548 
guages other than English) as the Secretary may 
prescribe in regulations to carry out this section. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘sexual assault survivor’ means 
any individual who presents at a military medical 
treatment facility and— 
‘‘(A) states to personnel of the facility that 
the individual experienced a sexual assault; 
‘‘(B) is accompanied by another person 
who states that the individual experienced a 
sexual assault; or 
‘‘(C) whom the personnel of the facility 
reasonably believes to be a survivor of sexual 
assault. 
‘‘(2) The term ‘sexual assault’ means the con-
duct described in section 1565b(c) of this title that 
may result in pregnancy.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1074o the following new 
item: 
‘‘1074p. Provision of pregnancy prevention assistance at military medical treat-
ment facilities.’’.
549 
SEC. 703. MODIFICATION OF ELIGIBILITY FOR TRICARE RE-
SERVE SELECT FOR CERTAIN MEMBERS OF 
THE SELECTED RESERVE. 
Section 1076d(a)(2) of title 10, United States Code, 
is amended by striking ‘‘Paragraph (1) does not apply’’ 
and inserting ‘‘During the period preceding January 1, 
2030, paragraph (1) does not apply’’. 
SEC. 704. LEAD LEVEL SCREENINGS AND TESTINGS FOR 
CHILDREN. 
(a) TRICARE.— 
(1) WELL-BABY CARE.—Section 1077 of title 
10, United States Code, is amended by adding at 
the end the following new subsection: 
‘‘(i)(1) Beginning January 1, 2020, in furnishing 
well-baby care under subsection (a)(8), the Secretary shall 
ensure that the following care is made available: 
‘‘(A) With respect to a child who lives in hous-
ing built before 1978 at any time during the first 24 
months of the life of the child— 
‘‘(i) the first testing of the child for the 
level of lead in the blood of the child at approxi-
mately the age of 12 months; and 
‘‘(ii) the second such test at approximately 
the age of 24 months. 
‘‘(B) With respect to a child not covered by 
subparagraph (A) whose parent or guardian, at any
550 
time during the first 24 months of the life of the 
child, has a military occupational specialty that the 
Secretary determines poses an elevated risk of lead 
exposure— 
‘‘(i) the first testing of the child for the 
level of lead in the blood of the child at approxi-
mately the age of 12 months; and 
‘‘(ii) the second such test at approximately 
the age of 24 months. 
‘‘(C) With respect to a child not covered by 
subparagraph (A) or (B)— 
‘‘(i) the first screening of the child for an 
elevated risk of lead exposure at approximately 
the age of 12 months; and 
‘‘(ii) the second such screening at approxi-
mately the age of 24 months. 
‘‘(D) With respect to a child covered by sub-
paragraph (C) whose screening indicates an elevated 
risk of lead exposure, testing of the child for the 
level of lead in the blood of the child. 
‘‘(2) The Secretary shall ensure that any care pro-
vided to a child pursuant to this chapter for lead poi-
soning, including the care under paragraph (1), is carried 
out in accordance with applicable advice from the Centers 
for Disease Control and Prevention.
551 
‘‘(3)(A) With respect to a child who receives a test 
under paragraph (1), the Secretary shall provide the re-
sults of the test to the parent or guardian of the child. 
‘‘(B) With respect to a child who receives a test under 
paragraph (1), the Secretary shall provide the results of 
the test and the address at which the child resides to— 
‘‘(i) the relevant health department of the State 
in which the child resides if the child resides in the 
United States; or 
‘‘(ii) the Centers for Disease Control and Pre-
vention if the child resides outside the United 
States. 
‘‘(C) In providing information regarding a child to 
a State or the Centers for Disease Control and Prevention 
under subparagraph (B), the Secretary may not provide 
any identifying information or health information of the 
child that is not specifically authorized in such subpara-
graph. 
‘‘(D) In this paragraph, the term ‘State’ means each 
of the several States, the District of Columbia, the Com-
monwealth of Puerto Rico, and any territory or possession 
of the United States.’’. 
(2) 
CONFORMING
AMENDMENT.—Subsection 
(a)(8) of such section is amended by striking ‘‘in-
cluding well-baby care that includes one screening of
552 
an infant for the level of lead in the blood of the in-
fant’’ and inserting ‘‘including, in accordance with 
subsection 
(i), 
well-baby 
care 
that 
includes 
screenings and testings for lead exposure and lead 
poisoning’’. 
