§ 1071. Purpose of this chapter

§ 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.)

The words “and certain former members” are inserted to reflect the fact that many of the persons entitled to retired pay are former members only. The words “and dental” are inserted to reflect the fact that members and, in certain limited situations, dependents are entitled to dental care under sections 1071–1085 of this title.

Editorial Notes

Prior Provisions

A prior section 1071, act Aug. 10, 1956, ch. 1041, 70A Stat. 81, which stated the purpose of former sections 1071 to 1086 of this title, and provided for their construction, was repealed by Pub. L. 85–861, § 36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which was classified to subchapter I–D (§ 1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare, prior to repeal by Pub. L. 99–410, title II, § 203, Aug. 28, 1986, 100 Stat. 930.

Amendments

1980—Pub. L. 96–513 substituted “Purpose of this chapter” for “Purpose of sections 1071–1087 of this title” in section catchline, and substituted reference to this chapter for reference to sections 1071–1087 of this title in text.

1966—Pub. L. 89–614 substituted “1087” for “1085” in section catchline and text.

Statutory Notes and Related Subsidiaries

Effective Date of 1980 Amendment

Amendment by Pub. L. 96–513 effective Dec. 12, 1980, see section 701(b)(3) of Pub. L. 96–513, set out as a note under section 101 of this title.

Effective Date of 1966 Amendment

Pub. L. 89–614, § 3, Sept. 30, 1966, 80 Stat. 866, provided that: “The amendments made by this Act [see Short Title of 1966 Amendment note below] shall become effective January 1, 1967, except that those amendments relating to outpatient care in civilian facilities for spouses and children of members of the uniformed services who are on active duty for a period of more than 30 days shall become effective on October 1, 1966.”

Short Title of 2008 Amendment

Pub. L. 110–181, div. A, title XVI, § 1601, Jan. 28, 2008, 122 Stat. 431, provided that: “This title [enacting sections 1074l, 1216a, and 1554a of this title, amending sections 1074, 1074f, 1074i, 1145, 1201, 1203, 1212, and 1599c of this title and section 6333 of Title 5, Government Organization and Employees, and enacting provisions set out as notes under this section, sections 1074, 1074f, 1074i, 1074l, 1212, and 1554a of this title, and section 6333 of Title 5] may be cited as the ‘Wounded Warrior Act’.”

Short Title of 1987 Amendment

Pub. L. 100–180, div. A, title VII, § 701, Dec. 4, 1987, 101 Stat. 1108, provided that: “This title [enacting sections 1103, 2128 to 2130 [now 16201 to 16203], and 6392 of this title, amending sections 533, 591, 1079, 1086, 1251, 2120, 2122, 2123, 2124, 2127, 2172 [now 16302], 3353, 3855, 5600, 8353, and 8855 of this title, section 302 of Title 37, Pay and Allowances of the Uniformed Services, and section 3809 of Title 50, War and National Defense, enacting provisions set out as notes under sections 1073, 1074, 1079, 1092, 1103, 2121, 2124, 12201, and 16201 of this title, amending provisions set out as notes under sections 1073 and 1101 of this title, and repealing provisions set out as notes under sections 2121 and 2124 of this title] may be cited as the ‘Military Health Care Amendments of 1987’.”

Short Title of 1966 Amendment

Pub. L. 89–614, § 1, Sept. 30, 1966, 80 Stat. 862, provided: “That this Act [enacting sections 1086 and 1087 of this title, amending this section and sections 1072 to 1074, 1076 to 1079, 1082, and 1084 of this title, and enacting provisions set out as a note under this section] may be cited as the ‘Military Medical Benefits Amendments of 1966’.”

Pilot Program on Wastewater Surveillance System of Department of Defense

Pub. L. 119–60, div. A, title VII, § 733, Dec. 18, 2025, 139 Stat. 932, provided that: “(a) Pilot Program Required.—Commencing not later than 180 days after the date of the enactment of this Act [Dec. 18, 2025], the Secretary of Defense shall carry out a pilot program under which the Secretary shall develop and implement a comprehensive wastewater surveillance system at not fewer than four installations of a military department at which the Secretary seeks to identify the prevalence of infectious diseases among members of the Armed Forces at the installation (in this section referred to as the ‘pilot program’). “(b) Technologies and Data System Used.—In carrying out the pilot program, the Secretary shall ensure the system developed and implemented under subsection (a) is comprised of appropriate technologies and a uniform data system across the Department of Defense. “(c) Duration.—The pilot program shall be carried out during a two-year period beginning on the date of the commencement of the pilot program. “(d) Report.—Not later than 90 days after the termination of the pilot program, the Secretary shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report that includes the following:“(1) A summary of the findings from the wastewater surveillance system under the pilot program. “(2) Recommendations for interventions or policy changes based on trends observed under the pilot program. “(3) An assessment of the effectiveness of the pilot program in enhancing force health protection and readiness.”

Pilot Program To Assist Certain Members of the Armed Forces and Dependents With Additional Supplemental Coverage Relating to Cancer

Pub. L. 119–60, div. A, title VII, § 734, Dec. 18, 2025, 139 Stat. 933, provided that: “(a) Establishment.—Not later than September 30, 2027, the Secretary of Defense shall establish a pilot program under which a covered individual may obtain supplemental insurance for noncovered expenses under a fixed indemnity supplemental benefit plan described in subsection (b)(1) (in this section referred to as the ‘pilot program’). The Secretary shall carry out such program until the date on which the last agreement terminates pursuant to subsection (b)(2). “(b) Agreement.—“(1) In general.—In carrying out the pilot program, the Secretary shall enter into an agreement with not fewer than two companies to each offer one or more fixed indemnity supplemental benefit plans that—“(A) meet the requirements for a supplemental insurance plan under section 199.2 of title 32, Code of Federal Regulations, and the exceptions under section 199.8(b)(4) of such title, as in effect on the date of the enactment of this Act [Dec. 18, 2025]; “(B) are provided under a separate policy, certificate, or contract; and “(C) are designed to help participants pay noncovered expenses. “(2) Duration of agreement.—An agreement entered into under paragraph (1) shall be for a period of not more than three years, and may not be renewed. “(c) Provision of Information.—The Secretary shall provide information to covered individuals regarding the pilot program by making available on a publicly accessible internet website the following information:“(1) A notice of availability of a fixed indemnity supplemental benefit plan provided under the pilot program. “(2) A description of how to enroll in such plan. “(3) A description and explanation of such plan, including the diagnoses, screenings, and treatments covered by the plan. “(4) A description of the costs to the individual through premiums and remittances to a company providing such plan. “(5) A notice that—“(A) the availability of a fixed indemnity supplemental benefit plan provided under the pilot program does not affect the health care benefits provided to covered individuals under the TRICARE program; and “(B) covered individuals are not required to purchase such a plan in order to receive health care benefits covered under the TRICARE program. “(d) Enrollment.—“(1) Election.—A covered individual may elect to enroll in a fixed indemnity supplemental benefit plan provided under the pilot program. “(2) Verification of eligibility.—The Secretary shall establish procedures to determine the eligibility of applicants seeking to enroll in a fixed indemnity supplemental benefit plan provided under the pilot program. “(e) Limitations on Authorization of Appropriations.—None of the amounts authorized to be appropriated by this Act or otherwise made available for fiscal year 2026 or any fiscal year thereafter to carry out the pilot program may be used to subsidize the cost of a fixed indemnity supplemental benefit plan provided under the pilot program. “(f) Briefing.—Not later than one year after the date on which the pilot program commences and annually thereafter during the life of the pilot program, the Secretary shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing regarding the pilot program, including the following:“(1) A description of the insurance products provided through a fixed indemnity supplemental benefit plan provided under the pilot program. “(2) The number of covered individuals who enrolled in such a plan. “(3) Feedback and examples of use cases by such individuals. “(4) A determination by the Secretary with respect to whether the pilot program should be made permanent. “(g) Definitions.—In this section:“(1) The term ‘covered individual’ means the following:“(A) A member of the regular component of the Army, Navy, Marine Corps, Air Force, or Space Force. “(B) A dependent (as defined in section 1072 of title 10, United States Code) of such a member who is enrolled in the TRICARE program. “(2) The term ‘noncovered expense’ means, with respect to a covered individual, any expenses relating to the screening for and diagnosis and treatment of cancer that are not otherwise covered by the health care benefits the individuals [sic] receives under chapter 55 of title 10, United States Code, or any other benefit provided by the Secretary of Defense. “(3) The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10, United States Code.”

