-CITE- 10 USC CHAPTER 55 - MEDICAL AND DENTAL CARE 01/03/2007 -EXPCITE- TITLE 10 - ARMED FORCES Subtitle A - General Military Law PART II - PERSONNEL CHAPTER 55 - MEDICAL AND DENTAL CARE -HEAD- CHAPTER 55 - MEDICAL AND DENTAL CARE -MISC1- Sec. 1071. Purpose of this chapter. 1072. Definitions. 1073. Administration of this chapter. 1073a. Contracts for health care: best value contracting. 1073b. Recurring reports. 1074. Medical and dental care for members and certain former members. 1074a. Medical and dental care: members on duty other than active duty for a period of more than 30 days. 1074b. Medical and dental care: Academy cadets and midshipmen; members of, and designated applicants for membership in, Senior ROTC. 1074c. Medical care: authority to provide a wig. 1074d. Certain primary and preventive health care services. 1074e. Medical care: certain Reserves who served in Southwest Asia during the Persian Gulf Conflict. 1074f. Medical tracking system for members deployed overseas. 1074g. Pharmacy benefits program. 1074h. Medical and dental care: medal of honor recipients; dependents. 1074i. Reimbursement for certain travel expenses. 1074j. Sub-acute care program. 1074k. Long-term care insurance. [1075. Repealed.] 1076. Medical and dental care for dependents: general rule. 1076a. TRICARE dental program. [1076b. Repealed.] 1076c. Dental insurance plan: certain retirees and their surviving spouses and other dependents. 1076d. TRICARE program: TRICARE Standard coverage for members of the Selected Reserve. 1077. Medical care for dependents: authorized care in facilities of uniformed services. 1078. Medical and dental care for dependents: charges. 1078a. Continued health benefits coverage. 1079. Contracts for medical care for spouses and children: plans. 1079a. CHAMPUS: treatment of refunds and other amounts collected. 1079b. Procedures for charging fees for care provided to civilians; retention and use of fees collected. 1080. Contracts for medical care for spouses and children: election of facilities. 1081. Contracts for medical care for spouses and children: review and adjustment of payments. 1082. Contracts for health care: advisory committees. 1083. Contracts for medical care for spouses and children: additional hospitalization. 1084. Determinations of dependency. 1085. Medical and dental care from another executive department: reimbursement. 1086. Contracts for health benefits for certain members, former members, and their dependents. 1086a. Certain former spouses: extension of period of eligibility for health benefits. 1086b. Prohibition against requiring retired members to receive health care solely through the Department of Defense. 1087. Programing facilities for certain members, former members, and their dependents in construction projects of the uniformed services. 1088. Air evacuation patients: furnished subsistence. 1089. Defense of certain suits arising out of medical malpractice. 1090. Identifying and treating drug and alcohol dependence. 1091. Personal services contracts. 1092. Studies and demonstration projects relating to delivery of health and medical care. 1092a. Persons entering the armed forces: baseline health data. 1093. Performance of abortions: restrictions. 1094. Licensure requirement for health-care professionals. 1094a. Continuing medical education requirements: system for monitoring physician compliance. 1095. Health care services incurred on behalf of covered beneficiaries: collection from third-party payers. 1095a. Medical care: members held as captives and their dependents. 1095b. TRICARE program: contractor payment of certain claims. 1095c. TRICARE program: facilitation of processing of claims. 1095d. TRICARE program: waiver of certain deductibles. 1095e. TRICARE program: beneficiary counseling and assistance coordinators. 1095f. TRICARE program: referrals for specialty health care. 1096. Military-civilian health services partnership program. 1097. Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care. 1097a. TRICARE Prime: automatic enrollments; payment options. 1097b. TRICARE program: financial management. 1097c. TRICARE program: relationship with employer-sponsored group health plans. 1098. Incentives for participation in cost-effective health care plans. 1099. Health care enrollment system. 1100. Defense Health Program Account. 1101. Resource allocation methods: capitation or diagnosis-related groups. 1102. Confidentiality of medical quality assurance records: qualified immunity for participants. 1103. Contracts for medical and dental care: State and local preemption. 1104. Sharing of health-care resources with the Department of Veterans Affairs. 1105. Specialized treatment facility program. 1106. Submittal of claims: standard form; time limits. 1107. Notice of use of an investigational new drug or a drug unapproved for its applied use. 1107a. Emergency use products. 1108. Health care coverage through Federal Employees Health Benefits program: demonstration project. 1109. Organ and tissue donor program. 1110. Anthrax vaccine immunization program; procedures for exemptions and monitoring reactions. AMENDMENTS 2006 - Pub. L. 109-364, div. A, title VII, Sec. 707(b), Oct. 17, 2006, 120 Stat. 2284, added item 1097c. Pub. L. 109-364, div. A, title VII, Sec. 706(e), Oct. 17, 2006, 120 Stat. 2282, struck out item 1076b "TRICARE program: TRICARE Standard coverage for members of the Selected Reserve" and substituted "TRICARE program: TRICARE Standard coverage for members of the Selected Reserve" for "TRICARE program: coverage for members of reserve components who commit to continued service in the Selected Reserve after release from active duty in support of a contingency operation" in item 1076d, effective Oct. 1, 2007. Pub. L. 109-163, div. A, title VII, Secs. 701(f)(2), 702(a)(2), Jan. 6, 2006, 119 Stat. 3340, 3342, substituted "TRICARE program: TRICARE Standard coverage for members of the Selected Reserve" for "TRICARE program: coverage for members of the Ready Reserve" in item 1076b and "TRICARE program: coverage for members of reserve components who commit to continued service in the Selected Reserve after release from active duty in support of a contingency operation" for "TRICARE program: coverage for members of reserve components who commit to continued service in the Selected Reserve after release from active duty" in item 1076d. 2004 - Pub. L. 108-375, div. A, title V, Sec. 555(a)(2), title VI, Sec. 607(a)(2), title VII, Secs. 701(a)(2), 733(a)(2), 739(a)(2), title X, Sec. 1084(d)(7), Oct. 28, 2004, 118 Stat. 1914, 1946, 1981, 1998, 2002, 2061, added items 1073b, 1074b, 1076d, and 1092a, reenacted item 1076b without change, and struck out item 1075 "Officers and certain enlisted members: subsistence charges". 2003 - Pub. L. 108-136, div. A, title XVI, Sec. 1603(b)(2), Nov. 24, 2003, 117 Stat. 1690, added item 1107a. Pub. L. 108-106, title I, Sec. 1115(b), Nov. 6, 2003, 117 Stat. 1218, added item 1076b. 2001 - Pub. L. 107-107, div. A, title VII, Secs. 701(a)(2), (f)(2), 731(b), 732(a)(2), 736(c)(2), title X, Sec. 1048(a)(10), Dec. 28, 2001, 115 Stat. 1158, 1161, 1169, 1173, 1223, struck out item 1074b "Transitional medical and dental care: members on active duty in support of contingency operations", transferred item 1074i to appear after item 1074h, and added items 1074j, 1074k, 1079b, and 1086b. 2000 - Pub. L. 106-398, Sec. 1 [[div. A], title VII, Secs. 706(a)(2), 728(a)(2), 751(b)(2), 758(b)], Oct. 30, 2000, 114 Stat. 1654, 1654A-175, 1654A-189, 1654A-194, 1654A-200, added items 1074h, 1074i, 1095f, and 1110. 1999 - Pub. L. 106-65, div. A, title VII, Secs. 701(a)(2), 711(b), 713(a)(2), 714(b), 715(a)(2), 716(a)(2), 722(b), Oct. 5, 1999, 113 Stat. 680, 687, 689-691, 695, added items 1073a, 1074g, 1076a, 1095c, 1095d, 1095e, and 1097b and struck out former items 1076a "Dependents' dental program" and 1076b "Selected Reserve dental insurance". 1998 - Pub. L. 105-261, div. A, title VII, Secs. 711(b), 712(a)(2), 721(a)(2), 734(b)(2), 741(b)(2), Oct. 17, 1998, 112 Stat. 2058, 2059, 2065, 2073, 2074, added items 1094a, 1095b, 1097a, 1108, and 1109. 1997 - Pub. L. 105-85, div. A, title VII, Secs. 738(b), 764(b), 765(a)(2), 766(b), Nov. 18, 1997, 111 Stat. 1815, 1826-1828, added items 1074e, 1074f, 1106, and 1107 and struck out former item 1106 "Submittal of claims under CHAMPUS". 1996 - Pub. L. 104-201, div. A, title VII, Secs. 701(a)(2)(B), 703(a)(2), 733(a)(2), Sept. 23, 1996, 110 Stat. 2587, 2590, 2598, substituted "Certain primary and preventive health care services" for "Primary and preventive health care services for women" in item 1074d and added items 1076c and 1079a. Pub. L. 104-106, div. A, title VII, Secs. 705(a)(2), 735(d)(2), 738(b)(2), Feb. 10, 1996, 110 Stat. 373, 383, added item 1076b and substituted "Performance of abortions: restrictions" for "Restriction on use of funds for abortions" in item 1093 and "Defense Health Program Account" for "Military Health Care Account" in item 1100. 1993 - Pub. L. 103-160, div. A, title VII, Secs. 701(a)(2), 712(a)(2), 714(b)(2), 716(a)(2), Nov. 30, 1993, 107 Stat. 1686, 1689, 1690, 1692, added item 1074d, substituted "Personal services contracts" for "Contracts for direct health care providers" in item 1091 and "Resource allocation methods: capitation or diagnosis- related groups" for "Diagnosis-related groups" in item 1101, added item 1105, and struck out former item 1105 "Issuance of nonavailability of health care statements". 1992 - Pub. L. 102-484, div. D, title XLIV, Sec. 4408(a)(2), Oct. 23, 1992, 106 Stat. 2712, added item 1078a. 1991 - Pub. L. 102-190, div. A, title VI, Sec. 640(b), title VII, Secs. 715(b), 716(a)(2), Dec. 5, 1991, 105 Stat. 1385, 1403, 1404, added item 1074b, redesignated former item 1074b as 1074c, and added items 1105 and 1106. 1990 - Pub. L. 101-510, div. A, title VII, Sec. 713(d)(2)[(3)], Nov. 5, 1990, 104 Stat. 1584, substituted "Health care services incurred on behalf of covered beneficiaries: collection from third- party payers" for "Collection from third-party payers of reasonable inpatient hospital care costs incurred on behalf of retirees and dependents" in item 1095. 1989 - Pub. L. 101-189, div. A, title VII, Secs. 722(b), 731(b)(2), Nov. 29, 1989, 103 Stat. 1478, 1482, added items 1086a and 1104. 1987 - Pub. L. 100-180, div. A, title VII, Sec. 725(a)(2), Dec. 4, 1987, 101 Stat. 1116, added item 1103. Pub. L. 100-26, Sec. 7(e)(2), Apr. 21, 1987, 101 Stat. 281, redesignated item 1095 "Medical care: members held as captives and their dependents" as item 1095a. 1986 - Pub. L. 99-661, div. A, title VI, Sec. 604(a)(2), title VII, Secs. 701(a)(2), 705(a)(2), Nov. 14, 1986, 100 Stat. 3875, 3897, 3904 substituted "active duty for a period of more than 30 days" for "active duty; injuries, diseases, and illnesses incident to duty" in item 1074a and added items 1096 to 1102. Pub. L. 99-399, title VIII, Sec. 801(c)(2), Aug. 27, 1986, 100 Stat. 886, added item 1095 "Medical care: members held as captives and their dependents". Pub. L. 99-272, title II, Sec. 2001(a)(2), Apr. 7, 1986, 100 Stat. 101, added item 1095 "Collection from third-party payers of reasonable inpatient hospital care costs incurred on behalf of retirees and dependents". 1985 - Pub. L. 99-145, title VI, Secs. 651(a)(2), 653(a)(2), Nov. 8, 1985, 99 Stat. 656, 658, added items 1076a and 1094. 1984 - Pub. L. 98-525, title VI, Sec. 631(a)(2), title XIV, Sec. 1401(e)(2)(B), (5)(B), Oct. 19, 1984, 98 Stat. 2543, 2616, 2618, substituted in item 1074a "Medical and dental care: members on duty other than active duty; injuries, diseases, and illnesses incident to duty" for "Medical and dental care for members of the uniformed services for injuries incurred or aggravated while traveling to and from inactive duty training" and added items 1074b and 1093. 1983 - Pub. L. 98-94, title IX, Secs. 932(a)(2), 933(a)(2), title X, Sec. 1012(a)(2), title XII, Sec. 1268(5)(B), Sept. 24, 1983, 97 Stat. 650, 651, 665, 706, added items 1074a, 1091, and 1092, and struck out "; reports" at end of item 1081. 1982 - Pub. L. 97-295, Sec. 1(15)(B), Oct. 12, 1982, 96 Stat. 1290, added item 1090. 1980 - Pub. L. 96-513, title V, Sec. 511(34)(D), Dec. 12, 1980, 94 Stat. 2923, in items 1071 and 1073 substituted "this chapter" for "sections 1071-1087 of this title", and in item 1086 substituted "benefits" for "care". 1976 - Pub. L. 94-464, Sec. 1(b), Oct. 8, 1976, 90 Stat. 1986, added item 1089. 1970 - Pub. L. 91-481, Sec. 2(2), Oct. 21, 1970, 84 Stat. 1082, added item 1088. 1966 - Pub. L. 89-614, Sec. 2(9), Sept. 30, 1966, 80 Stat. 866, substituted "1087" for "1085" in items 1071 and 1073, "Medical care" and "authorized care in facilities of uniformed services" for "Medical and dental care" and "specific inclusions and exclusions" in item 1077, "Contracts for health care" for "Contracts for medical care for spouses and children" in item 1082, and added items 1086 and 1087. 1965 - Pub. L. 89-264, Sec. 2, Oct. 19, 1965, 79 Stat. 989, substituted "executive department" for "uniformed service" in item 1085. 