(3) STUDY.—Not later than January 1, 2021, 
the Secretary of Defense shall submit to the con-
gressional defense committees a report detailing the 
following: 
(A) The number of children who were test-
ed for the level of lead in the blood of the child 
pursuant to subparagraph (A) of subsection 
(i)(1) of section 1077 of title 10, United States 
Code, as added by paragraph (1), and of such 
number, the number who were found to have 
elevated blood lead levels. 
(B) The number of children who were test-
ed for the level of lead in the blood of the child 
pursuant to subparagraph (B) of such sub-
section (i)(1), and of such number, the number 
who were found to have lead poisoning. 
(C) The number of children who were 
screened for an elevated risk of lead exposure 
pursuant to subparagraph (C) of such sub-
section (i)(1).
553 
(D) The number of children who were test-
ed for the level of lead in the blood of the child 
pursuant to subparagraph (D) of such sub-
section, and of such number, the number who 
were found to have elevated blood lead levels. 
(E) The treatment provided to children 
pursuant to chapter 55 of title 10, United 
States Code, for lead poisoning. 
(4) GAO REPORT.—Not later than January 1, 
2022, the Comptroller General of the United States 
shall submit to the congressional defense committees 
a report on the effectiveness of screening, testing, 
and treating children for lead exposure and lead poi-
soning pursuant to chapter 55 of title 10, United 
States Code. 
(b) NOTIFICATION
OF HOUSING.—Section 403 of 
title 37, United States Code, is amended by adding at the 
end the following new subsection: 
‘‘(p) RECORDS REGARDING HOUSING
AND LEAD- 
BASED PAINT.—(1) The Secretary concerned shall keep 
a record of whether the following housing was built before, 
during, or after 1978: 
‘‘(A) Quarters of the United States under the 
jurisdiction of that Secretary concerned.
554 
‘‘(B) A housing facility under the jurisdiction of 
that Secretary concerned. 
‘‘(C) Other housing in which a member of the 
uniformed service of that Secretary concerned re-
sides. 
‘‘(2) As a condition of receipt of a basic allowance 
for housing under this section, a member of the uniformed 
services shall notify the Secretary concerned whether the 
housing in which that member resides was built before, 
during, or after 1978.’’. 
SEC. 705. EXPOSURE TO OPEN BURN PITS AND TOXIC AIR-
BORNE CHEMICALS OR OTHER AIRBORNE 
CONTAMINANTS 
AS 
PART 
OF 
PERIODIC 
HEALTH ASSESSMENTS AND OTHER PHYS-
ICAL EXAMINATIONS. 
(a) PERIODIC HEALTH ASSESSMENT.—The Sec-
retary of Defense shall ensure that any periodic health as-
sessment provided to members of the Armed Forces in-
cludes an evaluation of whether the member has been— 
(1) based or stationed at a location where an 
open burn pit was used; or 
(2) exposed to toxic airborne chemicals or other 
airborne contaminants, including any information re-
corded as part of the Airborne Hazards and Open 
Burn Pit Registry.
555 
(b) SEPARATION HISTORY AND PHYSICAL EXAMINA-
TIONS.—Section 1145(a)(5) of title 10, United States 
Code, is amended by adding at the end the following new 
subparagraph: 
‘‘(C) The Secretary concerned shall ensure that each 
physical examination of a member under subparagraph 
(A) includes an assessment of whether the member was— 
‘‘(i) based or stationed at a location where an 
open burn pit, as defined in subsection (c) of section 
201 of the Dignified Burial and Other Veterans’ 
Benefits Improvement Act of 2012 (Public Law 
112–260; 38 U.S.C. 527 note), was used; or 
‘‘(ii) exposed to toxic airborne chemicals or 
other airborne contaminants, including any informa-
tion recorded as part of the registry established by 
the Secretary of Veterans Affairs under such section 
201.’’. 
