10 U.S.C. § 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. 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’). 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. The pilot program shall be carried out during a two-year period beginning on the date of the commencement of the pilot program. A summary of the findings from the wastewater surveillance system under the pilot program. Recommendations for interventions or policy changes based on trends observed under the pilot program. An assessment of the effectiveness of the pilot program in enhancing force health protection and readiness.” 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). 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 ]; are provided under a separate policy, certificate, or contract; and are designed to help participants pay noncovered expenses. An agreement entered into under paragraph (1) shall be for a period of not more than three years, and may not be renewed. A notice of availability of a fixed indemnity supplemental benefit plan provided under the pilot program. A description of how to enroll in such plan. A description and explanation of such plan, including the diagnoses, screenings, and treatments covered by the plan. A description of the costs to the individual through premiums and remittances to a company providing such plan. 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 covered individuals are not required to purchase such a plan in order to receive health care benefits covered under the TRICARE program. A covered individual may elect to enroll in a fixed indemnity supplemental benefit plan provided under the pilot program. 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. 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. A description of the insurance products provided through a fixed indemnity supplemental benefit plan provided under the pilot program. The number of covered individuals who enrolled in such a plan. Feedback and examples of use cases by such individuals. A determination by the Secretary with respect to whether the pilot program should be made permanent. A member of the regular component of the Army, Navy, Marine Corps, Air Force, or Space Force. A dependent (as defined in section 1072 of title 10 , United States Code) of such a member who is enrolled in the TRICARE program. 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. The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10 , United States Code.” 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. identification of symptoms of perinatal mental health conditions, brief intervention by primary care providers, referral to care, and treatment; 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; existing parenting resiliency programs of the military departments; 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 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. 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. A communications strategy to increase awareness of the services available under the program. A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities. How resources are allocated for the purpose of establishing and maintaining perinatal support programs at military medical treatment facilities. Measurements for adherence to evidence-based protocols at military medical treatment facilities with respect to identifying potential mental health issues. 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. Feasibility and advisability of adding specialized perinatal mental health support services via a helpline through Military One Source. Recommendations for administrative or legislative changes to improve the effectiveness of the program. In this section, the term ‘perinatal period’ means the period beginning with pregnancy through one year following childbirth.” 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. 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. 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. 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. the number of individuals to whom the Network has provided services; 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; the number of individuals whose families are able to participate in programs provided by the Network; and the number of individuals on a waitlist for treatment at the Network and the average period those individuals are on the waitlist.” provide multidisciplinary specialist evaluations, treatment initiation, and aftercare for members of the Armed Forces and dependents of members; and make evidence-based improvements in such evaluations, treatment, and aftercare. 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. 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. One or more pilot programs for demonstrating the effectiveness of intensive outpatient multidisciplinary specialist treatment and care coordination. Incorporation of evidence-based therapy with complementary and alternative medicine approaches. Thorough evaluations of the effectiveness of innovative activities for diagnosis, treatment, and aftercare of brain trauma and promotion of brain health. A description of the range of activities included in the program and data assessing the effectiveness or shortcomings of such activities. The scope of each pilot program carried out under subsection (b)(3). Recommendations for administrative or legislative changes to improve the effectiveness of the program.” 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. Standardized monitoring, treatment, and referral guidelines for traumatic brain injury programs across all covered Armed Forces. A review and update of the current brain injury diagnostic tools used by such programs. Standardized, 72-hour follow-up requirements for all traumatic brain injury patients, including protocols for the treatment and observation during such follow-up appointments. Oversight and documentation standards to aid in data collection. 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 ]. 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. In this section, the term ‘covered Armed Forces’ means the Army, Navy, Marine Corps, Air Force, and Space Force.” 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; 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 a requirement that any test plan for a new weapon system shall incorporate testing for blast overpressure measurements and safety data.” 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. The number of covered personnel in areas in which the use of tactical nuclear weapons is a substantial threat. Peer-reviewed and published scientific studies regarding safety and efficacy of the potential countermeasures described in subsection (a). Operational requirements of the Department. Appropriate doctrine, training, and operational plans for effective use of such countermeasures. A feasible schedule for implementation of the program. members of the Armed Forces deployed outside the United States; and civilian employees of the Department of Defense deployed outside the United States.” 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. 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). 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. 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. 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. An assessment of the feasibility of affording various additional due process protections to members of the Armed Forces undergoing the medical evaluation board process. 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. A description of the types of due process protections specified in paragraph (7), including an identification of each specific due process protection. 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). 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. In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10 , United States Code.” 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. The term ‘dependent’ has the meaning given that term in section 1072 of title 10 , United States Code. The term ‘dependent child’ means a dependent child of a remarried former spouse and a member or former member of a uniformed service. The term ‘remarried former spouse’ means a remarried former spouse of a member or former member of a uniformed service.” 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. 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. cover brain injury and impulse noise; measure impact over 24-hour, 72-hour to 96-hour, monthly, annual, and lifetime periods; are designed to prevent cognitive deficits after firing; account for the cumulative impact of firing multiple weapon systems during the same period; include minimum safe distances and levels of exposure for observers and instructors; and address shoulder-fired heavy weapons. The modification of high-risk training and operational activities to mitigate the negative effects of repetitive blast exposure. The identification of individuals who perform high-risk training or occupational activities, for purposes of increased monitoring of the brain health of such individuals. The development and operational fielding of non-invasive, portable, point-of-care medical devices, to inform the diagnosis and treatment of traumatic brain injury. 