1958 - Pub. L. 85-861, Sec. 1(25)(A), (C), Sept. 2, 1958, 72 Stat. 1445, 1450, substituted "Medical and Dental Care" for "Voting by Members of Armed Forces" in heading of chapter, and substituted items 1071 to 1085 for former items 1071 to 1086. -End- -CITE- 10 USC Sec. 1071 01/03/2007 -EXPCITE- TITLE 10 - ARMED FORCES Subtitle A - General Military Law PART II - PERSONNEL CHAPTER 55 - MEDICAL AND DENTAL CARE -HEAD- Sec. 1071. Purpose of this chapter -STATUTE- 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. -SOURCE- (Added Pub. L. 85-861, Sec. 1(25)(B), Sept. 2, 1958, 72 Stat. 1445; amended Pub. L. 89-614, Sec. 2(1), Sept. 30, 1966, 80 Stat. 862; Pub. L. 96-513, title V, Sec. 511(34)(A), (B), Dec. 12, 1980, 94 Stat. 2922.) -MISC1- HISTORICAL AND REVISION NOTES -------------------------------------------------------------------- Revised Source (U.S. Code) Source (Statutes at section Large) -------------------------------------------------------------------- 1071 37:401. June 7, 1956, ch. 374, Sec. 101, 70 Stat. 250. -------------------------------------------------------------------- The words "and certain former members" are inserted to reflect the fact that many of the persons entitled to retired pay are former members only. The words "and dental" are inserted to reflect the fact that members and, in certain limited situations, dependents are entitled to dental care under sections 1071-1085 of this title. PRIOR PROVISIONS A prior section 1071, act Aug. 10, 1956, ch. 1041, 70A Stat. 81, which stated the purpose of former sections 1071 to 1086 of this title, and provided for their construction, was repealed by Pub. L. 85-861, Sec. 36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which is classified to subchapter I-D (Sec. 1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare. AMENDMENTS 1980 - Pub. L. 96-513 substituted "Purpose of this chapter" for "Purpose of sections 1071-1087 of this title" in section catchline, and substituted reference to this chapter for reference to sections 1071-1087 of this title in text. 1966 - Pub. L. 89-614 substituted "1087" for "1085" in section catchline and text. EFFECTIVE DATE OF 1980 AMENDMENT Amendment by Pub. L. 96-513 effective Dec. 12, 1980, see section 701(b)(3) of Pub. L. 96-513, set out as a note under section 101 of this title. EFFECTIVE DATE OF 1966 AMENDMENT Section 3 of Pub. L. 89-614 provided that: "The amendments made by this Act [see Short Title of 1966 Amendment note below] shall become effective January 1, 1967, except that those amendments relating to outpatient care in civilian facilities for spouses and children of members of the uniformed services who are on active duty for a period of more than 30 days shall become effective on October 1, 1966." SHORT TITLE OF 1987 AMENDMENT Pub. L. 100-180, div. A, title VII, Sec. 701, Dec. 4, 1987, 101 Stat. 1108, provided that: "This title [enacting sections 1103, 2128 to 2130 [now 16201 to 16203], and 6392 of this title, amending sections 533, 591, 1079, 1086, 1251, 2120, 2122, 2123, 2124, 2127, 2172 [now 16302], 3353, 3855, 5600, 8353, and 8855 of this title, section 302 of Title 37, Pay and Allowances of the Uniformed Services, and section 460 of Title 50, Appendix, War and National Defense, enacting provisions set out as notes under sections 1073, 1074, 1079, 1092, 1103, 2121, 2124, 12201, and 16201 of this title, amending provisions set out as notes under sections 1073 and 1101 of this title, and repealing provisions set out as notes under sections 2121 and 2124 of this title] may be cited as the 'Military Health Care Amendments of 1987'." SHORT TITLE OF 1966 AMENDMENT Section 1 of Pub. L. 89-614 provided: "That this Act [enacting sections 1086 and 1087 of this title, amending this section and sections 1072 to 1074, 1076 to 1079, 1082, and 1084 of this title, and enacting provisions set out as a note under this section] may be cited as the 'Military Medical Benefits Amendments of 1966'." DISEASE AND CHRONIC CARE MANAGEMENT Pub. L. 109-364, div. A, title VII, Sec. 734, Oct. 17, 2006, 120 Stat. 2299, provided that: "(a) Program Design and Development Required. - Not later than October 1, 2007, the Secretary of Defense shall design and develop a fully integrated program on disease and chronic care management for the military health care system that provides, to the extent practicable, uniform policies and practices on disease management and chronic care management throughout that system, including both military hospitals and clinics and civilian healthcare providers within the TRICARE network. "(b) Purposes of Program. - The purposes of the program required by subsection (a) are as follows: "(1) To facilitate the improvement of the health status of individuals under care in the military health care system. "(2) To ensure the availability of effective health care services in that system for individuals with diseases and other chronic conditions. "(3) To ensure the proper allocation of health care resources for individuals who need care for disease or other chronic conditions. "(c) Elements of Program Design. - The program design required by subsection (a) shall meet the following requirements: "(1) Based on uniform policies prescribed by the Secretary, the program shall, at a minimum, address the following chronic diseases and conditions: "(A) Diabetes. "(B) Cancer. "(C) Heart disease. "(D) Asthma. "(E) Chronic obstructive pulmonary disorder. "(F) Depression and anxiety disorders. "(2) The program shall meet nationally recognized accreditation standards for disease and chronic care management. "(3) The program shall include specific outcome measures and objectives on disease and chronic care management. "(4) The program shall include strategies for disease and chronic care management for all beneficiaries, including beneficiaries eligible for benefits under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), for whom the TRICARE program is not the primary payer for health care benefits. "(5) Activities under the program shall conform to applicable laws and regulations relating to the confidentiality of health care information. "(d) Implementation Plan Required. - Not later than February 1, 2008, the Secretary of Defense, in coordination with the Secretaries of the military departments, shall develop an implementation plan for the disease and chronic care management program. In order to facilitate the carrying out of the program, the plan developed by the Secretary shall - "(1) require a comprehensive analysis of the disease and chronic care management opportunities within each region of the TRICARE program, including within military treatment facilities and through contractors under the TRICARE program; "(2) ensure continuous, adequate funding of disease and chronic care management activities throughout the military health care system in order to achieve maximum health outcomes and cost avoidance; "(3) eliminate, to the extent practicable, any financial disincentives to sustained investment by military hospitals and health care services contractors of the Department of Defense in the disease and chronic care management activities of the Department; "(4) ensure that appropriate clinical and claims data, including pharmacy utilization data, is available for use in implementing the program; "(5) ensure outreach to eligible beneficiaries who, on the basis of their clinical conditions, are candidates for the program utilizing print and electronic media, telephone, and personal interaction; and "(6) provide a system for monitoring improvements in health status and clinical outcomes under the program and savings associated with the program. "(e) Report. - "(1) In general. - Not later than March 1, 2008, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the design, development, and implementation of the program on disease and chronic care management required by this section. "(2) Report elements. - The report required by paragraph (1) shall include the following: "(A) A description of the design and development of the program required by subsection (a). "(B) A description of the implementation plan required by subsection (d). "(C) A description and assessment of improvements in health status and clinical outcomes that are anticipated as a result of implementation of the program. "(D) A description of the savings and return on investment associated with the program. "(E) A description of an investment strategy to assure the sustainment of the disease and chronic care management programs of the Department of Defense." PREVENTION, MITIGATION, AND TREATMENT OF BLAST INJURIES Pub. L. 109-163, div. A, title II, Sec. 256, Jan. 6, 2006, 119 Stat. 3181, provided that: "(a) Designation of Executive Agent. - The Secretary of Defense shall designate an executive agent to be responsible for coordinating and managing the medical research efforts and programs of the Department of Defense relating to the prevention, mitigation, and treatment of blast injuries. "(b) General Responsibilities. - The executive agent designated under subsection (a) shall be responsible for - "(1) planning for the medical research and development projects, diagnostic and field treatment programs, and patient tracking and monitoring activities within the Department that relate to combat blast injuries; "(2) efficient execution of such projects, programs, and activities; "(3) enabling the sharing of blast injury health hazards and survivability data collected through such projects, programs, and activities with the programs of the Department of Defense; "(4) working with the Director, Defense Research and Engineering and the Secretaries of the military departments to ensure resources are adequate to also meet non-medical requirements related to blast injury prevention, mitigation, and treatment; and "(5) ensuring that a joint combat trauma registry is established and maintained for the purposes of collection and analysis of contemporary combat casualties, including casualties with traumatic brain injury. "(c) Medical Research Efforts. - "(1) In general. - The executive agent designated under subsection (a) shall review and assess the adequacy of medical research efforts of the Department of Defense as of the date of the enactment of this Act [Jan. 6, 2006] relating to the following: "(A) The characterization of blast effects leading to injury, including the injury potential of blasts in various environments. "(B) Medical technologies and protocols to more accurately detect and diagnose blast injuries, including improved discrimination between traumatic brain injuries and mental health disorders. "(C) Enhanced treatment of blast injuries in the field. "(D) Integrated treatment approaches for members of the Armed Forces who have a combination of traumatic brain injuries and mental health disorders or other injuries. "(E) Such other blast injury matters as the executive agent considers appropriate. "(2) Requirements for research efforts. - Based on the assessment under paragraph (1), the executive agent shall establish requirements for medical research efforts described in that paragraph in order to enhance and accelerate those research efforts. "(3) Oversight of research efforts. - The executive agent shall establish, coordinate, and oversee Department-wide medical research efforts relating to the prevention, mitigation, and treatment of blast injuries, as necessary, to fulfill requirements established under paragraph (2). "(d) Other Related Research Efforts. - The Director, Defense Research and Engineering, in coordination with the executive agent designated under subsection (a) and the Director of the Joint IED Defeat Task Force, shall - "(1) review and assess the adequacy of current research efforts of the Department on the prevention and mitigation of blast injuries; "(2) based on subsection (c)(1), establish requirements for further research; and "(3) address any deficiencies identified in paragraphs (1) and (2) by establishing, coordinating, and overseeing Department-wide research and development initiatives on the prevention and mitigation of blast injuries, including explosive detection and defeat and personnel and vehicle blast protection. "(e) Studies. - The executive agent designated under subsection (a) shall conduct studies on the prevention, mitigation, and treatment of blast injuries, including - "(1) studies to improve the clinical evaluation and treatment approach for blast injuries, with an emphasis on traumatic brain injuries and other consequences of blast injury, including acoustic and eye injuries and injuries resulting from over- pressure wave; "(2) studies on the incidence of traumatic brain injuries attributable to blast injury in soldiers returning from combat; "(3) studies to develop protocols for medical tracking of members of the Armed Forces for up to five years following blast injuries; and "(4) studies to refine and improve educational interventions for blast injury survivors and their families. "(f) Training. - The executive agent designated under subsection (a), in coordination with the Director of the Joint IED Defeat Task Force, shall develop training protocols for medical and non-medical personnel on the prevention, mitigation, and treatment of blast injuries. Those protocols shall be intended to improve field and clinical training on early identification of blast injury consequences, both seen and unseen, including traumatic brain injuries, acoustic injuries, and internal injuries. "(g) Information Sharing. - The executive agent designated under subsection (a) shall make available the results of relevant medical research and development projects and studies to - "(1) Department of Defense programs focused on - "(A) promoting the exchange of blast health hazards data with blast characterization data and blast modeling and simulation tools; and "(B) encouraging the incorporation of blast hazards data into design and operational features of blast detection, mitigation, and defeat capabilities, such as comprehensive armor systems which provide blast, ballistic, and fire protection for the head, neck, ears, eyes, torso, and