not medically or psychologically necessary to prevent, diagnose, or treat a mental or physical illness, injury, or bodily malfunction as assessed or diagnosed by a physician, dentist, clinical psychologist, certified marriage and family therapist, optometrist, podiatrist, certified nurse-midwife, certified nurse practitioner, certified clinical social worker, or other class of provider as designated by the Secretary of Defense, as appropriate, may not be provided, except as authorized in paragraph (4). Pursuant to an agreement with the Secretary of Health and Human Services and under such regulations as the Secretary of Defense may prescribe, the Secretary of Defense may waive the operation of this paragraph in connection with clinical trials sponsored or approved by the National Institutes of Health if the Secretary of Defense determines that such a waiver will promote access by covered beneficiaries to promising new treatments and contribute to the development of such treatments. The prohibition contained in section 1077(b)(3) of this title shall not apply in the case of a member or former member of the uniformed services. Electronic cardio-respiratory home monitoring equipment (apnea monitors) for home use may be provided if a physician prescribes and supervises the use of the monitor for an infant— who has had an apparent life-threatening event, who is a subsequent sibling of a victim of sudden infant death syndrome, whose birth weight was 1,500 grams or less, or who is a pre-term infant with pathologic apnea, in which case the coverage may include the cost of the equipment, hard copy analysis of physiological alarms, professional visits, diagnostic testing, family training on how to respond to apparent life threatening events, and assistance necessary for proper use of the equipment. Hospice care may be provided only in the manner and under the conditions provided in section 1861(dd) of the Social Security Act ( 42 U.S.C. 1395x(dd) ), except that hospice care may be provided to an individual under the age of 21 concurrently with health care services or hospitalization for the same condition. Forensic examinations following a sexual assault or domestic violence may be provided. Breastfeeding support, supplies (including breast pumps and associated equipment), and counseling shall be provided as appropriate during pregnancy and the postpartum period. Treatment for eating disorders may be provided in accordance with subsection (r). Preconception and prenatal carrier screening tests shall be provided to eligible covered beneficiaries, with a limit per beneficiary of one test per condition per lifetime, for the following conditions: Cystic Fibrosis. Spinal Muscular Atrophy. Fragile X Syndrome. Tay-Sachs Disease. Hemoglobinopathies. Conditions linked with Ashkenazi Jewish descent. Medical interventions for the treatment of gender dysphoria that could result in sterilization may not be provided to a child under the age of 18.

(b) Plans covered by subsection (a) shall include provisions for payment by the patient of the following amounts: $25foreachadmissiontoahospital,ortheamountthepatientwouldhavebeenchargedundersection1078(a)ofthistitlehadthecarebeingpaidforbeenobtainedinahospitaloftheuniformedservices,whicheveramountisthegreater.TheSecretaryofDefensemayexemptapatientfrompayingsuchamountifthehospitaltowhichthepatientisadmitteddoesnotimposealegalobligationonanyofitspatientstopayforinpatientcare.Exceptasprovidedinclause(3),thefirst$150 each calendar year of the charges for all types of care authorized by subsection (a) and received while in an outpatient status and 20 percent of all subsequent charges for such care during a calendar year. Notwithstanding the preceding sentence, in the case of a dependent of an enlisted member in a pay grade below E–5, the initial deductible each calendar year under this paragraph shall be limited to $50.Afamilygroupoftwoormorepersonscoveredbythissectionshallnotberequiredtopaycollectivelymorethanthefirst$300 (or in the case of the family group of an enlisted member in a pay grade below E–5, the first $100)eachcalendaryearofthechargesforalltypesofcareauthorizedbysubsection(a)andreceivedwhileinanoutpatientstatusand20percentoftheadditionalchargesforsuchcareduringacalendaryear.$25 for surgical care that is authorized by subsection (a) and received while in an outpatient status and that has been designated (under joint regulations to be prescribed by the administering Secretaries) as care to be treated as inpatient care for purposes of this subsection. Any care for which payment is made under this clause shall not be considered to be care received while in an outpatient status for purposes of clauses (2) and (3). An individual or family group of two or more persons covered by this section may not be required by reason of this subsection to pay a total of more than $1,000 for health care received during any calendar year under a plan under subsection (a).

(c) The methods for making payment under subsection (b) shall be prescribed under joint regulations issued by the administering Secretaries.

(d) The Secretary of Defense shall establish a program to provide extended benefits for eligible dependents, which may include the provision of comprehensive health care services, including case management services, to assist in the reduction of the disabling effects of a qualifying condition of an eligible dependent. Registration shall be required to receive the extended benefits. The Secretary of Defense, after consultation with the other administering Secretaries, shall promulgate regulations to carry out this subsection. In this subsection: The term “eligible dependent” means a dependent of a member of the uniformed services on active duty for a period of more than 30 days, as described in subparagraph (A), (D), or (I) of section 1072(2) of this title , who has a qualifying condition. The term “qualifying condition” means the condition of a dependent who is moderately or severely mentally retarded, has a serious physical disability, or has an extraordinary physical or psychological condition.

(e) Extended benefits for eligible dependents under subsection (d) may include comprehensive health care services (including services necessary to maintain, or minimize or prevent deterioration of, function of the patient) and case management services with respect to the qualifying condition of such a dependent, and include, to the extent such benefits are not provided under provisions of this chapter other than under this section, the following: Diagnosis and screening. Inpatient, outpatient, and comprehensive home health care supplies and services which may include cost-effective and medically appropriate services other than part-time or intermittent services (within the meaning of such terms as used in the second sentence of section 1861(m) of the Social Security Act ( 42 U.S.C. 1395x )). Rehabilitation services and devices. In accordance with paragraph (2), respite care for the primary caregiver of the eligible dependent. In accordance with paragraph (3), service and modification of durable equipment and assistive technology devices. Special education. Vocational training, which may be furnished to an eligible dependent in the residence of the eligible dependent or at a facility in which such training is provided. Such other services and supplies as determined appropriate by the Secretary, notwithstanding the limitations in subsection (a)(12). Respite care under paragraph (1)(D) shall be provided subject to the following conditions: Pursuant to regulations prescribed by the Secretary for purposes of this paragraph, such respite care shall be limited to 32 hours per month for a primary caregiver. Unused hours of such respite care may not be carried over to another month. Such respite care may be provided to an eligible beneficiary regardless of whether the eligible beneficiary is receiving another benefit under this subsection. Service and modification of durable equipment and assistive technology devices under paragraph (1)(E) may be provided only upon determination by the Secretary that the service or modification is necessary for the use of such equipment or device by the eligible dependent. Service and modification of durable equipment and assistive technology devices under such paragraph may not be provided— in the case of misuse, loss, or theft of the equipment or device; or for a deluxe, luxury, or immaterial feature of the equipment or device, as determined by the Secretary. Service and modification of durable equipment and assistive technology devices under such paragraph may include training of the eligible dependent and immediate family members of the eligible dependent on the use of the equipment or device.

(f) Members shall be required to share in the cost of any benefits provided to their dependents under subsection (d) as follows: Members in the lowest enlisted pay grade shall be required to pay the first $25incurredeachmonth,andmembersinthehighestcommissionedpaygradeshallberequiredtopaythefirst$250 incurred each month. The amounts to be paid by members in all other pay grades shall be determined under regulations to be prescribed by the Secretary of Defense in consultation with the administering Secretaries. A member who has more than one dependent incurring expenses in a given month under a plan covered by subsection (d) shall not be required to pay an amount greater than would be required if the member had only one such dependent. In the case of extended benefits provided under subparagraph (C), (E), (F), or (G) of subsection (e)(1) to a dependent of a member of the uniformed services— the Government’s share of the total cost of providing such benefits in any year shall not exceed $36,000, prorated as determined by the Secretary of Defense, except for costs that a member is exempt from paying under paragraph (3); and the member shall pay (in addition to any amount payable under paragraph (1)) the amount, if any, by which the amount of such total cost for the year exceeds the Government’s maximum share under subparagraph (A). A member of the uniformed services who incurs expenses under paragraph (2) for a month for more than one dependent shall not be required to pay for the month under subparagraph (B) of that paragraph an amount greater than the amount the member would otherwise be required to pay under that subparagraph for the month if the member were incurring expenses under that subparagraph for only one dependent. To qualify for extended benefits under subparagraph (C), (E), (F), or (G) of subsection (e)(1), a dependent of a member of the uniformed services shall be required to use public facilities to the extent such facilities are available and adequate, as determined under joint regulations of the administering Secretaries. The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to carry out this subsection.

(g) When a member dies while he is eligible for receipt of hostile fire pay under section 310 or 351 of title 37 or from a disease or injury incurred while eligible for such pay, his dependents who are receiving benefits under a plan covered by subsection (d) shall continue to be eligible for such benefits until they pass their twenty-first birthday. In addition to any continuation of eligibility for benefits under paragraph (1), when a member dies while on active duty for a period of more than 30 days, the member’s dependents who are receiving benefits under a plan covered by subsection (a) shall continue to be eligible for benefits under TRICARE Prime during the three-year period beginning on the date of the member’s death, except that, in the case of such a dependent of the deceased who is described by subparagraph (D) or (I) of section 1072(2) of this title , the period of continued eligibility shall be the longer of the following periods beginning on such date: Three years. The period ending on the date on which such dependent attains 21 years of age. In the case of such a dependent who, at 21 years of age, is enrolled in a full-time course of study in a secondary school or in a full-time course of study in an institution of higher education approved by the administering Secretary and was, at the time of the member’s death, in fact dependent on the member for over one-half of such dependent’s support, the period ending on the earlier of the following dates: The date on which such dependent ceases to pursue such a course of study, as determined by the administering Secretary. The date on which such dependent attains 23 years of age. For the purposes of paragraph (2)(C), a dependent shall be treated as being enrolled in a full-time course of study in an institution of higher education during any reasonable period of transition between the dependent’s completion of a full-time course of study in a secondary school and the commencement of an enrollment in a full-time course of study in an institution of higher education, as determined by the administering Secretary. The terms and conditions under which health benefits are provided under this chapter to a dependent of a deceased member under paragraph (2) shall be the same as those that would apply to the dependent under this chapter if the member were living and serving on active duty for a period of more than 30 days. In this subsection, the term “TRICARE Prime” means the managed care option of the TRICARE program.

(h) Except as provided in paragraphs (2) and (3), payment for a charge for services by an individual health care professional (or other noninstitutional health care provider) for which a claim is submitted under a plan contracted for under subsection (a) shall be equal to an amount determined to be appropriate, to the extent practicable, in accordance with the same reimbursement rules as apply to payments for similar services under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). The Secretary of Defense shall determine the appropriate payment amount under this paragraph in consultation with the other administering Secretaries. The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to provide for such exceptions to the payment limitations under paragraph (1) as the Secretary determines to be necessary to assure that covered beneficiaries retain adequate access to health care services. Such exceptions may include the payment of amounts higher than the amount allowed under paragraph (1) when enrollees in managed care programs obtain covered services from nonparticipating providers. To provide a suitable transition from the payment methodologies in effect before February 10, 1996 , to the methodology required by paragraph (1), the amount allowable for any service may not be reduced by more than 15 percent below the amount allowed for the same service during the immediately preceding 12-month period (or other period as established by the Secretary of Defense). In addition to the authority provided under paragraph (2), the Secretary of Defense may authorize the commander of a facility of the uniformed services, the lead agent (if other than the commander), and the health care contractor to modify the payment limitations under paragraph (1) for certain health care providers when necessary to ensure both the availability of certain services for covered beneficiaries and lower costs than would otherwise be incurred to provide the services. With the consent of the health care provider, the Secretary is also authorized to reduce the authorized payment for certain health care services below the amount otherwise required by the payment limitations under paragraph (1). The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to establish limitations (similar to the limitations established under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.)) on beneficiary liability for charges of an individual health care professional (or other noninstitutional health care provider). The regulations shall include a restriction that prohibits an individual health care professional (or other noninstitutional health care provider) from billing a beneficiary for services for more than the amount that is equal to— the excess of the limiting charge (as defined in section 1848(g)(2) of the Social Security Act ( 42 U.S.C. 1395w–4(g)(2) )) that would be applicable if the services had been provided by the professional (or other provider) as an individual health care professional (or other noninstitutional health care provider) on a nonassignment-related basis under part B of title XVIII of such Act over the amount that is payable by the United States for those services under this subsection, plus any unpaid amounts of deductibles or copayments that are payable directly to the professional (or other provider) by the beneficiary. In the case of a dependent described in clause (ii), the regulations shall provide that, in addition to amounts otherwise payable by the United States, the Secretary may pay the amount referred to in subparagraph (B)(i). This subparagraph applies to a dependent referred to in subsection (a) of a member of a reserve component serving on active duty pursuant to a call or order to active duty for a period of more than 30 days. To assure access to care for all covered beneficiaries, the Secretary of Defense, in consultation with the other administering Secretaries, shall designate specific rates for reimbursement for services in certain localities if the Secretary determines that without payment of such rates access to health care services would be severely impaired. Such a determination shall be based on consideration of the number of providers in a locality who provide the services, the number of such providers who are CHAMPUS participating providers, the number of covered beneficiaries under CHAMPUS in the locality, the availability of military providers in the location or a nearby location, and any other factors determined to be relevant by the Secretary.

(i) A benefit may not be paid under a plan covered by this section in the case of a person enrolled in, or covered by, any other insurance, medical service, or health plan, including any plan offered by a third-party payer (as defined in section 1095(h)(1) of this title ), to the extent that the benefit is also a benefit under the other plan, except in the case of a plan administered under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.). The amount to be paid to a provider of services for services provided under a plan covered by this section shall be determined under joint regulations to be prescribed by the administering Secretaries which provide that the amount of such payments shall be determined to the extent practicable in accordance with the same reimbursement rules as apply to payments to providers of services of the same type under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). A contract for a plan covered by this section shall include a clause that prohibits each provider of services under the plan from billing any person covered by the plan for any balance of charges for services in excess of the amount paid for those services under the joint regulations referred to in paragraph (2), except for any unpaid amounts of deductibles or copayments that are payable directly to the provider by the person. In this subsection, the term “provider of services” means a hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program (as defined in section 1861(dd)(2) of the Social Security Act ( 42 U.S.C. 1395x(dd)(2) )), or other institutional facility providing services for which payment may be made under a plan covered by this section.

(j) A plan covered by this section may include provision of liver transplants (including the cost of acquisition and transportation of the donated liver) in accordance with this subsection. Such a liver transplant may be provided if— the transplant is for a dependent considered appropriate for that procedure by the Secretary of Defense in consultation with the other administering Secretaries and such other entities as the Secretary considers appropriate; and the transplant is to be carried out at a health-care facility that has been approved for that purpose by the Secretary of Defense after consultation with the other administering Secretaries and such other entities as the Secretary considers appropriate.

(k) Contracts entered into under subsection (a) shall also provide for medical care for dependents of former members of the uniformed services who are authorized to receive medical and dental care under section 1076(e) of this title in facilities of the uniformed services. Except as provided in paragraph (3), medical care in the case of a dependent described in section 1076(e) shall be furnished under the same conditions and subject to the same limitations as medical care furnished under this section to spouses and children of members of the uniformed services described in the first sentence of subsection (a). Medical care may be furnished to a dependent pursuant to paragraph (1) only for an injury, illness, or other condition described in section 1076(e) of this title .