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. 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. 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). 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. The modification of existing weapons systems to reduce blast exposure of the individual using the weapon and those within the minimum safe distance. To harmonize and prioritize the efforts of the Department of Defense into a single approach to brain health. 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). 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). 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. 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. 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. 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. the number of waivers issued, disaggregated by military department; and 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. 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. 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. 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 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. 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. A description of the activities taken under the Initiative and resources expended under the Initiative during the prior fiscal year. the number of members who reported adverse health effects from blast overpressure or blast exposure; the number of members exposed to blast overpressure or blast exposure; 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 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. A summary of the progress made during the prior fiscal year with respect to the objectives of the Initiative under subsection (b). 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. In this section, the term ‘Secretary concerned’ has the meaning given that term in section 101 of title 10 , United States Code.” The sharing of relevant lessons learned from the Russo-Ukraine War. The conduct of relevant joint conferences and exchanges with military medical professionals from Ukraine and the United States. Collaboration with the armed forces of Ukraine on matters relating to health policy, health administration, and medical supplies and equipment, including through knowledge exchanges. The conduct of joint research and development on the health effects of new and emerging weapons. 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. 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. the exchange of subject matter expertise; training and support relating to advanced clinical skills development; and training and support relating to clinical case management support. Health matters relating to chemical, biological, radiological, nuclear and explosive weapons. Preventive medicine and infectious disease. Post traumatic stress disorder. Suicide prevention. The maintenance of a list of medical supplies and equipment needed. Such other elements as the Secretary of Defense may determine appropriate.” the quality of the databases of the Department of Defense that provide the information presented in such Individual Longitudinal Exposure Record; and 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. 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. 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. the Committee on Armed Services and the Committee on Veterans’ Affairs of the Senate; and the Committee on Armed Services and the Committee on Veterans’ Affairs of the House of Representatives. 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.” 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. 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. Such member shall have the option to be represented at a hearing by legal counsel.” 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). 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. Pelvic health rehabilitation services. Obstetric hemorrhage treatment, including through the use of pathogen reduced resuscitative products. 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. 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). 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. 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.” be compatible with the electronic health record system maintained by the Secretary for members of the Armed Forces; 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 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. 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. The terms ‘covered beneficiary’ and ‘TRICARE program’ have the meanings given such terms in section 1072 of title 10 , United States Code. 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.” 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. 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. 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 ]. 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. current and former employees of the United States Government and their family members; and current and former members of the Armed Forces and their family members.” 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’). 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. an analysis of such event, which shall occur and be documented as soon as possible after the event; use of such analysis for clinical quality management; and 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. 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. Accreditation of military medical treatment facilities by a recognized external accreditation body. 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. 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. 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); providing an opportunity for the patient to be heard in relation to quality reviews; and to resolve patient concerns by independent, neutral health care resolution specialists. 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. 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. 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.” 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. 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. Blindness or visual impairment. Loss of use of a limb, paralysis, or other significant mobility issues. Loss of hearing. Traumatic brain injury. Post-traumatic stress disorder. Any other disability that the Secretary of Defense considers appropriate. receiving medical treatment, recuperation, or therapy under chapter 55 of title 10, United States Code; in medical hold or medical holdover status; or covered under section 1202 or 1205 of title 10, United States Code. 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.” 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. The date of the exposure. The duration of the exposure, and, if known, the measured blast pressure experienced by the individual during such exposure. Whether the exposure occurred during combat or training. 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). 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.” 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. The use of live tissue training within the Department of Defense may be used as determined necessary by the medical chain of command. 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. A discussion of the benefits and needs of both medical simulation technology and live tissue training. Ways and means to enhance and advance the use of simulation technologies in training. An assessment of current medical simulation technology requirements, gaps, and limitations. 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. Any other matters the Secretary determines appropriate.” 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 ]. The first Health Related Behaviors Survey of Active Duty Military Personnel conducted after the date of the enactment of this Act. The first Health Related Behaviors Survey of Reserve Component Personnel conducted after that date. 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.” 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. 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. Serve as the reference body for all trauma care provided across the military health system. Establish standards of care for trauma services provided at military medical treatment facilities. Coordinate the translation of research from the centers of excellence of the Department of Defense into standards of clinical trauma care. Coordinate the incorporation of lessons learned from the trauma education and training partnerships pursuant to section 708 into clinical practice. 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. 