extremities; and "(2) traumatic brain injury treatment programs to enhance the evaluation and care of members of the Armed Forces with traumatic brain injuries in medical facilities in the United States and in deployed medical facilities, including those outside the Department of Defense. "(h) Reports on Blast Injury Matters. - "(1) Reports required. - Not later than 270 days after the date of the enactment of this Act [Jan. 6, 2006], and annually thereafter through 2008, the Secretary of Defense shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report on the efforts and programs of the Department of Defense relating to the prevention, mitigation, and treatment of blast injuries. "(2) Elements. - Each report under paragraph (1) shall include the following: "(A) A description of the activities undertaken under this section during the two years preceding the report to improve the prevention, mitigation, and treatment of blast injuries. "(B) A consolidated budget presentation for Department of Defense biomedical research efforts and studies related to blast injury for the two fiscal years following the year of the report. "(C) A description of any gaps in the capabilities of the Department and any plans to address such gaps within biomedical research related to blast injury, blast injury diagnostic and treatment programs, and blast injury tracking and monitoring activities. "(D) A description of collaboration, if any, with other departments and agencies of the Federal Government, and with other countries, during the two years preceding the report in efforts for the prevention, mitigation, and treatment of blast injuries. "(E) A description of any efforts during the two years preceding the report to disseminate findings on the diagnosis and treatment of blast injuries through civilian and military research and medical communities. "(F) A description of the status of efforts during the two years preceding the report to incorporate blast injury effects data into appropriate programs of the Department of Defense and into the development of comprehensive force protection systems that are effective in confronting blast, ballistic, and fire threats. "(i) Deadline for Designation of Executive Agent. - The Secretary shall make the designation required by subsection (a) not later than 90 days after the date of the enactment of this Act [Jan. 6, 2006]. "(j) Blast Injuries Defined. - In this section, the term 'blast injuries' means injuries that occur as the result of the detonation of high explosives, including vehicle-borne and person-borne explosive devices, rocket-propelled grenades, and improvised explosive devices. "(k) Executive Agent Defined. - In this section, the term 'executive agent' has the meaning provided such term in Department of Defense Directive 5101.1." ACCESS TO HEALTH CARE SERVICES FOR BENEFICIARIES ELIGIBLE FOR TRICARE AND DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE Pub. L. 107-314, div. A, title VII, Sec. 708, Dec. 2, 2002, 116 Stat. 2585, provided that: "(a) Requirement To Establish Process. - (1) The Secretary of Defense shall prescribe in regulations a process for resolving issues relating to patient safety and continuity of care for covered beneficiaries who are concurrently entitled to health care under the TRICARE program and eligible for health care services provided by the Department of Veterans Affairs. The Secretary shall - "(A) ensure that the process provides for coordination of, and access to, health care from the two sources in a manner that prevents diminution of access to health care from either source; and "(B) in consultation with the Secretary of Veterans Affairs, prescribe a clear definition of an 'episode of care' for use in the resolution of patient safety and continuity of care issues under such process. "(2) Not later than May 1, 2003, the Secretary shall submit to the Committees on Armed Services of the Senate and of the House of Representatives a report describing the process prescribed under paragraph (1). "(3) While prescribing the process under paragraph (1) and upon completion of the report under paragraph (2), the Secretary shall provide to the Comptroller General information that would be relevant in carrying out the study required by subsection (b). "(b) Comptroller General Study and Report. - (1) The Comptroller General shall conduct a study of the health care issues of covered beneficiaries described in subsection (a). The study shall include the following: "(A) An analysis of whether covered beneficiaries who seek services through the Department of Veterans Affairs are receiving needed health care services in a timely manner from the Department of Veterans Affairs, as compared to the timeliness of the care available to covered beneficiaries under TRICARE Prime (as set forth in access to care standards under TRICARE program policy that are applicable to the care being sought). "(B) An evaluation of the quality of care for covered beneficiaries who do not receive needed services from the Department of Veterans Affairs within a time period that is comparable to the time period provided for under such access to care standards and who then must seek alternative care under the TRICARE program. "(C) Recommendations to improve access to, and timeliness and quality of, care for covered beneficiaries described in subsection (a). "(D) An evaluation of the feasibility and advisability of making access to care standards applicable jointly under the TRICARE program and the Department of Veterans Affairs health care system. "(E) A review of the process prescribed by the Secretary of Defense under subsection (a) to determine whether the process ensures the adequacy and quality of the health care services provided to covered beneficiaries under the TRICARE program and through the Department of Veterans Affairs, together with timeliness of access to such services and patient safety. "(2) Not later than 60 days after the congressional committees specified in subsection (a)(2) receive the report required under that subsection, the Comptroller General shall submit to those committees a report on the study conducted under this subsection. "(c) Definitions. - In this section: "(1) The term 'covered beneficiary' has the meaning provided by section 1072(5) of title 10, United States Code. "(2) The term 'TRICARE program' has the meaning provided by section 1072(7) of such title. "(3) The term 'TRICARE Prime' has the meaning provided by section 1097a(f) of such title." PILOT PROGRAM PROVIDING FOR DEPARTMENT OF VETERANS AFFAIRS SUPPORT IN THE PERFORMANCE OF SEPARATION PHYSICAL EXAMINATIONS Pub. L. 107-107, div. A, title VII, Sec. 734, Dec. 28, 2001, 115 Stat. 1170, authorized the Secretary of Defense and the Secretary of Veterans Affairs to jointly carry out a pilot program, to begin not later than July 1, 2002, and terminate on Dec. 31, 2005, under which the Secretary of Veterans Affairs, in one or more geographic areas, could perform the physical examinations required for separation of members from the uniformed services, and directed the Secretaries to jointly submit to Congress interim and final reports not later than Mar. 1, 2005. HEALTH CARE MANAGEMENT DEMONSTRATION PROGRAM Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 733], Oct. 30, 2000, 114 Stat. 1654, 1654A-191, as amended by Pub. L. 107-107, div. A, title VII, Sec. 737, Dec. 28, 2001, 115 Stat. 1173, directed the Secretary of Defense to carry out a demonstration program on health care management, to begin not later than 180 days after Oct. 30, 2000, and terminate on Dec. 31, 2003, to explore opportunities for improving the planning, programming, budgeting systems, and management of the Department of Defense health care system, and directed the Secretary to submit a report on such program to committees of Congress not later than Mar. 15, 2004. PROCESSES FOR PATIENT SAFETY IN MILITARY AND VETERANS HEALTH CARE SYSTEMS Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 742], Oct. 30, 2000, 114 Stat. 1654, 1654A-192, provided that: "(a) Error Tracking Process. - The Secretary of Defense shall implement a centralized process for reporting, compilation, and analysis of errors in the provision of health care under the defense health program that endanger patients beyond the normal risks associated with the care and treatment of such patients. To the extent practicable, that process shall emulate the system established by the Secretary of Veterans Affairs for reporting, compilation, and analysis of errors in the provision of health care under the Department of Veterans Affairs health care system that endanger patients beyond such risks. "(b) Sharing of Information. - The Secretary of Defense and the Secretary of Veterans Affairs - "(1) shall share information regarding the designs of systems or protocols established to reduce errors in the provision of health care described in subsection (a); and "(2) shall develop such protocols as the Secretaries consider necessary for the establishment and administration of effective processes for the reporting, compilation, and analysis of such errors." COOPERATION IN DEVELOPING PHARMACEUTICAL IDENTIFICATION TECHNOLOGY Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 743], Oct. 30, 2000, 114 Stat. 1654, 1654A-192, provided that: "The Secretary of Defense and the Secretary of Veterans Affairs shall cooperate in developing systems for the use of bar codes for the identification of pharmaceuticals in the health care programs of the Department of Defense and the Department of Veterans Affairs. In any case in which a common pharmaceutical is used in such programs, the bar codes for those pharmaceuticals shall, to the maximum extent practicable, be identical." PATIENT CARE REPORTING AND MANAGEMENT SYSTEM Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 754], Oct. 30, 2000, 114 Stat. 1654, 1654A-196, as amended by Pub. L. 109-163, div. A, title VII, Sec. 741, Jan. 6, 2006, 119 Stat. 3360, provided that: "(a) Establishment. - The Secretary of Defense shall establish a patient care error reporting and management system. "(b) Purposes of System. - The purposes of the system are as follows: "(1) To study the occurrences of errors in the patient care provided under chapter 55 of title 10, United States Code. "(2) To identify the systemic factors that are associated with such occurrences. "(3) To provide for action to be taken to correct the identified systemic factors. "(c) Requirements for System. - The patient care error reporting and management system shall include the following: "(1) A hospital-level patient safety center, within the quality assurance department of each health care organization of the Department of Defense, to collect, assess, and report on the nature and frequency of errors related to patient care. "(2) For each health care organization of the Department of Defense and for the entire Defense health program, patient safety standards that are necessary for the development of a full understanding of patient safety issues in each such organization and the entire program, including the nature and types of errors and the systemic causes of the errors. "(3) Establishment of a Department of Defense Patient Safety Center, which shall have the following missions: "(A) To analyze information on patient care errors that is submitted to the Center by each military health care organization. "(B) To develop action plans for addressing patterns of patient care errors. "(C) To execute those action plans to mitigate and control errors in patient care with a goal of ensuring that the health care organizations of the Department of Defense provide highly reliable patient care with virtually no error. "(D) To provide, through the Assistant Secretary of Defense for Health Affairs, to the Agency for Healthcare Research and Quality of the Department of Health and Human Services any reports that the Assistant Secretary determines appropriate. "(E) To review and integrate processes for reducing errors associated with patient care and for enhancing patient safety. "(F) To contract with a qualified and objective external organization to manage the national patient safety database of the Department of Defense. "(d) Medical Team Training Program. - The Secretary shall expand the health care team coordination program to integrate that program into all Department of Defense health care operations. In carrying out this subsection, the Secretary shall take the following actions: "(1) Establish not less than two Centers of Excellence for the development, validation, proliferation, and sustainment of the health care team coordination program, one of which shall support all fixed military health care organizations, the other of which shall support all combat casualty care organizations. "(2) Deploy the program to all fixed and combat casualty care organizations of each of the Armed Forces, at the rate of not less than 10 organizations in each fiscal year. "(3) Expand the scope of the health care team coordination program from a focus on emergency department care to a coverage that includes care in all major medical specialties, at the rate of not less than one specialty in each fiscal year. "(4) Continue research and development investments to improve communication, coordination, and team work in the provision of health care. "(e) Consultation. - The Secretary shall consult with the other administering Secretaries (as defined in section 1072(3) of title 10, United States Code) in carrying out this section." CONFIDENTIALITY OF COMMUNICATIONS WITH PROFESSIONALS PROVIDING THERAPEUTIC