(l) Subject to paragraph (2), the Secretary of Defense may, upon request, make payments under this section for a charge for services for which a claim is submitted under a plan contracted for under subsection (a) to a hospital that does not impose a legal obligation on any of its patients to pay for such services. A payment under paragraph (1) may not exceed the average amount paid for comparable services in the geographic area in which the hospital is located or, if no comparable services are available in that area, in an area similar to the area in which the hospital is located. The Secretary of Defense shall periodically review the billing practices of each hospital the Secretary approves for payment under this subsection to ensure that the hospital’s practices of not billing patients for payment are not resulting in increased costs to the Government. The Secretary of Defense may require each hospital the Secretary approves for payment under this subsection to provide evidence that it has sources of revenue to cover unbilled costs.

(m) The Secretary of Defense may enter into contracts (or amend existing contracts) with fiscal intermediaries under which the intermediaries agree to organize and operate, directly or through subcontractors, managed health care networks for the provision of health care under this chapter. The managed health care networks shall include cost containment methods, such as utilization review and contracting for care on a discounted basis.

(n) Health care services provided pursuant to this section or section 1086 of this title (or pursuant to any other contract or project under the Civilian Health and Medical Program of the Uniformed Services) may not include services determined under the CHAMPUS Peer Review Organization program to be not medically or psychologically necessary. The Secretary of Defense, after consulting with the other administering Secretaries, may adopt or adapt for use under the CHAMPUS Peer Review Organization program, as the Secretary considers appropriate, any of the quality and utilization review requirements and procedures that are used by the Peer Review Organization program under part B of title XI of the Social Security Act ( 42 U.S.C. 1320c et seq.).

(o) Subject to such exceptions as the Secretary of Defense considers necessary, coverage for medical care under this section for the dependents described in paragraph (3), and standards with respect to timely access to such care, shall be comparable to coverage for medical care and standards for timely access to such care under the managed care option of the TRICARE program known as TRICARE Prime. The Secretary of Defense shall enter into arrangements with contractors under the TRICARE program or with other appropriate contractors for the timely and efficient processing of claims under this subsection. This subsection applies with respect to a dependent referred to in subsection (a) who— is a dependent of a member of the uniformed services referred to in section 1074(c)(3) of this title and is residing with the member; is a dependent of a member who, after having served in a duty assignment described in section 1074(c)(3) of this title , has relocated without the dependent pursuant to orders for a permanent change of duty station from a remote location described in subparagraph (B)(ii) of such section where the member and the dependent resided together while the member served in such assignment, if the orders do not authorize dependents to accompany the member to the new duty station at the expense of the United States and the dependent continues to reside at the same remote location, or is a dependent of a reserve component member ordered to active duty for a period of more than 30 days and is residing with the member, and the residence is located more than 50 miles, or approximately one hour of driving time, from the nearest military medical treatment facility adequate to provide the needed care. The Secretary of Defense may provide for coverage of a dependent referred to in subsection (a) who is not described in paragraph (3) if the Secretary determines that exceptional circumstances warrant such coverage. The Secretary of Defense shall consult with the other administering Secretaries in the administration of this subsection.

(p) Subject to subsection (a), a physician or other health care practitioner who is eligible to receive reimbursement for services provided under medicare (as defined in section 1086(d)(3)(C) of this title ) shall be considered approved to provide medical care authorized under this section and section 1086 of this title unless the administering Secretaries have information indicating medicare, TRICARE, or other Federal health care program integrity violations by the physician or other health care practitioner.

(q) In the case of any pharmaceutical agent (as defined in section 1074g(i) of this title ) provided under a contract entered into under this section by a physician, in an outpatient department of a hospital, or otherwise as part of any medical services provided under such a contract, the Secretary of Defense may, under regulations prescribed by the Secretary, adopt special reimbursement methods, amounts, and procedures to encourage the use of high-value products and discourage the use of low-value products, as determined by the Secretary.

(r) The provision of health care services for an eating disorder under subsection (a)(18) may include the following services: Outpatient services for in-person or telehealth care, including partial hospitalization services and intensive outpatient services. Inpatient services, which shall include residential services only if medically indicated for treatment of a primary diagnosis of an eating disorder. A dependent provided health care services for an eating disorder under subsection (a)(18) shall be provided such services without regard to— the age of the dependent, except with respect to residential services under paragraph (1)(B), which may be provided only to a dependent who is not eligible for hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.); and except as otherwise specified in paragraph (1)(B), whether the eating disorder is the primary or secondary diagnosis of the dependent. In this section, the term “eating disorder” has the meaning given the term “feeding and eating disorders” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (or successor edition), published by the American Psychiatric Association.

§ 1079a TRICARE program: treatment of refunds and other amounts collected

All refunds and other amounts collected in the administration of the TRICARE program shall be credited to the appropriation available for that program for the fiscal year in which the refund or amount is collected. (Added Pub. L. 104–201, div. A, title VII, § 733(a)(1) , Sept. 23, 1996 , 110 Stat. 2597 ; amended Pub. L. 114–328, div. A, title VII, § 701(j)(1)(D) , Dec. 23, 2016 , 130 Stat. 2192 .)

§ 1079b Procedures for charging fees for care provided to civilians; retention and use of fees collected

(a) Requirement To Implement Procedures.— The Secretary of Defense shall implement procedures under which a military medical treatment facility may charge civilians who are not covered beneficiaries (or their insurers) fees representing the costs, as determined by the Secretary, of trauma and other medical care provided to such civilians.

(b) Waiver of Fees.— The Director of the Defense Health Agency may issue a waiver for a fee that would otherwise be charged under the procedures implemented under subsection (a) to a civilian provided medical care who is not a covered beneficiary if the provision of such care enhances the knowledge, skills, and abilities of health care providers, as determined by the Director of the Defense Health Agency.

(c) Modified Payment Plan for Certain Civilians.— If a civilian specified in subsection (a) is covered by a covered payer at the time care under this section is provided, the civilian shall only be responsible to pay the standard copays, coinsurance, deductibles, or nominal fees that are otherwise applicable under the covered payer plan. Except with respect to the copays, coinsurance, deductibles, and nominal fees specified in subparagraph (A)— the Secretary of Defense may bill only the covered payer for care provided to a civilian described in subparagraph (A); and payment received by the Secretary from the covered payer of a civilian for care provided under this section that is provided to the civilian shall be considered payment in full for such care. If a civilian specified in subsection (a) does not meet the criteria under paragraph (1), is underinsured, or has a remaining balance and is at risk of financial harm, the Director of the Defense Health Agency shall reduce each fee that would otherwise be charged to the civilian under this section according to a sliding fee discount program, as prescribed by the Director of the Defense Health Agency. If a civilian specified in subsection (a) does not meet the criteria under paragraph (1) or (2), the Director of the Defense Health Agency shall implement an additional catastrophic waiver to prevent severe financial harm. The modified payment plan under this subsection may not be administered by a Federal agency other than the Department of Defense.

(d) Use of Fees Collected.— A military medical treatment facility may retain and use the amounts collected under subsection (a) for— trauma consortium activities; administrative, operating, and equipment costs; and readiness training.

(e) Definitions.— In this section: The term “covered payer” means a third-party payer or other insurance, medical service, or health plan. The terms “third-party payer” and “insurance, medical service, or health plan” have the meaning given those terms in section 1095(h) of this title .

§ 1079c Provisional coverage for emerging services and supplies

(a) Provisional Coverage.— In carrying out the TRICARE program, including pursuant to section 1079(a)(12) of this title , the Secretary of Defense, acting through the Assistant Secretary of Defense for Health Affairs, may provide provisional coverage for the provision of a service or supply if the Secretary determines that such service or supply is widely recognized in the United States as being safe and effective.

(b) Consideration of Evidence.— In making a determination under subsection (a), the Secretary may consider— clinical trials published in refereed medical literature; formal technology assessments; the positions of national medical policy organizations; national professional associations; national expert opinion organizations; and such other validated evidence as the Secretary considers appropriate.

(c) Independent Evaluation.— In making a determination under subsection (a), the Secretary may arrange for an evaluation from the Institute of Medicine of the National Academies or such other independent entity as the Secretary selects.

(d) Duration and Terms of Coverage.— Provisional coverage under subsection (a) for a service or supply may be in effect for not longer than a total of five years. Prior to the expiration of provisional coverage of a service or supply, the Secretary shall determine the coverage, if any, that will follow such provisional coverage and take appropriate action to implement such determination. If the Secretary determines that the implementation of such determination regarding coverage requires legislative action, the Secretary shall make a timely recommendation to Congress regarding such legislative action. The Secretary, at any time, may— terminate the provisional coverage under subsection (a) of a service or supply, regardless of whether such termination is before the end of the period described in paragraph (1); establish or disestablish terms and conditions for such coverage; or take any other action with respect to such coverage.

(e) Public Notice.— The Secretary shall promptly publish on a publicly accessible Internet website of the TRICARE program a notice for each service or supply that receives provisional coverage under subsection (a), including any terms and conditions for such coverage.

(f) Finality of Determinations.— Any determination to approve or disapprove a service or supply under subsection (a) and any action made under subsection (d)(3) shall be final.

§ 1080 Contracts for medical care for spouses and children: election of facilities

(a) Election.— A dependent covered by section 1079 of this title may elect to receive inpatient medical care either in (1) the facilities of the uniformed services, under the conditions prescribed by sections 1076–1078 of this title, or (2) the facilities provided under a plan contracted for under section 1079 of this title . However, under such regulations as the Secretary of Defense, after consulting the other administering Secretaries, may prescribe, the right to make this election may be limited for dependents residing in the area where the member concerned is assigned, if adequate medical facilities of the uniformed services are available in that area for those dependents.

(b) Issuance of Nonavailability-of-Health-Care Statements.— In determining whether to issue a nonavailability-of-health-care statement for a dependent described in subsection (a), the commanding officer of a facility of the uniformed services may consider the availability of health care services for the dependent pursuant to any contract or agreement entered into under this chapter for the provision of health care services. Notwithstanding any other provision of law, with respect to obstetrics and gynecological care for beneficiaries not enrolled in a managed care plan offered pursuant to any contract or agreement under this chapter, a nonavailability-of-health-care statement shall be required for receipt of health care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy.

(c) Waivers and Exceptions to Requirements.— A covered beneficiary enrolled in a managed care plan offered pursuant to any contract or agreement under this chapter for the provision of health care services shall not be required to obtain a nonavailability-of-health-care statement as a condition for the receipt of health care. The Secretary of Defense may waive the requirement to obtain nonavailability-of-health-care statements following an evaluation of the effectiveness of such statements in optimizing the use of facilities of the uniformed services.

§ 1081 Contracts for medical care for spouses and children: review and adjustment of payments

Each plan under section 1079 of this title shall provide for a review, and if necessary an adjustment of payments, by the appropriate administering Secretary, not later than 120 days after the close of each year the plan is in effect. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1449 ; amended Pub. L. 96–513, title V, § 511(36) , Dec. 12, 1980 , 94 Stat. 2923 ; Pub. L. 97–375, title I, § 104(a) , Dec. 21, 1982 , 96 Stat. 1819 ; Pub. L. 98–94, title XII, § 1268(5)(A) , Sept. 24, 1983 , 97 Stat. 706 ; Pub. L. 98–557, § 19(9) , Oct. 30, 1984 , 98 Stat. 2870 .)

§ 1082 Contracts for health care: advisory committees

To carry out sections 1079–1081 and 1086 of this title, the Secretary of Defense may establish advisory committees on insurance, medical service, and health plans, to advise and make recommendations to him. He shall prescribe regulations defining their scope, activities, and procedures. Each committee shall consist of the Secretary, or his designee, as chairman, and such other persons as the Secretary may select. So far as possible, the members shall be representative of the organizations in the field of insurance, medical service, and health plans. They shall serve without compensation but may be allowed transportation and a per diem payment in place of subsistence and other expenses. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1449 ; amended Pub. L. 89–614, § 2(8) , Sept. 30, 1966 , 80 Stat. 866 .)

§ 1083 Contracts for medical care for spouses and children: additional hospitalization

If a dependent covered by a plan under section 1079 of this title needs hospitalization beyond the time limits in that plan, and if the hospitalization is authorized in medical facilities of the uniformed services, he may be transferred to such a facility for additional hospitalization. If transfer is not feasible, the expenses of additional hospitalization in the civilian facility may be paid under such regulations as the Secretary of Defense may prescribe after consulting the other administering Secretaries. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1449 ; amended Pub. L. 96–513, title V, § 511(36) , Dec. 12, 1980 , 94 Stat. 2923 ; Pub. L. 98–557, § 19(10) , Oct. 30, 1984 , 98 Stat. 2870 .)

§ 1084 Determinations of dependency

A determination of dependency by an administering Secretary under this chapter is conclusive. However, the administering Secretary may change a determination because of new evidence or for other good cause. The Secretary’s determination may not be reviewed in any court or by the Comptroller General, unless there has been fraud or gross negligence. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1450 ; amended Pub. L. 89–614, § 2(1) , Sept. 30, 1966 , 80 Stat. 862 ; Pub. L. 96–513, title V, § 511(34)(A) , (36), Dec. 12, 1980 , 94 Stat. 2922 , 2923; Pub. L. 98–557, § 19(11) , Oct. 30, 1984 , 98 Stat. 2870 ; Pub. L. 108–375, div. A, title X, § 1084(c)(1) , Oct. 28, 2004 , 118 Stat. 2061 .)

§ 1085 Medical and dental care from another executive department: reimbursement

If a member or former member of a uniformed service under the jurisdiction of one executive department (or a dependent of such a member or former member) receives inpatient medical or dental care in a facility under the jurisdiction of another executive department, the appropriation for maintaining and operating the facility furnishing the care shall be reimbursed at rates established by the President to reflect the average cost of providing the care. (Added Pub. L. 85–861, § 1(25)(B) , Sept. 2, 1958 , 72 Stat. 1450 ; amended Pub. L. 89–264, § 1 , Oct. 19, 1965 , 79 Stat. 989 ; Pub. L. 96–513, title V, § 511(36) , (37), Dec. 12, 1980 , 94 Stat. 2923 ; Pub. L. 98–94, title XII, § 1268(6) , Sept. 24, 1983 , 97 Stat. 706 ; Pub. L. 98–557, § 19(12) , Oct. 30, 1984 , 98 Stat. 2870 ; Pub. L. 99–145, title XIII, § 1303(a)(8) , Nov. 8, 1985 , 99 Stat. 739 .)

§ 1086 Contracts for health benefits for certain members, former members, and their dependents

(a) To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under section 1079(a) of this title . However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).

(b) For persons covered by this section the plans contracted for under section 1079(a) of this title shall contain the following provisions for payment by the patient: Except as provided in paragraph (2), the first $150eachcalendaryearofthechargesforalltypesofcareauthorizedbythissectionandreceivedwhileinanoutpatientstatusand25percentofallsubsequentchargesforsuchcareduringacalendaryear.Afamilygroupoftwoormorepersonscoveredbythissectionshallnotberequiredtopaycollectivelymorethanthefirst$300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year. 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535perdayduringtheperiodbeginningonApril1,2006,andendingonSeptember30,2011.TheSecretaryofDefensemayexemptapatientfrompayingsuchchargesifthehospitaltowhichthepatientisadmitteddoesnotimposealegalobligationonanyofitspatientstopayforinpatientcare.Amemberorformermemberofauniformedservicecoveredbythissectionbyreasonofsection1074(b)ofthistitle,oranindividualorfamilygroupoftwoormorepersonscoveredbythissection,maynotberequiredtopayatotalofmorethan$3,000 for health care received during any calendar year under a plan contracted for under section 1079(a) of this title .