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 make publicly available a report containing such review and recommendations to establish a comprehensive trauma system for the Armed Forces.” 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. 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. 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. 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).” 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. To enter into and coordinate the partnerships under subsection (c). To establish the goals of such partnerships necessary for trauma teams led by traumatologists to maintain professional competency in trauma care. To establish metrics for measuring the performance of such partnerships in achieving such goals. To develop methods of data collection and analysis for carrying out paragraph (3). To communicate and coordinate lessons learned from such partnerships with the Joint Trauma System established under section 707 [set out as a note above]. To develop standardized combat casualty care instruction for all members of the Armed Forces, including the use of standardized trauma training platforms. 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. To develop quality of care outcome measures for combat casualty care. 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. 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. 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. 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. 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. Emergency medical services and prehospital care. Trauma surgery. Critical care. Anesthesiology. Emergency medicine. Other wartime medical specialties the Secretary determines appropriate for purposes of the plan. 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. The number of positions required in each such medical specialty. Crucial organizational and operational assignments for personnel in each such medical specialty. Career pathways for personnel in each such medical specialty. The Secretaries of the military departments shall carry out the plan established under paragraph (1). 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). 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.” 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. 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. Upon implementation of the system under subsection (a), no military treatment facility may use an appointment scheduling process other than such system. 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). 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. 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. 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. 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). An ability to send automated email and text message reminders, including repeat reminders, to patients regarding upcoming appointments. An ability to store appointment records to ensure rapid access by medical personnel to appointment data. The Secretary shall implement standards for the productivity of health care providers at military treatment facilities. civilian benchmarks for measuring the productivity of health care providers; 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 the readiness requirements of the Armed Forces. 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). A description of the manual appointment process to be used at military treatment facilities under the system required under subsection (a). A description of the automated appointment process to be used at military treatment facilities under such system. A timeline for the full implementation of such system throughout the military health system. 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). 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. An identification of the top five reasons for a covered beneficiary missing an appointment. A comparison of the number of missed appointments for specialty care versus primary care. An estimate of the cost to the Department of Defense of missed appointments. An assessment of strategies to reduce the number of missed appointments. In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10 , United States Code.” 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; the health care providers at the facility have the competencies, skills, and abilities required to treat the individual; and the facility has available space, equipment, and materials to treat the individual. 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). severely wounded or injured by acts of terror that occur in the United States; or residents of the United States who are severely wounded or injured by acts of terror outside the United States. 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. 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. 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). In this section, the term ‘covered beneficiary’ has the meaning given that term in section 1072 of title 10 , United States Code.” to improve access to primary care, urgent care, behavioral health care, and specialty care; to perform health assessments; to provide diagnoses, interventions, and supervision; to monitor individual health outcomes of covered beneficiaries with chronic diseases or conditions; to improve communication between health care providers and patients; and to reduce health care costs for covered beneficiaries and the Department of Defense. 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; allow covered beneficiaries to schedule appointments; and to assess and evaluate disease signs and symptoms; to diagnose diseases; to supervise treatments; and to monitor health outcomes. 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. 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. 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. 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. 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). 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). The satisfaction of covered beneficiaries with telehealth services furnished by the Department of Defense. The satisfaction of health care providers in providing telehealth services furnished by the Department. The ability of covered beneficiaries to access health care services in the direct care and purchased care components of the military health system. The frequency of use of telehealth services by covered beneficiaries. The productivity of health care providers providing care furnished by the Department. 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. The number and types of appointments for the receipt of telehealth services furnished by the Department. The savings, if any, realized by the Department by furnishing telehealth services to covered beneficiaries. 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. 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. 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. 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.” to establish best practices for the delivery of health care services for certain diseases or conditions at military medical treatment facilities, as selected by the Secretary; to incorporate such best practices into the daily operations of military medical treatment facilities selected by the Secretary for purposes of the program, with priority in selection given to facilities that provide specialty care; and to eliminate variability in health outcomes and to improve the quality of health care services delivered at military medical treatment facilities selected by the Secretary for purposes of the program. In carrying out the program under subsection (a), the Secretary shall develop, implement, monitor, and update clinical practice guidelines reflecting the best practices established under paragraph (1) of such subsection. In developing the clinical practice guidelines under subsection (b), the Secretary shall ensure that such development includes a baseline assessment of health care delivery and outcomes at military medical treatment facilities to evaluate and determine evidence-based best practices, within the direct care component of the military health system and the private sector, for treating the diseases or conditions selected by the Secretary under subsection (a)(1). The Secretary shall implement the clinical practice guidelines under subsection (b) in military medical treatment facilities selected by the Secretary under subsection (a)(2) using means determined appropriate by the Secretary, including by communicating with the relevant health care providers of the evidence upon which the guidelines are based and by providing education and training on the most appropriate implementation of the guidelines. The Secretary shall monitor the implementation of the clinical practice guidelines under subsection (b) using appropriate means, including by monitoring the results in clinical outcomes based on specific metrics included as part of the guidelines. The Secretary shall periodically update the clinical practice guidelines under subsection (b) based