OR RELATED SERVICES REGARDING SEXUAL OR DOMESTIC ABUSE Pub. L. 106-65, div. A, title V, Sec. 585, Oct. 5, 1999, 113 Stat. 636, provided that: "(a) Study and Report. - (1) The Comptroller General of the United States shall study the policies, procedures, and practices of the military departments for protecting the confidentiality of communications between - "(A) a dependent (as defined in section 1072(2) of title 10, United States Code, with respect to a member of the Armed Forces) of a member of the Armed Forces who - "(i) is a victim of sexual harassment, sexual assault, or intrafamily abuse; or "(ii) has engaged in such misconduct; and "(B) a therapist, counselor, advocate, or other professional from whom the dependent seeks professional services in connection with effects of such misconduct. "(2) Not later than 180 days after the date of the enactment of this Act [Oct. 5, 1999], the Comptroller General shall conclude the study and submit a report on the results of the study to Congress and the Secretary of Defense. "(b) Regulations. - The Secretary of Defense shall prescribe in regulations the policies and procedures that the Secretary considers appropriate to provide the maximum protections for the confidentiality of communications described in subsection (a) relating to misconduct described in that subsection, taking into consideration - "(1) the findings of the Comptroller General; "(2) the standards of confidentiality and ethical standards issued by relevant professional organizations; "(3) applicable requirements of Federal and State law; "(4) the best interest of victims of sexual harassment, sexual assault, or intrafamily abuse; "(5) military necessity; and "(6) such other factors as the Secretary, in consultation with the Attorney General, may consider appropriate. "(c) Report by Secretary of Defense. - Not later than January 21, 2000, the Secretary of Defense shall submit to Congress a report on the actions taken under subsection (b) and any other actions taken by the Secretary to provide the maximum possible protections for confidentiality described in that subsection." HEALTH CARE QUALITY INFORMATION AND TECHNOLOGY ENHANCEMENT Pub. L. 106-65, div. A, title VII, Sec. 723, Oct. 5, 1999, 113 Stat. 695, as amended by Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 753(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A-195; Pub. L. 109-163, div. A, title VII, Sec. 742, Jan. 6, 2006, 119 Stat. 3360; Pub. L. 109-364, div. A, title X, Sec. 1046(e), Oct. 17, 2006, 120 Stat. 2394, provided that: "(a) Purpose. - The purpose of this section is to ensure that the Department of Defense addresses issues of medical quality surveillance and implements solutions for those issues in a timely manner that is consistent with national policy and industry standards. "(b) Department of Defense Program for Medical Informatics and Data. - The Secretary of Defense shall establish a Department of Defense program, the purposes of which shall be the following: "(1) To develop parameters for assessing the quality of health care information. "(2) To develop the defense digital patient record. "(3) To develop a repository for data on quality of health care. "(4) To develop capability for conducting research on quality of health care. "(5) To conduct research on matters of quality of health care. "(6) To develop decision support tools for health care providers. "(7) To refine medical performance report cards. "(8) To conduct educational programs on medical informatics to meet identified needs. "(c) Automation and Capture of Clinical Data. - (1) Through the program established under subsection (b), the Secretary of Defense shall accelerate the efforts of the Department of Defense to automate, capture, and exchange controlled clinical data and present providers with clinical guidance using a personal information carrier, clinical lexicon, or digital patient record. "(2) The program shall serve as a primary resource for the Department of Defense for matters concerning the capture, processing, and dissemination of data on health care quality. "(d) Medical Informatics Advisory Committee. - (1) The Secretary of Defense shall establish a Medical Informatics Advisory Committee (hereinafter referred to as the 'Committee'), the members of which shall be the following: "(A) The Assistant Secretary of Defense for Health Affairs. "(B) The Director of the TRICARE Management Activity of the Department of Defense. "(C) The Surgeon General of the Army. "(D) The Surgeon General of the Navy. "(E) The Surgeon General of the Air Force. "(F) Representatives of the Department of Veterans Affairs, designated by the Secretary of Veterans Affairs. "(G) Representatives of the Department of Health and Human Services, designated by the Secretary of Health and Human Services. "(H) Any additional members appointed by the Secretary of Defense to represent health care insurers and managed care organizations, academic health institutions, health care providers (including representatives of physicians and representatives of hospitals), and accreditors of health care plans and organizations. "(2) The primary mission of the Committee shall be to advise the Secretary on the development, deployment, and maintenance of health care informatics systems that allow for the collection, exchange, and processing of health care quality information for the Department of Defense in coordination with other Federal departments and agencies and with the private sector. "(3) Specific areas of responsibility of the Committee shall include advising the Secretary on the following: "(A) The ability of the medical informatics systems at the Department of Defense and Department of Veterans Affairs to monitor, evaluate, and improve the quality of care provided to beneficiaries. "(B) The coordination of key components of medical informatics systems, including digital patient records, both within the Federal Government and between the Federal Government and the private sector. "(C) The development of operational capabilities for executive information systems and clinical decision support systems within the Department of Defense and Department of Veterans Affairs. "(D) Standardization of processes used to collect, evaluate, and disseminate health care quality information. "(E) Refinement of methodologies by which the quality of health care provided within the Department of Defense and Department of Veterans Affairs is evaluated. "(F) Protecting the confidentiality of personal health information. "(4) The Assistant Secretary of Defense for Health Affairs shall consult with the Committee on the issues described in paragraph (3). "(5) Members of the Committee shall not be paid by reason of their service on the Committee. "(6) The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Committee. "(e) Annual Report. - The Assistant Secretary of Defense for Health Affairs shall submit to Congress on an annual basis a report on the quality of health care furnished under the health care programs of the Department of Defense. The report shall cover the most recent fiscal year ending before the date the report is submitted and shall contain a discussion of the quality of the health care measured on the basis of each statistical and customer satisfaction factor that the Assistant Secretary determines appropriate, including, at a minimum, a discussion of the following: "(1) Measures of the quality of health care furnished, including timeliness and accessibility of care. "(2) Population health. "(3) Patient safety. "(4) Patient satisfaction. "(5) The extent of use of evidence-based health care practices. "(6) The effectiveness of biosurveillance in detecting an emerging epidemic." JOINT DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS REPORTS RELATING TO INTERDEPARTMENTAL COOPERATION IN DELIVERY OF MEDICAL CARE Pub. L. 105-261, div. A, title VII, Sec. 745, Oct. 17, 1998, 112 Stat. 2075, as amended by Pub. L. 106-65, div. A, title X, Sec. 1067(3), Oct. 5, 1999, 113 Stat. 774; Pub. L. 108-136, div. A, title X, Sec. 1031(g)(1), Nov. 24, 2003, 117 Stat. 1604, (1) directed the Secretary of Defense and the Secretary of Veterans Affairs to jointly conduct a survey of their respective medical care beneficiary populations to identify the expectations of, requirements for, and behavior patterns of the beneficiaries with respect to medical care, and to submit a report on the results of the survey to committees of Congress not later than Jan. 1, 2000; (2) directed the same Secretaries to jointly conduct a review to identify impediments to cooperation between the Department of Defense and the Department of Veterans Affairs regarding the delivery of medical care and to submit a report on the results of the review to committees of Congress not later than Mar. 1, 1999; (3) directed the Secretary of Defense to review the TRICARE program to identify opportunities for increased participation by the Department of Veterans Affairs in that program; (4) directed the Department of Defense-Department of Veterans Affairs Federal Pharmacy Executive Steering Committee to examine existing pharmaceutical benefits and programs for beneficiaries and review existing methods for contracting for and distributing medical supplies and services and to submit a report on the results of the examination to committees of Congress not later than 60 days after its completion; and (5) directed the Secretary of Defense and the Secretary of Veterans Affairs to jointly submit to committees of Congress a report, not later than Mar. 1, 1999, on the status of the efforts of the Department of Defense and the Department of Veterans Affairs to standardize physical examinations administered by the two departments for the purpose of determining or rating disabilities. EXTERNAL PEER REVIEW FOR DEFENSE HEALTH PROGRAM EXTRAMURAL MEDICAL RESEARCH INVOLVING HUMAN SUBJECTS Pub. L. 104-201, div. A, title VII, Sec. 742, Sept. 23, 1996, 110 Stat. 2600, provided that: "(a) Establishment of External Peer Review Process. - The Secretary of Defense shall establish a peer review process that will use persons who are not officers or employees of the Government to review the research protocols of medical research projects. "(b) Peer Review Requirements. - Funds of the Department of Defense may not be obligated or expended for any medical research project unless the research protocol for the project has been approved by the external peer review process established under subsection (a). "(c) Medical Research Project Defined. - For purposes of this section, the term 'medical research project' means a research project that - "(1) involves the participation of human subjects; "(2) is conducted solely by a non-Federal entity; and "(3) is funded through the Defense Health Program account. "(d) Effective Date. - The peer review requirements of subsection (b) shall take effect on October 1, 1996, and, except as provided in subsection (e), shall apply to all medical research projects proposed funded on or after that date, including medical research projects funded pursuant to any requirement of law enacted before, on, or after that date. "(e) Exceptions. - Only the following medical research projects shall be exempt from the peer review requirements of subsection (b): "(1) A medical research project that the Secretary determines has been substantially completed by October 1, 1996. "(2) A medical research project funded pursuant to any provision of law enacted on or after that date if the provision of law specifically refers to this section and specifically states that the peer review requirements do not apply." ANNUAL BENEFICIARY SURVEY Pub. L. 102-484, div. A, title VII, Sec. 724, Oct. 23, 1992, 106 Stat. 2440, as amended by Pub. L. 103-337, div. A, title VII, Sec. 717, Oct. 5, 1994, 108 Stat. 2804, provided that: "(a) Survey Required. - The administering Secretaries shall conduct annually a formal survey of persons receiving health care under chapter 55 of title 10, United States Code, in order to determine the following: "(1) The availability of health care services to such persons through the health care system provided for under that chapter, the types of services received, and the facilities in which the services were provided. "(2) The familiarity of such persons with the services available under that system and with the facilities in which such services are provided. "(3) The health of such persons. "(4) The level of satisfaction of such persons with that system and the quality of the health care provided through that system. "(5) Such other matters as the administering Secretaries determine appropriate. "(b) Exemption. - An annual survey under subsection (a) shall be treated as not a collection of information for the purposes for which such term is defined in section 3502(4) of title 44, United States Code. "(c) Definition. - For purposes of this section, the term 'administering Secretaries' has the meaning given such term in section 1072(3) of title 10, United States Code." COMPREHENSIVE STUDY OF MILITARY MEDICAL CARE SYSTEM Pub. L. 102-190, div. A, title VII, Sec. 733, Dec. 5, 1991, 105 Stat. 1408, as amended by Pub. L. 102-484, div. A, title VII, Sec. 723, Oct. 23, 1992, 106 Stat. 2440, directed Secretary of Defense to conduct a comprehensive study of the military medical care system, not later than Dec. 15, 1992, to submit to congressional defense committees a detailed accounting on progress of the study, including preliminary results of the study, and not later than Dec. 15, 1993, submit to congressional defense committees a final