Program To Prevent Perinatal Mental Health Conditions in Pregnant and Postpartum Members of the Armed Forces

Pub. L. 118–159, div. A, title VII, § 705, Dec. 23, 2024, 138 Stat. 1943, provided that: “(a) Requirement.—The Secretary of Defense, acting through the Under Secretary of Defense for Personnel and Readiness, shall carry out a program to improve clinical and nonclinical services targeting mental health conditions in pregnant and postpartum members of the Armed Forces and spouses of members during the perinatal period. “(b) Elements.—The Secretary shall ensure that the program under subsection (a) includes the following:“(1) Access to support resources during the perinatal period, including—“(A) identification of symptoms of perinatal mental health conditions, brief intervention by primary care providers, referral to care, and treatment; “(B) targeted nonmedical counseling services through the Department of Defense Military and Family Life Counseling Program of the Office of Military Family Readiness Policy under section 1781 of title 10, United States Code; “(C) existing parenting resiliency programs of the military departments; “(D) adherence to clinical practice guidelines in military medical treatment facilities in support of members of the uniformed services and dependents with a diagnosed mental health condition requiring clinical intervention, including through primary care services and women’s health clinics, in collaboration with behavioral health services; and “(E) prenatal and postnatal support programs at military medical treatment facilities that provide group counseling modeled after best clinical practices, such as the Centering Pregnancy program. “(2) A process for informing pregnant and postpartum members of the Armed Forces and spouses of members of nonmedical and clinical support services during the perinatal period. “(3) A communications strategy to increase awareness of the services available under the program. “(c) Report.—Not later than December 31, 2025, the Secretary shall submit to the Committees on Armed Services of the Senate and House of Representatives a report on the program under subsection (a) that includes the following:“(1) A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities. “(2) How resources are allocated for the purpose of establishing and maintaining perinatal support programs at military medical treatment facilities. “(3) Measurements for adherence to evidence-based protocols at military medical treatment facilities with respect to identifying potential mental health issues. “(4) Assessment of current training and credentials required for health care providers providing perinatal services and consideration for further certifications, such as the Perinatal Mental Health Certification. “(5) Feasibility and advisability of adding specialized perinatal mental health support services via a helpline through Military One Source. “(6) Recommendations for administrative or legislative changes to improve the effectiveness of the program. “(d) Perinatal Period Defined.—In this section, the term ‘perinatal period’ means the period beginning with pregnancy through one year following childbirth.”

Establishment of Defense Intrepid Network for Traumatic Brain Injury and Brain Health as Program of Record

Pub. L. 118–159, div. A, title VII, § 721, Dec. 23, 2024, 138 Stat. 1951, provided that: “(a) In General.—Not later than January 1, 2026, the Secretary of Defense shall establish the Defense Intrepid Network for Traumatic Brain Injury and Brain Health (in this section referred to as the ‘Network’) headquartered at the National Intrepid Center of Excellence as a program of record subject to milestone reviews and compliance with the requirements under this section. “(b) Duties.—The duties of the Network are as follows:“(1) To provide clinical care to prevent, diagnose, treat, and rehabilitate members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, symptoms from blast overpressure or blast exposure, and other mental health conditions. “(2) To promote standardization of care among the 10 Intrepid Spirit Centers throughout the continental United States, brain health clinics in Alaska and Germany, and other sites as designated by the Director of the Defense Health Agency as being a part of the long-term brain health strategy of the Department of Defense. “(3) To support and conduct research and education on traumatic brain injury, post-traumatic stress disorder, blast overpressure or blast exposure, and other mental health conditions. “(c) Annual Briefing.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2024], and annually thereafter for a period of five years, the Secretary of Defense shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing that shall include, for the year covered by the briefing—“(1) the number of individuals to whom the Network has provided services; “(2) the number of individuals who return to active duty in the Armed Forces after receiving services from the Network, and the stage in their career at which they seek treatment at the Network; “(3) the number of individuals whose families are able to participate in programs provided by the Network; and “(4) the number of individuals on a waitlist for treatment at the Network and the average period those individuals are on the waitlist.”

Brain Health and Trauma Program

Pub. L. 118–159, div. A, title VII, § 722, Dec. 23, 2024, 138 Stat. 1951, provided that: “(a) Establishment.—The Secretary of Defense shall establish an intensive comprehensive brain health and trauma program to—“(1) provide multidisciplinary specialist evaluations, treatment initiation, and aftercare for members of the Armed Forces and dependents of members; and “(2) make evidence-based improvements in such evaluations, treatment, and aftercare. “(b) Program Elements.—The Secretary shall ensure that the program under subsection (a) includes the following:“(1) Initiatives of the Defense Health Agency that provide coordinated evaluations, treatment, and aftercare for traumatic brain injuries and related conditions, that incorporates specialized evaluations, innovative and evidence-based treatments, and comprehensive follow-up care. “(2) Collaboration with private sector nonprofit health care organizations involved in innovative clinical activities in brain health and trauma care, including transitional and residential brain injury treatment programs. “(3) One or more pilot programs for demonstrating the effectiveness of intensive outpatient multidisciplinary specialist treatment and care coordination. “(4) Incorporation of evidence-based therapy with complementary and alternative medicine approaches. “(5) Thorough evaluations of the effectiveness of innovative activities for diagnosis, treatment, and aftercare of brain trauma and promotion of brain health. “(c) Briefing.—Not later than December 31, 2025, the Secretary shall provide to the Armed Services Committees of the Senate and House of Representatives a briefing on the program under subsection (a). Such briefing shall include the following:“(1) A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities. “(2) The scope of each pilot program carried out under subsection (b)(3). “(3) Recommendations for administrative or legislative changes to improve the effectiveness of the program.”

Blast Overpressure and Traumatic Brain Injury Oversight Strategy and Action Plan

Pub. L. 118–159, div. A, title VII, § 724, Dec. 23, 2024, 138 Stat. 1954, provided that: “(a) Strategy and Plan Required.—The Secretary of Defense shall develop and implement a traumatic brain injury oversight strategy and action plan that includes, at a minimum, the following:“(1) Assigned roles and responsibilities for the components of the Office of the Secretary of Defense for the mitigation, identification, and treatment of traumatic brain injury and the monitoring and documentation of blast overpressure exposure. “(2) Standardized monitoring, treatment, and referral guidelines for traumatic brain injury programs across all covered Armed Forces. “(3) A review and update of the current brain injury diagnostic tools used by such programs. “(4) Standardized, 72-hour follow-up requirements for all traumatic brain injury patients, including protocols for the treatment and observation during such follow-up appointments. “(5) Oversight and documentation standards to aid in data collection. “(b) Implementation.—The Secretary shall implement the oversight strategy and action plan under subsection (a) not later than one year after the date of the enactment of this Act [Dec. 23, 2024]. “(c) Submission to GAO.—Upon development of the oversight strategy and action plan under subsection (a), the Secretary shall submit to the Comptroller General of the United States the oversight strategy and action plan. “(d) Covered Armed Forces Defined.—In this section, the term ‘covered Armed Forces’ means the Army, Navy, Marine Corps, Air Force, and Space Force.”

Establishment of Requirements Relating to Blast Overpressure Exposure

Pub. L. 118–159, div. A, title VII, § 725, Dec. 23, 2024, 138 Stat. 1955, provided that: “Not later than two years after the date of the enactment of this Act [Dec. 23, 2024], the Secretary of Defense shall establish— “(1) performance parameters to minimize exposure to blast overpressure when drafting requirements for new weapon systems for the Department of Defense, taking into account the thresholds for blast exposure and overpressure safety identified pursuant to section 735(b)(1) of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (Public Law 117–263; 10 U.S.C. 1071 note), as amended by section 723; “(2) with respect to contractual agreements entered into by any entity and the Department of Defense as part of the defense weapon acquisition process on or after the date on which such parameters are established, a requirement that the entity shall provide to the Secretary blast overpressure measurements and safety data for a weapon system procured under such agreement that produces blast overpressure that exceeds such thresholds; and “(3) a requirement that any test plan for a new weapon system shall incorporate testing for blast overpressure measurements and safety data.”