(c) 
DEPLOYMENT
ASSESSMENTS.—Section 
1074f(b)(2) of title 10, United States Code, is amended 
by adding at the end the following new subparagraph: 
‘‘(D) An assessment of whether the member 
was— 
‘‘(i) based or stationed at a location where 
an open burn pit, as defined in subsection (c) 
of section 201 of the Dignified Burial and
556 
Other Veterans’ Benefits Improvement Act of 
2012 (Public Law 112–260; 38 U.S.C. 527 
note), was used; or 
‘‘(ii) exposed to toxic airborne chemicals or 
other airborne contaminants, including any in-
formation recorded as part of the registry es-
tablished by the Secretary of Veterans Affairs 
under such section 201.’’. 
(d) SHARING OF INFORMATION.— 
(1) DOD–VA.—The Secretary of Defense and 
the Secretary of Veterans Affairs shall jointly enter 
into a memorandum of understanding providing for 
the sharing by the Department of Defense with the 
Department of Veterans Affairs of the results of 
covered evaluations regarding the exposure by a 
member of the Armed Forces to toxic airborne 
chemicals or other airborne contaminants. 
(2) REGISTRY.—If a covered evaluation of a 
member of the Armed Forces establishes that the 
member was based or stationed at a location where 
an open burn pit was used or that the member was 
exposed to toxic airborne chemicals or other airborne 
contaminants, the member shall be enrolled in the 
Airborne Hazards and Open Burn Pit Registry un-
less the member elects to not so enroll.
557 
(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion may be construed to preclude eligibility for benefits 
under the laws administered by the Secretary of Veterans 
Affairs by reason of the open burn pit exposure history 
of a veteran not being recorded in a covered evaluation. 
(f) DEFINITIONS.—In this section: 
(1) The term ‘‘Airborne Hazards and Open 
Burn Pit Registry’’ means the registry established 
by the Secretary of Veterans Affairs under section 
201 of the Dignified Burial and Other Veterans’ 
Benefits Improvement Act of 2012 (Public Law 
112–260; 38 U.S.C. 527 note). 
(2) The term ‘‘covered evaluation’’ means— 
(A) a periodic health assessment conducted 
in accordance with subsection (a); 
(B) a separation history and physical ex-
amination conducted under section 1145(a)(5) 
of title 10, United States Code, as amended by 
this section; and 
(C) a deployment assessment conducted 
under section 1074f(b)(2) of such title, as 
amended by this section. 
(3) The term ‘‘open burn pit’’ has the meaning 
given that term in section 201(c) of the Dignified 
Burial and Other Veterans’ Benefits Improvement
558 
Act of 2012 (Public Law 112–260; 38 U.S.C. 527 
note). 
SEC. 
706. 
ENHANCEMENT 
OF 
RECORDKEEPING 
AND 
POSTDEPLOYMENT 
MEDICAL 
ASSESSMENT 
REQUIREMENTS 
RELATED 
TO 
OCCUPA-
TIONAL AND ENVIRONMENTAL HAZARD EX-
POSURE DURING DEPLOYMENT. 
(a) RECORDING OF OCCUPATIONAL AND ENVIRON-
MENTAL HEALTH RISKS IN DEPLOYMENT AREA.— 
(1) ELEMENTS
OF
MEDICAL
TRACKING
SYS-
TEM.—Subsection (b)(1)(A) of section 1074f of title 
10, United States Code, is amended— 
(A) in clause (ii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iv) accurately record any 
exposure to occupational and en-
vironmental health risks during 
the course of their deployment.’’. 
(2) RECORDKEEPING.—Subsection (c) of such 
section is amended by inserting after ‘‘deployment 
area’’ the following: ‘‘(including the results of any
559 
assessment performed by the Secretary of occupa-
tional and environmental health risks for such 
area)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of the 
enactment of this Act. 
(b) INTEGRATION OF BURN PIT REGISTRY INFORMA-
TION INTO ELECTRONIC HEALTH RECORDS.— 
(1) 
UPDATES
TO
ELECTRONIC
HEALTH 
RECORDS.—Beginning not later than one year after 
the date of the enactment of this Act— 
(A) the Secretary of Defense shall ensure 
that the electronic health record maintained by 
such Secretary of a member of the Armed 
Forces registered with the burn pit registry is 
updated with any information contained in such 
registry; and 
(B) the Secretary of Veterans Affairs shall 
ensure that the electronic health record main-
tained by such Secretary of a veteran registered 
with the burn pit registry is updated with any 
information contained in such registry. 