on the results of monitoring conducted under subsection (e) and by continuously assessing evidence-based best practices within the direct care component of the military health system and the private sector. The Secretary shall establish a continuous cycle of carrying out subsections (c) through (f) with respect to the clinical practice guidelines established under subsection (a).” Not later than 180 days after the date of the enactment of this Act [ Dec. 23, 2016 ], the Secretary of Defense shall adopt, to the extent appropriate, the core quality performance metrics agreed upon by the Core Quality Measures Collaborative for use by the military health system and in contracts awarded to carry out the TRICARE program. Accountable care organizations, patient centered medical homes, and primary care. Cardiology. Gastroenterology. HIV and hepatitis C. Medical oncology. Obstetrics and gynecology. Orthopedics. Such other sets of core quality performance metrics released by the Core Quality Measures Collaborative as the Secretary considers appropriate.” Commencing not later than 180 days after the date of the enactment of this Act [ Dec. 23, 2016 ], the Secretary of Defense, in consultation with the Secretaries of the military departments, shall incorporate into the annual performance review of each military and civilian leader in the military health system, as determined by the Secretary of Defense, measures of accountability for the performance of the military health system described in subsection (b). Quality of care. Access of beneficiaries to care. Improvement in health outcomes for beneficiaries. Patient safety. Such other matters as the Secretary of Defense, in consultation with the Secretaries of the military departments, considers appropriate. Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the incorporation of measures of accountability for the performance of the military health system into the annual performance reviews of individuals as required by this section. A comprehensive plan for the use of measures of accountability for performance in annual performance reviews pursuant to this section as a means of assessing and assuring accountability for the performance of the military health system. The identification of each leadership position in the military health system determined under subsection (a) and a description of the specific measures of accountability for performance to be incorporated into the annual performance reviews of each such position pursuant to this section.” The Secretary of Defense shall establish, under such regulations as the Secretary may prescribe, an advisory committee for each military treatment facility. A member of an advisory committee established under subsection (a) who is not a member of the Armed Forces on active duty or an employee of the Federal Government shall, with the approval of the commanding officer or director of the military treatment facility concerned, be treated as a volunteer under section 1588 of title 10 , United States Code, in carrying out the duties of the member under this section. Each advisory committee established under subsection (a) for a military treatment facility shall provide to the commanding officer or director of such facility advice on the administration and activities of such facility as it relates to the experience of care for beneficiaries at such facility.” to each officer candidate during initial training; to each recruit during basic training; and to other members of the Armed Forces at such times as the Secretary of Defense considers appropriate. The information required to be provided under subsection (a) shall include information on the applicability of the Department of Defense Instruction on Privacy of Individually Identifiable Health Information in DoD Health Care Programs and other regulations regarding privacy prescribed pursuant to the Health Insurance Portability and Accountability Act of 1996 ( Public Law 104–191 ) to records regarding a member of the Armed Forces seeking and receiving mental health services.” The Secretary of Defense shall establish a policy containing uniform performance outcome measurements to be used by each Secretary of a military department in tracking and monitoring members of the Armed Forces in Warriors in Transition programs. Physical health and behavioral health. Rehabilitation. Educational and vocational preparation. Such other matters as the Secretary considers appropriate. When the member commences participation in the program. At least once each year the member participates in the program. When the member ceases participation in the program or is transferred to the jurisdiction of the Secretary of Veterans Affairs. may differentiate among cohort groups within the population of members in Warriors in Transition programs, as appropriate; and shall include parameters for specific outcome measurements in each element under subsection (b) and each metric and milestone under subsection (c). Warrior Transition Units and the Wounded Warrior Program of the Army. The Wounded Warrior Safe Harbor program of the Navy. The Wounded Warrior Regiment of the Marine Corps. The Recovery Care Program and the Wounded Warrior programs of the Air Force. The Care Coalition of the United States Special Operations Command.” the use of such non-government organizations to reduce the number of suicides among members of the Armed Forces by comprehensively addressing the needs of members of the Armed Forces who have been identified as being at risk of suicide; the delineation of the responsibilities within the Department of Defense regarding interaction with such organizations; the collection of data regarding the efficacy and cost of coordinating with such organizations; and the preparation and preservation of any reporting material the Secretary determines necessary to carry out the policy. The Secretary of Defense is authorized to take any necessary measures to prevent suicides by members of the Armed Forces, including by facilitating the access of members of the Armed Forces to successful non-governmental treatment regimen.” any suicide or attempted suicide involving a member of the Armed Forces, including reserve components thereof; and any death that is reported as a suicide involving a dependent of a member of the Armed Forces. the suicide prevention policy developed pursuant to section 582 of the National Defense Authorization Act for Fiscal Year 2013 ( Public Law 112–239 ; 10 U.S.C. 1071 note); and the suicide prevention and resilience program for the National Guard and Reserves established pursuant to section 10219 of title 10 , United States Code. The Secretary of Defense shall develop the policy required by this subsection in consultation with the Secretaries of the military departments and the Chief of the National Guard Bureau. Not later than 180 days after the date of the enactment of this Act [ Dec. 19, 2014 ], the Secretary of Defense shall submit the policy developed under subsection (a) to the Committees on Armed Services of the Senate and the House of Representatives. The Secretaries of the military departments shall implement the policy developed under subsection (a) not later than 180 days after the date of the submittal of the policy under paragraph (1). In this section, the term ‘dependent’, with respect to a member of the Armed Forces, means a person described in section 1072(2) of title 10 , United States Code, except that, in the case of a parent or parent-in-law of the member, the income requirements of subparagraph (E) of such section do not apply.” The Secretary of Defense shall, acting through the Under Secretary of Defense for Personnel and Readiness, establish within the Office of the Secretary of Defense a position with responsibility for oversight of all suicide prevention and resilience programs of the Department of Defense (including those of the military departments and the Armed Forces). To establish a uniform definition of resiliency for use in the suicide prevention and resilience programs and preventative behavioral health programs of the Department of Defense (including those of the military departments and the Armed Forces). To oversee the implementation of the comprehensive policy on the prevention of suicide among members of the Armed Forces required by section 582.” Not later than 180 days after the date of the enactment of this Act [ Jan. 2, 2013 ], the Secretary of Defense shall, acting through the Under Secretary of Defense for Personnel and Readiness, develop within the Department of Defense a comprehensive policy on the prevention of suicide among members of the Armed Forces. In developing the policy, the Secretary shall consider recommendations from the operational elements of the Armed Forces regarding the feasibility of the implementation and execution of particular elements of the policy. Increased awareness among members of the Armed Forces about mental health conditions and the stigma associated with mental health conditions and mental health care. The means of identifying members