Medical Countermeasures for Overseas Personnel of the Department of Defense for Acute Radiation Syndrome and Thermal Burns

Pub. L. 118–159, div. A, title VII, § 734, Dec. 23, 2024, 138 Stat. 1956, provided that: “(a) Program Required.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2024], the Secretary of Defense shall establish a program to develop requirements for the procurement, pre-positioning, and maintenance of medical countermeasures approved, cleared, licensed, or authorized by the Food and Drug Administration to diagnose, prevent, and treat acute radiation syndrome and thermal burns for use by covered personnel. “(b) Program Specifications.—In carrying out the program required by subsection (a), the Secretary of Defense shall consider, in coordination with the Chairman of the Joint Chiefs of Staff and the commanders of the combatant commands, the following:“(1) The number of covered personnel in areas in which the use of tactical nuclear weapons is a substantial threat. “(2) Peer-reviewed and published scientific studies regarding safety and efficacy of the potential countermeasures described in subsection (a). “(3) Operational requirements of the Department. “(4) Appropriate doctrine, training, and operational plans for effective use of such countermeasures. “(5) A feasible schedule for implementation of the program. “(c) Covered Personnel Defined.—In this section, the term ‘covered personnel’ means—“(1) members of the Armed Forces deployed outside the United States; and “(2) civilian employees of the Department of Defense deployed outside the United States.”

Accountability for Wounded Warriors Undergoing Disability Evaluation

Pub. L. 117–263, div. A, title VII, § 711, Dec. 23, 2022, 136 Stat. 2656, provided that: “(a) Policy.—Not later than April 1, 2023, the Secretary of Defense, in consultation with the Secretaries concerned, shall establish a policy to ensure accountability for actions taken under the authorities of the Defense Health Agency and the Armed Forces, respectively, concerning wounded, ill, and injured members of the Armed Forces during the integrated disability evaluation system process. Such policy shall include the following:“(1) A restatement of the requirement that, in accordance with section 1216(b) of title 10, United States Code, a determination of fitness for duty of a member of the Armed Forces under chapter 61 of title 10, United States Code, is the responsibility of the Secretary concerned. “(2) A description of the role of the Director of the Defense Health Agency in supporting the Secretaries concerned in carrying out determinations of fitness for duty as specified in paragraph (1). “(3) A description of how the medical evaluation board processes of the Armed Forces are integrated with the Defense Health Agency, including with respect to case management, appointments, and other relevant matters. “(4) A requirement that, in determining fitness for duty of a member of the Armed Forces under chapter 61 of title 10, United States Code, the Secretary concerned shall consider the results of any medical evaluation of the member provided under the authority of the Defense Health Agency pursuant to section 1073c of title 10, United States Code. “(5) A description of how the Director of the Defense Health Agency adheres to the medical evaluation processes of the Armed Forces, including an identification of each applicable regulation or policy to which the Director is required to so adhere. “(6) An assessment of the feasibility of affording various additional due process protections to members of the Armed Forces undergoing the medical evaluation board process. “(7) A restatement of the requirement that wounded, ill, and injured members of the Armed Forces may not be denied any due process protection afforded under applicable law or regulation of the Department of Defense or the Armed Forces. “(8) A description of the types of due process protections specified in paragraph (7), including an identification of each specific due process protection. “(b) Clarification of Responsibilities Regarding Medical Evaluation Boards.— [Amended section 1073c of this title.] “(c) Briefing.—Not later than February 1, 2023, the Secretary of Defense shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the status of the implementation of subsections (a) and (b). “(d) Report.—Not later than one year after the date of the enactment of this Act [Dec. 23, 2022], the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a report on the implementation of subsections (a) and (b), lessons learned as a result of such implementation, and the recommendations of the Secretary relating to the policy on wounded, ill, and injured members of the Armed Forces undergoing the integrated disability evaluation system process. “(e) Secretary Concerned Defined.—In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10, United States Code.”

Access to Certain Dependent Medical Records by Remarried Former Spouses

Pub. L. 117–263, div. A, title VII, § 721, Dec. 23, 2022, 136 Stat. 2663, provided that: “(a) Access.—The Secretary of Defense may authorize a remarried former spouse who is a custodial parent of a dependent child to retain electronic access to the privileged medical records of such dependent child, notwithstanding that the former spouse is no longer a dependent under section 1072(2) of title 10, United States Code. “(b) Definitions.—In this section:“(1) The term ‘dependent’ has the meaning given that term in section 1072 of title 10, United States Code. “(2) The term ‘dependent child’ means a dependent child of a remarried former spouse and a member or former member of a uniformed service. “(3) The term ‘remarried former spouse’ means a remarried former spouse of a member or former member of a uniformed service.”