(c) Except as provided in subsection (d), the following persons are eligible for health benefits under this section: Those covered by sections 1074(b) and 1076(b) of this title, except those covered by section 1072(2)(E) of this title . A dependent (other than a dependent covered by section 1072(2)(E) of this title ) of a member of a uniformed service— who died while on active duty for a period of more than 30 days; or who died from an injury, illness, or disease incurred or aggravated— while on active duty under a call or order to active duty of 30 days or less, on active duty for training, or on inactive duty training; or while traveling to or from the place at which the member is to perform, or has performed, such active duty, active duty for training, or inactive duty training. A dependent covered by clause (F), (G), or (H) of section 1072(2) of this title who is not eligible under paragraph (1).

(d) A person who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.) is not eligible for health benefits under this section. The prohibition contained in paragraph (1) shall not apply to a person referred to in subsection (c) who— is enrolled in the supplementary medical insurance program under part B of such title ( 42 U.S.C. 1395j et seq.); and in the case of a person under 65 years of age, is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act pursuant to subparagraph (A) or (C) of section 226(b)(2) of such Act ( 42 U.S.C. 426(b)(2) ) or section 226A(a) of such Act ( 42 U.S.C. 426–1(a) ). Subject to subparagraph (B), if a person described in paragraph (2) receives medical or dental care for which payment may be made under medicare and a plan contracted for under subsection (a), the amount payable for that care under the plan shall be the amount of the actual out-of-pocket costs incurred by the person for that care over the sum of— the amount paid for that care under medicare; and the total of all amounts paid or payable by third party payers other than medicare. The amount payable for care under a plan pursuant to subparagraph (A) may not exceed the total amount that would be paid under the plan if payment for that care were made solely under the plan. In this paragraph: The term “medicare” means title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.). The term “third party payer” has the meaning given such term in section 1095(h)(1) of this title . If a person referred to in subsection (c) and described by paragraph (2)(B) is subject to a retroactive determination by the Social Security Administration of entitlement to hospital insurance benefits described in paragraph (1), the person shall, during the period described in subparagraph (B), be deemed for purposes of health benefits under this section— not to have been covered by paragraph (1); and not to have been subject to the requirements of section 1079(i)(1) of this title , whether through the operation of such section or subsection (g) of this section. The period described in this subparagraph with respect to a person covered by subparagraph (A) is the period that— begins on the date that eligibility of the person for hospital insurance benefits referred to in paragraph (1) is effective under the retroactive determination of eligibility with respect to the person as described in subparagraph (A); and ends on the date of the issuance of such retroactive determination of eligibility by the Social Security Administration. The administering Secretaries shall develop a mechanism by which persons described in subparagraph (B) of paragraph (2) who do not satisfy the condition specified in subparagraph (A) of such paragraph are promptly notified of their ineligibility for health benefits under this section. In developing the notification mechanism, the administering Secretaries shall consult with the Administrator of the Centers for Medicare & Medicaid Services.

(e) A person covered by this section may elect to receive inpatient medical care either in (1) Government facilities, under the conditions prescribed in sections 1074 and 1076–1078 of this title, or (2) the facilities provided under a plan contracted for under this section. However, under joint regulations issued by the administering Secretaries, the right to make this election may be limited for those persons residing in an area where adequate facilities of the uniformed service are available. In addition, subsections (b) and (c) of section 1080 of this title shall apply in making the determination whether to issue a nonavailability of health care statement for a person covered by this section.

(f) The provisions of section 1079(h) of this title shall apply to payments for services by an individual health-care professional (or other noninstitutional health-care provider) under a plan contracted for under subsection (a).

(g) Section 1079(i) of this title shall apply to a plan contracted for under this section, except that no person eligible for health benefits under this section may be denied benefits under this section with respect to care or treatment for any service-connected disability which is compensable under chapter 11 of title 38 solely on the basis that such person is entitled to care or treatment for such disability in facilities of the Department of Veterans Affairs.

(h) Subject to paragraph (2), the Secretary of Defense may, upon request, make payments under this section for a charge for services for which a claim is submitted under a plan contracted for under subsection (a) to a hospital that does not impose a legal obligation on any of its patients to pay for such services. A payment under paragraph (1) may not exceed the average amount paid for comparable services in the geographic area in which the hospital is located or, if no comparable services are available in that area, in an area similar to the area in which the hospital is located. The Secretary of Defense shall periodically review the billing practices of each hospital the Secretary approves for payment under this subsection to ensure that the hospital’s practices of not billing patients for payment are not resulting in increased costs to the Government. The Secretary of Defense may require each hospital the Secretary approves for payment under this subsection to provide evidence that it has sources of revenue to cover unbilled costs.

(i) If, prior to October 1, 2022 , a category of persons covered by this section was eligible to receive a specific type of treatment for eating disorders under a plan contracted for under subsection (a), the general prohibition on the provision of treatments for eating disorders specified in such subsection shall not apply with respect to the provision of the specific type of treatment to such category of persons.

§ 1086a Certain former spouses: extension of period of eligibility for health benefits

(a) Availability of Conversion Health Policies.— The Secretary of Defense shall inform each person who has been a dependent for a period of one year or more under section 1072(2)(H) of this title of the availability of a conversion health policy for purchase by the person. A conversion health policy offered under this subsection shall provide coverage for not less than a 24-month period.

(b) Effect of Purchase.— Subject to paragraph (2), if a person who is a dependent for a one-year period under section 1072(2)(H) of this title purchases a conversion health policy within that period (or within a reasonable time after that period as prescribed by the Secretary of Defense), the person shall continue to be eligible for medical and dental care in the manner described in section 1076 of this title and health benefits under section 1086 of this title until the end of the 24-month period beginning on the later of— the date the person is no longer a dependent under section 1072(2)(H) of this title ; and the date of the purchase of the policy. The extended period of eligibility provided under paragraph (1) shall apply only with regard to a condition of the person that— exists on the date on which coverage under the conversion health policy begins; and for which care is not provided under the policy solely on the grounds that the condition is a preexisting condition.

(c) Effect of Unavailability of Policies.— If the Secretary of Defense is unable, within a reasonable time, to enter into a contract with a private insurer to offer conversion health policies under subsection (a) at a rate not to exceed the payment required under section 8905a(d)(1)(A) of title 5 for comparable coverage, the Secretary shall provide the coverage required under such a policy through the Civilian Health and Medical Program of the Uniformed Services. Subject to paragraph (2), a person receiving coverage under this subsection shall be required to pay into the Military Health Care Account or other appropriate account an amount equal to the sum of— the individual and Government contributions which would be required in the case of a person enrolled in a health benefits plan contracted for under section 1079 of this title ; and an amount necessary for administrative expenses, but not to exceed two percent of the amount under subparagraph (A). The amount paid by a person who purchases a conversion health policy from the Secretary of Defense under paragraph (1) may not exceed the payment required under section 8905a(d)(1)(A) of title 5 for comparable coverage. In order to reduce premiums required under paragraph (1), the Secretary of Defense may offer a program of coverage that, with respect to mental health services, offers reduced coverage and increased cost-sharing by the purchaser.

(d) Conversion Health Policy Defined.— In this section, the term “conversion health policy” means a health insurance policy with a private insurer, developed through negotiations between the Secretary of Defense and the private insurer, that is available for purchase by or for the use of a person who is a dependent for a one-year period under section 1072(2)(H) of this title .

§ 1086b Prohibition against requiring retired members to receive health care solely through the Department of Defense

The Secretary of Defense may not take any action that would require, or have the effect of requiring, a member or former member of the armed forces who is entitled to retired or retainer pay to enroll to receive health care from the Federal Government only through the Department of Defense. (Added Pub. L. 107–107, div. A, title VII, § 731(a) , Dec. 28, 2001 , 115 Stat. 1169 .)

§ 1087 Programing facilities for certain members, former members, and their dependents in construction projects of the uniformed services

(a) Space for inpatient and outpatient care may be programed in facilities of the uniformed services for persons covered by sections 1074(b) and 1076(b) of this title. The maximum amount of space that may be so programed for a facility is the greater of— the amount of space that would be so programed for the facility in order to meet the requirements to be placed on the facility for support of the teaching and training of health-care professionals; and the amount of space that would be so programed for the facility based upon the most cost-effective provision of inpatient and outpatient care to persons covered by sections 1074(b) and 1076(b) of this title.

(b) In making determinations for the purposes of clauses (1) and (2) of subsection (a), the Secretary concerned shall take into consideration— the amount of space that would be so programed for the facility based upon projected inpatient and outpatient workloads at the facility for persons covered by sections 1074(b) and 1076(b) of this title; and the anticipated capability of the medical and dental staff of the facility, determined in accordance with regulations prescribed by the Secretary of Defense and based upon realistic projections of the number of physicians and other health-care providers that it can reasonably be expected will be assigned to or will otherwise be available to the facility. In addition, a determination made for the purpose of clause (2) of subsection (a) shall be made in accordance with an economic analysis (including a life-cycle cost analysis) of the facility and consideration of all reasonable and available medical care treatment alternatives (including treatment provided under a contract under section 1086 of this title or under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.)).

§ 1088 Air evacuation patients: furnished subsistence

Notwithstanding any other provision of law, and under regulations to be prescribed by the Secretary concerned, a person entitled to medical and dental care under this chapter may be furnished subsistence without charge while being evacuated as a patient by military aircraft of the United States. (Added Pub. L. 91–481, § 2(1) , Oct. 21, 1970 , 84 Stat. 1081 .)

§ 1089 Defense of certain suits arising out of medical malpractice

(a) The remedy against the United States provided by sections 1346(b) and 2672 of title 28 for damages for personal injury, including death, caused by the negligent or wrongful act or omission of any physician, dentist, nurse, pharmacist, or paramedical or other supporting personnel (including medical and dental technicians, nursing assistants, and therapists) of the armed forces, the National Guard while engaged in training or duty under section 316, 502, 503, 504, or 505 of title 32, the Department of Defense, the Armed Forces Retirement Home, or the Central Intelligence Agency in the performance of medical, dental, or related health care functions (including clinical studies and investigations) while acting within the scope of his duties or employment therein or therefor shall hereafter be exclusive of any other civil action or proceeding by reason of the same subject matter against such physician, dentist, nurse, pharmacist, or paramedical or other supporting personnel (or the estate of such person) whose act or omission gave rise to such action or proceeding. This subsection shall also apply to such a physician, dentist, nurse, pharmacist, or paramedical or other supporting personnel (or the estate of such person) serving under a personal services contract entered into under section 1091 of this title or a subcontract at any tier under such a contract that is authorized in accordance with the requirements of such section 1091.

(b) The Attorney General shall defend any civil action or proceeding brought in any court against any person referred to in subsection (a) of this section (or the estate of such person) for any such injury. Any such person against whom such civil action or proceeding is brought shall deliver within such time after date of service or knowledge of service as determined by the Attorney General, all process served upon such person or an attested true copy thereof to such person’s immediate superior or to whomever was designated by the head of the agency concerned to receive such papers and such person shall promptly furnish copies of the pleading and process therein to the United States attorney for the district embracing the place wherein the action or proceeding is brought, to the Attorney General and to the head of the agency concerned.

(c) Upon a certification by the Attorney General that any person described in subsection (a) was acting in the scope of such person’s duties or employment at the time of the incident out of which the suit arose, any such civil action or proceeding commenced in a State court shall be removed without bond at any time before trial by the Attorney General to the district court of the United States of the district and division embracing the place wherein it is pending and the proceeding deemed a tort action brought against the United States under the provisions of title 28 and all references thereto. Should a United States district court determine on a hearing on a motion to remand held before a trial on the merits that the case so removed is one in which a remedy by suit within the meaning of subsection (a) of this section is not available against the United States, the case shall be remanded to the State court.

(d) The Attorney General may compromise or settle any claim asserted in such civil action or proceeding in the manner provided in section 2677 of title 28 , and with the same effect.

(e) For purposes of this section, the provisions of section 2680(h) of title 28 shall not apply to any cause of action arising out of a negligent or wrongful act or omission in the performance of medical, dental, or related health care functions (including clinical studies and investigations).

(f) The head of the agency concerned may, to the extent that the head of the agency concerned considers appropriate, hold harmless or provide liability insurance for any person described in subsection (a) for damages for personal injury, including death, caused by such person’s negligent or wrongful act or omission in the performance of medical, dental, or related health care functions (including clinical studies and investigations) while acting within the scope of such person’s duties if such person is assigned to a foreign country or detailed for service with other than a Federal department, agency, or instrumentality or if the circumstances are such as are likely to preclude the remedies of third persons against the United States described in section 1346(b) of title 28 , for such damage or injury. With respect to the Secretary of Defense and the Armed Forces Retirement Home Board, the authority provided by paragraph (1) also includes the authority to provide for reasonable attorney’s fees for persons described in subsection (a), as determined necessary pursuant to regulations prescribed by the head of the agency concerned.

(g) In this section, the term “head of the agency concerned” means— the Director of the Central Intelligence Agency, in the case of an employee of the Central Intelligence Agency; the Secretary of Homeland Security, in the case of a member or employee of the Coast Guard when it is not operating as a service in the Navy; the Chief Operating Officer of the Armed Forces Retirement Home, in the case of an employee of the Armed Forces Retirement Home; and the Secretary of Defense, in all other cases.

§ 1090 Identifying and treating drug and alcohol dependence

The Secretary of Defense, and the Secretary of Homeland Security with respect to the Coast Guard when it is not operating as a service in the Navy, shall prescribe regulations, implement procedures using each practical and available method, and provide necessary facilities to identify, treat, and rehabilitate members of the armed forces who are dependent on drugs or alcohol. (Added Pub. L. 97–295, § 1(15)(A) , Oct. 12, 1982 , 96 Stat. 1290 ; amended Pub. L. 98–94, title XII, § 1268(7) , Sept. 24, 1983 , 97 Stat. 706 ; Pub. L. 101–510, div. A, title V, § 553 , Nov. 5, 1990 , 104 Stat. 1567 ; Pub. L. 107–296, title XVII, § 1704(b)(1) , Nov. 25, 2002 , 116 Stat. 2314 .)

§ 1090a Identifying and treating eating disorders

(a) Identification, Treatment, and Rehabilitation.— The Secretary of Defense, and the Secretary of Homeland Security with respect to the Coast Guard when it is not operating as a service in the Navy, shall prescribe regulations, implement procedures using each practical and available method, and provide necessary facilities to identify, treat, and rehabilitate members of the armed forces who have an eating disorder.

(b) Facilities Available.— In this section, the term “necessary facilities” includes facilities that provide the services specified in section 1079(r)(1) of this title . Consistent with section 1079(r)(1)(B) of this title , residential services shall be provided to a member pursuant to this section only if the member has a primary diagnosis of an eating disorder and treatment at such facility is medically indicated for treatment of that eating disorder.

(c) Eating Disorder Defined.— In this section, the term “eating disorder” has the meaning given that term in section 1079(r) of this title .

§ 1090b Commanding officer and supervisor referrals of members for mental health evaluations

(a) Regulations.— The Secretary of Defense shall prescribe and maintain regulations relating to commanding officer and supervisor referrals of members of the armed forces for mental health evaluations. The regulations shall incorporate the requirements set forth in subsections (b), (c), and (d) and such other matters as the Secretary considers appropriate.