report on the study. IDENTIFICATION AND TREATMENT OF DRUG AND ALCOHOL DEPENDENT PERSONS IN THE ARMED FORCES Pub. L. 92-129, title V, Sec. 501, Sept. 28, 1971, 85 Stat. 361, which directed Secretary of Defense to devise ways to identify, treat, and rehabilitate drug and alcohol dependent members of the armed forces, to identify, refuse admission to, and refer to civilian treatment facilities such persons seeking entrance to the armed forces, and to report to Congress on and suggest additional legislation concerning these matters, was repealed and restated as sections 978 and 1090 of this title by Pub. L. 97-295, Secs. 1(14)(A), (15)(A), 6(b), Oct. 12, 1982, 96 Stat. 1289, 1290, 1314. -End- -CITE- 10 USC Sec. 1072 01/03/2007 -EXPCITE- TITLE 10 - ARMED FORCES Subtitle A - General Military Law PART II - PERSONNEL CHAPTER 55 - MEDICAL AND DENTAL CARE -HEAD- Sec. 1072. Definitions -STATUTE- In this chapter: (1) The term "uniformed services" means the armed forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service. (2) The term "dependent", with respect to a member or former member of a uniformed service, means - (A) the spouse; (B) the unremarried widow; (C) the unremarried widower; (D) a child who - (i) has not attained the age of 21; (ii) has not attained the age of 23, is enrolled in a full- time course of study at an institution of higher learning approved by the administering Secretary and is, or was at the time of the member's or former member's death, in fact dependent on the member or former member for over one-half of the child's support; or (iii) is incapable of self-support because of a mental or physical incapacity that occurs while a dependent of a member or former member under clause (i) or (ii) and is, or was at the time of the member's or former member's death, in fact dependent on the member or former member for over one-half of the child's support; (E) a parent or parent-in-law who is, or was at the time of the member's or former member's death, in fact dependent on him for over one-half of his support and residing in his household; (F) the unremarried former spouse of a member or former member who (i) on the date of the final decree of divorce, dissolution, or annulment, had been married to the member or former member for a period of at least 20 years during which period the member or former member performed at least 20 years of service which is creditable in determining that member's or former member's eligibility for retired or retainer pay, or equivalent pay, and (ii) does not have medical coverage under an employer-sponsored health plan; (G) a person who (i) is the unremarried former spouse of a member or former member who performed at least 20 years of service which is creditable in determining the member or former member's eligibility for retired or retainer pay, or equivalent pay, and on the date of the final decree of divorce, dissolution, or annulment before April 1, 1985, had been married to the member or former member for a period of at least 20 years, at least 15 of which, but less than 20 of which, were during the period the member or former member performed service creditable in determining the member or former member's eligibility for retired or retainer pay, and (ii) does not have medical coverage under an employer-sponsored health plan; (H) a person who would qualify as a dependent under clause (G) but for the fact that the date of the final decree of divorce, dissolution, or annulment of the person is on or after April 1, 1985, except that the term does not include the person after the end of the one-year period beginning on the date of that final decree; and (I) an unmarried person who - (i) is placed in the legal custody of the member or former member as a result of an order of a court of competent jurisdiction in the United States (or possession of the United States) for a period of at least 12 consecutive months; (ii) either - (I) has not attained the age of 21; (II) has not attained the age of 23 and is enrolled in a full time course of study at an institution of higher learning approved by the administering Secretary; or (III) is incapable of self support because of a mental or physical incapacity that occurred while the person was considered a dependent of the member or former member under this subparagraph pursuant to subclause (I) or (II); (iii) is dependent on the member or former member for over one-half of the person's support; (iv) resides with the member or former member unless separated by the necessity of military service or to receive institutional care as a result of disability or incapacitation or under such other circumstances as the administering Secretary may by regulation prescribe; and (v) is not a dependent of a member or a former member under any other subparagraph. (3) The term "administering Secretaries" means the Secretaries of executive departments specified in section 1073 of this title as having responsibility for administering this chapter. (4) The term "Civilian Health and Medical Program of the Uniformed Services" means the program authorized under sections 1079 and 1086 of this title and includes contracts entered into under section 1091 or 1097 of this title and demonstration projects under section 1092 of this title. (5) The term "covered beneficiary" means a beneficiary under this chapter other than a beneficiary under section 1074(a) of this title. (6) The term "child", with respect to a member or former member of a uniformed service, means the following: (A) An unmarried legitimate child. (B) An unmarried adopted child. (C) An unmarried stepchild. (D) An unmarried person - (i) who is placed in the home of the member or former member by a placement agency (recognized by the Secretary of Defense), or by any other source authorized by State or local law to provide adoption placement, in anticipation of the legal adoption of the person by the member or former member; and (ii) who otherwise meets the requirements specified in paragraph (2)(D). (7) The term "TRICARE program" means the managed health care program that is established by the Department of Defense under the authority of this chapter, principally section 1097 of this title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. (8) The term "custodial care" means treatment or services, regardless of who recommends such treatment or services or where such treatment or services are provided, that - (A) can be rendered safely and reasonably by a person who is not medically skilled; or (B) is or are designed mainly to help the patient with the activities of daily living. (9) The term "domiciliary care" means care provided to a patient in an institution or homelike environment because - (A) providing support for the activities of daily living in the home is not available or is unsuitable; or (B) members of the patient's family are unwilling to provide the care. -SOURCE- (Added Pub. L. 85-861, Sec. 1(25)(B), Sept. 2, 1958, 72 Stat. 1446; amended Pub. L. 89-614, Sec. 2(1), Sept. 30, 1966, 80 Stat. 862; Pub. L. 89-718, Sec. 8(a), Nov. 2, 1966, 80 Stat. 1117; Pub. L. 96- 513, title I, Sec. 115(b), title V, Sec. 511(34)(A), (35), (36), Dec. 12, 1980, 94 Stat. 2877, 2922, 2923; Pub. L. 97-252, title X, Sec. 1004(a), Sept. 8, 1982, 96 Stat. 737; Pub. L. 98-525, title VI, Sec. 645(a), Oct. 19, 1984, 98 Stat. 2548; Pub. L. 98-557, Sec. 19(1), Oct. 30, 1984, 98 Stat. 2869; Pub. L. 99-661, div. A, title VII, Sec. 701(b), Nov. 14, 1986, 100 Stat. 3898; Pub. L. 101-189, div. A, title VII, Sec. 731(a), Nov. 29, 1989, 103 Stat. 1481; Pub. L. 102-484, div. A, title VII, Sec. 706, Oct. 23, 1992, 106 Stat. 2433; Pub. L. 103-160, div. A, title VII, Sec. 702(a), Nov. 30, 1993, 107 Stat. 1686; Pub. L. 103-337, div. A, title VII, Sec. 701(a), Oct. 5, 1994, 108 Stat. 2797; Pub. L. 105-85, div. A, title VII, Sec. 711, Nov. 18, 1997, 111 Stat. 1808; Pub. L. 107-107, div. A, title VII, Sec. 701(c), Dec. 28, 2001, 115 Stat. 1160; Pub. L. 109-163, div. A, title V, Sec. 592(b), title X, Sec. 1057(a)(2), Jan. 6, 2006, 119 Stat. 3280, 3440.) -MISC1- HISTORICAL AND REVISION NOTES -------------------------------------------------------------------- Revised Source (U.S. Code) Source (Statutes at section Large) -------------------------------------------------------------------- 1072(1) 37:402(a)(1). June 7, 1956, ch. 374, Sec. 102(a)(1), (4), 70 Stat. 250. 1072(2) 37:402(a)(4). -------------------------------------------------------------------- In clause (1), the words "the armed forces" are substituted for the words "the Army, the Navy, the Air Force, the Marine Corps, the Coast Guard" to reflect section 101(4) of this title. In clause (2), the words "or to a person who died while a member or retired member of a uniformed service" and "lawful" are omitted as surplusage. The word "former" is substituted for the word "retired", since a retired member or a member of the Fleet Reserve or the Fleet Marine Corps Reserve is already included as a "member" of an armed force. Clause (2)(E) combines 37:402(a)(4)(E) and (G). PRIOR PROVISIONS A prior section 1072, act Aug. 10, 1956, ch. 1041, 70A Stat. 81, defined terms used in former sections 1071 to 1086 of this title, prior to repeal by Pub. L. 85-861, Sec. 36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which is classified to subchapter I-D (Sec. 1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare. AMENDMENTS 2006 - Par. (2)(I)(i). Pub. L. 109-163, Sec. 1057(a)(2), struck out "or a Territory" before "or possession". Par. (6)(D)(i). Pub. L. 109-163, Sec. 592(b), inserted ", or by any other source authorized by State or local law to provide adoption placement," after "(recognized by the Secretary of Defense)". 2001 - Pars. (8), (9). Pub. L. 107-107 added pars. (8) and (9). 1997 - Par. (7). Pub. L. 105-85 added par. (7). 1994 - Par. (2)(D). Pub. L. 103-337, Sec. 701(a)(1), substituted "a child who" for "an unmarried legitimate child, including an adopted child or stepchild, who" in introductory provisions. Par. (6). Pub. L. 103-337, Sec. 701(a)(2), added par. (6). 1993 - Par. (2)(I). Pub. L. 103-160 added subpar. (I). 1992 - Par. (2)(D). Pub. L. 102-484 added subpar. (D) and struck out former subpar. (D) which read as follows: "an unmarried legitimate child, including an adopted child or a stepchild, who either - "(i) has not passed his twenty-first birthday; "(ii) is incapable of self-support because of a mental or physical incapacity that existed before that birthday and is, or was at the time of the member's or former member's death, in fact dependent on him for over one-half of his support; or "(iii) has not passed his twenty-third birthday, is enrolled in a full-time course of study in an institution of higher learning approved by the administering Secretary and is, or was at the time of the member's or former member's death, in fact dependent on him for over one-half of his support;". 1989 - Par. (2)(H). Pub. L. 101-189 added subpar. (H). 1986 - Par. (1). Pub. L. 99-661, Sec. 701(b)(1), substituted "The term 'uniformed services' means" for " 'Uniformed services' means". Par. (2). Pub. L. 99-661, Sec. 701(b)(2), substituted "The term 'dependent', with respect to" for " 'Dependent', with respect to". Par. (3). Pub. L. 99-661, Sec. 701(b)(3), substituted "The term 'administering Secretaries' means" for " 'Administering Secretaries' means". Pars. (4), (5). Pub. L. 99-661, Sec. 701(b)(4), added pars. (4) and (5). 1984 - Par. (2)(D)(iii). Pub. L. 98-557, Sec. 19(1)(A), substituted reference to the administering Secretary for reference to the Secretary of Defense or the Secretary of Health and Human Services. Par. (2)(G). Pub. L. 98-525 added subpar. (G). Par. (3). Pub. L. 98-557, Sec. 19(1)(B), added par. (3). 1982 - Par. (2)(F). Pub. L. 97-252 added cl. (F). 1980 - Pub. L. 96-513, Sec. 511(34)(A), substituted in introductory material reference to this chapter for reference to sections 1071-1087 of this title. Par. (1). Pub. L. 96-513, Sec. 511(35), substituted "National Oceanic and Atmospheric Administration" for "Environmental Science Services Administration". Par. (2). Pub. L. 96-513, Secs. 115(b), 511(36), substituted "spouse" for "wife" in cl. (A), struck out cl. (C) "the husband, if he is in fact dependent on the member or former member for over one- half of his support;", redesignated cls. (D), (E), and (F) as (C), (D), and (E), respectively, in cl. (C) as so redesignated, struck out ", if, because of mental or physical incapacity he was in fact dependent on the member or former member at the time of her death for over one-half of his support" after "the unremarried widower", and in cl. (D)(iii) as so redesignated, substituted "Health and Human Services" for "Health, Education, and Welfare". 