Brain Health Initiative of Department of Defense

Pub. L. 117–263, div. A, title VII, § 735, Dec. 23, 2022, 136 Stat. 2668, as amended by Pub. L. 118–159, div. A, title VII, § 723, Dec. 23, 2024, 138 Stat. 1952, provided that: “(a) In General.—The Secretary of Defense, in consultation with the Secretaries concerned, shall establish a comprehensive initiative for brain health to be known as the ‘Warfighter Brain Health Initiative’ (in this section referred to as the ‘Initiative’) for the purpose of unifying efforts and programs across the Department of Defense to improve the cognitive performance and brain health of members of the Armed Forces. “(b) Objectives.—The objectives of the Initiative shall be the following:“(1) To enhance, maintain, and restore the cognitive performance of members of the Armed Forces through education, training, prevention, protection, monitoring, detection, diagnosis, treatment, and rehabilitation, including through the following activities:“(A) The establishment of a program to monitor cognitive brain health across the Department of Defense, with the goal of detecting any need for cognitive enhancement or restoration resulting from potential brain exposures of members of Armed Forces, to mitigate possible evolution of injury or disease progression. “(B) In accordance with subsection (c), the identification and dissemination of thresholds for blast exposure and overpressure safety and associated emerging scientific evidence that—“(i) cover brain injury and impulse noise; “(ii) measure impact over 24-hour, 72-hour to 96-hour, monthly, annual, and lifetime periods; “(iii) are designed to prevent cognitive deficits after firing; “(iv) account for the cumulative impact of firing multiple weapon systems during the same period; “(v) include minimum safe distances and levels of exposure for observers and instructors; and “(vi) address shoulder-fired heavy weapons. “(C) The modification of high-risk training and operational activities to mitigate the negative effects of repetitive blast exposure. “(D) The identification of individuals who perform high-risk training or occupational activities, for purposes of increased monitoring of the brain health of such individuals. “(E) The development and operational fielding of non-invasive, portable, point-of-care medical devices, to inform the diagnosis and treatment of traumatic brain injury. “(F) The establishment of a standardized monitoring program that documents and analyzes blast exposures that may affect the brain health of members of the Armed Forces. “(G) The consideration of the findings and recommendations of the report of the National Academies of Science, Engineering, and Medicine titled ‘Traumatic Brain Injury: A Roadmap for Accelerating Progress’ and published in 2022 (relating to the acceleration of progress in traumatic brain injury research and care), or any successor report, in relation to the activities of the Department relating to brain health, as applicable. “(H) The establishment of a standardized treatment program based on interventions that have shown benefit to individuals with brain health issues after a brain injury and the provision of that treatment program to individuals with brain health issues after a brain injury resulting from a potential brain exposure described in subparagraph (A) or high-risk training or occupational activities described in subparagraph (D). “(I) The establishment of policies to encourage members of the Armed Forces to seek medical treatment for brain health when needed, prevent retaliation against such members who seek such medical treatment, and address other barriers to seeking medical treatment for brain health due to the impact of blast exposure, blast overpressure, or traumatic brain injury. “(J) The modification of existing weapons systems to reduce blast exposure of the individual using the weapon and those within the minimum safe distance. “(2) To harmonize and prioritize the efforts of the Department of Defense into a single approach to brain health. “(c) Thresholds for Blast Exposure and Overpressure Safety.—“(1) Timing.—“(A) Initial thresholds.—Not later than January 1, 2027, the Secretary of Defense shall identify and disseminate the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B). “(B) Periodic updates.—On a quinquennial basis, the Secretary shall review and, as necessary, update the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B). “(2) Formal training requirement.—The Secretary shall ensure that training on the thresholds for blast exposure and overpressure safety is provided to members of the Armed Forces before training, deployment, or entering other high-risk environments where exposure to blast overpressure is likely. “(3) Central repository.—Not later than January 1, 2027, the Secretary shall establish a central repository of blast-related characteristics, such as pressure profiles and common blast loads associated with specific systems and the environments in which the systems are used. “(4) Waivers.—“(A) Protocols.—The Secretary may waive the thresholds for blast exposure and overpressure safety under subsection (b)(1)(B) for operational or training requirements that the Secretary determines are essential to national security. The Secretary shall include in each such waiver a justification for exceeding such thresholds. “(B) Tracking system.—The Secretary shall establish a Department of Defense-wide tracking system for waivers issued under subparagraph (A) that includes data contributed by the Secretary of each military department. “(C) Report on waivers.—Not later than one year after issuing a waiver under subparagraph (A) and annually thereafter for a period of five years, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on such waivers that includes—“(i) the number of waivers issued, disaggregated by military department; and “(ii) a description of actions taken by the Secretary concerned to track the health effects of exceeding thresholds for blast exposure and overpressure safety on members of the Armed Forces, document such effects in medical records, and provide care to such members. “(d) Pilot Program Relating to Monitoring of Blast Coverage.—“(1) Authority.—The Director of the Defense Health Agency may conduct, as part of the Initiative, a pilot program under which the Director shall monitor blast overpressure exposure through the use of commercially available, off-the-shelf, wearable sensors or other remote measurement technology, and document and evaluate data collected as a result of such monitoring. “(2) Locations.—Monitoring activities under a pilot program conducted pursuant to paragraph (1) shall be carried out in each training environment that the Director determines poses a risk for blast overpressure exposure. “(3) Documentation and sharing of data.—If the Director conducts a pilot program pursuant to paragraph (1), the Director shall—“(A) ensure that any data collected pursuant to such pilot program that is related to the health effects of the blast overpressure exposure of a member of the Armed Forces who participated in the pilot program is documented and maintained by the Secretary of Defense in an electronic health record for the member; and “(B) to the extent practicable, and in accordance with applicable provisions of law relating to data privacy, make data collected pursuant to such pilot program available to other academic and medical researchers for the purpose of informing future research and treatment options. “(4) Weapons use.—Monitoring activities under a pilot program conducted pursuant to paragraph (1) shall be carried out for any member of the Armed Forces firing tier 1 weapons in training or combat, as identified by the Secretary of Defense. “(e) Reports on Warfighter Brain Health Initiative.—Not later than December 31, 2025, and not less frequently than annually thereafter for a period of five years, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that includes the following:“(1) A description of the activities taken under the Initiative and resources expended under the Initiative during the prior fiscal year. “(2) The number of members of the Armed Forces impacted by blast overpressure and blast exposure in the prior fiscal year, including—“(A) the number of members who reported adverse health effects from blast overpressure or blast exposure; “(B) the number of members exposed to blast overpressure or blast exposure; “(C) the number of members who received treatment for injuries related to blast overpressure or blast exposure, including at facilities of the Department of Defense and at facilities in the private sector; and “(D) the type of care that members receive from facilities of the Department of Defense and the type of care that members receive from facilities in the private sector. “(3) A summary of the progress made during the prior fiscal year with respect to the objectives of the Initiative under subsection (b). “(4) A description of the steps the Secretary is taking to ensure that activities under the Initiative are being implemented across the Department of Defense and the military departments. “(f) Secretary Concerned Defined.—In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10, United States Code.”

Establishment of Partnership Program Between United States and Ukraine for Military Trauma Care and Research

Pub. L. 117–263, div. A, title VII, § 736, Dec. 23, 2022, 136 Stat. 2670, as amended by Pub. L. 118–31, div. A, title VII, § 721, Dec. 22, 2023, 137 Stat. 305, provided that: “Not later than February 24, 2023, the Secretary of Defense shall seek to enter into a partnership with the appropriate counterpart from the Government of Ukraine for the establishment of a joint program on military trauma care and research. Such program shall consist of the following: “(1) The sharing of relevant lessons learned from the Russo-Ukraine War. “(2) The conduct of relevant joint conferences and exchanges with military medical professionals from Ukraine and the United States. “(3) Collaboration with the armed forces of Ukraine on matters relating to health policy, health administration, and medical supplies and equipment, including through knowledge exchanges. “(4) The conduct of joint research and development on the health effects of new and emerging weapons. “(5) The entrance into agreements with military medical schools of Ukraine for reciprocal education programs under which students at the Uniformed Services University of the Health Sciences receive specialized military medical instruction at the such military medical schools of Ukraine and military medical personnel of Ukraine receive specialized military medical instruction at the Uniformed Services University of the Health Sciences, pursuant to section 2114(f) of title 10, United States Code. “(6) The provision of support to Ukraine for the purpose of facilitating the establishment in Ukraine of a program substantially similar to the Wounded Warrior Program in the United States. “(7) The provision of training and support to Ukraine for the treatment of individuals with extremity trauma, amputations, post-traumatic stress disorder, traumatic brain injuries, and any other mental health conditions associated with post-traumatic stress disorder or traumatic brain injuries, including—“(A) the exchange of subject matter expertise; “(B) training and support relating to advanced clinical skills development; and “(C) training and support relating to clinical case management support. “(8) The provision of training to the armed forces of Ukraine in the following areas:“(A) Health matters relating to chemical, biological, radiological, nuclear and explosive weapons. “(B) Preventive medicine and infectious disease. “(C) Post traumatic stress disorder. “(D) Suicide prevention. “(9) The maintenance of a list of medical supplies and equipment needed. “(10) Such other elements as the Secretary of Defense may determine appropriate.”

Biennial Briefing on Individual Longitudinal Exposure Record

Pub. L. 117–168, title VIII, § 802, Aug. 10, 2022, 136 Stat. 1801, provided that: “(a) In General.—Not later than one year after the date on which the Individual Longitudinal Exposure Record achieves full operational capability, as determined by the Secretary of Defense, and every two years thereafter, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall provide the appropriate committees of Congress a briefing on—“(1) the quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and “(2) the usefulness of such Individual Longitudinal Exposure Record or system in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. “(b) Elements.—Each briefing required by subsection (a) shall include, for the period covered by the report, the following:“(1) An identification of potential exposures to occupational or environmental hazards captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. “(2) An analysis of the quality and accuracy of the location data used by the Department of Defense in determining potential exposures to occupational or environmental hazards by members of the Armed Forces and veterans, and recommendations for how to improve the quality of such data if necessary. “(c) Definitions.—In this section:“(1) Appropriate committees of congress.—The term ‘appropriate committees of Congress’ means—“(A) the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and “(B) the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. “(2) Individual longitudinal exposure record.—The term ‘Individual Longitudinal Exposure Record’ has the meaning given such term in section 1171 of title 38, United States Code, as added by section 202.”

Appeals to Physical Evaluation Board Determinations of Fitness for Duty

Pub. L. 117–81, div. A, title V, § 524, Dec. 27, 2021, 135 Stat. 1687, as amended by Pub. L. 119–60, div. A, title V, § 524(a), Dec. 18, 2025, 139 Stat. 865, provided that: “The Secretary of Defense shall incorporate a formal appeals process (including timelines established by the Secretary of Defense) into the policies and procedures applicable to the implementation of the Integrated Disability Evaluation System of the Department of Defense. The appeals process shall include the following: “(1) The Secretary concerned shall ensure that a member of the Armed Forces may submit a formal appeal made with respect to determinations of fitness for duty to a Physical Evaluation Board of such Secretary. The Secretary concerned may require submission of a statement of contention as part of the appeal submission. “(2) The appeals process shall include, at the request of such member, an impartial hearing on a fitness for duty determination to be conducted by the Secretary concerned. “(3) Such member shall have the option to be represented at a hearing by legal counsel.”