who are at risk for suicide (including enhanced means for early identification and treatment of such members). The continuous access by members to suicide prevention services, including suicide crisis services. The means to evaluate and assess the effectiveness of the suicide prevention and resilience programs and preventative behavioral health programs of the Department of Defense (including those of the military departments and the Armed Forces), including the development of metrics for that purpose. The means to evaluate and assess the current diagnostic tools and treatment methods in the programs referred to in paragraph (4) to ensure clinical best practices are used in such programs. The standard of care for suicide prevention to be used throughout the Department. The training of mental health care providers on suicide prevention. The training standards for behavioral health care providers to ensure that such providers receive training on clinical best practices and evidence-based treatments as information on such practices and treatments becomes available. The integration of mental health screenings and suicide risk and prevention for members into the delivery of primary care for such members. The standards for responding to attempted or completed suicides among members, including guidance and training to assist commanders in addressing incidents of attempted or completed suicide within their units. The means to ensure the protection of the privacy of members seeking or receiving treatment relating to suicide. Such other matters as the Secretary considers appropriate in connection with the prevention of suicide among members.” The Secretary of Defense shall take appropriate actions to enhance the suicide prevention program of the Department of Defense through the provision of suicide prevention information and resources to members of the Armed Forces from their initial enlistment or appointment through their final retirement or separation. the Secretary of Veterans Affairs, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; and to the extent appropriate, institutions of higher education and other public and private entities, including international entities, with expertise regarding suicide prevention.” Not later than March 31, 2011 , the Secretary of Defense shall develop and implement a comprehensive policy on pain management by the military health care system. The management of acute and chronic pain. The standard of care for pain management to be used throughout the Department of Defense. The consistent application of pain assessments throughout the Department of Defense. The assurance of prompt and appropriate pain care treatment and management by the Department when medically necessary. Programs of research related to acute and chronic pain, including pain attributable to central and peripheral nervous system damage characteristic of injuries incurred in modern warfare, brain injuries, and chronic migraine headache. Programs of pain care education and training for health care personnel of the Department. Programs of patient education for members suffering from acute or chronic pain and their families. The Secretary shall revise the policy required by subsection (a) on a periodic basis in accordance with experience and evolving best practice guidelines. Not later than 180 days after the date of the commencement of the implementation of the policy required by subsection (a), and on October 1 each year thereafter through 2018, the Secretary shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report on the policy. A description of the policy implemented under subsection (a), and any revisions to such policy under subsection (c). A description of the performance measures used to determine the effectiveness of the policy in improving pain care for beneficiaries enrolled in the military health care system. An assessment of the adequacy of Department pain management services based on a current survey of patients managed in Department clinics. An assessment of the research projects of the Department relevant to the treatment of the types of acute and chronic pain suffered by members of the Armed Forces and their families. An assessment of the training provided to Department health care personnel with respect to the diagnosis, treatment, and management of acute and chronic pain. An assessment of the pain care education programs of the Department. An assessment of the dissemination of information on pain management to beneficiaries enrolled in the military health care system.” With respect to both the direct care system and the purchased care system, an analysis of the type of health care facility in which dependents seek care. The 10 most common medical conditions for which dependents seek care. The availability of and access to health care providers to treat the conditions identified under paragraph (2), both in the direct care system and the purchased care system. Any shortfalls in the ability of dependents to obtain required health care services. Recommendations on how to improve access to care for dependents. With respect to dependents accompanying a member stationed at a military installation outside of the United States, the need for and availability of mental health care services. The Secretary of Defense, in consultation with the other administering Secretaries, shall undertake actions to enhance the capability of the military health system and improve the TRICARE program. Actions to guarantee the availability of care within established access standards for eligible beneficiaries, based on the results of the study required by subsection (a). Actions to expand and enhance sharing of health care resources among Federal health care programs, including designated providers (as that term is defined in section 721(5) of the National Defense Authorization Act for Fiscal Year 1997 ( Public Law 104–201 ; 110 Stat. 2593 ; 10 U.S.C. 1073 note)). Actions using medical technology to speed and simplify referrals for specialty care. Actions to improve regional or national staffing capabilities in order to enhance support provided to military medical treatment facilities facing staff shortages. Actions to improve health care access for members of the reserve components and their families, including such access with respect to mental health care and consideration of access issues for members and their families located in rural areas. Actions to ensure consistency throughout the TRICARE program to comply with access standards, which are applicable to both commanders of military treatment facilities and managed care support contractors. Actions to create new budgeting and resource allocation methodologies to fully support and incentivize care provided by military treatment facilities. Actions regarding additional financing options for health care provided by civilian providers. Actions to reduce administrative costs. Actions to control the cost of health care and pharmaceuticals. Actions to audit the Defense Enrollment Eligibility Reporting System to improve system checks on the eligibility of TRICARE beneficiaries. Actions, including a comprehensive plan, for the enhanced availability of prevention and wellness care. Actions using technology to improve direct communication with beneficiaries regarding health and preventive care. Actions to create performance metrics by which to measure improvement in the TRICARE program. Such other actions as the Secretary, in consultation with the other administering Secretaries, considers appropriate. In undertaking actions under this section, the Secretary of Defense and the other administering Secretaries shall continue or enhance the current level of quality health care provided by the Department of Defense and the military departments with no adverse impact to cost, access, or care. In considering actions to be undertaken under this section, and in undertaking such actions, the Secretary shall consult with a broad range of national health care and military advocacy organizations. Not later than 180 days after the date of the enactment of this Act [ Oct. 28, 2009 ], the Secretary shall submit to the congressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] an initial report on the progress made in undertaking actions under this section and future plans for improvement of the military health system. Updates on the progress made in undertaking actions under this section. Future plans for improvement of the military health system. An explanation of how the budget submission may reflect such progress and plans. The Secretary shall, on a periodic basis, submit to the congressional defense committees a report on the progress being made in the improvement of the TRICARE program under this section. A description and assessment of the progress made as of the date of such report in the improvement of the TRICARE program. Such recommendations for administrative or legislative action as the Secretary considers appropriate to expedite and enhance the improvement of the TRICARE program. The term ‘administering