(2) BURN
PIT
REGISTRY
DEFINED.—In this 
subsection, the term ‘‘burn pit registry’’ means the 
registry established under section 201 of the Dig-
560 
nified Burial and Other Veterans’ Improvements Act 
of 2012 (Public Law 112–260; 38 U.S.C. 527 note). 
(c) POSTDEPLOYMENT MEDICAL EXAMINATION AND 
REASSESSMENTS.— 
(1) 
ADDITIONAL
REQUIREMENTS.—Section 
1074f of title 10, United States Code is further 
amended by adding at the end the following new 
subsection: 
‘‘(g) 
ADDITIONAL
REQUIREMENTS
FOR 
POSTDEPLOYMENT
MEDICAL
EXAMINATIONS
AND 
HEALTH REASSESSMENTS.—(1) The Secretary of Defense 
shall— 
‘‘(A) standardize and make available to a pro-
vider that conducts a postdeployment medical exam-
ination or reassessment under the system described 
in subsection (a) questions relating to occupational 
and environmental health exposure; and 
‘‘(B) prior to an examination or reassessment 
of a member of the armed forces, require such pro-
vider to review information applicable to such mem-
ber— 
‘‘(i) in a Periodic Occupational and Envi-
ronmental Monitoring Summary (or any suc-
cessor document); and
561 
‘‘(ii) on the Defense Occupational and En-
vironmental Health Readiness System (or any 
successor system). 
‘‘(2) The Secretary shall ensure that the medical 
record of a member includes information on the external 
cause relating to a diagnosis of the member, including by 
associating an external cause code (as issued under the 
International Statistical Classification of Diseases, 10th 
Revision (or any successor revision)).’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect 180 days after 
the date of the enactment of this Act. 
(d) REPORT BY COMPTROLLER GENERAL OF THE 
UNITED STATES.—Not later than two years after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall submit to the congressional de-
fense committees and the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate a report 
containing an evaluation of the implementation of this sec-
tion (and the amendments made by this section), including 
an assessment of the extent to which the Secretary of De-
fense and Secretary of Veterans Affairs are in compliance 
with the applicable requirements of this section (and the 
amendments made by this section).
562 
SEC. 707. MODIFICATIONS TO POST-DEPLOYMENT MENTAL 
HEALTH ASSESSMENTS FOR MEMBERS OF 
THE ARMED FORCES DEPLOYED IN SUPPORT 
OF A CONTINGENCY OPERATION. 
(a) REQUIRED ASSESSMENTS.—Section 1074m(a)(1) 
of title 10, United States Code, is amended by striking 
subparagraphs (C) and (D) and inserting the following 
new subparagraphs: 
‘‘(C) Subject to paragraph (3) and sub-
section (d), once during the period beginning on 
the date of redeployment from the contingency 
operation and ending 14 days after such rede-
ployment date. 
‘‘(D) Subject to subsection (d), not less 
than once annually— 
‘‘(i) beginning 14 days after the date 
of redeployment from the contingency op-
eration; or 
‘‘(ii) if the assessment required by 
subparagraph (C) is performed during the 
period specified in paragraph (3), begin-
ning 180 days after the date of redeploy-
ment from the contingency operation.’’. 
(b) EXCEPTIONS.—Section 1074m(a) of such title, as 
amended by subsection (a), is further amended by striking 
paragraph (2) and inserting the following new paragraphs:
563 
‘‘(2) A mental health assessment is not required for 
a member of the armed forces under subparagraphs (C) 
and (D) of paragraph (1) (including an assessment per-
formed pursuant to paragraph (3)) if the Secretary deter-
mines that providing such assessment to the member dur-
ing the time periods under such subparagraphs would re-
move the member from forward deployment or put mem-
bers or operational objectives at risk. 
‘‘(3) A mental health assessment required under sub-
paragraph (C) of paragraph (1) may be provided during 
the period beginning 90 days after the date of redeploy-
ment from the contingency operation and ending 180 days 
after such redeployment date if the Secretary determines 
that— 
‘‘(A) an insufficient number of personnel are 
available to perform the assessment during the time 
period under such subparagraph; or 
‘‘(B) an administrative processing issue exists 
upon the return of the member to the home unit or 
duty station that would prohibit the effective per-
formance of the assessment during such time pe-
riod.’’. 