Improvement of Postpartum Care for Members of the Armed Forces and Dependents

Pub. L. 117–81, div. A, title VII, § 707, Dec. 27, 2021, 135 Stat. 1782, provided that: “(a) Clinical Practice Guidelines for Postpartum Care in Military Medical Treatment Facilities.—Not later than 180 days after the date of the enactment of this Act [Dec. 27, 2021], the Secretary of Defense shall establish clinical practice guidelines for the provision of postpartum care in military medical treatment facilities. Such guidelines shall take into account the recommendations of established professional medical associations and address the following matters:“(1) Postpartum mental health assessments, including the appropriate intervals for furnishing such assessments and screening questions for such assessments (including questions relating to postpartum anxiety and postpartum depression). “(2) Pelvic health evaluation and treatment, including the appropriate timing for furnishing a medical evaluation for pelvic health, considerations for providing consultations for physical therapy for pelvic health (including pelvic floor health), and the appropriate use of telehealth services. “(3) Pelvic health rehabilitation services. “(4) Obstetric hemorrhage treatment, including through the use of pathogen reduced resuscitative products. “(b) Policy on Scheduling of Appointments for Postpartum Health Care Services.—“(1) Policy required.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall establish a policy for the scheduling of appointments for postpartum health care services in military medical treatment facilities. In developing the policy, the Secretary shall consider the extent to which it is appropriate to facilitate concurrent scheduling of appointments for postpartum care with appointments for well-baby care. “(2) Pilot program authorized.—The Secretary may carry out a pilot program in one or more military medical treatment facilities to evaluate the effect of concurrent scheduling, to the degree clinically appropriate, of the appointments specified in paragraph (1). “(c) Policy on Postpartum Physical Fitness Tests and Body Composition Assessments.—Not later than 180 days after the date of enactment of this Act, the Secretary shall establish a policy, which shall be standardized across each Armed Force to the extent practicable, for the time periods after giving birth that a member of the Armed Forces (including the reserve components) may be excused from, or provided an alternative to, a physical fitness test or a body composition assessment. “(d) Briefing.—Not later than 270 days after the date of enactment of this Act, the Secretary shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the implementation of the requirements under this section.”

Implementation of Integrated Product for Management of Population Health Across Military Health System

Pub. L. 117–81, div. A, title VII, § 722, Dec. 27, 2021, 135 Stat. 1792, provided that: “(a) Integrated Product.—The Secretary of Defense shall develop and implement an integrated product for the management of population health across the military health system. Such integrated product shall serve as a repository for the health care, demographic, and other relevant data of all covered beneficiaries, including with respect to data on health care services furnished to such beneficiaries through the purchased care and direct care components of the TRICARE program, and shall—“(1) be compatible with the electronic health record system maintained by the Secretary for members of the Armed Forces; “(2) enable the collection and stratification of data from multiple sources to measure population health goals, facilitate disease management programs of the Department, improve patient education, and integrate wellness services across the military health system; and “(3) enable predictive modeling to improve health outcomes for patients and to facilitate the identification and correction of medical errors in the treatment of patients, issues regarding the quality of health care services provided, and gaps in health care coverage. “(b) Considerations in Development.—In developing the integrated product under subsection (a), the Secretary shall harmonize such development with any policies of the Department relating to a digital health strategy (including the digital health strategy under section 723 [135 Stat. 1792]), coordinate with improvements to the electronic health record system specified in subsection (a)(1) to ensure the compatibility required under such subsection, and consider methods to improve beneficiary interface. “(c) Definitions.—In this section:“(1) The terms ‘covered beneficiary’ and ‘TRICARE program’ have the meanings given such terms in section 1072 of title 10, United States Code. “(2) The term ‘integrated product’ means an electronic system of systems (or solutions or products) that provides for the integration and sharing of data to meet the needs of an end user in a timely and cost-effective manner.”

Mandatory Training on Health Effects of Burn Pits

Pub. L. 117–81, div. A, title VII, § 725, Dec. 27, 2021, 135 Stat. 1795, provided that: “The Secretary of Defense shall provide to each medical provider of the Department of Defense mandatory training with respect to the potential health effects of burn pits.”

Access by Covered Individuals to Certain Facilities of Department of Defense for Assessment and Treatment of Anomalous Health Conditions

Pub. L. 117–81, div. A, title VII, § 732, Dec. 27, 2021, 135 Stat. 1797, as amended by Pub. L. 117–263, div. A, title X, § 1044(b), Dec. 23, 2022, 136 Stat. 2772, provided that: “(a) Assessment.—The Secretary of Defense shall provide to covered individuals whom the Secretary determines are experiencing symptoms of certain anomalous health conditions, as defined by the Secretary for purposes of this section, timely access for medical assessment, subject to space availability, to the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility, as determined by the Secretary. “(b) Treatment.—With respect to an individual described in subsection (a) diagnosed with an anomalous health condition or a related affliction, whether diagnosed under an assessment under subsection (a) or otherwise, the Secretary of Defense shall furnish to the individual treatment for the condition or affliction, subject to space availability, at the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility, as determined by the Secretary. “(c) Development of Process.—The Secretary of Defense, in consultation with the heads of such Federal agencies as the Secretary considers appropriate, shall develop a process to ensure that covered individuals are afforded timely access to the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility pursuant to subsection (a) by not later than 60 days after the date of the enactment of this Act [Dec. 27, 2021]. “(d) Modification of Department of Defense Trauma Registry.—The Secretary of Defense shall modify the Trauma Registry of the Department of Defense to include data on the demographics, condition-producing event, diagnosis and treatment, and outcomes of anomalous health conditions experienced by covered individuals assessed or treated under this section, subject to the consent of the covered individual and, if applicable, an agreement with the employing agency. “(e) Covered Individuals Defined.—In this section, the term ‘covered individuals’ means—“(1) current and former employees of the United States Government and their family members; and “(2) current and former members of the Armed Forces and their family members.”

Military Health System Clinical Quality Management Program

Pub. L. 116–283, div. A, title VII, § 744, Jan. 1, 2021, 134 Stat. 3708, provided that: “(a) In General.—The Secretary of Defense, acting through the Director of the Defense Health Agency, shall implement a comprehensive program to be known as the ‘Military Health System Clinical Quality Management Program’ (in this section referred to as the ‘Program’). “(b) Elements of Program.—The Program shall include, at a minimum, the following:“(1) The implementation of systematic procedures to eliminate, to the extent feasible, risk of harm to patients at military medical treatment facilities, including through identification, investigation, and analysis of events indicating a risk of patient harm and corrective action plans to mitigate such risks. “(2) With respect to a potential sentinel event (including those involving members of the Armed Forces) at a military medical treatment facility—“(A) an analysis of such event, which shall occur and be documented as soon as possible after the event; “(B) use of such analysis for clinical quality management; and “(C) reporting of such event to the National Practitioner Data Bank in accordance with guidelines of the Secretary of Health and Human Services under the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.), giving special emphasis to the results of external peer reviews of the event. “(3) Validation of provider credentials and granting of clinical privileges by the Director of the Defense Health Agency for all health care providers at a military medical treatment facility. “(4) Accreditation of military medical treatment facilities by a recognized external accreditation body. “(5) Systematic measurement of indicators of health care quality, emphasizing clinical outcome measures, comparison of such indicators with benchmarks from leading health care quality improvement organizations, and transparency with the public of appropriate clinical measurements for military medical treatment facilities. “(6) Systematic activities emphasized by leadership at all organizational levels to use all elements of the Program to eliminate unwanted variance throughout the health care system of the Department of Defense and make constant improvements in clinical quality. “(7) A full range of procedures for productive communication between patients and health care providers regarding actual or perceived adverse clinical events at military medical treatment facilities, including procedures—“(A) for full disclosure of such events (respecting the confidentiality of peer review information under a medical quality assurance program under section 1102 of title 10, United States Code); “(B) providing an opportunity for the patient to be heard in relation to quality reviews; and “(C) to resolve patient concerns by independent, neutral health care resolution specialists. “(c) Additional Clinical Quality Management Activities.—“(1) In general.—In addition to the elements of the Program set forth in subsection (b), the Secretary shall establish and maintain clinical quality management activities in relation to functions of the health care system of the Department separate from delivery of health care services in military medical treatment facilities. “(2) Health care delivery outside military medical treatment facilities.—In carrying out paragraph (1), the Secretary shall maintain policies and procedures to promote clinical quality in health care delivery on ships and planes, in deployed settings, and in all other circumstances not covered by subsection (b), with the objective of implementing standards and procedures comparable, to the extent practicable, to those under such subsection. “(3) Purchased care system.—In carrying out paragraph (1), the Secretary shall maintain policies and procedures for health care services provided outside the Department but paid for by the Department, reflecting best practices by public and private health care reimbursement and management systems.”