Secretaries’ has the meaning given that term in section 1072(3) of title 10 , United States Code. The term ‘TRICARE program’ has the meaning given that term in section 1072(7) of title 10 , United States Code.” The Secretary of Defense is authorized to develop a plan to establish a program to build cooperative health care arrangements and agreements between military installations projected to grow and local and regional non-military health care systems. identify and analyze health care delivery options involving the private sector and health care services in military facilities located on military installations; develop methods for determining the cost avoidance or savings resulting from innovative partnerships between the Department of Defense and the private sector; develop requirements for Department of Defense health care providers to deliver health care in civilian community hospitals; and collaborate with State and local authorities to create an arrangement to share and exchange, between the Department of Defense and nonmilitary health care systems, personal health information, and data of military personnel and their families. The plan shall include requirements for coordination with Federal, State, and local entities, TRICARE managed care support contractors, and other contracted assets around installations selected for participation in the program. The Secretary of Defense shall develop the plan in consultation with the Secretaries of the military departments. The military installation has members of the Armed Forces on active duty and members of reserve components of the Armed Forces that use the installation as a training and operational base, with members routinely deploying in support of the global war on terrorism. The military population of an installation will significantly increase by 2013 due to actions related to either Grow the Force initiatives or recommendations of the Defense Base Realignment and Closure Commission. no inpatient or trauma center care capabilities; and no current or planned capacity that would satisfy the proposed increase in military personnel at the installation. no inpatient services or limited capability to expand inpatient care beds, intensive care, and specialty services; and limited or no capability to provide trauma care. Not later than one year after the date of the enactment of this Act [ Oct. 14, 2008 ], and every year thereafter, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and House of Representatives an annual report on any plan developed under subsection (a).” The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of hearing loss and auditory system injury to carry out the responsibilities specified in subsection (c). 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). implement a comprehensive plan and strategy for the Department of Defense, as developed by the Secretary of Defense, for a registry of information for the tracking of the diagnosis, surgical intervention or other operative procedure, other treatment, and follow up for each case of hearing loss and auditory system injury incurred by a member of the Armed Forces while serving on active duty; 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 hearing 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 ‘Hearing Loss and Auditory System Injury Registry’ (hereinafter referred to as the ‘Registry’). The center shall develop the Registry in consultation with audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Defense and the audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Veterans Affairs. The mechanisms and procedures of the Registry shall reflect applicable expert research on military and other hearing loss. 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 hearing loss and auditory system injury is reported or recorded in the medical record. The center shall provide notice to the National Center for Rehabilitative Auditory Research (NCRAR) of the Department of Veterans Affairs and to the auditory system impairment services of the Veterans Health Administration on each member of the Armed Forces described in subparagraph (B) for purposes of ensuring the coordination of the provision of ongoing auditory system rehabilitation benefits and services by the Department of Veterans Affairs after the separation or release of such member from the Armed Forces. A member of the Armed Forces described in this subparagraph is a member of the Armed Forces with significant hearing loss or auditory system injury incurred while serving on active duty, including a member with auditory dysfunction related to traumatic brain injury. The Secretary of Defense and the Secretary of Veterans Affairs shall jointly ensure that information in the Registry is available to appropriate audiologists, speech and language pathologists, otolaryngologists, and other specialist personnel of the Department of Defense and the Department of Veterans Affairs for purposes of encouraging and facilitating the conduct of research, and the development of best practices and clinical education, on hearing loss or auditory system injury incurred by members of the Armed Forces. The Secretary of Defense shall take appropriate actions to include in the Registry such records of members of the Armed Forces who incurred a hearing loss or auditory system injury while serving on active duty on or after September 11, 2001 , but before the establishment of the Registry, as the Secretary considers appropriate for purposes of the Registry.” in the care of recovering service members; in the administrative management relating to such care; to carry out applicable provisions of Federal law; and recommended by the Comptroller General of the United States in the report titled ‘Army Needs to Improve Oversight of Warrior Transition Units’. appointments; rehabilitative services; recuperation in an outpatient status; contract care provided by a private health care provider outside of a military medical treatment facility; the disability evaluation system; and other administrative functions relating to the military department. The transition of a member of the Armed Forces who is retired under chapter 61 of title 10, United States Code, from receiving treatment furnished by the Secretary of Defense to treatment furnished by the Secretary of Veterans Affairs. Facility standards related to lodging and accommodations for recovering service members and the family members and non-medical attendants of recovering service members. Not later than one year after the date of the enactment of this Act [ Aug. 13, 2018 ], the Secretary of Defense and Secretaries of the military departments shall jointly submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the review conducted under subsection (a), including a description of the policies updated pursuant to subsection (b). In this section, the terms ‘disability evaluation system’, ‘outpatient status’, and ‘recovering service members’ have the meaning given those terms in section 1602 of the Wounded Warrior Act (title XVI of Public Law 110–181 ; 10 U.S.C. 1071 note).” 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. 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. 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 .] 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. 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. 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 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 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. 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. 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. 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; 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 ]. 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. 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. 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). 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). 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. In medical facilities of the Department of Defense. Through the TRICARE program. 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. 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. 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. 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. 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. 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. 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. 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. 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 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). 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. A clearly-defined process of the Department of Defense and the Department of Veterans Affairs for disability determinations of recovering service members. 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. 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). An assessment of the feasability [sic] and advisability of consolidating the disability evaluation systems described in paragraph (1) as specified in that paragraph. 