1966 - Pub. L. 89-718 substituted "Environmental Science Services Administration" for "Coast and Geodetic Survey" in clause (1). Pub. L. 89-614 substituted "1087" for "1085" in introductory phrase. EFFECTIVE DATE OF 1993 AMENDMENT Section 702(b) of Pub. L. 103-160 provided that: "Section 1072(2)(I) of title 10, United States Code, as added by subsection (a), shall apply with respect to determinations of dependency made on or after July 1, 1994." EFFECTIVE DATE OF 1989 AMENDMENT Section 731(d) of Pub. L. 101-189 provided that: "(1) The amendments made by this section [enacting section 1086a of this title and amending this section and sections 1076 and 1086 of this title] apply to a person referred to in section 1072(2)(H) of title 10, United States Code (as added by subsection (a)), whose decree of divorce, dissolution, or annulment becomes final on or after the date of the enactment of this Act [Nov. 29, 1989]. "(2) The amendments made by this section shall also apply to a person referred to in such section whose decree of divorce, dissolution, or annulment became final during the period beginning on September 29, 1988, and ending on the day before the date of the enactment of this Act, as if the amendments had become effective on September 29, 1988." EFFECTIVE DATE OF 1984 AMENDMENT Section 645(d) of Pub. L. 98-525 provided that: "The amendments made by subsections (a), (b), and (c) [amending this section and provisions set out as a note under section 1408 of this title and enacting provisions set out as a note under this section] shall be effective on January 1, 1985, and shall apply with respect to health care furnished on or after that date." EFFECTIVE DATE OF 1982 AMENDMENT; TRANSITION PROVISIONS Amendment by Pub. L. 97-252 effective Feb. 1, 1983, and applicable in the case of any former spouse of a member or former member of the uniformed services whether final decree of divorce, dissolution, or annulment of marriage of former spouse and such member or former member is dated before, on, or after Feb. 1, 1983, see section 1006 of Pub. L. 97-252, set out as an Effective Date; Transition Provisions note under section 1408 of this title. EFFECTIVE DATE OF 1980 AMENDMENT Amendment by section 115(b) of Pub. L. 96-513 effective Sept. 15, 1981, but the authority to prescribe regulations under the amendment by Pub. L. 96-513 effective on Dec. 12, 1980, and amendment by section 511(34)(A), (35), (36) of Pub. L. 96-513 effective Dec. 12, 1980, see section 701 of Pub. L. 96-513, set out as a note under section 101 of this title. EFFECTIVE DATE OF 1966 AMENDMENT For effective date of amendment by Pub. L. 89-614, see section 3 of Pub. L. 89-614, set out as a note under section 1071 of this title. REPEALS The directory language of, but not the amendment made by, Pub. L. 89-718, Sec. 8(a), Nov. 2, 1966, 80 Stat. 1117, cited as a credit to this section, was repealed by Pub. L. 97-295, Sec. 6(b), Oct. 12, 1982, 96 Stat. 1314. CONTINUATION OF INDIVIDUAL CASE MANAGEMENT SERVICES FOR CERTAIN ELIGIBLE BENEFICIARIES Pub. L. 107-107, div. A, title VII, Sec. 701(d), Dec. 28, 2001, 115 Stat. 1160, provided that: "(1) Notwithstanding the termination of the Individual Case Management Program by subsection (g) [amending section 1079 of this title and repealing provisions set out as a note under section 1077 of this title], the Secretary of Defense shall, in any case in which the Secretary makes the determination described in paragraph (2), continue to provide payment as if such program were in effect for home health care or custodial care services provided to an eligible beneficiary that would otherwise be excluded from coverage under regulations implementing chapter 55 of title 10, United States Code. "(2) The determination referred to in paragraph (1) is a determination that discontinuation of payment for services not otherwise provided under such chapter would result in the provision of services inadequate to meet the needs of the eligible beneficiary and would be unjust to such beneficiary. "(3) For purposes of this subsection, 'eligible beneficiary' means a covered beneficiary (as that term is defined in section 1072 of title 10, United States Code) who, before the effective date of this section [Dec. 28, 2001], was provided custodial care services under the Individual Case Management Program for which the Secretary provided payment." IMPROVEMENTS IN ADMINISTRATION OF THE TRICARE PROGRAM; FLEXIBILITY OF CONTRACTING Pub. L. 107-107, div. A, title VII, Sec. 708(a), Dec. 28, 2001, 115 Stat. 1164, provided that: "(1) During the one-year period following the date of the enactment of this Act [Dec. 28, 2001], section 1072(7) of title 10, United States Code, shall be deemed to be amended by striking 'the competitive selection of contractors to financially underwrite'. "(2) The terms and conditions of any contract to provide health care services under the TRICARE program entered into during the period described in paragraph (1) shall not be considered to be modified or terminated as a result of the termination of such period." TRANSITIONAL PROVISIONS FOR QUALIFICATION FOR CONVERSION HEALTH POLICIES; PREEXISTING CONDITIONS Section 731(e) of Pub. L. 101-189 provided that: "(1) In the case of a person who qualified as a dependent under section 645(c) of the Department of Defense Authorization Act, 1985 (Public Law 98-525; 98 Stat. 2549) [set out below], on September 28, 1988, the Secretary of Defense shall make a conversion health policy available for purchase by the person during the remaining period the person is considered to be a dependent under that section (or within a reasonable time after that period as prescribed by the Secretary of Defense). "(2) Purchase of a conversion health policy under paragraph (1) by a person shall entitle the person to health care for preexisting conditions in the same manner and to the same extent as provided by section 1086a(b) of title 10, United States Code (as added by subsection (b)), until the end of the one-year period beginning on the later of - "(A) the date the person is no longer qualified as a dependent under section 645(c) of the Department of Defense Authorization Act, 1985; and "(B) the date of the purchase of the policy. "(3) For purposes of this subsection, the term 'conversion health policy' has the meaning given that term in section 1086a(c) of title 10, United States Code (as added by subsection (b))." DEPENDENT; QUALIFICATION AS; EFFECTIVE DATE Section 645(c) of Pub. L. 98-525, as amended by Pub. L. 99-661, div. A, title VI, Sec. 646, Nov. 14, 1986, 100 Stat. 3887; Pub. L. 100-271, Sec. 1, Mar. 29, 1988, 102 Stat. 45; Pub. L. 100-271, Sec. 1, Mar. 29, 1988, 102 Stat. 45, provided that a person who would qualify as a dependent under section 1072(2)(G) of title 10 but for the fact that the person's final decree of divorce, dissolution, or annulment was dated on or after Apr. 1, 1985, would be considered to be a dependent under such section until the later of (1) Dec. 31, 1988, and (2) the last day of the two-year period beginning on the date of such final decree, prior to repeal by Pub. L. 100-456, div. A, title VI, Sec. 651(b), Sept. 29, 1988, 102 Stat. 1990, effective Sept. 29, 1988, or 30 days after the Secretary of Defense first makes available a conversion health policy (as defined in section 1076(f) of title 10), whichever is later. -End- -CITE- 10 USC Sec. 1073 01/03/2007 -EXPCITE- TITLE 10 - ARMED FORCES Subtitle A - General Military Law PART II - PERSONNEL CHAPTER 55 - MEDICAL AND DENTAL CARE -HEAD- Sec. 1073. Administration of this chapter -STATUTE- (a) Responsible Officials. - Except as otherwise provided in this chapter, the Secretary of Defense shall administer this chapter, for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy, and the Secretary of Health and Human Services shall administer this chapter and for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997 (42 U.S.C. 14401 et seq.). (b) Stability in Program of Benefits. - The Secretary of Defense shall, to the maximum extent practicable, provide a stable program of benefits under this chapter throughout each fiscal year. To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense may implement any such change prior to the next fiscal quarter if the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter. -SOURCE- (Added Pub. L. 85-861, Sec. 1(25)(B), Sept. 2, 1958, 72 Stat. 1446; amended Pub. L. 89-614, Sec. 2(1), Sept. 30, 1966, 80 Stat. 862; Pub. L. 89-718, Sec. 8(a), Nov. 2, 1966, 80 Stat. 1117; Pub. L. 96- 513, title V, Sec. 511(34)(A), (C), (35), (36), Dec. 12, 1980, 94 Stat. 2922, 2923; Pub. L. 98-557, Sec. 19(2), Oct. 30, 1984, 98 Stat. 2869; Pub. L. 105-12, Sec. 9(h), Apr. 30, 1997, 111 Stat. 27; Pub. L. 106-65, div. A, title VII, Sec. 725, title X, Sec. 1066(a)(7), Oct. 5, 1999, 113 Stat. 698, 770; Pub. L. 107-296, title XVII, Sec. 1704(b)(1), Nov. 25, 2002, 116 Stat. 2314.) -MISC1- HISTORICAL AND REVISION NOTES -------------------------------------------------------------------- Revised Source (U.S. Code) Source (Statutes at section Large) -------------------------------------------------------------------- 1073 37:402(b). June 7, 1956, ch. 374, Sec. 102(b), 70 Stat. 251. -------------------------------------------------------------------- The words "armed forces under his jurisdiction" are substituted for the words "Army, Navy, Air Force, and Marine Corps and for the Coast Guard when it is operating as a service in the Navy" to reflect section 101(4) of this title. -REFTEXT- REFERENCES IN TEXT The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (a), is Pub. L. 105-12, Apr. 30, 1997, 111 Stat. 23, which is classified principally to chapter 138 (Sec. 14401 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under section 14401 of Title 42 and Tables. -MISC2- PRIOR PROVISIONS A prior section 1073, act Aug. 10, 1956, ch. 1041, 70A Stat. 82, related to right to vote in war-time presidential and congressional election, prior to repeal by Pub. L. 85-861, Sec. 36B(5), Sept. 2, 1958, 72 Stat. 1570, as superseded by the Federal Voting Assistance Act of 1955 which is classified to subchapter I-D (Sec. 1973cc et seq.) of chapter 20 of Title 42, The Public Health and Welfare. AMENDMENTS 2002 - Subsec. (a). Pub. L. 107-296 substituted "of Homeland Security" for "of Transportation". 1999 - Pub. L. 106-65, Sec. 725, designated existing provisions, as amended by Pub. L. 106-65, Sec. 1066(a)(7), as subsec. (a), inserted heading, and added subsec. (b). Pub. L. 106-65, Sec. 1066(a)(7), inserted "(42 U.S.C. 14401 et seq.)" after "Act of 1997". 1997 - Pub. L. 105-12 inserted at end "This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997." 1984 - Pub. L. 98-557 inserted provisions which transferred authority to administer chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy from the Secretary of Health and Human Services to the Secretary of Transportation. 1980 - Pub. L. 96-513 substituted in section catchline "of this chapter" for "of sections 1071-1087 of this title", and substituted in text "this chapter" for "sections 1071-1087 of this title", "those sections", and "them", "Secretary of Health and Human Services" for "Secretary of Health, Education, and Welfare", and "National Oceanic and Atmospheric Administration" for "Environmental Science Services Administration". 1966 - Pub. L. 89-718 substituted "Environmental Science Services Administration" for "Coast and Geodetic Survey". Pub. L. 89-614 substituted "1087" for "1085" in section catchline and text. EFFECTIVE DATE OF 2002 AMENDMENT Amendment by Pub. L. 107-296 effective on the date of transfer of the Coast Guard to the Department of Homeland Security, see section 1704(g) of Pub. L. 107-296, set out as a note under section 101 of this title. EFFECTIVE DATE OF 1997 AMENDMENT Amendment by Pub. L. 105-12 effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of Pub. L. 105-12, set out as an Effective Date note under section 14401 of Title 42, The Public Health and Welfare. EFFECTIVE DATE OF 1980 AMENDMENT Amendment by Pub. L. 96-513 effective Dec. 12, 1980, see section 701(b)(3) of Pub. L. 96-513, set out as a note under section 101 of this title. EFFECTIVE DATE OF 1966 AMENDMENT For effective date of amendment by Pub. L. 89-614, see section 3 of Pub. L. 89-614, set out as a note under section 1071 of this title. REPEALS The directory language of, but not the amendment made by, Pub. L. 89-718, Sec. 8(a), Nov. 2, 1966, 80 Stat. 1117, cited as a credit to this section, was repealed by Pub. L. 97-295, Sec. 6(b), Oct. 12, 1982, 96 Stat. 1314. REQUIREMENTS FOR SUPPORT OF MILITARY TREATMENT FACILITIES BY CIVILIAN CONTRACTORS UNDER TRICARE Pub. L. 109-364, div. A, title VII, Sec. 732, Oct. 17, 2006, 120 Stat. 2296, provided that: "(a) Annual Integrated Regional Requirements on Support. - The Regional Director of each region under the TRICARE program shall develop each year integrated, comprehensive requirements for the support of military treatment facilities in such region that is provided by contract civilian health care and administrative personnel under the TRICARE program. "(b) Purposes. - The purposes of the requirements established under subsection (a) shall be as follows: "(1) To ensure consistent standards of quality in the support of military treatment facilities by contract civilian health care personnel under the TRICARE program. "(2) To identify targeted, actionable opportunities throughout each region of the TRICARE program for the most efficient and cost effective delivery of health care and support of military treatment facilities. "(3) To ensure the most effective use of various available contracting methods in securing support of military treatment facilities by civilian health care personnel under the TRICARE program, including resource-sharing and clinical support agreements, direct contracting, and venture capital investments. "(c) Facilitation and Enhancement of Contractor Support. - "(1) In general. - The Secretary of Defense shall take appropriate actions to facilitate and enhance the support of military treatment facilities under the TRICARE program in order to assure maximum quality and productivity. "(2) Actions. - In taking actions under paragraph (1), the Secretary shall - "(A) require consistent standards of quality for contract civilian health care personnel providing support of military treatment facilities under the TRICARE