Wounded Warrior Service Dog Program

Pub. L. 116–283, div. A, title VII, § 745, Jan. 1, 2021, 134 Stat. 3710, provided that: “(a) Program.—The Secretary of Defense shall establish a program, to be known as the ‘Wounded Warrior Service Dog Program’, to provide assistance dogs to covered members and covered veterans. “(b) Definitions.—In this section:“(1) The term ‘assistance dog’ means a dog specifically trained to perform physical tasks to mitigate the effects of a covered disability, except that the term does not include a dog specifically trained for comfort or personal defense. “(2) The term ‘covered disability’ means any of the following:“(A) Blindness or visual impairment. “(B) Loss of use of a limb, paralysis, or other significant mobility issues. “(C) Loss of hearing. “(D) Traumatic brain injury. “(E) Post-traumatic stress disorder. “(F) Any other disability that the Secretary of Defense considers appropriate. “(3) The term ‘covered member’ means a member of the Armed Forces who is—“(A) receiving medical treatment, recuperation, or therapy under chapter 55 of title 10, United States Code; “(B) in medical hold or medical holdover status; or “(C) covered under section 1202 or 1205 of title 10, United States Code. “(4) The term ‘covered veteran’ means a veteran who is enrolled in the health care system established under section 1705(a) of title 38, United States Code.”

Inclusion of Blast Exposure History in Medical Records of Members of the Armed Forces

Pub. L. 116–92, div. A, title VII, § 717, Dec. 20, 2019, 133 Stat. 1453, provided that: “(a) Requirement.—If a covered incident occurs with respect to a member of the Armed Forces, the Secretary of Defense, in coordination with the Secretaries of the military departments, shall document blast exposure history in the medical record of the member to assist in determining whether a future illness or injury of the member is service-connected and inform future blast exposure risk mitigation efforts of the Department of Defense. “(b) Elements.—A blast exposure history under subsection (a) shall include, at a minimum, the following:“(1) The date of the exposure. “(2) The duration of the exposure, and, if known, the measured blast pressure experienced by the individual during such exposure. “(3) Whether the exposure occurred during combat or training. “(c) Report.—Not later than one year after the date of the enactment of this Act [Dec. 20, 2019], the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the types of information included in a blast exposure history under subsection (a). “(d) Covered Incident Defined.—In this section, the term ‘covered incident’ means a concussive event or injury that requires a military acute concussive evaluation by a skilled health care provider.”

Modification to Referrals for Mental Health Services

Pub. L. 116–92, div. A, title VII, § 722, Dec. 20, 2019, 133 Stat. 1457, provided that: “If the Secretary of Defense is unable to provide mental health services in a military medical treatment facility to a member of the Armed Forces within 15 days of the date on which such services are first requested by the member, the Secretary may refer the member to a provider under the TRICARE program (as that term is defined in section 1072 of title 10, United States Code) to receive such services.”

Medical Simulation Technology and Live Tissue Training

Pub. L. 115–232, div. A, title VII, § 718, Aug. 13, 2018, 132 Stat. 1816, provided that: “(a) In General.—“(1) Use of simulation technology.—Except as provided by paragraph (2), the Secretary of Defense shall use medical simulation technology, to the maximum extent practicable, before the use of live tissue training to train medical professionals and combat medics of the Department of Defense. “(2) Determination.—The use of live tissue training within the Department of Defense may be used as determined necessary by the medical chain of command. “(b) Briefing.—Not later than 180 days after the date of the enactment of this Act [Aug. 13, 2018], the Secretary of Defense, in consultation with the Chairman of the Joint Chiefs of Staff and the Secretaries of the military departments, shall provide a briefing to the Committees on Armed Services of the House of Representatives and the Senate on the use and benefit of medical simulation technology and live tissue training within the Department of Defense to train medical professionals, combat medics, and members of the Special Operations Forces. “(c) Elements.—The briefing under subsection (b) shall include the following:“(1) A discussion of the benefits and needs of both medical simulation technology and live tissue training. “(2) Ways and means to enhance and advance the use of simulation technologies in training. “(3) An assessment of current medical simulation technology requirements, gaps, and limitations. “(4) An overview of Department of Defense medical training programs, as of the date of the briefing, that use live tissue training and medical simulation technologies. “(5) Any other matters the Secretary determines appropriate.”

Inclusion of Gambling Disorder in Health Assessments of Members of the Armed Forces and Related Research Efforts

Pub. L. 115–232, div. A, title VII, § 733, Aug. 13, 2018, 132 Stat. 1818, provided that: “(a) Inclusion in Next Annual Periodic Health Assessments.—The Secretary of Defense shall incorporate medical screening questions specific to gambling disorder into the Annual Periodic Health Assessments of members of the Armed Forces conducted by the Department of Defense during the one-year period beginning 180 days after the date of the enactment of this Act [Aug. 13, 2018]. “(b) Inclusion in Certain Surveys.—The Secretary shall incorporate into ongoing research efforts of the Department questions on gambling disorder, as appropriate, including by restoring such questions to the following:“(1) The first Health Related Behaviors Survey of Active Duty Military Personnel conducted after the date of the enactment of this Act. “(2) The first Health Related Behaviors Survey of Reserve Component Personnel conducted after that date. “(c) Reports.—Not later than one year after the date of the completion of the assessment referred to in subsection (a), and of each survey referred to in subsection (b), as modified pursuant to this section, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the findings of the assessment or survey in connection with the prevalence of gambling disorder among members of the Armed Forces.”

Joint Trauma System

Pub. L. 114–328, div. A, title VII, § 707, Dec. 23, 2016, 130 Stat. 2208, provided that: “(a) Plan.—“(1) In general.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate an implementation plan to establish a Joint Trauma System within the Defense Health Agency that promotes improved trauma care to members of the Armed Forces and other individuals who are eligible to be treated for trauma at a military medical treatment facility. “(2) Implementation.—The Secretary shall implement the plan under paragraph (1) after a 90-day period has elapsed following the date on which the Comptroller General of the United States is required to submit to the Committees on Armed Services of the House of Representatives and the Senate the review under subsection (c). In implementing such plan, the Secretary shall take into account any recommendation made by the Comptroller General under such review. “(b) Elements.—The Joint Trauma System described in subsection (a)(1) shall include the following elements:“(1) Serve as the reference body for all trauma care provided across the military health system. “(2) Establish standards of care for trauma services provided at military medical treatment facilities. “(3) Coordinate the translation of research from the centers of excellence of the Department of Defense into standards of clinical trauma care. “(4) Coordinate the incorporation of lessons learned from the trauma education and training partnerships pursuant to section 708 into clinical practice. “(c) Review.—Not later than 180 days after the date on which the Secretary submits to the Committees on Armed Services of the House of Representatives and the Senate the implementation plan under subsection (a)(1), the Comptroller General of the United States shall submit to such committees a review of such plan to determine if each element under subsection (b) is included in such plan. “(d) Review of Military Trauma System.—In establishing a Joint Trauma System, the Secretary of Defense may seek to enter into an agreement with a non-governmental entity with subject matter experts to—“(1) conduct a system-wide review of the military trauma system, including a comprehensive review of combat casualty care and wartime trauma systems during the period beginning on January 1, 2001, and ending on the date of the review, including an assessment of lessons learned to improve combat casualty care in future conflicts; and “(2) make publicly available a report containing such review and recommendations to establish a comprehensive trauma system for the Armed Forces.”