(b) Reduction of Perceived Stigma.— The regulations required by subsection (a) shall, to the greatest extent possible— seek to eliminate perceived stigma associated with seeking and receiving mental health services, promoting the use of mental health services on a basis comparable to the use of other medical and health services; and clarify the appropriate action to be taken by commanders or supervisory personnel who, in good faith, believe that a subordinate may require a mental health evaluation.

(c) Procedures for Inpatient Evaluations.— The regulations required by subsection (a) shall provide that, when a commander or supervisor determines that it is necessary to refer a member of the armed forces for a mental health evaluation or is required to make such a referral pursuant to the process described in subsection (e)(1)(A)— the health evaluation shall only be conducted in the most appropriate clinical setting, in accordance with the least restrictive alternative principle; and only a psychiatrist, or, in cases in which a psychiatrist is not available, another mental health professional or a physician, may admit the member pursuant to the referral for a mental health evaluation to be conducted on an inpatient basis.

(d) Prohibition on Use of Referrals for Mental Health Evaluations to Retaliate Against Whistleblowers.— The regulations required by subsection (a) shall provide that no person may refer a member of the armed forces for a mental health evaluation as a reprisal for making or preparing a lawful communication of the type described in section 1034(c)(2) of this title , and applicable regulations. For purposes of this subsection, such communication shall also include a communication to any appropriate authority in the chain of command of the member.

(e) Self-initiated Referral Process.— The regulations required by subsection (a) shall, with respect to a member of the armed forces described in paragraph (3)— provide for a self-initiated process that enables the member to trigger a referral for a mental health evaluation by requesting such a referral from a commanding officer or supervisor who is in a grade above E-5; ensure the function of the process described in subparagraph (A) by— requiring the commanding officer or supervisor of the member to refer the member to a mental health provider for a mental health evaluation as soon as practicable following the request of the member (including by providing to the mental health provider the name and contact information of the member and providing to the member the date, time, and place of the scheduled mental health evaluation); and ensuring the member may request a referral pursuant to subparagraph (A) on any basis (including on the basis of a concern relating to fitness for duty, occupational requirements, safety issues, significant changes in performance, or behavioral changes that may be attributable to possible changes in mental status); and ensure that the process described in subparagraph (A)— reduces stigma in accordance with subsection (b), including by treating referrals for mental health evaluations made pursuant to such process in a manner similar to referrals for other medical services, to the maximum extent practicable; and protects the confidentiality of the member to the maximum extent practicable, in accordance with requirements for the confidentiality of health information under the Health Insurance Portability and Accountability Act of 1996 ( Public Law 104–191 ) and applicable privacy laws. In making a referral for an evaluation of a member of the armed forces triggered by a request made pursuant to the process described in paragraph (1)(A), if the member has made such a request on the basis of a concern that the member is a potential or imminent danger to self or others, the commanding officer or supervisor of the member shall observe the following principles: With respect to safety, if the commander or supervisor determines the member is exhibiting dangerous behavior, the first priority of the commander or supervisor shall be to ensure that precautions are taken to protect the safety of the member, and others, prior to the arrival of the member at the location of the evaluation. With respect to communication, prior to such arrival, the commander or supervisor shall communicate to the provider to which the member is being referred (in a manner and to an extent consistent with paragraph (1)(C)(ii)), information on the circumstances and observations that led to— the member requesting the referral; and the commander or supervisor making such referral based on the request. A member of the armed forces described in this paragraph is— a member on active duty for a period of longer than 30 days; or a member of the Selected Reserve in a duty status.

(f) Annual Training Requirement.— On an annual basis, each Secretary concerned shall provide to the members of the Armed Forces under the jurisdiction of such Secretary a training on how to recognize personnel who may require mental health evaluations on the basis of the individual being an imminent danger to self or others, as demonstrated by the behavior or apparent mental state of the individual.

(g) Definitions.— In this section: The term “mental health professional” means a psychiatrist or clinical psychologist, a person with a doctorate in clinical social work, or a psychiatric clinical nurse specialist. The term “mental health evaluation” means a psychiatric examination or evaluation, a psychological examination or evaluation, an examination for psychiatric or psychological fitness for duty, or any other means of assessing the state of mental health of a member of the armed forces. The term “least restrictive alternative principle” means a principle under which a member of the armed forces committed for hospitalization and treatment shall be placed in the most appropriate and therapeutic available setting— that is no more restrictive than is conducive to the most effective form of treatment; and in which treatment is available and the risks of physical injury or property damage posed by such placement are warranted by the proposed plan of treatment.

§ 1091 Personal services contracts

(a) Authority.— The Secretary of Defense, with respect to medical treatment facilities of the Department of Defense, and the Secretary of Homeland Security, with respect to medical treatment facilities of the Coast Guard when the Coast Guard is not operating as a service in the Navy, may enter into personal services contracts to carry out health care responsibilities in such facilities, as determined to be necessary by the Secretary. The authority provided in this subsection is in addition to any other contract authorities of the Secretary, including authorities relating to the management of such facilities and the administration of this chapter. The Secretary of Defense, and the Secretary of Homeland Security with respect to the Coast Guard when it is not operating as a service in the Navy, may also enter into personal services contracts to carry out other health care responsibilities of the Secretary (such as the provision of medical screening examinations at Military Entrance Processing Stations) at locations outside medical treatment facilities, as determined necessary pursuant to regulations prescribed by the Secretary.

(b) Limitation on Amount of Compensation.— In no case may the total amount of compensation paid to an individual in any year under a personal services contract entered into under subsection (a) exceed the amount of annual compensation (excluding the allowances for expenses) specified in section 102 of title 3 .

(c) Procedures.— The Secretary shall establish by regulation procedures for entering into personal services contracts with individuals under subsection (a). At a minimum, such procedures shall assure— the provision of adequate notice of contract opportunities to individuals residing in the area of the medical treatment facility involved; and consideration of interested individuals solely on the basis of the qualifications established for the contract and the proposed contract price. Upon the establishment of the procedures under paragraph (1), the Secretary may exempt contracts covered by this section from the competitive contracting requirements specified in section 2304 1 of this title or any other similar requirements of law. The procedures established under paragraph (1) may provide for a contracting officer to authorize a contractor to enter into a subcontract for personal services on behalf of the agency upon a determination that the subcontract is— consistent with the requirements of this section and the procedures established under paragraph (1); and in the best interests of the agency.

(d) Exceptions.— The procedures and exemptions provided under subsection (c) shall not apply to personal services contracts entered into under subsection (a) with entities other than individuals or to any contract that is not an authorized personal services contract under subsection (a).

§ 1091a Identification in patient medical records of affiliation of certain non-Department of Defense health care providers

(a) Requirement.— The Secretary of Defense shall ensure that medical records of the Department of Defense include the organizational affiliation of any independent health care contractor identified in such medical records.

(b) Independent Health Care Contractor Defined.— In this section, the term “independent health care contractor” means a health care provider who meets the following criteria: The health care provider is a nonpersonal services contractor, or an employee of such a contractor, pursuant to subpart 37.4 of the Federal Acquisition Regulation, or other applicable regulation. The health care provider provides health care services under this chapter in any military medical treatment facility (as defined in section 1073c(j) of this title ) or other location under the jurisdiction of the Secretary of Defense, including an operational clinic.

§ 1092 Studies and demonstration projects relating to delivery of health and medical care

(a) The Secretary of Defense, in consultation with the other administering Secretaries, shall conduct studies and demonstration projects on the health care delivery system of the uniformed services with a view to improving the quality, efficiency, convenience, and cost effectiveness of providing health care services (including dental care services) under this title to members and former members and their dependents. Such studies and demonstration projects may include the following: Alternative methods of payment for health and medical care services. Cost-sharing by eligible beneficiaries. Methods of encouraging efficient and economical delivery of health and medical care services. Innovative approaches to delivery and financing of health and medical care services. Alternative approaches to reimbursement for the administrative charges of health care plans. Prepayment for medical care services provided to maintain the health of a defined population. The Secretary of Defense shall include in the studies conducted under paragraph (1) alternative programs for the provision of dental care to the spouses and dependents of members of the uniformed services who are on active duty, including a program under which dental care would be provided the spouses and dependents of such members under insurance or dental plan contracts. A demonstration project may not be conducted under this section that provides for the furnishing of dental care under an insurance or dental plan contract. The Secretary of Defense may include in the studies and demonstration projects conducted under paragraph (1) studies and demonstration projects to provide awards and incentives to members of the armed forces and covered beneficiaries who obtain health promotion and disease prevention health care services under the TRICARE program in accordance with terms and schedules prescribed by the Secretary. Such awards and incentives may include cash awards and, in the case of members of the armed forces, personnel incentives. The Secretary of Defense may, in consultation with the other administering Secretaries, include in the studies and demonstration projects conducted under paragraph (1) studies and demonstration projects to provide awards or incentives to individual health care professionals under the authority of such Secretaries, including members of the uniformed services, Federal civilian employees, and contractor personnel, to encourage and reward effective implementation of innovative health care programs designed to improve quality, cost-effectiveness, health promotion, medical readiness, and other priority objectives. Such awards and incentives may include cash awards and, in the case of members of the armed forces and Federal civilian employees, personnel incentives. Amounts available for the pay of members of the uniformed services shall be available for awards and incentives under this paragraph with respect to members of the uniformed services. The Secretary of Defense may include in the studies and demonstration projects conducted under paragraph (1) studies and demonstration projects to improve the medical and dental readiness of members of reserve components of the armed forces, including the provision of health care services to such members for which they are not otherwise entitled or eligible under this chapter. The Secretary of Defense may include in the studies and demonstration projects conducted under paragraph (1) studies and demonstration projects to improve the continuity of health care services for family members of mobilized members of the reserve components of the armed forces who are eligible for such services under this chapter, including payment of a stipend for continuation of employer-provided health coverage during extended periods of active duty.

(b) Subject to the availability of appropriations for that purpose, the Secretary of Defense may enter into contracts or transactions (other than contracts, cooperative agreements, and grants) with public or private agencies, institutions, and organizations to conduct studies and demonstration projects under subsection (a).

(c) The Secretary of Defense may obtain the advice and recommendations of such advisory committees as the Secretary considers appropriate. Each such committee consulted by the Secretary under this subsection shall evaluate the proposed study or demonstration project as to the soundness of the objectives of such study or demonstration project, the likelihood of obtaining productive results based on such study or demonstration project, the resources which were required to conduct such study or demonstration project, and the relationship of such study or demonstration project to other on­going or completed studies and demonstration projects.

§ 1092a Persons entering the armed forces: baseline health data

(a) Program Required.— The Secretary of Defense shall carry out a program— to collect baseline health data from each person entering the armed forces, at the time of entry into the armed forces; and to provide for computerized compilation and maintenance of the baseline health data.

(b) Purposes.— The program under this section shall be designed to achieve the following purposes: To facilitate understanding of how subsequent exposures related to service in the armed forces affect health. To facilitate development of early intervention and prevention programs to protect health and readiness.

§ 1093 Performance of abortions: restrictions

(a) Restriction on Use of Funds.— Funds available to the Department of Defense may not be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

(b) Restriction on Use of Facilities.— No medical treatment facility or other facility of the Department of Defense may be used to perform an abortion except where the life of the mother would be endangered if the fetus were carried to term or in a case in which the pregnancy is the result of an act of rape or incest.

§ 1094 Licensure requirement for health-care professionals

(a) A person under the jurisdiction of the Secretary of a military department may not provide health care independently as a health-care professional under this chapter unless the person has a current license to provide such care. In the case of a physician, the physician may not provide health care as a physician under this chapter unless the current license is an unrestricted license that is not subject to limitation on the scope of practice ordinarily granted to other physicians for a similar specialty by the jurisdiction that granted the license. The Secretary of Defense may waive paragraph (1) with respect to any person in unusual circumstances. The Secretary shall prescribe by regulation the circumstances under which such a waiver may be granted.

(b) The commanding officer of each health care facility of the Department of Defense shall ensure that each person who provides health care independently as a health-care professional at the facility meets the requirement of subsection (a).

(c) A person (other than a person subject to chapter 47 of this title) who provides health care in violation of subsection (a) is subject to a civil money penalty of not more than $5,000. The provisions of subsections (c) and (e) through (h) of section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7a ) shall apply to the imposition of a civil money penalty under paragraph (1) in the same manner as they apply to the imposition of a civil money penalty under that section, except that for purposes of this subsection— a reference to the Secretary in that section is deemed a reference to the Secretary of Defense; and a reference to a claimant in subsection (e) of that section is deemed a reference to the person described in paragraph (1).

(d) Notwithstanding any law regarding the licensure of health care providers, a health-care professional described in paragraph (2), (3), or (4) may practice the health profession or professions of the health-care professional at any location in any State, the District of Columbia, or a Commonwealth, territory, or possession of the United States, regardless of where such health-care professional or the patient are located, so long as the practice is within the scope of the authorized Federal duties. A health-care professional referred to in paragraph (1) as being described in this paragraph is a member of the armed forces, civilian employee of the Department of Defense, personal services contractor under section 1091 of this title , contractor not covered under section 1091 of this title who is providing an examination or assessment under section 10206 of this title or medical treatment as part of a mission relating to emergency, humanitarian, or refugee assistance, or other health-care professional credentialed and privileged at a Federal health care institution or location specially designated by the Secretary for this purpose who— has a current license to practice medicine, osteopathic medicine, dentistry, or another health profession; and is performing authorized duties for the Department of Defense. A health-care professional referred to in paragraph (1) as being described in this paragraph is a member of the National Guard who— has a current license to practice medicine, osteopathic medicine, dentistry, or another health profession; and is performing training or duty under section 502(f) of title 32 in response to an actual or potential disaster. To the extent provided in regulations prescribed by the Secretary for the purpose of assuring the availability of high-quality mental health care services to members of the armed forces and dependents entitled to health care under section 1076 of this title , a health care professional referred to in paragraph (1) as being described in this paragraph is a mental health provider providing care through a network under the TRICARE program who— has a current license to practice as a mental health care professional; is providing tele-mental health care services to members of the armed forces or such dependents; and is providing such services under terms and conditions specified by the Secretary (which shall establish the scope of authorized Federal duties for purposes of paragraph (1)).

(e) In this section: The term “license”— means a grant of permission by an official agency of a State, the District of Columbia, or a Commonwealth, territory, or possession of the United States to provide health care independently as a health-care professional, or the official agency of the government of a partner country; and includes, in the case of such care furnished in a foreign country by any person who is not a national of the United States, a grant of permission by an official agency of that foreign country for that person to provide health care independently as a health-care professional. The term “health-care professional” means a physician, dentist, clinical psychologist, marriage and family therapist certified as such by a certification recognized by the Secretary of Defense, or nurse and any other person providing direct patient care as may be designated by the Secretary of Defense in regulations. The term “partner country” means any of the following: Australia. Canada. New Zealand. The United Kingdom. Any other country designated as a partner country by the Secretary of Defense for the purposes of this section.

§ 1094a Continuing medical education requirements: system for monitoring physician compliance

The Secretary of Defense shall establish a mechanism for ensuring that each person under the jurisdiction of the Secretary of a military department who provides health care under this chapter as a physician satisfies the continuing medical education requirements applicable to the physician. (Added Pub. L. 105–261, div. A, title VII, § 734(b)(1) , Oct. 17, 1998 , 112 Stat. 2073 .)