(c) ELIMINATION
OF SUNSET
FOR ASSESSMENTS 
DURING DEPLOYMENT.—Section 1074m(a)(1)(B) of such
564 
title is amended by striking ‘‘Until January 1, 2019, 
once’’ and inserting ‘‘Once’’. 
(d) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to a date 
of redeployment that is on or after January 1, 2020. 
SEC. 708. PROVISION OF BLOOD TESTING FOR FIRE-
FIGHTERS OF DEPARTMENT OF DEFENSE TO 
DETERMINE 
EXPOSURE 
TO 
PERFLUOROALKYL AND POLYFLUOROALKYL 
SUBSTANCES. 
The Secretary of Defense shall include, as part of the 
annual physical examination provided by the Secretary to 
each firefighter of the Department of Defense, blood test-
ing to determine and document the potential exposure of 
such firefighters to perfluoroalkyl and polyfluoroalkyl sub-
stances (commonly known as ‘‘PFAS’’). 
SEC. 709. INCLUSION OF INFERTILITY TREATMENTS FOR 
MEMBERS OF THE UNIFORMED SERVICES. 
(a) INCLUSION.—The Secretary of Defense may pro-
vide to members of uniformed services under section 
1074(a) of title 10, United States Code, and spouses of 
such members, treatment for infertility, including non-
experimental assisted reproductive services, including, at 
a minimum, the following:
565 
(1) Services, medications, and supplies for non- 
coital reproductive technologies. 
(2) Counseling on such services. 
(3) Reversal of tubal ligation or vasectomy in 
conjunction with services furnished under this sec-
tion. 
(4) Cryopreservation, including associated serv-
ices, supplies, and storage. 
(b) PROHIBITION ON COST SHARING.—The Secretary 
may not require any fees or other cost-sharing require-
ments under subsection (a). 
(c) INFERTILITY DEFINED.—In this section, the 
term ‘‘infertility’’ means a disease, characterized by the 
failure to establish a clinical pregnancy— 
(1) after 12 months of regular, unprotected sex-
ual intercourse; or 
(2) due to a person’s incapacity for reproduc-
tion either as an individual or with his or her part-
ner, which may be determined after a period of less 
than 12 months of regular, unprotected sexual inter-
course, or based on medical, sexual and reproductive 
history, age, physical findings, or diagnostic testing.
566 
SEC. 
710. 
AUTHORIZATION 
OF 
APPROPRIATIONS 
FOR 
TRICARE LEAD SCREENING AND TESTING 
FOR CHILDREN. 
(a) INCREASE.—Notwithstanding the amounts set 
forth in the funding tables in division D, the amount au-
thorized to be appropriated in section 1405 for the De-
fense Health Program, as specified in the corresponding 
funding table in section 4501, for Undistributed, 
TRICARE lead level screening and testing for children, 
is hereby increased by $5,000,000. 
(b) OFFSET.—Notwithstanding the amounts set forth 
in the funding tables in division D, the amount authorized 
to be appropriated in section 101 for Procurement of 
Wheeled and Tracked Combat Vehicles, Army, as specified 
in the corresponding funding table in section 4101, for 
Bradley Program (Mod) is hereby reduced by $5,000,000. 
Subtitle B—Health Care 
Administration 
SEC. 711. REQUIREMENTS FOR CERTAIN PRESCRIPTION 
DRUG LABELS. 
(a) REQUIREMENT.—Section 1074g of title 10, 
United States Code, is amended— 
(1) by redesignating subsections (h) and (i) as 
subsections (i) and (j), respectively; and 
(2) by inserting after subsection (g) the fol-
lowing new subsection (h):
567 
‘‘(h) LABELING.—The Secretary of Defense shall en-
sure that drugs made available through the facilities of 
the armed forces under the jurisdiction of the Secretary 
include labels that— 
‘‘(1) are printed and physically located on or 
within the package from which the drug is to be dis-
pensed; and 
‘‘(2) provide adequate directions for the pur-
poses for which the drug is intended.’’. 
(b) CONFORMING AMENDMENT.—Subsection (b)(1) 
of such section is amended by striking ‘‘under subsection 
(h)’’ and inserting ‘‘under subsection (j)’’. 
(c) IMPLEMENTATION.—Beginning not later than 90 
days after the date of the enactment of this Act, the Sec-
retary of Defense shall implement subsection (h) of section 
1074g of title 10, United States Code, as added by sub-
section (a). 