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. “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. 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. 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. 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). 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. 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. 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. 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. 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. 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. 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. 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 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. 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. 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 .] 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. 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). is enrolled in the program; and 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. 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. 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. 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. 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)). 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). 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). 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. 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). 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). 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. 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). 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). 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. 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 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. 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. 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. 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 .] 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. 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. 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 .] 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. 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. 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. 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. 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). 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. 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. 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. 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. 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. 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. 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. 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. 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. 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). 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. 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). 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. 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]. 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. move efficiently within and across organizational boundaries; make high-quality decisions; and effectively carry out complete plans of care. 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 .] 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. 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). 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). 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). 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; 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). 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). 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. 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. 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. be uniform and consistent for all such facilities; and be uniform and consistent throughout the Department of Defense and the military departments. Military medical treatment facilities. Specialty medical care facilities. Military quarters or leased housing for patients. 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. 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. 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). 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 standards established under subsection (a). 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 .] 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. 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. 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. 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. 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. “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 .] “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. 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. 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. 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. 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). 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. 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.” ensure that the process provides for coordination of, and access to, health care from the two sources in a manner that prevents diminution of access to health care from either source; and in consultation with the Secretary of Veterans Affairs, prescribe a clear definition of an ‘episode of care’ for use in the resolution of patient safety and continuity of care issues under such process. Not later than May 1, 2003 , the Secretary shall submit to the Committees on Armed Services of the Senate and of the House of Representatives a report describing the process prescribed under paragraph (1). While prescribing the process under paragraph (1) and upon completion of the report under paragraph (2), the Secretary shall provide to the Comptroller General information that would be relevant in carrying out the study required by subsection (b). An analysis of whether covered beneficiaries who seek services through the Department of Veterans Affairs are receiving needed health care services in a timely manner from the Department of Veterans Affairs, as compared to the timeliness of the care available to covered beneficiaries under TRICARE Prime (as set forth in access to care standards under TRICARE program policy that are applicable to the care being sought). An evaluation of the quality of care for covered beneficiaries who do not receive needed services from the Department of Veterans Affairs within a time period that is comparable to the time period provided for under such access to care standards and who then must seek alternative care under the TRICARE program. Recommendations to improve access to, and timeliness and quality of, care for covered beneficiaries described in subsection (a). An evaluation of the feasibility and advisability of making access to care standards applicable jointly under the TRICARE program and the Department of Veterans Affairs health care system. A review of the process prescribed by the Secretary of Defense under subsection (a) to determine whether the process ensures the adequacy and quality of the health care services provided to covered beneficiaries under the TRICARE program and through the Department of Veterans Affairs, together with timeliness of access to such services and patient safety. Not later than 60 days after the congressional committees specified in subsection (a)(2) receive the report required under that subsection, the Comptroller General shall submit to those committees a report on the study conducted under this subsection. The term ‘covered beneficiary’ has the meaning provided by section 1072(5) of title 10 , United States Code. The term ‘TRICARE program’ has the meaning provided by section 1072(7) of such title. The term ‘TRICARE Prime’ has the meaning provided by section 1097a(f) of such title.” The Secretary of Defense shall implement a centralized process for reporting, compilation, and analysis of errors in the provision of health care under the defense health program that endanger patients beyond the normal risks associated with the care and treatment of such patients. To the extent practicable, that process shall emulate the system established by the Secretary of Veterans Affairs for reporting, compilation, and analysis of errors in the provision of health care under the Department of Veterans Affairs health care system that endanger patients beyond such risks. shall share information regarding the designs of systems or protocols established to reduce errors in the provision of health care described in subsection (a); and shall develop such protocols as the Secretaries consider necessary for the