§ 1095 Health care services incurred on behalf of covered beneficiaries: collection from third-party payers

(a) In the case of a person who is a covered beneficiary, the United States shall have the right to collect from a third-party payer reasonable charges for health care services incurred by the United States on behalf of such person through a facility of the uniformed services to the extent that the person would be eligible to receive reimbursement or indemnification from the third-party payer if the person were to incur such charges on the person’s own behalf. If the insurance, medical service, or health plan of that payer includes a requirement for a deductible or copayment by the beneficiary of the plan, then the amount that the United States may collect from the third-party payer is a reasonable charge for the care provided less the appropriate deductible or copayment amount. A covered beneficiary may not be required to pay an additional amount to the United States for health care services by reason of this section.

(b) No provision of any insurance, medical service, or health plan contract or agreement having the effect of excluding from coverage or limiting payment of charges for certain care shall operate to prevent collection by the United States under subsection (a) if that care is provided— through a facility of the uniformed services; directly or indirectly by a governmental entity; to an individual who has no obligation to pay for that care or for whom no other person has a legal obligation to pay; or by a provider with which the third party payer has no participation agreement.

(c) Under regulations prescribed under subsection (f), records of the facility of the uniformed services that provided health care services to a beneficiary of an insurance, medical service, or health plan of a third-party payer shall be made available for inspection and review by representatives of the payer from which collection by the United States is sought.

(d) Notwithstanding subsections (a) and (b), and except as provided in subsection (j), collection may not be made under this section in the case of a plan administered under title XVIII or XIX of the Social Security Act ( 42 U.S.C. 1395 et seq.).

(e) The United States may institute and prosecute legal proceedings against a third-party payer to enforce a right of the United States under this section. The administering Secretary may compromise, settle, or waive a claim of the United States under this section.

(f) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section. Such regulations shall provide for computation of the reasonable cost of health care services. Computation of such reasonable cost may be based on— per diem rates; all-inclusive per visit rates; diagnosis-related groups; or such other method as may be appropriate.

(g) Amounts collected under this section from a third-party payer or under any other provision of law from any other payer for health care services provided at or through a facility of the uniformed services shall be credited to the appropriation supporting the maintenance and operation of the facility and shall not be taken into consideration in establishing the operating budget of the facility.

(h) In this section: The term “third-party payer” means an entity that provides an insurance, medical service, or health plan by contract or agreement, including an automobile liability insurance or no fault insurance carrier, and any other plan or program that is designed to provide compensation or coverage for expenses incurred by a beneficiary for health care services or products. Such term also includes entities described in subsection (j) under the terms and to the extent provided in such subsection. The term “insurance, medical service, or health plan” includes a preferred provider organization, an insurance plan described as Medicare supplemental insurance, and a personal injury protection plan or medical payments benefit plan for personal injuries resulting from the operation of a motor vehicle. The term “health care services” includes products provided or purchased through a facility of the uniformed services.

(i) In the case of a third-party payer that is an automobile liability insurance or no fault insurance carrier, the right of the United States to collect under this section shall extend to health care services provided to a person entitled to health care under section 1074(a) of this title . In cases in which a tort liability is created upon some third person, collection from a third-party payer that is an automobile liability insurance carrier shall be governed by the provisions of Public Law 87–693 ( 42 U.S.C. 2651 et seq.).

(j) The Secretary of Defense may enter into an agreement with any health maintenance organization, competitive medical plan, health care prepayment plan, or other similar plan (pursuant to regulations issued by the Secretary) providing for collection under this section from such organization or plan for services provided to a covered beneficiary who is an enrollee in such organization or plan.

(k) To improve the administration of this section and sections 1079(j)(1) 1 and 1086(d) of this title, the Secretary of Defense, in consultation with the other administering Secretaries, may prescribe regulations providing for the collection of information regarding insurance, medical service, or health plans of third-party payers held by covered beneficiaries. The collection of information under regulations prescribed under paragraph (1) shall be conducted in the same manner as is provided in section 1862(b)(5) of the Social Security Act ( 42 U.S.C. 1395y(b)(5) ). The Secretary may provide for obtaining from the Commissioner of Social Security employment information comparable to the information provided to the Administrator of the Centers for Medicare & Medicaid Services pursuant to such section. Such regulations may require the mandatory disclosure of Social Security account numbers for all covered beneficiaries. The Secretary may disclose relevant employment information collected under this subsection to fiscal intermediaries or other designated contractors. The Secretary may provide for contacting employers of covered beneficiaries to obtain group health plan information comparable to the information authorized to be obtained under section 1862(b)(5)(C) of the Social Security Act ( 42 U.S.C. 1395y(b)(5)(C) ). Notwithstanding clause (iii) of such section, clause (ii) of such section regarding the imposition of civil money penalties shall apply to the collection of information under this paragraph. Information obtained under this subsection may not be disclosed for any purpose other than to carry out the purpose of this section and sections 1079(j)(1) 1 and 1086(d) of this title.

§ 1095a Medical care: members held as captives and their dependents

(a) Under regulations prescribed by the President, the Secretary concerned shall pay (by advancement or reimbursement) any person who is a former captive, and any dependent of that person or of a person who is in a captive status, for health care and other expenses related to such care, to the extent that such care— is incident to the captive status; and is not covered— by any other Government medical or health program; or by insurance.

(b) In the case of any person who is eligible for medical care under section 1074 or 1076 of this title, such regulations shall require that, whenever practicable, such care be provided in a facility of the uniformed services.

(c) In this section: The terms “captive status” and “former captive” have the meanings given those terms in section 559 of title 37 . The term “dependent” has the meaning given that term in section 551 of that title.

§ 1095b TRICARE program: contractor payment of certain claims

(a) Payment of Claims.— The Secretary of Defense may authorize a contractor under the TRICARE program to pay a claim described in paragraph (2) before seeking to recover from a third-party payer the costs incurred by the contractor to provide health care services that are the basis of the claim to a beneficiary under such program. A claim under this paragraph is a claim— that is submitted to the contractor by a provider under the TRICARE program for payment for services for health care provided to a covered beneficiary; and that is identified by the contractor as a claim for which a third-party payer may be liable.

(b) Recovery From Third-Party Payers.— The United States shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095 of this title .

(c) Definition of Third-Party Payer.— In this section, the term “third-party payer” has the meaning given that term in section 1095(h) of this title , except that such term excludes primary medical insurers.

§ 1095c TRICARE program: facilitation of processing of claims

(a) Reduction of Processing Time.— With respect to claims for payment for medical care provided under the TRICARE program, the Secretary of Defense shall implement a system for processing of claims under which— 95 percent of all clean claims must be processed not later than 30 days after the date that such claims are submitted to the claims processor; and 100 percent of all clean claims must be processed not later than 100 days after the date that such claims are submitted to the claims processor. The Secretary may, under the system required by paragraph (1) and consistent with the provisions in chapter 39 of title 31 (commonly referred to as the “Prompt Payment Act”), require that interest be paid on clean claims that are not processed within 30 days. For purposes of this subsection, the term “clean claim” means a claim that has no defect, impropriety (including a lack of any required substantiating documentation), or particular circumstance requiring special treatment that prevents timely payment on the claim under this section.

(b) Requirement to Provide Start-Up Time For Certain Contractors.— Except as provided in paragraph (3), the Secretary of Defense shall not require that a contractor described in paragraph (2) begin to provide managed care support pursuant to a contract to provide such support under the TRICARE program until at least nine months after the date of the award of the contract, but in no case later than one year after the date of such award. A contractor under this paragraph is a contractor who is awarded a contract to provide managed care support under the TRICARE program— who has not previously been awarded such a contract by the Department of Defense; or who has previously been awarded such a contract by the Department of Defense but for whom the subcontractors have not previously been awarded the subcontracts for such a contract. The Secretary may reduce the nine-month start-up period required under paragraph (1) if— the Secretary— determines that a shorter period is sufficient to ensure effective implementation of all contract requirements; and submits notification to the Committees on Armed Services of the House of Representatives and the Senate of the Secretary’s intent to reduce the nine-month start-up period; and 60 days have elapsed since the date of such notification.

(c) Incentives for Electronic Processing.— The Secretary of Defense shall require that new contracts for managed care support under the TRICARE program provide that the contractor be permitted to provide financial incentives to health care providers who file claims for payment electronically.

(d) Correspondence to Medicare Claims Information Requirements.— The Secretary of Defense, in consultation with the other administering Secretaries, shall limit the information required in support of claims for payment for health care items and services provided under the TRICARE program to that information that is identical to the information that would be required for claims for reimbursement for those items and services under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) except for that information, if any, that is uniquely required by the TRICARE program. The Secretary of Defense shall report to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives any information that is excepted under this provision, and the justification for that exception.

§ 1095d TRICARE program: waiver of certain deductibles

(a) Waiver Authorized.— The Secretary of Defense may waive the deductible payable for medical care provided under the TRICARE program to an eligible dependent of— a member of a reserve component on active duty pursuant to a call or order to active duty for a period of more than 30 days; or a member of the National Guard on full-time National Guard duty pursuant to a call or order to full-time National Guard duty for a period of more than 30 days.

(b) Eligible Dependent.— As used in this section, the term “eligible dependent” means a dependent described in subparagraph (A), (D), or (I) of section 1072(2) of this title .

§ 1095e TRICARE program: beneficiary counseling and assistance coordinators

(a) Establishment of Positions.— The Secretary of Defense shall require in regulations that— each lead agent under the TRICARE program— designate a person to serve full-time as a beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program; designate for each of the TRICARE program regions at least one person (other than a person designated under subparagraph (A)) to serve full-time as a beneficiary counseling and assistance coordinator solely for members of the reserve components and their dependents who are beneficiaries under the TRICARE program; and provide for toll-free telephone communication between such beneficiaries and the beneficiary counseling and assistance coordinator; and the commander of each military medical treatment facility under this chapter designate a person to serve, as a primary or collateral duty, as beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program served at that facility.

(b) Duties.— The Secretary shall prescribe the duties of the position of beneficiary counseling and assistance coordinator in the regulations required by subsection (a).

§ 1095f TRICARE program: referrals and preauthorizations under TRICARE Prime

(a) Referrals.— Except as provided by paragraph (2), a beneficiary enrolled in TRICARE Prime shall be required to obtain a referral for care through a designated primary care manager (or other care coordinator) prior to obtaining care under the TRICARE program. The Secretary may waive the referral requirement in paragraph (1) in such circumstances as the Secretary may establish for purposes of this subsection. The Secretary shall waive the referral requirement in paragraph (1) in the case of a member of the armed forces serving on active duty who seeks to obtain any of the following kinds of care in a military medical treatment facility: Physical therapy. Nutritional. Audiological. Optometric. Podiatric. The cost-sharing amounts for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph (1) (or a waiver pursuant to paragraph (2) for such care) shall be determined under section 1075a(c) of this title .

(b) Preauthorization.— A beneficiary enrolled in TRICARE Prime shall be required to obtain preauthorization only with respect to a referral for the following: Inpatient hospitalization. Inpatient care at a skilled nursing facility. Inpatient care at a rehabilitation facility. Inpatient care at a residential treatment center.

(c) Prohibition Regarding Prior Authorization for Certain Referrals.— The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.

§ 1095g TRICARE program: waiver of recoupment of erroneous payments caused by administrative error

(a) Waiver of Recoupment.— The Secretary of Defense may waive recoupment from an individual who has benefitted from an erroneous TRICARE payment in a case in which each of the following applies: The payment was made because of an administrative error by an employee of the Department of Defense or a contractor under the TRICARE program. The individual (or in the case of a minor, the parent or guardian of the individual) had a good faith, reasonable belief that the individual was entitled to the benefit of such payment under this chapter. The individual relied on the expectation of such entitlement. The Secretary determines that a waiver of recoupment of such payment is necessary to prevent an injustice.

(b) Responsibility of Contractor.— In any case in which the Secretary waives recoupment under subsection (a) and the administrative error was on the part of a contractor under the TRICARE program, the Secretary shall, consistent with the requirements and procedures of the applicable contract, impose financial responsibility on the contractor for the erroneous payment.

(c) Finality of Determinations.— Any determination by the Secretary under this section to waive or decline to waive recoupment under subsection (a) is a final determination and shall not be subject to appeal or judicial review.

§ 1096 Military-civilian health services partnership program; medical surge program

(a) Resources Sharing Agreements.— The Secretary of Defense may enter into an agreement providing for the sharing of resources between facilities of the uniformed services and facilities of a civilian health care provider or providers that the Secretary contracts with under section 1079, 1086, or 1097 of this title if the Secretary determines that such an agreement would result in the delivery of health care to which covered beneficiaries are entitled under this chapter in a more effective, efficient, or economical manner.

(b) Eligible Resources.— An agreement entered into under subsection (a) may provide for the sharing of— personnel (including support personnel); equipment; supplies; and any other items or facilities necessary for the provision of health care services.

(c) Computation of Charges.— A covered beneficiary who is a dependent, with respect to care provided to such beneficiary in facilities of the uniformed services under a sharing agreement entered into under subsection (a), shall pay the charges prescribed by section 1078 of this title .

(d) Reimbursement for License Fees.— In any case in which it is necessary for a member of the uniformed services to pay a professional license fee imposed by a government in order to provide health care services at a facility of a civilian health care provider pursuant to an agreement entered into under subsection (a), the Secretary of Defense may reimburse the member for up to $500 of the amount of the license fee paid by the member.