SEC. 712. OFFICERS AUTHORIZED TO COMMAND ARMY 
DENTAL UNITS. 
Section 7081(d) of title 10, United States Code, is 
amended by striking ‘‘Dental Corps Officer’’ and inserting 
‘‘commissioned officer of the Army Medical Department’’.
568 
SEC. 713. IMPROVEMENTS TO INTERAGENCY PROGRAM OF-
FICE OF THE DEPARTMENT OF DEFENSE AND 
THE DEPARTMENT OF VETERANS AFFAIRS. 
(a) LEADERSHIP.—Subsection (c) of section 1635 of 
the Wounded Warrior Act (title XVI of Public Law 110– 
181; 10 U.S.C. 1071 note) is amended to read as follows: 
‘‘(c) LEADERSHIP.— 
‘‘(1) DIRECTOR.—The Director of the Office 
shall be the head of the Office. 
‘‘(2) DEPUTY DIRECTOR.—The Deputy Director 
of the Office shall be the deputy head of the Office 
and shall assist the Director in carrying out the du-
ties of the Director. 
‘‘(3) REPORTING.—The Director shall report to 
the Department of Veterans Affairs-Department of 
Defense Joint Executive Committee established by 
section 320 of title 38, United States Code. 
‘‘(4) APPOINTMENTS.— 
‘‘(A) DIRECTOR.—The Director shall be 
jointly appointed by the Secretary of Veterans 
Affairs and the Secretary of Defense for a five- 
year term. The Director may be reappointed for 
one or more additional terms. 
‘‘(B) DEPUTY
DIRECTOR.—The Deputy 
Director shall be jointly appointed by the Sec-
retary of Veterans Affairs and the Secretary of
569 
Defense for a five-year term. The Deputy Di-
rector may be reappointed for one or more ad-
ditional terms. 
‘‘(C) ADVICE.—The Department of Vet-
erans Affairs-Department of Defense Joint Ex-
ecutive Committee shall provide the Secretary 
of Veterans Affairs and the Secretary of De-
fense with advice regarding potential individuals 
to be appointed Director and Deputy Director 
under subparagraphs (A) and (B), respectively. 
‘‘(D) 
MINIMUM
QUALIFICATIONS.—The 
Department of Veterans Affairs-Department of 
Defense Joint Executive Committee shall de-
velop qualification requirements for the office of 
the Director and the Deputy Director. Such re-
quirements shall ensure that, at a minimum, 
the Director and Deputy Director, individually 
or together, meet the following qualifications: 
‘‘(i) Significant experience as a clini-
cian, at the level of chief medical officer or 
equivalent. 
‘‘(ii) Significant experience in health 
informatics, at the level of chief health 
informatics officer or equivalent.
570 
‘‘(iii) Significant experience leading 
implementation of enterprise-wide tech-
nology in a health care setting in the pub-
lic or private sector. 
‘‘(5) ADDITIONAL
GUIDANCE.—In addition to 
providing direction, supervision, and control of the 
Office pursuant to paragraph (3), the Department of 
Veterans Affairs-Department of Defense Joint Exec-
utive Committee shall— 
‘‘(A) provide guidance in the discharge of 
the functions of the Office under this section; 
and 
‘‘(B) facilitate the establishment of a char-
ter and mission statement for the Office. 
‘‘(6) INFORMATION TO CONGRESS.—Upon re-
quest by any of the appropriate committees of Con-
gress, the Director and the Deputy Director shall 
testify before such committee, or provide a briefing 
or otherwise provide requested information to such 
committee, regarding the discharge of the functions 
of the Office under this section.’’. 
(b) AUTHORITY.—Paragraph (1) of subsection (b) of 
such section is amended by adding at the end the following 
new sentence: ‘‘The Office shall carry out decision making 
authority delegated to the office by the Secretary of De-
572 
to the strategy under subsection (a) and com-
municate such requirements and activities to 
the Office of the National Coordinator for 
Health Information Technology of the Depart-
ment of Health and Human Services for the 
purpose of implementing title IV of the 21st 
Century Cures Act (division A of Public Law 
114–255), and the amendments made by that 
title, and other objectives of the Office of the 
National Coordinator for Health Information 
Technology. 