program, including - "(i) consistent credentialing requirements among military treatment facilities; "(ii) consistent performance standards for private sector companies providing health care staffing services to military treatment facilities and clinics, including, at a minimum, those standards established for accreditation of health care staffing firms by the Joint Commission on the Accreditation of Health Care Organizations Health Care Staffing Standards; and "(iii) additional standards covering - "(I) financial stability; "(II) medical management; "(III) continuity of operations; "(IV) training; "(V) employee retention; "(VI) access to contractor data; and "(VII) fraud prevention; "(B) ensure the availability of adequate and sustainable funding support for projects which produce a return on investment to the military treatment facilities; "(C) ensure that a portion of any return on investment is returned to the military treatment facility to which such savings are attributable; "(D) remove financial disincentives for military treatment facilities and civilian contractors to initiate and sustain agreements for the support of military treatment facilities by such contractors under the TRICARE program; "(E) provide for a consistent methodology across all regions of the TRICARE program for developing cost benefit analyses of agreements for the support of military treatment facilities by civilian contractors under the TRICARE program based on actual cost and utilization data within each region of the TRICARE program; and "(F) provide for a system for monitoring the performance of significant projects for support of military treatment facilities by a civilian contractor under the TRICARE program. "(d) Reports to Congress. - "(1) Annual reports required. - Not later than February 1, 2008, and each year thereafter, the Secretary, in coordination with the military departments, shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the support of military treatment facilities by civilian contractors under the TRICARE program during the preceding fiscal year. "(2) Elements. - Each report shall set forth, for the fiscal year covered by such report, the following: "(A) The level of support of military health treatment facilities that is provided by contract civilian health care personnel under the TRICARE program in each region of the TRICARE program. "(B) An assessment of the compliance of such support with regional requirements under subsection (a). "(C) The number and type of agreements for the support of military treatment facilities by contract civilian health care personnel. "(D) The standards of quality in effect under the requirements under subsection (a). "(E) The savings anticipated, and any savings achieved, as a result of the implementation of the requirements under subsection (a). "(F) An assessment of the compliance of contracts for health care staffing services for Department of Defense facilities with the requirements of subsection (c)(2)(A). "(e) Effective Date. - This section shall take effect on October 1, 2006." TRICARE STANDARD IN TRICARE REGIONAL OFFICES Pub. L. 109-163, div. A, title VII, Sec. 716, Jan. 6, 2006, 119 Stat. 3345, provided that: "(a) Responsibilities of TRICARE Regional Office. - The responsibilities of each TRICARE Regional Office shall include the monitoring, oversight, and improvement of the TRICARE Standard option in the TRICARE region concerned, including - "(1) identifying health care providers who will participate in the TRICARE program and provide the TRICARE Standard option under that program; "(2) communicating with beneficiaries who receive the TRICARE Standard option; "(3) outreach to community health care providers to encourage their participation in the TRICARE program; and "(4) publication of information that identifies health care providers in the TRICARE region concerned who provide the TRICARE Standard option. "(b) Annual Report. - The Secretary of Defense shall submit an annual report to the Committees on Armed Services of the Senate and the House of Representatives on the monitoring, oversight, and improvement of TRICARE Standard activities of each TRICARE Regional Office. The report shall include - "(1) a description of the activities of the TRICARE Regional Office to monitor, oversee, and improve the TRICARE Standard option; "(2) an assessment of the participation of eligible health care providers in TRICARE Standard in each TRICARE region; and "(3) a description of any problems or challenges that have been identified by both providers and beneficiaries with respect to use of the TRICARE Standard option and the actions undertaken to address such problems or challenges. "(c) Definition. - In this section, the term 'TRICARE Standard' or 'TRICARE standard option' means the Civilian Health and Medical Program of the Uniformed Services option under the TRICARE program." QUALIFICATIONS FOR INDIVIDUALS SERVING AS TRICARE REGIONAL DIRECTORS Pub. L. 109-163, div. A, title VII, Sec. 717, Jan. 6, 2006, 119 Stat. 3345, provided that: "(a) Qualifications. - Effective as of the date of the enactment of this Act [Jan. 6, 2006], no individual may be selected to serve in the position of Regional Director under the TRICARE program unless the individual - "(1) is - "(A) an officer of the Armed Forces in a general or flag officer grade; "(B) a civilian employee of the Department of Defense in the Senior Executive Service; or "(C) a civilian employee of the Federal Government in a department or agency other than the Department of Defense, or a civilian working in the private sector, who has experience in a position comparable to an officer described in subparagraph (A) or a civilian employee described in subparagraph (B); and "(2) has at least 10 years of experience, or equivalent expertise or training, in the military health care system, managed care, and health care policy and administration. "(b) Tricare Program Defined. - In this section, the term 'TRICARE program' has the meaning given such term in section 1072(7) of title 10, United States Code." PILOT PROJECTS ON PEDIATRIC EARLY LITERACY AMONG CHILDREN OF MEMBERS OF THE ARMED FORCES Pub. L. 109-163, div. A, title VII, Sec. 740, Jan. 6, 2006, 119 Stat. 3359, as amended by Pub. L. 109-364, div. A, title X, Sec. 1071(e)(8), Oct. 17, 2006, 120 Stat. 2402, provided that: "(a) Pilot Projects Authorized. - The Secretary of Defense may conduct pilot projects to assess the feasibility, advisability, and utility of encouraging pediatric early literacy among the children of members of the Armed Forces. "(b) Locations. - "(1) In general. - The pilot projects conducted under subsection (a) shall be conducted at not more than 20 military medical treatment facilities designated by the Secretary for purposes of this section. "(2) Co-location with certain installations. - In designating military medical treatment facilities under paragraph (1), the Secretary shall, to the extent practicable, designate facilities that are located on, or co-located with, military installations at which the mobilization or demobilization of members of the Armed Forces occurs. "(c) Activities. - Activities under the pilot projects conducted under subsection (a) shall include the following: "(1) The provision of training to health care providers and other appropriate personnel on early literacy promotion. "(2) The purchase and distribution of children's books to members of the Armed Forces, their spouses, and their children. "(3) The modification of treatment facility and clinic waiting rooms to include a full selection of literature for children. "(4) The dissemination to members of the Armed Forces and their spouses of parent education materials on pediatric early literacy. "(5) Such other activities as the Secretary considers appropriate. "(d) Report. - "(1) In general. - Not later than March 1, 2007, 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 pilot projects conducted under this section. "(2) Elements. - The report under paragraph (1) shall include - "(A) a description of the pilot projects conducted under this section, including the location of each pilot project and the activities conducted under each pilot project; and "(B) an assessment of the feasibility, advisability, and utility of encouraging pediatric early literacy among the children of members of the Armed Forces." SURVEYS ON CONTINUED VIABILITY OF TRICARE STANDARD Pub. L. 108-136, div. A, title VII, Sec. 723, Nov. 24, 2003, 117 Stat. 1532, as amended by Pub. L. 109-163, div. A, title VII, Sec. 711, Jan. 6, 2006, 119 Stat. 3343, provided that: "(a) Requirement for Surveys. - (1) The Secretary of Defense shall conduct surveys in the TRICARE market areas in the United States to determine how many health care providers are accepting new patients under TRICARE Standard in each such market area. "(2) The Secretary shall carry out the surveys in at least 20 TRICARE market areas in the United States each fiscal year after fiscal year 2003 until all such market areas in the United States have been surveyed. The Secretary shall complete six of the fiscal year 2004 surveys not later than March 31, 2004. "(3) In prioritizing the market areas for the sequence in which market areas are to be surveyed under this subsection, the Secretary shall consult with representatives of TRICARE beneficiaries and health care providers to identify locations where TRICARE Standard beneficiaries are experiencing significant levels of access-to-care problems under TRICARE Standard and shall give a high priority to surveying health care providers in such areas. "(4) Surveys required by paragraph (1) shall include questions seeking to determine from health care providers the following: "(A) Whether the provider is aware of the TRICARE program. "(B) What percentage of the provider's current patient population uses any form of TRICARE. "(C) Whether the provider accepts patients for whom payment is made under the medicare program for health care services. "(D) If the provider accepts patients referred to in subparagraph (C), whether the provider would accept additional such patients who are not in the provider's current patient population. "(b) Supervision. - (1) The Secretary shall designate a senior official of the Department of Defense to take the actions necessary for achieving and maintaining participation of health care providers in TRICARE Standard in each TRICARE market area in a number that is adequate to ensure the viability of TRICARE Standard for TRICARE beneficiaries in that market area. "(2) The official designated under paragraph (1) shall have the following duties: "(A) To educate health care providers about TRICARE Standard. "(B) To encourage health care providers to accept patients under TRICARE Standard. "(C) To ensure that TRICARE beneficiaries have the information necessary to locate TRICARE Standard providers readily. "(D) To recommend adjustments in TRICARE Standard provider payment rates that the official considers necessary to ensure adequate availability of TRICARE Standard providers for TRICARE Standard beneficiaries. "(c) GAO Review. - (1) The Comptroller General shall, on an ongoing basis, review - "(A) the processes, procedures, and analysis used by the Department of Defense to determine the adequacy of the number of health care providers - "(i) that currently accept TRICARE Standard beneficiaries as patients under TRICARE Standard in each TRICARE market area (as of the date of completion of the review); and "(ii) that would accept TRICARE Standard beneficiaries as new patients under TRICARE Standard in each TRICARE market area (within a reasonable time after the date of completion of the review); and "(B) the actions taken by the Department of Defense to ensure ready access of TRICARE Standard beneficiaries to health care under TRICARE Standard in each TRICARE market area. "(2)(A) The Comptroller General shall submit to the Committees on Armed Services of the Senate and the House of Representatives a semiannual report on the results of the review under paragraph (1). The first semiannual report shall be submitted not later than June 30, 2004. "(B) The semiannual report under subparagraph (A) shall include the following: "(i) An analysis of the adequacy of the surveys under subsection (a). "(ii) The adequacy of existing statutory authority to address inadequate levels of participation by health care providers in TRICARE Standard. "(iii) Identification of policy-based obstacles to achieving adequacy of availability of TRICARE Standard health care in the TRICARE market areas. "(iv) An assessment of the adequacy of Department of Defense education programs to inform health care providers about TRICARE Standard. "(v) An assessment of the adequacy of Department of Defense initiatives to encourage health care providers to accept patients under TRICARE Standard. "(vi) An assessment of the adequacy of information available to TRICARE Standard beneficiaries to facilitate access by such beneficiaries to health care under TRICARE Standard. "(vii) Any need for adjustment of health care provider payment rates to attract participation in TRICARE Standard by appropriate numbers of health care providers. "(d) Definitions. - In this section: "(1) The term 'TRICARE Standard' means the option of the TRICARE program that is also known as the Civilian Health and Medical Program of the Uniformed Services, as defined in section 1072(4) of title 10, United States Code. "(2) The term 'United States' means the United States (as defined in section 101(a) of title 10, United States Code), its possessions (as defined in such section), and the Commonwealth of Puerto Rico." MODERNIZATION OF TRICARE BUSINESS PRACTICES AND INCREASE OF USE OF MILITARY TREATMENT FACILITIES Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 723], Oct. 30, 2000, 114 Stat. 1654, 1654A-186, provided that: "(a) Requirement To Implement Internet-Based System. - Not later than October 1, 2001, the Secretary of Defense shall implement a system to simplify and make accessible through the use of the Internet, through commercially available systems and products, critical administrative processes within the military health care system and the TRICARE program. The purposes of the system shall be to enhance efficiency, improve service, and achieve commercially recognized standards of performance. "(b) Elements of System. - The system required by subsection (a) - "(1) shall comply with patient confidentiality and security requirements, and incorporate data requirements, that are currently widely used by insurers under medicare and commercial insurers; "(2) shall be designed to achieve improvements with respect to - "(A) the availability and scheduling of appointments; "(B) the filing, processing, and payment of claims; "(C) marketing and information initiatives; "(D) the continuation of enrollments without expiration; "(E) the portability of enrollments nationwide; "(F) education of beneficiaries regarding the military health care system and the TRICARE program; and "(G) education of health care providers regarding such system and program; and "(3) may be implemented through a contractor under TRICARE Prime. "(c) Areas of Implementation. - The Secretary shall implement the system required by subsection (a) in at least one region under the TRICARE program. "(d) Plan for Improved Portability of Benefits. - Not later than March 15, 2001, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a plan to provide portability and reciprocity of benefits for all enrollees under the TRICARE program throughout all TRICARE regions. "(e) Increase of Use of Military Medical Treatment Facilities. - The Secretary shall initiate a program to maximize the use of military medical treatment facilities by improving the efficiency of health care operations in such facilities. "(f) Definition. - In this section the term 'TRICARE program' has the meaning given such term in section 1072 of title 10, United States Code." IMPROVEMENT OF ACCESS TO HEALTH CARE UNDER THE TRICARE PROGRAM Pub. L. 107-107, div. A, title VII, Sec. 735(e), Dec. 28, 2001, 115 Stat. 1172, directed the Secretary of Defense to submit to committees of Congress, not later than Mar. 1, 2002, a report on the Secretary's plans for implementing Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 721], as amended, set out below. Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 721], Oct. 30, 2000, 114 Stat. 1654, 1654A-184, as amended by Pub. L. 107-107, div. A, title VII, Sec. 735(a)-(d), Dec. 28, 2001, 115 Stat. 1171, 1172, provided that: "(a) Waiver of Nonavailability Statement or Preauthorization. - In the case of a covered beneficiary under TRICARE Standard pursuant to chapter 55 of title 10, United States Code, the Secretary of Defense may not require with regard to authorized health care services (other than mental health services) under such chapter that the beneficiary - "(1) obtain a nonavailability statement or preauthorization from a military medical treatment facility in order to receive the services from a civilian provider; or "(2) obtain a nonavailability statement for care in specialized treatment facilities outside the 200-mile radius of a military medical treatment facility. "(b) Waiver Authority. - The Secretary may waive the prohibition in subsection (a) if - "(1) the Secretary - "(A) demonstrates that significant costs would be avoided by performing specific procedures at the affected military medical treatment facility or facilities; "(B) determines that a specific procedure must be provided at the affected military medical treatment facility or facilities to ensure the proficiency levels of the practitioners at the facility or facilities; or "(C) determines that the lack of nonavailability statement data would significantly interfere with TRICARE contract administration; "(2) the Secretary provides notification of the Secretary's intent to grant a waiver under this subsection to covered beneficiaries who receive care at the military medical treatment facility or facilities that will be affected by the decision to grant a waiver under this subsection; "(3) the Secretary notifies the Committees on Armed Services of the House of Representatives and the Senate of the Secretary's intent to grant a waiver under this subsection, the reason for the waiver, and the date that a nonavailability statement will be required; and "(4) 60 days have elapsed since the date of the notification described in paragraph (3). "(c) Waiver Exception for Maternity Care. - Subsection (b) shall not apply with respect to maternity care. "(d) Effective Date. - This section shall take effect on the earlier of the following: "(1) The date that a new contract entered into by the Secretary to provide health care services under TRICARE Standard takes effect. "(2) The date that is two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2002 [Dec. 28, 2001].". Pub. L. 106-65, div. A, title VII, Sec. 712(a), (b), Oct. 5, 1999, 113 Stat. 687, provided that: "(a) Access. - The Secretary of Defense shall, to the maximum extent practicable, minimize the authorization and certification requirements imposed on covered beneficiaries under the TRICARE program as a condition of access to benefits under that program. "(b) Report on Initiatives To Improve Access. - Not later than March 31, 2000, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on specific actions taken to - "(1) reduce the requirements for preauthorization for care under the TRICARE program; "(2) reduce the requirements for beneficiaries to obtain preventive services, such as obstetric or gynecologic examinations, mammograms for females over 35 years of age, and urological examinations for males over the age of 60 without preauthorization; and "(3) reduce the requirements for statements of nonavailability of services." TRICARE MANAGED CARE SUPPORT CONTRACTS Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 724], Oct. 30, 2000, 114 Stat. 1654, 1654A-187, provided that: "(a) Authority. - Notwithstanding any other provision of law and subject to subsection (b), any TRICARE managed care support contract in effect, or in the final stages of acquisition, on September 30, 1999, may be extended for four years. "(b) Conditions. - Any extension of a contract under subsection (a) - "(1) may be made only if the Secretary of Defense determines that it is in the best interest of the United States to do so; and "(2) shall be based on the price in the final best and final offer for the last year of the existing contract as adjusted for inflation and other factors mutually agreed to by the contractor and the Federal Government." Pub. L. 106-259, title VIII, Sec. 8090, Aug. 9, 2000, 114 Stat. 694, provided that: "Notwithstanding any other provision of law, the TRICARE managed care support contracts in effect, or in final stages of acquisition as of September 30, 2000, may be extended for 2 years: Provided, That any such extension may only take place if the Secretary of Defense determines that it is in the best interest of the Government: Provided further, That any contract extension shall be based on the price in the final best and final offer for the last year of the existing contract as adjusted for inflation and other factors mutually agreed to by the contractor and the Government: Provided further, That notwithstanding any other provision of law, all future TRICARE managed care support contracts replacing contracts in effect, or in the final stages of acquisition as of September 30, 2000, may include a base contract period for transition and up to seven 1-year option periods." Similar provisions were contained in the following prior appropriation act: Pub. L. 106-79, title VIII, Sec. 8095, Oct. 25, 1999, 113 Stat. 1254. Pub. L. 105-262, title VIII, Sec. 8107, Oct. 17, 1998, 112 Stat. 2321. REDESIGN OF MILITARY PHARMACY SYSTEM Pub. L. 105-261, div. A, title VII, Sec. 703, Oct. 17, 1998, 112 Stat. 2057, provided that: "(a) Plan Required. - The Secretary of Defense shall submit to Congress a plan that would provide for a system-wide redesign of the military and contractor retail and mail-order pharmacy system of the Department of Defense by incorporating 'best business practices' of the private sector. The Secretary shall work with contractors of TRICARE retail pharmacy and national mail-order pharmacy programs to develop a plan for the redesign of the pharmacy system that - "(1) may include a plan for an incentive-based formulary for military medical treatment facilities and contractors of TRICARE retail pharmacies and the national mail-order pharmacy; and "(2) shall include a plan for each of the following: "(A) A uniform formulary for such facilities and contractors. "(B) A centralized database that integrates the patient databases of pharmacies of military medical treatment facilities and contractor retail and mail-order programs to implement automated prospective drug utilization review systems. "(C) A system-wide drug benefit for covered beneficiaries under chapter 55 of title 10, United States Code, who are entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). "(b) Submission of Plan. - The Secretary shall submit the plan required under subsection (a) not later than March 1, 1999. "(c) Suspension of Implementation of Program. - The Secretary shall suspend any plan to establish a national retail pharmacy program for the Department of Defense until - "(1) the plan required under subsection (a) is submitted; and "(2) the Secretary implements cost-saving reforms with respect to the military and contractor retail and mail order pharmacy system." Pub. L. 105-261, div. A, title VII, Sec. 723, Oct. 17, 1998, 112 Stat. 2068, as amended by Pub. L. 106-65, div. A, title X, Sec. 1067(3), Oct. 5, 1999, 113 Stat. 774; Pub. L. 106-398, Sec. 1 [[div. A], title VII, Sec. 711(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A-175, provided that: "(a) In General. - Not later than April 1, 2001, the Secretary of Defense shall implement, with respect to eligible individuals described in subsection (e), the redesign of the pharmacy system under TRICARE (including the mail-order and retail pharmacy benefit under TRICARE) to incorporate 'best business practices' of the private sector in providing pharmaceuticals, as developed under the plan described in section 703 [set out as a note above]. "(b) Program Requirements. - The same coverage for pharmacy services and the same requirements for cost sharing and reimbursement as are applicable under section 1086 of title 10, United States Code, shall apply with respect to the program required by subsection (a). "(c) Evaluation. - The Secretary shall provide for an evaluation of the implementation of the redesign of the pharmacy system under TRICARE under this section by an appropriate person or entity that is independent of the Department of Defense. The evaluation shall include the following: "(1) An analysis of the costs of the implementation of the redesign of the pharmacy system under TRICARE and to the eligible individuals who participate in the system. "(2) An assessment of the extent to which the implementation of such system satisfies the requirements of the eligible individuals for the health care services available under TRICARE. "(3) An assessment of the effect, if any, of the implementation of the system on military medical readiness. "(4) A description of the rate of the participation in the system of the individuals who were eligible to participate. "(5) An evaluation of any other matters that the Secretary considers appropriate. "(d) Reports. - The Secretary shall submit two reports on the results of the evaluation under subsection (c), together with the evaluation, to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives. The first report shall be submitted not later than December 31, 2001, and the second report shall be submitted not later than December 31, 2003. "(e) Eligible Individuals. - (1) An individual is eligible to participate under this section if the individual is a member or former member of the uniformed services described in section 1074(b) of title 10, United States Code, a dependent of the member described in section 1076(a)(2)(B) or 1076(b) of that title, or a dependent of a member of the uniformed services who died while on active duty for a period of more than 30 days, who - "(A) is 65 years of age or older; "(B) is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.); and "(C) except as provided in paragraph (2), is enrolled in the supplemental medical insurance program under part B of such title XVIII (42 U.S.C. 1395j et seq.). "(2) Paragraph (1)(C) shall not apply in the case of an individual who, before April 1, 2001, has attained the age of 65 and did not enroll in the program described in such paragraph." SYSTEM FOR TRACKING DATA AND MEASURING PERFORMANCE IN MEETING TRICARE ACCESS STANDARDS Pub. L. 105-261, div. A, title VII, Sec. 713, Oct. 17, 1998, 112 Stat. 2060, provided that: "(a) Requirement To Establish System. - (1) The Secretary of Defense shall establish a system - "(A) to track data regarding access of covered beneficiaries under chapter 55 of title 10, Unite