Joint Trauma Education and Training Directorate

Pub. L. 116–92, div. A, title VII, § 721, Dec. 20, 2019, 133 Stat. 1456, provided that: “(a) Partnerships.—“(1) In general.—The Secretary of Defense, through the Joint Trauma Education and Training Directorate established under section 708 of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114–328; 10 U.S.C. 1071 note), may develop partnerships with civilian academic medical centers and large metropolitan teaching hospitals to improve combat casualty care for personnel of the Armed Forces. “(2) Partnerships with level i trauma centers.—In carrying out partnerships under paragraph (1), trauma surgeons and physicians of the Department of Defense may partner with level I civilian trauma centers to provide training and readiness for the next generation of medical providers to treat critically injured burn patients. “(b) Support of Partnerships.—The Secretary of Defense may make every effort to support partnerships under the Joint Trauma Education and Training Directorate with academic institutions that have level I civilian trauma centers, specifically those centers with a burn center, that offer burn rotations and clinical experience to provide training and readiness for the next generation of medical providers to treat critically injured burn patients. “(c) Level I Civilian Trauma Center Defined.—In this section, the term ‘level I civilian trauma center’ has the meaning given that term in section 708 of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114–328; 10 U.S.C. 1071 note).”

Pub. L. 114–328, div. A, title VII, § 708, Dec. 23, 2016, 130 Stat. 2209, as amended by Pub. L. 115–232, div. A, title VII, § 719, Aug. 13, 2018, 132 Stat. 1817; Pub. L. 117–81, div. A, title III, § 373(b), Dec. 27, 2021, 135 Stat. 1667, provided that: “(a) Establishment.—The Secretary of Defense shall establish a Joint Trauma Education and Training Directorate (in this section referred to as the ‘Directorate’) to ensure that the traumatologists of the Armed Forces maintain readiness and are able to be rapidly deployed for future armed conflicts. The Secretary shall carry out this section in collaboration with the Secretaries of the military departments. “(b) Duties.—The duties of the Directorate are as follows:“(1) To enter into and coordinate the partnerships under subsection (c). “(2) To establish the goals of such partnerships necessary for trauma teams led by traumatologists to maintain professional competency in trauma care. “(3) To establish metrics for measuring the performance of such partnerships in achieving such goals. “(4) To develop methods of data collection and analysis for carrying out paragraph (3). “(5) To communicate and coordinate lessons learned from such partnerships with the Joint Trauma System established under section 707 [set out as a note above]. “(6) To develop standardized combat casualty care instruction for all members of the Armed Forces, including the use of standardized trauma training platforms. “(7) To develop a comprehensive trauma care registry to compile relevant data from point of injury through rehabilitation with respect to both members of the Armed Forces and military working dogs. “(8) To develop quality of care outcome measures for combat casualty care. “(9) To inform and advise the conduct of research on the leading causes of morbidity and mortality of members of the Armed Forces and military working dogs in combat. “(c) Partnerships.—“(1) In general.—The Secretary may enter into partnerships with civilian academic medical centers and trauma centers to provide integrated combat trauma teams, including forward surgical teams, with maximum exposure to a high volume of patients with critical injuries. “(2) Trauma teams.—Under the partnerships entered into under paragraph (1), trauma teams of the Armed Forces led by traumatologists of the Armed Forces shall embed within trauma centers on an enduring basis. “(3) Selection.—The Secretary shall select civilian academic medical centers and trauma centers to enter into partnerships under paragraph (1) based on patient volume, acuity, and other factors the Secretary determines necessary to ensure that the traumatologists of the Armed Forces and the associated clinical support teams have adequate and continuous exposure to critically injured patients. “(4) Consideration.—In entering into partnerships under paragraph (1), the Secretary may consider the experiences and lessons learned by the military departments that have entered into memoranda of understanding with civilian medical centers for trauma care. “(d) Personnel Management Plan.—“(1) Plan.—The Secretary shall establish a personnel management plan for the following wartime medical specialties:“(A) Emergency medical services and prehospital care. “(B) Trauma surgery. “(C) Critical care. “(D) Anesthesiology. “(E) Emergency medicine. “(F) Other wartime medical specialties the Secretary determines appropriate for purposes of the plan. “(2) Elements.—The elements of the plan established under paragraph (1) shall include, at a minimum, the following:“(A) An accession plan for the number of qualified medical personnel to maintain wartime medical specialties on an annual basis in order to maintain the required number of trauma teams as determined by the Secretary. “(B) The number of positions required in each such medical specialty. “(C) Crucial organizational and operational assignments for personnel in each such medical specialty. “(D) Career pathways for personnel in each such medical specialty. “(3) Implementation.—The Secretaries of the military departments shall carry out the plan established under paragraph (1). “(e) Implementation Plan.—Not later than July 1, 2017, the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate an implementation plan for establishing the Joint Trauma Education and Training Directorate under subsection (a), entering into partnerships under subsection (c), and establishing the plan under subsection (d). “(f) Level I Civilian Trauma Center Defined.—In this section, the term ‘level I civilian trauma center’ means a comprehensive regional resource that is a tertiary care facility central to the trauma system and is capable of providing total care for every aspect of injury from prevention through rehabilitation.”

Standardized System for Scheduling Medical Appointments at Military Treatment Facilities

Pub. L. 114–328, div. A, title VII, § 709, Dec. 23, 2016, 130 Stat. 2211, provided that: “(a) Standardized System.—“(1) In general.—Not later than January 1, 2018, the Secretary of Defense shall implement a system for scheduling medical appointments at military treatment facilities that is standardized throughout the military health system to enable timely access to care for covered beneficiaries. “(2) Lack of variance.—The system implemented under paragraph (1) shall ensure that the appointment scheduling processes and procedures used within the military health system do not vary among military treatment facilities. “(b) Sole System.—Upon implementation of the system under subsection (a), no military treatment facility may use an appointment scheduling process other than such system. “(c) Scheduling of Appointments.—“(1) In general.—Under the system implemented under subsection (a), each military treatment facility shall use a centralized appointment scheduling capability for covered beneficiaries that includes the ability to schedule appointments manually via telephone as described in paragraph (2) or automatically via a device that is connected to the Internet through an online scheduling system described in paragraph (3). “(2) Telephone appointment process.—“(A) In general.—In the case of a covered beneficiary who contacts a military treatment facility via telephone to schedule an appointment under the system implemented under subsection (a), the Secretary shall implement standard processes to ensure that the needs of the covered beneficiary are met during the first such telephone call. “(B) Matters included.—The standard processes implemented under subparagraph (A) shall include the following:“(i) The ability of a covered beneficiary, during the telephone call to schedule an appointment, to also schedule wellness visits or follow-up appointments during the 180-day period beginning on the date of the request for the visit or appointment. “(ii) The ability of a covered beneficiary to indicate the process through which the covered beneficiary prefers to be reminded of future appointments, which may include reminder telephone calls, emails, or cellular text messages to the covered beneficiary at specified intervals prior to appointments. “(3) Online system.—“(A) In general.—The Secretary shall implement an online scheduling system that is available 24 hours per day, seven days per week, for purposes of scheduling appointments under the system implemented under subsection (a). “(B) Capabilities of online system.—The online scheduling system implemented under subparagraph (A) shall have the following capabilities:“(i) An ability to send automated email and text message reminders, including repeat reminders, to patients regarding upcoming appointments. “(ii) An ability to store appointment records to ensure rapid access by medical personnel to appointment data. “(d) Standards for Productivity of Health Care Providers.—“(1) In general.—The Secretary shall implement standards for the productivity of health care providers at military treatment facilities. “(2) Matters considered.—In developing standards under paragraph (1), the Secretary shall consider—“(A) civilian benchmarks for measuring the productivity of health care providers; “(B) the optimal number of medical appointments for each health care provider that would be required, as determined by the Secretary, to maintain access of covered beneficiaries to health care from the Department; and “(C) the readiness requirements of the Armed Forces. “(e) Plan.—“(1) In general.—Not later than January 1, 2017, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a comprehensive plan to implement the system required under subsection (a). “(2) Elements.—The plan required under paragraph (1) shall include the following:“(A) A description of the manual appointment process to be used at military treatment facilities under the system required under subsection (a). “(B) A description of the automated appointment process to be used at military treatment facilities under such system. “(C) A timeline for the full implementation of such system throughout the military health system. “(f) Briefing.—Not later than February 1, 2018, the Secretary shall brief the Committees on Armed Services of the Senate and the House of Representatives on the implementation of the system required under subsection (a) and the standards for the productivity of health care providers required under subsection (d). “(g) Report on Missed Appointments.—“(1) In general.—Not later than March 1 each year, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the total number of medical appointments at military treatment facilities for which a covered beneficiary failed to appear without prior notification during the one-year period preceding the submittal of the report. “(2) Elements.—Each report under paragraph (1) shall include for each military treatment facility the following:“(A) An identification of the top five reasons for a covered beneficiary missing an appointment. “(B) A comparison of the number of missed appointments for specialty care versus primary care. “(C) An estimate of the cost to the Department of Defense of missed appointments. “(D) An assessment of strategies to reduce the number of missed appointments. “(h) Covered Beneficiary Defined.—In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10, United States Code.”