‘‘(G) To plan for and effectuate the broad-
est possible implementation of standards, spe-
cifically with respect to the Fast Healthcare 
Interoperability Resources standard or suc-
cessor standard, the evolution of such stand-
ards, and the obsolescence of such standards. 
‘‘(H) To actively engage with national and 
international health standards setting organiza-
tions, including by taking membership in such 
organizations, to ensure that standards estab-
lished by such organizations meet the needs of 
the Department of Defense and the Department 
of Veterans Affairs pursuant to the strategy 
under subsection (a), and oversee and approve
573 
adoption of and mapping to such standards by 
the Departments. 
‘‘(I) To express the content and format of 
health data of the Departments using a com-
mon language to improve the exchange of data 
between the Departments and with the private 
sector, and to ensure that clinicians of both De-
partments have access to integrated, comput-
able, comprehensive health records of patients. 
‘‘(J) To inform each Chief Information Of-
ficer of the Department of Defense and the 
Chief Information Officer of the Department of 
Veterans Affairs of any activities of the Office 
affecting or relevant to cybersecurity.’’. 
(d) RESOURCES AND STAFFING.—Subsection (g) of 
such section is amended— 
(1) in paragraph (1), by inserting before the pe-
riod at the end the following: ‘‘, including the as-
signment of clinical or technical personnel of the De-
partment of Defense or the Department of Veterans 
Affairs to the Office’’; and 
(2) by adding at the end the following new 
paragraphs: 
‘‘(3) COST
SHARING.—The Secretary of De-
fense and the Secretary of Veterans Affairs, acting
574 
through the Department of Veterans Affairs-Depart-
ment of Defense Joint Executive Committee, shall 
enter into an agreement on cost sharing and pro-
viding resources for the operations and staffing of 
the Office. 
‘‘(4) HIRING
AUTHORITY.—The Secretary of 
Defense and the Secretary of Veterans Affairs shall 
delegate to the Director the authority under title 5, 
United States Code, regarding appointments in the 
competitive service to hire personnel of the Office.’’. 
(e) BUDGET MATTERS.—Such section is amended by 
adding at the end the following new subsection: 
‘‘(k) BUDGET AND CONTRACTING MATTERS.— 
‘‘(1) BUDGET.—The Director may obligate and 
expend funds allocated to the operations of the Of-
fice. 
‘‘(2) CONTRACT
AUTHORITY.—The Director 
may enter into contracts to carry out this section.’’. 
(f) REPORTS.—Subsection (h) of such section is 
amended to read as follows: 
‘‘(h) REPORTS.— 
‘‘(1) ANNUAL REPORTS.—Not later than Sep-
tember 30, 2020, and each year thereafter through 
2024, the Director shall submit to the Secretary of 
Defense and the Secretary of Veterans Affairs, and
575 
to the appropriate committees of Congress, a report 
on the activities of the Office during the preceding 
calendar year. Each report shall include the fol-
lowing: 
‘‘(A) A detailed description of the activities 
of the Office during the year covered by such 
report, including a detailed description of the 
amounts expended and the purposes for which 
expended. 
‘‘(B) With respect to the objectives of the 
strategy under paragraph (2)(C) of subsection 
(b), and the purposes of the Office under such 
subsection— 
‘‘(i) a discussion, description, and as-
sessment of the progress made by the De-
partment of Defense and the Department 
of Veterans Affairs during the preceding 
calendar year; and 
‘‘(ii) a discussion and description of 
the goals of the Department of Defense 
and the Department of Veterans Affairs 
for the following calendar year. 
‘‘(2) QUARTERLY
REPORTS.—On a quarterly 
basis, the Director shall submit to the appropriate 
committees of Congress a detailed financial sum-
576 
mary of the activities of the Office, including the 
funds allocated to the Office by each Department, 
the expenditures made, and an assessment as to 
whether the current funding is sufficient to carry 
out the activities of the Office. 
‘‘(3) AVAILABILITY.—Each report under this 
subsection shall be made publicly available.’’. 
(g) CONFORMING REPEAL.—Section 713 of the Na-
tional Defense Authorization Act for Fiscal Year 2014 
(Public Law 113–66; 10 U.S.C. 1071 note) is repealed. 
SEC. 
714. 
COMPREHENSIVE 
ENTERPRISE 
INTEROPER-
ABILITY STRATEGY FOR THE ARMED FORCES 
AND THE DEPARTMENT OF VETERANS AF-
FAIRS. 