(e) Medical Surge Program.— The Secretary of Defense, in collaboration with the Secretary of Health and Human Services, shall carry out a program of record known as the Military-Civilian Medical Surge Program to— support locations that the Secretary of Defense selects under paragraph (3)(B); and enhance the interoperability and medical surge capability and capacity of the National Disaster Medical System in response to a declaration or other action described in subparagraphs (A) through (F) of paragraph (4). The Secretary of Defense, acting through the Institute 1 for Defense Health Cooperation at the Uniformed Services University of the Health Sciences (or such successor center), shall oversee the management, staffing, and deployment of the Program, in coordination with the Chairman of the Joint Chiefs of Staff, the Director of the Defense Health Agency, and, for purposes of ensuring that the Program is carried out in a manner that is consistent with paragraph (6), the Secretary of Health and Human Services. In carrying out subparagraph (A) during a contingency operation, the Secretary of Defense shall ensure that the Program provides support, acting through the Defense Health Agency serving as a combat support agency, to the relevant combatant command. The Secretary of Defense shall ensure the program is administrated in coordination with the military departments, the Joint Staff, the Defense Health Agency, and the Department of Health and Human Services through semiannual coordination meetings and quarterly updates. On an annual basis, one such meeting shall include the participation of partners specified in paragraph (3)(A). In carrying out the Program, the Secretary of Defense shall maintain requirements for staffing, specialized training, research, and education, regarding patient regulation, movement, definitive care, and other matters the Secretary determines critical to sustaining the health of members of the armed forces. In carrying out the Program, the Secretary of Defense shall establish partnerships at locations selected under subparagraph (B) with public, private, and nonprofit health care organizations, health care institutions, health care entities, academic medical centers of institutions of higher education, and hospitals that the Secretary and the Secretary of Health and Human Services determine— are critical in mobilizing a civilian medical response in support of a wartime contingency or other catastrophic event in the United States; and have demonstrated technical proficiency in critical national security domains, including high-consequence infectious disease and special pathogen preparedness, and matters relating to defense, containment, management, care, and transportation. The Secretary of Defense shall select not fewer than eight locations that are operationally relevant to the missions of the Department of Defense under the National Disaster Medical System and are aeromedical or other transport hubs or logistics centers in the United States for partnerships under subparagraph (A). The Secretary may select more than eight locations, including locations outside of the continental United States, if the Secretary determines such additional locations cover areas of strategic and operational relevance to the Department. The Secretary of Defense and the Secretary of Health and Human Services shall ensure that the partnerships under paragraph (3)(A) allow for civilian medical personnel to quickly and effectively mobilize direct support to military medical treatment facilities and provide support to other requirements of the military health system pursuant to the following: A declaration of a national emergency under the National Emergencies Act ( 50 U.S.C. 1621 2 et seq.). A public health emergency declared under section 319 of the Public Health Service Act ( 42 U.S.C. 247d ). A declaration of war by Congress. A contingency operation. The President’s exercise of executive powers under the War Powers Resolution ( 50 U.S.C. 1541 et seq.). Any other emergency or major disaster as declared by the President. Not later than 180 days after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2026, and annually thereafter, the Secretary of Defense shall submit to the Committee on Armed Services and the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Armed Services and the Committee on Energy and Commerce of the House of Representatives a report on the status, readiness, and operational capabilities of the Program. Each report shall include an assessment of personnel readiness, resource availability, interagency coordination efforts, and recommendations for continued improvements to the Program. Nothing in this section shall be construed to authorize the Secretary of Defense to control, direct, limit, or otherwise affect the authorities of the Secretary of Health and Human Services with respect to the leadership and administration of the National Disaster Medical System, public health and medical preparedness and response, staffing levels, or resource allocation. In this subsection: The term “institution of higher education” means a four-year institution of higher education (as defined in section 101(a) of the Higher Education Act of 1965 ( 20 U.S.C. 1001(a) )). The term “National Disaster Medical System” means the system established under section 2812 of the Public Health Service Act ( 42 U.S.C. 300hh–11 ). The term “Program” means the Military-Civilian Medical Surge Program established under paragraph (1).

§ 1097 Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care

(a) In General.— The Secretary of Defense, after consulting with the other administering Secretaries, may contract for the delivery of health care to which covered beneficiaries are entitled under this chapter. The Secretary may enter into a contract under this section with any of the following: Health maintenance organizations. Preferred provider organizations. Individual providers, individual medical facilities, or insurers. Consortiums of such providers, facilities, or insurers.

(b) Scope of Coverage Under Health Care Plans.— A contract entered into under this section may provide for the delivery of— selected health care services; total health care services for selected covered beneficiaries; or total health care services for all covered beneficiaries who reside in a geographical area designated by the Secretary.

(c) Coordination With Facilities of the Uniformed Services.— The Secretary of Defense may provide for the coordination of health care services provided pursuant to any contract or agreement under this section with those services provided in medical treatment facilities of the uniformed services. Subject to the availability of space and facilities and the capabilities of the medical or dental staff, the Secretary may not deny access to facilities of the uniformed services to a covered beneficiary on the basis of whether the beneficiary enrolled or declined enrollment in any program established under, or operating in connection with, any contract under this section. Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall, as an incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiaries enrolled in any program established under, or operating in connection with, any contract under this section.

(d) Coordination With Other Health Care Programs.— In the case of a covered beneficiary who is enrolled in a managed health care program not operated under the authority of this chapter, the Secretary may contract under this section with such other managed health care program for the purpose of coordinating the beneficiary’s dual entitlements under such program and this chapter. A managed health care program with which arrangements may be made under this subsection includes any health maintenance organization, competitive medical plan, health care prepayment plan, or other managed care program recognized pursuant to regulations issued by the Secretary.

(e) Charges for Health Care.— The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided under this section. In the case of contracts for health care services under this section or health care plans offered under section 1099 of this title for which the Secretary permits covered beneficiaries who are covered by section 1086 of this title and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in section 1086(b) of this title , the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in section 1086(d)(1) of this title who also participate in such contracts or plans. Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under section 1099 of this title , the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation. Except as provided by paragraph (2), a premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on April 1, 2006 , and ending on September 30, 2011 . Beginning October 1, 2012 , the Secretary of Defense may only increase in any year the annual enrollment fees described in paragraph (1) by an amount equal to the percentage by which retired pay is increased under section 1401a of this title .

§ 1097a TRICARE Prime: automatic enrollments

(a) Automatic Enrollment of Certain Dependents.— In the case of a dependent of a member of the uniformed services who is entitled to medical and dental care under section 1076(a)(2)(A) of this title and resides in a catchment area in which TRICARE Prime is offered, the Secretary— shall automatically enroll the dependent in TRICARE Prime if the member is in pay grade E–4 or below; and may automatically enroll the dependent in TRICARE Prime if the member is in pay grade E–5 or higher. Whenever a dependent of a member is enrolled in TRICARE Prime under paragraph (1), the Secretary concerned shall provide written notice of the enrollment to the member. The enrollment of a dependent of the member may be terminated by the member or the dependent at any time.

(b) Automatic Renewal of Enrollments of Covered Beneficiaries.— An enrollment of a covered beneficiary in TRICARE Prime shall be automatically renewed upon the expiration of the enrollment unless the renewal is declined.

(c) Regulations and Exceptions.— The Secretary of Defense shall prescribe regulations, including procedures, to carry out this section. Regulations prescribed to carry out the automatic enrollment requirements under this section may include such exceptions to the automatic enrollment procedures as the Secretary determines appropriate for the effective operation of TRICARE Prime.

(d) No Copayment for Immediate Family.— No copayment shall be charged a member for care provided under TRICARE Prime to a dependent of a member of the uniformed services described in subparagraph (A), (D), or (I) of section 1072(2) of this title .

(e) Authority for Multiple Networks in the Same Geographic Area.— The Secretary may establish a system of multiple networks of providers under TRICARE Prime in the same geographic area or areas. Under a system established under paragraph (1), the Secretary may require a covered beneficiary enrolling in TRICARE Prime to enroll in a specific provider network established pursuant to such system, in which case any provider not in that specific provider network shall be deemed an out-of-network provider with respect to the covered beneficiary (regardless of whether the provider is in a different TRICARE Prime provider network) for purposes of this section or any other provision of law limiting the coverage or provision of health care services to those provided by network providers under the TRICARE program.

(f) Definitions.— In this section: The term “TRICARE Prime” means the managed care option of the TRICARE program. The term “catchment area”, with respect to a facility of a uniformed service, means the service area of the facility, as designated under regulations prescribed by the administering Secretaries.

§ 1097b TRICARE program: financial management

(a) Reimbursement of Providers.— Subject to paragraph (2), the Secretary of Defense may reimburse health care providers under the TRICARE program at rates higher than the reimbursement rates otherwise authorized for the providers under that program if the Secretary determines that application of the higher rates is necessary in order to ensure the availability of an adequate number of qualified health care providers under that program. The amount of reimbursement provided under paragraph (1) with respect to a health care service may not exceed the lesser of the following: The amount equal to the local fee for service charge for the service in the service area in which the service is provided as determined by the Secretary based on one or more of the following payment rates: Usual, customary, and reasonable. The Health Care Finance Administration’s Resource Based Relative Value Scale. Negotiated fee schedules. Global fees. Sliding scale individual fee allowances. The amount equal to 115 percent of the CHAMPUS maximum allowable charge for the service. In establishing rates and procedures for reimbursement of providers and other administrative requirements, including those contained in provider network agreements, the Secretary shall, to the extent practicable, maintain adequate networks of providers, including institutional, professional, and pharmacy. For the purpose of determining whether network providers under such provider network agreements are subcontractors for purposes of the Federal Acquisition Regulation or any other law, a TRICARE managed care support contract that includes the requirement to establish, manage, or maintain a network of providers may not be considered to be a contract for the performance of health care services or supplies on the basis of such requirement.

(b) Third-Party Collections.— A medical treatment facility of the uniformed services under the TRICARE program has the same right as the United States under section 1095 of this title to collect from a third-party payer the reasonable charges for health care services described in paragraph (2) that are incurred by the facility on behalf of a covered beneficiary under that program. The Secretary of Defense shall prescribe regulations for the administration of this subsection. The regulations shall set forth the method to be used for the computation of the reasonable charges for inpatient, outpatient, and other health care services. The method of computation may be— a method that is based on— per diem rates; all-inclusive rates for each visit; diagnosis-related groups; or rates prescribed under the regulations implementing sections 1079 and 1086 of this title; or any other method considered appropriate.

(c) Consultation Requirement.— The Secretary of Defense shall carry out the responsibilities under this section after consultation with the other administering Secretaries.

§ 1097c TRICARE program: relationship with employer-sponsored group health plans

(a) Prohibition on Financial Incentives Not to Enroll in a Group Health Plan.— Except as provided in this subsection, the provisions of section 1862(b)(3)(C) of the Social Security Act shall apply with respect to financial or other incentives for a TRICARE-eligible employee not to enroll (or to terminate enrollment) under a health plan which would (in the case of such enrollment) be a primary plan under sections 1079(j)(1) 1 and 1086(g) of this title in the same manner as such section 1862(b)(3)(C) applies to financial or other incentives for an individual entitled to benefits under title XVIII of the Social Security Act not to enroll (or to terminate enrollment) under a group health plan or a large group health plan which would (in the case of enrollment) be a primary plan (as defined in section 1862(b)(2)(A) of such Act). The Secretary of Defense may by regulation adopt such additional exceptions to the prohibition referenced and applied under paragraph (1) as the Secretary deems appropriate and such paragraph (1) shall be implemented taking into account the adoption of such exceptions. The Secretary of Defense and the Secretary of Health and Human Services are authorized to enter into agreements for carrying out this subsection. Any such agreement shall provide that any expenses incurred by the Secretary of Health and Human Services pertaining to carrying out this subsection shall be reimbursed by the Secretary of Defense. Authorities of the Inspector General of the Department of Defense shall be available for oversight and investigations of responsibilities of employers and other entities under this subsection. Information obtained under section 1095(k) of this title may be used in carrying out this subsection in the same manner as information obtained under section 1862(b)(5) of the Social Security Act may be used in carrying out section 1862(b) of such Act. Any amounts collected in carrying out paragraph (1) shall be handled in accordance with section 1079a of this title .

(b) Election of TRICARE-Eligible Employees to Participate in Group Health Plan.— A TRICARE-eligible employee shall have the opportunity to elect to participate in the group health plan offered by the employer of the employee and receive primary coverage for health care services under the plan in the same manner and to the same extent as similarly situated employees of such employer who are not TRICARE-eligible employees.

(c) Inapplicability to Certain Employers.— The provisions of this section do not apply to any employer who has fewer than 20 employees.

(d) Retention of Eligibility for Coverage Under TRICARE.— Nothing in this section, including an election made by a TRICARE-eligible employee under subsection (b), shall be construed to affect, modify, or terminate the eligibility of a TRICARE-eligible employee or spouse of such employee for health care or dental services under this chapter in accordance with the other provisions of this chapter.

(e) Outreach.— The Secretary of Defense shall, in coordination with the other administering Secretaries, conduct outreach to inform covered beneficiaries who are entitled to health care benefits under the TRICARE program of the rights and responsibilities of such beneficiaries and employers under this section.

(f) Definitions.— In this section: The term “employer” includes a State or unit of local government. The term “group health plan” means a group health plan (as that term is defined in section 5000(b)(1) of the Internal Revenue Code of 1986 without regard to section 5000(d) of the Internal Revenue Code of 1986). The term “TRICARE-eligible employee” means a covered beneficiary under section 1086 of this title entitled to health care benefits under the TRICARE program.

(g) Effective Date.— This section shall take effect on January 1, 2008 .

§ 1097d TRICARE program: notice of change to benefits

(a) Provision of Notice.— If the Secretary makes a significant change to any benefits provided by the TRICARE program to covered beneficiaries, the Secretary shall provide individuals described in paragraph (2) with notice explaining such changes. The individuals described by this paragraph are covered beneficiaries participating in the TRICARE program who may be affected by a significant change covered by a notification under paragraph (1). The Secretary shall provide notice under paragraph (1) through electronic means.

(b) Timing of Notice.— The Secretary shall provide notice under paragraph (1) of subsection (a) by the earlier of the following dates: The date that the Secretary determines would afford individuals described in paragraph (2) of such subsection adequate time to understand the change covered by the notification. The date that is 90 days before the date on which the change covered by the notification becomes effective. The effective date of a significant change that is required by law.

(c) Significant Change Defined.— In this section, the term “significant change” means a systemwide change— in the structure of the TRICARE program or the benefits provided under the TRICARE program (not including the addition of new services or benefits); or in beneficiary cost-share rates of more than 20 percent.

§ 1098 Incentives for participation in cost-effective health care plans

(a) Waiver of Limitations and Copayments.— Subject to subsection (b), the Secretary of Defense, with respect to any plan contracted for under the authority of section 1079 or 1086 of this title, may waive, in whole or in part— any limitation set out in the second sentence of section 1079(a) of this title ; or any requirement for payment by the patient under section 1079(b) or 1086(b) of this title.

(b) Determination and Report.— Subject to paragraph (3), the Secretary may waive a limitation or requirement as authorized by subsection (a) if the Secretary determines that during the period of the waiver such a plan will— be less costly to the Government than a plan subject to such limitations or payment requirements; or provide better services than those provided by a plan subject to such limitations or payment requirements at no additional cost to the Government. 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 with respect to a waiver under paragraph (1), including a comparison of costs of and benefits available under— a plan with respect to which the limitations and payment requirements are waived; and a plan with respect to which there is no such waiver. A waiver under paragraph (1) may not take effect until the end of the 180-day period beginning on the date on which the Secretary submits the report required by paragraph (2) with respect to such waiver.

§ 1099 Health care enrollment system and payment options

(a) Establishment of System.— The Secretary of Defense, after consultation with the other administering Secretaries, shall establish a system of health care enrollment for covered beneficiaries who reside in the United States.

(b) Description of System.— Such system shall— allow covered beneficiaries to elect to enroll in a health care plan, or modify a previous election, from eligible health care plans designated by the Secretary of Defense during— an annual open enrollment period; and any period based on a qualifying event experienced by the beneficiary, as determined appropriate by the Secretary; or if necessary in order to ensure full use of facilities of the uniformed services in a geographical area, assign covered beneficiaries who reside in such area to such facilities.

(c) Health Care Plans Available Under System.— A health care plan designated by the Secretary of Defense under the system described in subsection (a) shall provide all health care to which a covered beneficiary is entitled under this chapter. Such a plan may consist of any of the following: Use of facilities of the uniformed services. A plan under the TRICARE program. Any other health care plan contracted for by the Secretary of Defense. Any combination of the plans described in paragraphs (1), (2), and (3).

(d) Payment Options.— A member or former member of the uniformed services, or a dependent thereof, eligible for medical care and dental care under section 1074(b) or 1076 of this title shall pay a premium for coverage under this chapter. To the maximum extent practicable, a premium owed by a member, former member, or dependent under paragraph (1) shall be withheld from the retired, retainer, or equivalent pay of the member, former member, or dependent. In all other cases, a premium shall be paid in a frequency and method determined by the Secretary.

(e) Regulations.— The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe regulations to carry out this section.