[For termination, effective Dec. 30, 2021, of reporting requirements in section 709(g) of Pub. L. 114–328, set out above, see section 1702(a), (b), of Pub. L. 116–92, set out as a Termination of Reporting Requirements note under section 111 of this title.]

Evaluation and Treatment of Veterans and Civilians at Military Treatment Facilities

Pub. L. 114–328, div. A, title VII, § 717, Dec. 23, 2016, 130 Stat. 2223, as amended by Pub. L. 115–91, div. A, title VII, § 712, Dec. 12, 2017, 131 Stat. 1437, provided that: “(a) In General.—The Secretary of Defense shall authorize a veteran (in consultation with the Secretary of Veterans Affairs) or civilian to be evaluated and treated at a military treatment facility if the Secretary of Defense determines that—“(1) the evaluation and treatment of the individual is necessary to attain the relevant mix and volume of medical casework required to maintain medical readiness skills and competencies of health care providers at the facility; “(2) the health care providers at the facility have the competencies, skills, and abilities required to treat the individual; and “(3) the facility has available space, equipment, and materials to treat the individual. “(b) Priority of Covered Beneficiaries.—“(1) In general.—Except as provided in paragraph (2), the evaluation and treatment of covered beneficiaries at military treatment facilities shall be prioritized ahead of the evaluation and treatment of veterans and civilians at such facilities under subsection (a). “(2) Waiver.—The Secretary may waive the requirement under paragraph (1) in order to provide timely evaluation and treatment for individuals who are—“(A) severely wounded or injured by acts of terror that occur in the United States; or “(B) residents of the United States who are severely wounded or injured by acts of terror outside the United States. “(c) Reimbursement for Treatment.—“(1) Civilians.—A military treatment facility that evaluates or treats an individual (other than an individual described in paragraph (2)) under subsection (a) shall bill the individual and accept reimbursement from the individual or a third-party payer (as that term is defined in section 1095(h) of title 10, United States Code) on behalf of such individual for the costs of any health care services provided to the individual under such subsection. “(2) Veterans.—The Secretary of Defense shall enter into a memorandum of agreement with the Secretary of Veterans Affairs under which the Secretary of Veterans Affairs will pay a military treatment facility using a prospective payment methodology (including interagency transfers of funds or obligational authority and similar transactions) for the costs of any health care services provided at the facility under subsection (a) to individuals eligible for such health care services from the Department of Veterans Affairs. “(3) Use of amounts.—The Secretary of Defense shall make available to a military treatment facility any amounts collected by such facility under paragraph (1) or (2) for health care services provided to an individual under subsection (a). “(d) Covered Beneficiary Defined.—In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10, United States Code.”

Enhancement of Use of Telehealth Services in Military Health System

Pub. L. 114–328, div. A, title VII, § 718, Dec. 23, 2016, 130 Stat. 2224, provided that: “(a) Incorporation of Telehealth.—“(1) In general.—Not later than 18 months after the date of the enactment of this Act [Dec. 23, 2016], the Secretary of Defense shall incorporate, throughout the direct care and purchased care components of the military health system, the use of telehealth services, including mobile health applications—“(A) to improve access to primary care, urgent care, behavioral health care, and specialty care; “(B) to perform health assessments; “(C) to provide diagnoses, interventions, and supervision; “(D) to monitor individual health outcomes of covered beneficiaries with chronic diseases or conditions; “(E) to improve communication between health care providers and patients; and “(F) to reduce health care costs for covered beneficiaries and the Department of Defense. “(2) Types of telehealth services.—The telehealth services required to be incorporated under paragraph (1) shall include those telehealth services that—“(A) maximize the use of secure messaging between health care providers and covered beneficiaries to improve the access of covered beneficiaries to health care and reduce the number of visits to medical facilities for health care needs; “(B) allow covered beneficiaries to schedule appointments; and “(C) allow health care providers, through video conference, telephone or tablet applications, or home health monitoring devices—“(i) to assess and evaluate disease signs and symptoms; “(ii) to diagnose diseases; “(iii) to supervise treatments; and “(iv) to monitor health outcomes. “(b) Coverage of Items or Services.—An item or service furnished to a covered beneficiary via a telecommunications system shall be covered under the TRICARE program to the same extent as the item or service would be covered if furnished in the location of the covered beneficiary. “(c) Reimbursement Rates for Telehealth Services.—The Secretary shall develop standardized payment methods to reimburse health care providers for telehealth services provided to covered beneficiaries in the purchased care component of the TRICARE program, including by using reimbursement rates that incentivize the provision of telehealth services. “(d) Reduction or Elimination of Copayments.—The Secretary shall reduce or eliminate, as the Secretary considers appropriate, copayments or cost shares for covered beneficiaries in connection with the receipt of telehealth services under the purchased care component of the TRICARE program. “(e) Reports.—“(1) Initial report.—“(A) In general.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report describing the full range of telehealth services to be available in the direct care and purchased care components of the military health system and the copayments and cost shares, if any, associated with those services. “(B) Reimbursement plan.—The report required under subparagraph (A) shall include a plan to develop standardized payment methods to reimburse health care providers for telehealth services provided to covered beneficiaries in the purchased care component of the TRICARE program, as required under subsection (c). “(2) Final report.—“(A) In general.—Not later than three years after the date on which the Secretary begins incorporating, throughout the direct care and purchased care components of the military health system, the use of telehealth services as required under subsection (a), the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report describing the impact made by the use of telehealth services, including mobile health applications, to carry out the actions specified in subparagraphs (A) through (F) of subsection (a)(1). “(B) Elements.—The report required under subparagraph (A) shall include an assessment of the following:“(i) The satisfaction of covered beneficiaries with telehealth services furnished by the Department of Defense. “(ii) The satisfaction of health care providers in providing telehealth services furnished by the Department. “(iii) The effect of telehealth services furnished by the Department on the following: “(I) The ability of covered beneficiaries to access health care services in the direct care and purchased care components of the military health system. “(II) The frequency of use of telehealth services by covered beneficiaries. “(III) The productivity of health care providers providing care furnished by the Department. “(IV) The reduction, if any, in the use by covered beneficiaries of health care services in military treatment facilities or medical facilities in the private sector. “(V) The number and types of appointments for the receipt of telehealth services furnished by the Department. “(VI) The savings, if any, realized by the Department by furnishing telehealth services to covered beneficiaries. “(f) Regulations.—“(1) Interim final rule.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2016], the Secretary shall prescribe an interim final rule to implement this section. “(2) Final rule.—Not later than 180 days after prescribing the interim final rule under paragraph (1) and considering public comments with respect to such interim final rule, the Secretary shall prescribe a final rule to implement this section. “(3) Objectives.—The regulations prescribed under paragraphs (1) and (2) shall accomplish the objectives set forth in subsection (a) and ensure quality of care, patient safety, and the integrity of the TRICARE program. “(g) Definitions.—In this section, the terms ‘covered beneficiary’ and ‘TRICARE program’ have the meaning given those terms in section 1072 of title 10, United States Code.”

Program To Eliminate Variability in Health Outcomes and Improve Quality of Health Care Services Delivered in Military Medical Treatment Facilities