establishment and administration of effective processes for the reporting, compilation, and analysis of such errors.” The Secretary of Defense shall establish a patient care error reporting and management system. To study the occurrences of errors in the patient care provided under chapter 55 of title 10, United States Code. To identify the systemic factors that are associated with such occurrences. To provide for action to be taken to correct the identified systemic factors. A hospital-level patient safety center, within the quality assurance department of each health care organization of the Department of Defense, to collect, assess, and report on the nature and frequency of errors related to patient care. For each health care organization of the Department of Defense and for the entire Defense health program, patient safety standards that are necessary for the development of a full understanding of patient safety issues in each such organization and the entire program, including the nature and types of errors and the systemic causes of the errors. To analyze information on patient care errors that is submitted to the Center by each military health care organization. To develop action plans for addressing patterns of patient care errors. To execute those action plans to mitigate and control errors in patient care with a goal of ensuring that the health care organizations of the Department of Defense provide highly reliable patient care with virtually no error. To provide, through the Assistant Secretary of Defense for Health Affairs, to the Agency for Healthcare Research and Quality of the Department of Health and Human Services any reports that the Assistant Secretary determines appropriate. To review and integrate processes for reducing errors associated with patient care and for enhancing patient safety. To contract with a qualified and objective external organization to manage the national patient safety database of the Department of Defense. Establish not less than two Centers of Excellence for the development, validation, proliferation, and sustainment of the health care team coordination program, one of which shall support all fixed military health care organizations, the other of which shall support all combat casualty care organizations. Deploy the program to all fixed and combat casualty care organizations of each of the Armed Forces, at the rate of not less than 10 organizations in each fiscal year. Expand the scope of the health care team coordination program from a focus on emergency department care to a coverage that includes care in all major medical specialties, at the rate of not less than one specialty in each fiscal year. Continue research and development investments to improve communication, coordination, and team work in the provision of health care. The Secretary shall consult with the other administering Secretaries (as defined in section 1072(3) of title 10 , United States Code) in carrying out this section.” The purpose of this section is to ensure that the Department of Defense addresses issues of medical quality surveillance and implements solutions for those issues in a timely manner that is consistent with national policy and industry standards. To develop parameters for assessing the quality of health care information. To develop the defense digital patient record. To develop a repository for data on quality of health care. To develop capability for conducting research on quality of health care. To conduct research on matters of quality of health care. To develop decision support tools for health care providers. To refine medical performance report cards. To conduct educational programs on medical informatics to meet identified needs. Through the program established under subsection (b), the Secretary of Defense shall accelerate the efforts of the Department of Defense to automate, capture, and exchange controlled clinical data and present providers with clinical guidance using a personal information carrier, clinical lexicon, or digital patient record. The program shall serve as a primary resource for the Department of Defense for matters concerning the capture, processing, and dissemination of data on health care quality. The Assistant Secretary of Defense for Health Affairs. The Director of the TRICARE Management Activity of the Department of Defense. The Surgeon General of the Army. The Surgeon General of the Navy. The Surgeon General of the Air Force. Representatives of the Department of Veterans Affairs, designated by the Secretary of Veterans Affairs. Representatives of the Department of Health and Human Services, designated by the Secretary of Health and Human Services. Any additional members appointed by the Secretary of Defense to represent health care insurers and managed care organizations, academic health institutions, health care providers (including representatives of physicians and representatives of hospitals), and accreditors of health care plans and organizations. The primary mission of the Committee shall be to advise the Secretary on the development, deployment, and maintenance of health care informatics systems that allow for the collection, exchange, and processing of health care quality information for the Department of Defense in coordination with other Federal departments and agencies and with the private sector. The ability of the medical informatics systems at the Department of Defense and Department of Veterans Affairs to monitor, evaluate, and improve the quality of care provided to beneficiaries. The coordination of key components of medical informatics systems, including digital patient records, both within the Federal Government and between the Federal Government and the private sector. The development of operational capabilities for executive information systems and clinical decision support systems within the Department of Defense and Department of Veterans Affairs. Standardization of processes used to collect, evaluate, and disseminate health care quality information. Refinement of methodologies by which the quality of health care provided within the Department of Defense and Department of Veterans Affairs is evaluated. Protecting the confidentiality of personal health information. The Assistant Secretary of Defense for Health Affairs shall consult with the Committee on the issues described in paragraph (3). Members of the Committee shall not be paid by reason of their service on the Committee. Chapter 10 of title 5, United States Code, shall not apply to the Committee.” The Secretary of Defense shall establish a peer review process that will use persons who are not officers or employees of the Government to review the research protocols of medical research projects. Funds of the Department of Defense may not be obligated or expended for any medical research project unless the research protocol for the project has been approved by the external peer review process established under subsection (a). involves the participation of human subjects; is conducted solely by a non-Federal entity; and is funded through the Defense Health Program account. The peer review requirements of subsection (b) shall take effect on October 1, 1996 , and, except as provided in subsection (e), shall apply to all medical research projects proposed funded on or after that date, including medical research projects funded pursuant to any requirement of law enacted before, on, or after that date. A medical research project that the Secretary determines has been substantially completed by October 1, 1996 . A medical research project funded pursuant to any provision of law enacted on or after that date if the provision of law specifically refers to this section and specifically states that the peer review requirements do not apply.” The availability of health care services to such persons through the health care system provided for under that chapter, the types of services received, and the facilities in which the services were provided. The familiarity of such persons with the services available under that system and with the facilities in which such services are provided. The health of such persons. The level of satisfaction of such persons with that system and the quality of the health care provided through that system. Such other matters as the administering Secretaries determine appropriate. An annual survey under subsection (a) shall be treated as not a collection of information for the purposes for which such term is defined in section 3502(4) of title 44 , United States Code. For purposes of this section, the term ‘administering Secretaries’ has the meaning given such term in section 1072(3) of title 10 , United States Code.” The term ‘Core Quality Measures Collaborative’ means the collaboration between the Centers for Medicare & Medicaid Services, major health insurance companies, national physician organizations, and other entities to reach consensus on core performance measures reported by health care providers. The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10 , United States Code.”