§ 1100 Defense Health Program Account

(a) Establishment of Account.— There is hereby established in the Department of Defense an account to be known as the “Defense Health Program Account”. All sums appropriated to carry out the functions of the Secretary of Defense with respect to medical and health care programs of the Department of Defense shall be appropriated to the account. Of the total amount appropriated for a fiscal year for programs and activities carried out under this chapter, the amount equal to three percent of such total amount shall remain available for obligation until the end of the following fiscal year.

(b) Obligation of Amounts From Account by Secretary of Defense.— The Secretary of Defense may obligate or expend funds from the account for purposes of conducting programs and activities under this chapter, including contracts entered into under section 1079, 1086, 1092, or 1097 of this title, to the extent amounts are available in the account.

(c) Regulations.— The Secretary of Defense shall prescribe regulations to carry out this section.

§ 1101 Resource allocation methods: capitation or diagnosis-related groups

(a) Establishment of Capitation or DRG Method.— The Secretary of Defense, after consultation with the other administering Secretaries, shall establish by regulation the use of capitation or diagnosis-related groups as the primary criteria for allocation of resources to facilities of the uniformed services.

(b) Exception for Mobilization Missions.— Capitation or diagnosis-related groups shall not be used to allocate resources to the facilities of the uniformed services to the extent that such resources are required by such facilities for mobilization missions.

(c) Content of Regulations.— Such regulations may establish a system of diagnosis-related groups similar to the system established under section 1886(d)(4) of the Social Security Act ( 42 U.S.C. 1395ww(d)(4) ). Such regulations may include the following: A classification of inpatient treatments by diagnosis-related groups and a similar classification of outpatient treatment. A methodology for classifying specific treatments within such groups. An appropriate weighting factor for each such diagnosis-related group which reflects the relative resources used by a facility of a uniformed service with respect to treatments classified within that group compared to treatments classified within other groups. An appropriate method for calculating or estimating the annual per capita costs of providing comprehensive health care services to members of the uniformed services on active duty and covered beneficiaries.

§ 1102 Confidentiality of medical quality assurance records: qualified immunity for participants

(a) Confidentiality of Records.— Medical quality assurance records created by or for the Department of Defense as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection (c).

(b) Prohibition on Disclosure and Testi­mony.— No part of any medical quality assurance record described in subsection (a) may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection (c). A person who reviews or creates medical quality assurance records for the Department of Defense or who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding, recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in this section.

(c) Authorized Disclosure and Testimony.— Subject to paragraph (2), a medical quality assurance record described in subsection (a) may be disclosed, and a person referred to in subsection (b) may give testimony in connection with such a record, only as follows: To a Federal executive agency or private organization, if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to Department of Defense health care facilities or to perform monitoring, required by law, of Department of Defense health care facilities. To an administrative or judicial proceeding commenced by a present or former Department of Defense health care provider concerning the termination, suspension, or limitation of clinical privileges of such health care provider. To a governmental board or agency or to a professional health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency, society, or organization to perform licensing, credentialing, or the monitoring of professional standards with respect to any health care provider who is or was a member or an employee of the Department of Defense. To a hospital, medical center, or other institution that provides health care services, if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was a member or employee of the Department of Defense and who has applied for or been granted authority or employment to provide health care services in or on behalf of such institution. To an officer, employee, or contractor of the Department of Defense who has a need for such record or testimony to perform official duties. To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety, if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law. In an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to the subject of such proceeding. With the exception of the subject of a quality assurance action, the identity of any person receiving health care services from the Department of Defense or the identity of any other person associated with such department for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection (a) shall be deleted from that record or document before any disclosure of such record is made outside the Department of Defense. Such requirement does not apply to the release of information pursuant to section 552a of title 5 .

(d) Disclosure for Certain Purposes.— Nothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of Department of Defense medical quality assurance programs. Nothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Comptroller General if such record pertains to any matter within their respective jurisdictions.

(e) Prohibition on Disclosure of Record or Testimony.— A person or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section.

(f) Exemption From Freedom of Information Act.— Medical quality assurance records described in subsection (a) may not be made available to any person under section 552 of title 5 .

(g) Limitation on Civil Liability.— A person who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (a) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place.

(h) Application to Information in Certain Other Records.— Nothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient’s medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program.

(i) Regulations.— The Secretary of Defense shall prescribe regulations to implement this section.

(j) Definitions.— In this section: The term “medical quality assurance program” means any peer review activity carried out before, on, or after November 14, 1986 by or for the Department of Defense to assess the quality of medical care, including activities conducted by individuals, military medical or dental treatment facility committees, or other review bodies responsible for quality assurance, credentials, infection control, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review and identification and prevention of medical or dental incidents and risks. The term “medical quality assurance record” means the proceedings, records, minutes, and reports that emanate from quality assurance program activities described in paragraph (1) and are produced or compiled by the Department of Defense as part of a medical quality assurance program. The term “health care provider” means any military or civilian health care professional who, under regulations of a military department, is granted clinical practice privileges to provide health care services in a military medical or dental treatment facility or who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization. The term “peer review” means any assessment of the quality of medical care carried out by a health care professional, including any such assessment of professional performance, any patient safety program root cause analysis or report, or any similar activity described in regulations prescribed by the Secretary under subsection (i).

(k) Penalty.— Any person who willfully discloses a medical quality assurance record other than as provided in this section, knowing that such record is a medical quality assurance record, shall be fined not more than $3,000inthecaseofafirstoffenseandnotmorethan$20,000 in the case of a subsequent offense.

§ 1103 Contracts for medical and dental care: State and local preemption

(a) Occurrence of Preemption.— A law or regulation of a State or local government relating to health insurance, prepaid health plans, or other health care delivery or financing methods shall not apply to any contract entered into pursuant to this chapter by the Secretary of Defense or the administering Secretaries to the extent that the Secretary of Defense or the administering Secretaries determine that— the State or local law or regulation is inconsistent with a specific provision of the contract or a regulation promulgated by the Secretary of Defense or the administering Secretaries pursuant to this chapter; or the preemption of the State or local law or regulation is necessary to implement or administer the provisions of the contract or to achieve any other important Federal interest.

(b) Effect of Preemption.— In the case of the preemption under subsection (a) of a State or local law or regulation regarding financial solvency, the Secretary of Defense or the administering Secretaries shall require an independent audit of the prime contractor of each contract that is entered into pursuant to this chapter and covered by the preemption. The audit shall be performed by the Defense Contract Audit Agency.

(c) State Defined.— In this section, the term “State” includes the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and each possession of the United States.

§ 1104 Sharing of health-care resources with the Department of Veterans Affairs

(a) Sharing of Health-Care Resources.— Health-care resources of the Department of Defense shall be shared with health-care resources of the Department of Veterans Affairs in accordance with section 8111 of title 38 or under section 1535 of title 31 .

(b) Reimbursement From CHAMPUS Funds.— Pursuant to an agreement entered into under section 8111 of title 38 or section 1535 of title 31 , the Secretary of a military department may reimburse the Secretary of Veterans Affairs from funds available for that military department for the payment of medical care provided under section 1079 or 1086 of this title.

(c) Charges.— The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided to covered beneficiaries under this chapter pursuant to an agreement entered into by the Secretary of a military department under section 8111 of title 38 or section 1535 of title 31 .

(d) Provision of Services During War or National Emergency.— Members of the armed forces on active duty during and immediately following a period of war, or during and immediately following a national emergency involving the use of the armed forces in armed conflict, may be provided health-care services by the Department of Veterans Affairs in accordance with section 8111A of title 38 .

§ 1104a Shared medical facilities with Department of Veterans Affairs

(a) Agreements.— Secretary of Defense may enter into agreements with the Secretary of Veterans Affairs for the planning, design, and construction, or the leasing, of facilities to be operated as shared medical facilities.

(b) Transfer of Funds by Secretary of Defense.— The Secretary of Defense may transfer to the Secretary of Veterans Affairs amounts as follows: For the construction of a shared medical facility, amounts not in excess of the amount authorized under subsection (a)(2) of section 2805 of this title , if— the amount of the share of the Department of Defense for the estimated cost of the project does not exceed the amount authorized under such subsection; and the other requirements of such section have been met with respect to funds identified for transfer. For the planning, design, and construction, or the leasing, of space for a shared medical facility, amounts appropriated for the Defense Health Program. The authority to transfer funds under this section is in addition to any other authority to transfer funds available to the Secretary of Defense. Section 2215 of this title does not apply to a transfer of funds under this subsection.

(c) Transfer of Funds to Secretary of Defense.— Any amount transferred to the Secretary of Defense by the Secretary of Veterans Affairs for necessary expenses for the planning, design, and construction, or the leasing, of a shared medical facility, if the amount of the share of the Department of Defense for the cost of such project does not exceed the amount specified in section 2805(a)(2) of this title , may be credited to accounts of the Department of Defense available for the construction of a shared medical facility. Any amount transferred to the Secretary of Defense by the Secretary of Veterans Affairs for the purpose of the planning and design, or the leasing, of space for a shared medical facility may be credited to accounts of the Department of Defense available for such purposes, and may be used for such purposes. Using accounts credited with transfers from the Secretary of Veterans Affairs under paragraph (1), the Secretary of Defense may carry out unspecified minor military construction projects, if the share of the Department of Defense for the cost of such project does not exceed the amount specified in section 2805(a)(2) of this title .

(d) Merger of Amounts Transferred.— Any amount transferred to the Secretary of Veterans Affairs under subsection (b) and any amount transferred to the Secretary of Defense under subsection (c) shall be merged with and available for the same purposes and the same period as the appropriation or fund to which transferred.

(e) Appropriation in Advance.— Amounts may be transferred pursuant to the authority under this section only to the extent and in the amounts provided in advance in appropriations Acts.

(f) Shared Medical Facility Defined.— In this section, the term “shared medical facility”— means a building or buildings, or a campus, intended to be used by both the Department of Veterans Affairs and the Department of Defense for the provision of health care services, whether under the jurisdiction of the Secretary of Veterans Affairs or the Secretary of Defense, and whether or not located on a military installation or on real property under the jurisdiction of the Secretary of Veterans Affairs; and includes any necessary building and auxiliary structure, garage, parking facility, mechanical equipment, abutting and covered sidewalks, and accommodations for attending personnel.

§ 1105 Specialized treatment facility program

(a) Program Authorized.— The Secretary of Defense may conduct a specialized treatment facility program pursuant to regulations prescribed by the Secretary of Defense. The Secretary shall consult with the other administering Secretaries in prescribing regulations for the program and in conducting the program.

(b) Facilities Authorized To Be Used.— Under the specialized treatment facility program, the Secretary may designate health care facilities of the uniformed services and civilian health care facilities as specialized treatment facilities.

(c) Waiver of Nonemergency Health Care Restriction.— Under the specialized treatment facility program, the Secretary may waive, with regard to the provision of a particular service, the 40-mile radius restriction set forth in section 1079(a)(6) of this title if the Secretary determines that the use of a different geographical area restriction will result in a more cost-effective provision of the service.

(d) Civilian Facility Service Area.— For purposes of the specialized treatment facility program, the service area of a civilian health care facility designated pursuant to subsection (b) shall be comparable in size to the service areas of facilities of the uniformed services.

(e) Issuance of Nonavailability of Health Care Statements.— A covered beneficiary who resides within the service area of a specialized treatment facility designated under the specialized treatment facility program may be required to obtain a nonavailability of health care statement in the case of a specialized service offered by the facility in order for the covered beneficiary to receive the service outside of the program.

(f) Payment of Costs Related to Care in Specialized Treatment Facilities.— Subject to paragraph (2), in connection with the treatment of a covered beneficiary under the specialized treatment facility program, the Secretary may provide the following benefits: Full or partial reimbursement of a member of the uniformed services for the reasonable expenses incurred by the member in transporting a covered beneficiary to or from a health care facility of the uniformed services or a civilian health care facility at which specialized health care services are provided pursuant to this chapter. Full or partial reimbursement of a person (including a member of the uniformed services) for the reasonable expenses of transportation, temporary lodging, and meals (not to exceed a per diem rate determined in accordance with implementing regulations) incurred by such person in accompanying a covered beneficiary as a nonmedical attendant to a health care facility referred to in subparagraph (A). In-kind transportation, lodging, or meals instead of reimbursements under subparagraph (A) or (B) for transportation, lodging, or meals, respectively. The Secretary may make reimbursements for or provide transportation, lodging, and meals under paragraph (1) in the case of a covered beneficiary only if the total cost to the Department of Defense of doing so and of providing the health care in such case is less than the cost to the Department of providing the health care to the covered beneficiary by other means authorized under this chapter.

(g) Covered Beneficiary Defined.— In this section, the term “covered beneficiary” means a person covered under section 1079 or 1086 of this title.

§ 1106 Submittal of claims: standard form; time limits

(a) Standard Form.— The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe by regulation a standard form for the submission of claims for the payment of health care services provided under this chapter.

(b) Time for Submission.— A claim for payment for services provided under this chapter shall be submitted as provided in such regulations as follows: In the case of services provided outside the United States, the Commonwealth of Puerto Rico, or the possessions of the United States, by not later than three years after the services are provided. In the case of any other services, by not later than one year after the services are provided.

§ 1107 Notice of use of an investigational new drug or a drug unapproved for its applied use

(a) Notice Required.— Whenever the Secretary of Defense requests or requires a member of the armed forces to receive an investigational new drug or a drug unapproved for its applied use, the Secretary shall provide the member with notice containing the information specified in subsection (d). The Secretary shall also ensure that health care providers who administer an investigational new drug or a drug unapproved for its applied use, or who are likely to treat members who receive such a drug, receive the information required to be provided under paragraphs (3) and (4) of subsection (d).

(b) Time of Notice.— The notice required to be provided to a member under subsection (a)(1) shall be provided before the investigational new drug or drug unapproved for its applied use is first administered to the member.

(c) Form of Notice.— The notice required under subsection (a)(1) shall be provided in writing.

(d) Content of Notice.— The notice required under subsection (a)(1) shall include the following: Clear notice that the drug being administered is an investigational new drug or a drug unapproved for its applied use. The reasons why the investigational new drug or drug unapproved for its applied use is being administered. Information regarding the possible side effects of the investigational new drug or drug unapproved for its applied use, including any known side effects possible as a result of the interaction of such drug with other drugs or treatments being administered to the members receiving such drug. Such other information that, as a condition of authorizing the use of the investigational new drug or drug unapproved for its applied use, the Secretary of Health and Human Services may require to be disclosed.

(e) Records of Use.— The Secretary of Defense shall ensure that the medical records of members accurately document— the receipt by members of any investigational new drug or drug unapproved for its applied use; and the notice required by subsection (a)(1).

(f) Limitation and Waiver.— In the case of the administration of an investigational new drug or a drug unapproved for its applied use to a member of the armed forces in connection with the member’s participation in a particular military operation, the requirement that the member provide prior consent to receive the drug in accordance with the prior consent requirement imposed under section 505(i)(4) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(i)(4) ) may be waived only by the President. The President may grant such a waiver only if the President determines, in writing, that obtaining consent is not in the interests of national security. The waiver authority provided in paragraph (1) shall not be construed to apply to any case other than a case in which prior consent for administration of a particular drug is required by reason of a determination by the Secretary of Health and Human Services that such drug is subject to the investigational new drug requirements of section 505(i) of the Federal Food, Drug, and Cosmetic Act. The Secretary of Defense may request the President to waive the prior consent requirement with respect to the administration of an investigational new drug or a drug unapproved for its applied use to a member of the armed forces in connection with the member’s participation in a particular military operation. With respect to any such administration— the Secretary may not delegate to any other official the authority to request the President to waive the prior consent requirement for the Department of Defense; and if the President grants the requested waiver, the Secretary shall submit to the chairman and ranking minority member of each congressional defense committee a notification of the waiver, together with the written determination of the President under paragraph (1) and the Secretary’s justification for the request or requirement under subsection (a) for the member to receive the drug covered by the waiver. In this subsection: The term “relevant FDA regulations” means the regulations promulgated under section 505(i) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(i) ). The term “prior consent requirement” means the requirement included in the relevant FDA regulations pursuant to section 505(i)(4) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(i)(4) ).

(g) Definitions.— In this section: The term “investigational new drug” means a drug covered by section 505(i) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(i) ). The term “drug unapproved for its applied use” means a drug administered for a use not described in the approved labeling of the drug under section 505 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355 ).

§ 1107a Emergency use products

(a) Waiver by the President.— In the case of the administration of a product authorized for emergency use under section 564 of the Federal Food, Drug, and Cosmetic Act to members of the armed forces, the condition described in section 564(e)(1)(A)(ii)(III) of such Act and required under paragraph (1)(A) or (2)(A) of such section 564(e), designed to ensure that individuals are informed of an option to accept or refuse administration of a product, may be waived only by the President only if the President determines, in writing, that complying with such requirement is not in the interests of national security. The waiver authority provided in paragraph (1) shall not be construed to apply to any case other than a case in which an individual is required to be informed of an option to accept or refuse administration of a particular product by reason of a determination by the Secretary of Health and Human Services that emergency use of such product is authorized under section 564 of the Federal Food, Drug, and Cosmetic Act.

(b) Provision of Information.— If the President, under subsection (a), waives the condition described in section 564(e)(1)(A)(ii)(III) of the Federal Food, Drug, and Cosmetic Act, and if the Secretary of Defense, in consultation with the Secretary of Health and Human Services, makes a determination that it is not feasible based on time limitations for the information described in section 564(e)(1)(A)(ii)(I) or (II) of such Act and required under paragraph (1)(A) or (2)(A) of such section 564(e), to be provided to a member of the armed forces prior to the administration of the product, such information shall be provided to such member of the armed forces (or next-of-kin in the case of the death of a member) to whom the product was administered as soon as possible, but not later than 30 days, after such administration. The authority provided for in this subsection may not be delegated. Information concerning the administration of the product shall be recorded in the medical record of the member.

(c) Applicability of Other Provisions.— In the case of an authorization by the Secretary of Health and Human Services under section 564(a)(1) of the Federal Food, Drug, and Cosmetic Act based on a determination by the Secretary of Defense under section 564(b)(1)(B) of such Act, subsections (a) through (f) of section 1107 shall not apply to the use of a product that is the subject of such authorization, within the scope of such authorization and while such authorization is effective.

§ 1108 Health care coverage through Federal Employees Health Benefits program: demonstration project

(a) FEHBP Option Demonstration.— The Secretary of Defense, after consulting with the other administering Secretaries, shall enter into an agreement with the Office of Personnel Management to conduct a demonstration project (in this section referred to as the “demonstration project”) under which eligible beneficiaries described in subsection (b) and residing within one of the areas covered by the demonstration project may enroll in health benefits plans offered through the Federal Employees Health Benefits program under chapter 89 of title 5. The number of eligible beneficiaries and family members of such beneficiaries under subsection (b)(2) who may be enrolled in health benefits plans during the enrollment period under subsection (d)(2) may not exceed 66,000.

(b) Eligible Beneficiaries; Coverage.— An eligible beneficiary under this subsection is— a member or former member of the uniformed services described in section 1074(b) of this title who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.); an individual who is an unremarried former spouse of a member or former member described in section 1072(2)(F) or 1072(2)(G)); an individual who is— a dependent of a deceased member or former member described in section 1076(b) or 1076(a)(2)(B) of this title or of a member who died while on active duty for a period of more than 30 days; and a member of family as defined in section 8901(5) of title 5 ; or an individual who is— a dependent of a living member or former member described in section 1076(b)(1) of this title who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act, regardless of the member’s or former member’s eligibility for such hospital insurance benefits; and a member of family as defined in section 8901(5) of title 5 . Eligible beneficiaries may enroll in a Federal Employees Health Benefit plan under chapter 89 of title 5 under this section for self-only coverage or for self and family coverage which includes any dependent of the member or former member who is a family member for purposes of such chapter. A person eligible for coverage under this subsection shall not be required to satisfy any eligibility criteria specified in chapter 89 of title 5 (except as provided in paragraph (1)(C) or (1)(D)) as a condition for enrollment in health benefits plans offered through the Federal Employees Health Benefits program under the demonstration project. For purposes of determining whether an individual is a member of family under paragraph (5) of section 8901 of title 5 for purposes of paragraph (1)(C) or (1)(D), a member or former member described in section 1076(b) or 1076(a)(2)(B) of this title shall be deemed to be an employee under such section. An eligible beneficiary who is eligible to enroll in the Federal Employees Health Benefits program as an employee under chapter 89 of title 5 is not eligible to enroll in a Federal Employees Health Benefits plan under this section.

(c) Area of Demonstration Project.— The Secretary of Defense and the Director of the Office of Personnel Management shall jointly identify and select the geographic areas in which the demonstration project will be conducted. The Secretary and the Director shall establish at least six, but not more than ten, such demonstration areas. In establishing the areas, the Secretary and Director shall include— an area that includes the catchment area of one or more military medical treatment facilities; an area that is not located in the catchment area of a military medical treatment facility; an area in which there is a Medicare Subvention Demonstration project area under section 1896 1 of title XVIII of the Social Security Act ( 42 U.S.C. 1395ggg ); and not more than one area for each TRICARE region.

(d) Duration of Demonstration Project.— The Secretary of Defense shall conduct the demonstration project during three contract years under the Federal Employees Health Benefits program. Eligible beneficiaries shall, as provided under the agreement pursuant to subsection (a), be permitted to enroll in the demonstration project during an open enrollment period for the year 2000 (conducted in the fall of 1999). The demonstration project shall terminate on December 31, 2002 .

(e) Prohibition Against Use of MTFs and Enrollment Under TRICARE.— Covered beneficiaries under this chapter who are provided coverage under the demonstration project shall not be eligible to receive care at a military medical treatment facility or to enroll in a health care plan under the TRICARE program.

(f) Term of Enrollment in Project.— Subject to paragraphs (2) and (3), the period of enrollment of an eligible beneficiary who enrolls in the demonstration project during the open enrollment period for the year 2000 shall be three years unless the beneficiary disenrolls before the termination of the project. A beneficiary who elects to enroll in the project, and who subsequently discontinues enrollment in the project before the end of the period described in paragraph (1), shall not be eligible to reenroll in the project. An eligible beneficiary enrolled in a Federal Employees Health Benefits plan under this section may change health benefits plans and coverage in the same manner as any other Federal Employees Health Benefits program beneficiary may change such plans.

(g) Effect of Cancellation.— The cancellation by an eligible beneficiary of coverage under the Federal Employee Health Benefits program shall be irrevocable during the term of the demonstration project.

(h) Separate Risk Pools; Charges.— The Director of the Office of Personnel Management shall require health benefits plans under chapter 89 of title 5 that participate in the demonstration project to maintain a separate risk pool for purposes of establishing premium rates for eligible beneficiaries who enroll in such a plan in accordance with this section. The Director shall determine total subscription charges for self only or for family coverage for eligible beneficiaries who enroll in a health benefits plan under chapter 89 of title 5 in accordance with this section. The subscription charges shall include premium charges paid to the plan and amounts described in section 8906(c) of title 5 for administrative expenses and contingency reserves.

(i) Government Contributions.— The Secretary of Defense shall be responsible for the Government contribution for an eligible beneficiary who enrolls in a health benefits plan under chapter 89 of title 5 in accordance with this section, except that the amount of the contribution may not exceed the amount of the Government contribution which would be payable if the electing beneficiary were an employee (as defined for purposes of such chapter) enrolled in the same health benefits plan and level of benefits.

(j) Application of Medigap Protections to Demonstration Project Enrollees.— Subject to paragraph (2), the provisions of section 1882(s)(3) (other than clauses (i) through (iv) of subparagraph (B)) and 1882(s)(4) of the Social Security Act shall apply to enrollment (and termination of enrollment) in the demonstration project under this section, in the same manner as they apply to enrollment (and termination of enrollment) with a Medicare+Choice 2 organization in a Medicare+Choice 2 plan. In applying paragraph (1)— any reference in clause (v) or (vi) of section 1882(s)(3)(B) of such Act to 12 months is deemed a reference to 36 months; and the notification required under section 1882(s)(3)(D) of such Act shall be provided in a manner specified by the Secretary of Defense in consultation with the Director of the Office of Personnel Management.

§ 1109 Organ and tissue donor program

(a) Responsibilities of the Secretary of Defense.— The Secretary of Defense shall ensure that the advanced systems developed for recording armed forces members’ personal data and information (such as the SMARTCARD, MEDITAG, and Personal Information Carrier) include the capability to record organ and tissue donation elections.

(b) Responsibilities of the Secretaries of the Military Departments.— The Secretaries of the military departments shall ensure that— appropriate information about organ and tissue donation is provided— to each officer candidate during initial training; and to each recruit— after completion by the recruit of basic training; and before arrival of the recruit at the first duty assignment of the recruit; members of the armed forces are given recurring, specific opportunities to elect to be organ or tissue donors during service in the armed forces and upon retirement; and members of the armed forces electing to be organ or tissue donors are encouraged to advise their next of kin concerning the donation decision and any subsequent change of that decision.

(c) Responsibilities of the Surgeons General of the Military Departments.— The Surgeons General of the military departments shall ensure that— appropriate training is provided to enlisted and officer medical personnel to facilitate the effective operation of organ and tissue donation activities under garrison conditions and, to the extent possible, under operational conditions; and medical logistical activities can, to the extent possible without jeopardizing operational requirements, support an effective organ and tissue donation program.

§ 1110 System for tracking and recording vaccine information; anthrax vaccine immunization program

(a) Overall System to Track and Record Vaccine Information.— The Secretary of Defense, in consultation with the Director of the Defense Health Agency and in coordination with the Secretaries of the military departments, shall establish a system to track and record the following information: Each vaccine administered by a health care provider of the Department of Defense to a member of an armed force under the jurisdiction of the Secretary of a military department. Any adverse reaction of the member related to such vaccine. Each refusal by such a member of any vaccine that is being so administered, including vaccines licensed by the Food and Drug Administration under section 351 of the Public Health Service Act ( 42 U.S.C. 262 ) and vaccines otherwise approved or authorized. Each refusal by such a member of a vaccine on the basis that the vaccine is being administered by a health care provider of the Department pursuant to an emergency use authorization granted by the Commissioner of Food and Drugs under section 564 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 360bbb–3 ). Each refusal by such a member of an investigational new drug or a drug unapproved for its applied use that is being administered pursuant to a request or requirement of the Secretary of Defense and with respect to which the President has granted a waiver of the prior consent requirement pursuant to section 1107(f)(1) of this title . In carrying out paragraph (1), the Secretary of Defense shall ensure that— any electronic health record maintained by the Secretary for a member of an armed force under the jurisdiction of the Secretary of a military department is updated with the information specified in such paragraph with respect to the member; any collection, storage, or use of such information is conducted through means involving such cyber protections as the Secretary determines necessary to safeguard the personal information of the member; and the system established under such paragraph is interoperable and compatible with the electronic health record system known as “MHS GENESIS”, or such successor system.

(b) Procedures for Medical and Administrative Exemptions From Anthrax Vaccine Immunization Program.— The Secretary shall establish uniform procedures under which members of the armed forces may be exempted from participating in the anthrax vaccine immunization program for either administrative or medical reasons. The Secretaries of the military departments shall provide for notification of all members of the armed forces of the procedures established pursuant to paragraph (1).

(c) System for Monitoring Adverse Reactions to Anthrax Vaccine.— The Secretary shall establish a system for monitoring adverse reactions of members of the armed forces to the anthrax vaccine. That system shall include the following: Independent review of Vaccine Adverse Event Reporting System reports. Periodic surveys of personnel to whom the vaccine is administered. A continuing longitudinal study of a pre-identified group of members of the armed forces (including men and women and members from all services). Active surveillance of a sample of members to whom the anthrax vaccine has been administered that is sufficient to identify, at the earliest opportunity, any patterns of adverse reactions, the discovery of which might be delayed by reliance solely on the Vaccine Adverse Event Reporting System. The Secretary may extend or expand any ongoing or planned study or analysis of trends in adverse reactions of members of the armed forces to the anthrax vaccine in order to meet any of the requirements in paragraph (1). The Secretary shall establish guidelines under which members of the armed forces who are determined by an independent expert panel to be experiencing unexplained adverse reactions may obtain access to a Department of Defense Center of Excellence treatment facility for expedited treatment and follow up.

§ 1110a Notification of certain individuals regarding options for enrollment under Medicare part B

(a) In General.— As soon as practicable, the Secretary of Defense shall notify each individual described in subsection (b)— that the individual is no longer eligible for health care benefits under the TRICARE program under this chapter; and of options available for enrollment of the individual in the supplementary medical insurance program under part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq.). In carrying out this subsection, the Secretary of Defense shall— establish procedures for identifying individuals described in subsection (b); and consult with the Secretary of Health and Human Services to accurately identify and notify such individuals.

(b) Individuals Described.— An individual described in this subsection is an individual who is— a covered beneficiary; entitled to benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c ) under section 226(b) or section 226A of such Act ( 42 U.S.C. 426(b) and 426–1); and eligible to enroll in the supplementary medical insurance program under part B of such title ( 42 U.S.C. 1395j et seq.).

§ 1110b TRICARE program: extension of dependent coverage

(a) In General.— In accordance with subsection (c), an individual described in subsection (b) shall be deemed to be a dependent (as described in section 1072(2)(D) of this title ) for purposes of coverage under the TRICARE program.

(b) Individual Described.— An individual described in this subsection is an individual who— would be a dependent under section 1072(2) of this title but for exceeding an age limit under such section; has not attained the age of 26; is not eligible to enroll in an eligible employer-sponsored plan (as defined in section 5000A(f)(2) of the Internal Revenue Code of 1986); is not otherwise a dependent of a member or a former member under any subparagraph of section 1072(2) of this title ; and meets other criteria specified in regulations prescribed by the Secretary, similar to regulations prescribed by the Secretary of Health and Human Services under section 2714(b) of the Public Health Service Act.

(c) Premium.— The Secretary shall prescribe by regulation a premium (or premiums) for coverage under the TRICARE program provided pursuant to this section to an individual described in subsection (b). Such premium shall apply instead of any enrollment fees required under section 1075 or 1075a of this title, as appropriate. The monthly amount of the premium in effect for a month for coverage under the TRICARE program pursuant to this section shall be the amount equal to the cost of such coverage that the Secretary determines on an appropriate actuarial basis. The Secretary shall prescribe the requirements and procedures applicable to the payment of premiums under this subsection. Amounts collected as premiums under this subsection shall be credited to the appropriation available for the Defense Health Program Account under section 1100 of this title , shall be merged with sums in such Account that are available for the fiscal year in which collected, and shall be available under subsection (b) of such section for such fiscal year.