(a) IN GENERAL.—The Secretary of Defense and the 
Secretary of Veterans Affairs, acting through the office 
established by section 1635(b) of the Wounded Warrior 
Act (title XVI of Public Law 110–181; 10 U.S.C. 1071 
note), shall jointly develop and implement a comprehensive 
interoperability strategy to— 
(1) improve the delivery of health care by the 
Armed Forces and the Department of Veterans Af-
fairs by taking advantage of advances in the health 
information technology marketplace;
577 
(2) achieve interoperability capabilities that are 
more adaptable and farther reaching than those 
achievable through bidirectional information ex-
change between electronic health records or the ex-
change of read-only data alone; 
(3) establish an environment that will enable 
and encourage the adoption of innovative tech-
nologies for health care delivery; 
(4) leverage data integration to advance health 
research and develop an evidence base for the health 
care programs of both Departments; 
(5) prioritize open systems architecture; 
(6) ensure ownership and control by patients of 
their health data; 
(7) protect patient privacy and enhance oppor-
tunities for innovation by preventing contractors of 
the Departments or other non-Department entities 
from owning or exclusively controlling patient health 
data; 
(8) make maximum use of open-application pro-
gram interfaces and the Fast Healthcare Interoper-
ability Resources standard, or successor standard; 
and 
(9) achieve—
578 
(A) a single lifetime longitudinal personal 
health record between the Armed Forces and 
the Department of Veterans Affairs; and 
(B) interoperability capabilities sufficient 
to enable the provision of seamless health care 
relating to— 
(i) the Armed Forces and private-sec-
tor health care providers under the 
TRICARE program; and 
(ii) the Department of Veterans Af-
fairs and community health care providers 
pursuant to sections 1703 and 1703A of 
title 38, United States Code, and other 
provisions of law administered by the Sec-
retary of Veterans Affairs. 
(b) CONTENT.—The strategy under subsection (a) 
shall— 
(1) include, but shall not be limited to, the 
Electronic Health Record Modernization Program 
and the Healthcare Management System Moderniza-
tion Program of the Armed Forces; and 
(2) consist of— 
(A) elements formulated and implemented 
jointly by the Secretary of Defense and the Sec-
retary of Veterans Affairs; and
579 
(B) elements that are unique to either De-
partment and are formulated and implemented 
separately by either Secretary. 
(c) SUBMISSION OF STRATEGY.— 
(1) STRATEGY.—Not later than 180 days after 
the date of the enactment of this Act, the Director 
shall submit to each Secretary concerned, and to the 
appropriate congressional committees, the strategy 
under subsection (a), including any accompanying or 
associated implementation plans and supporting in-
formation. 
(2) UPDATED STRATEGY.—Not later than De-
cember 31, 2024, the Director shall submit to each 
Secretary concerned, and to the appropriate congres-
sional committees, an update to the strategy under 
subsection (a), including any accompanying or asso-
ciated implementation plans and supporting infor-
mation. 
(3) AVAILABILITY.—The Secretaries concerned 
shall make available to the public the strategy sub-
mitted under paragraphs (1) and (2), including by 
posting such strategy on the internet websites of the 
Secretaries that is available to the public. 
(d) DEFINITIONS.—In this section:
580 
(1) The term ‘‘appropriate congressional com-
mittees’’ means the following: 
(A) The congressional defense committees. 
(B) The Committees on Veterans’ Affairs 
of the House of Representatives and the Sen-
ate. 
(2) The term ‘‘Director’’ means the Director of 
the office established by section 1635(b) of the 
Wounded Warrior Act (title XVI of Public Law 
110–181; 10 U.S.C. 1071 note). 
(3) The term ‘‘Electronic Health Record Mod-
ernization Program’’ has the meaning given that 
term in section 503 of the Veterans Benefits and 
Transition Act of 2018 (Public Law 115–407; 132 
Stat. 5376). 
(4) The term ‘‘interoperability’’ means the abil-
ity of different information systems, devices, or ap-
plications to connect in a coordinated and secure 
manner, within and across organizational bound-
aries, across the complete spectrum of care, includ-
ing all applicable care settings, and with relevant 
stakeholders, including the person whose information 
is being shared, to access, exchange, integrate, and 
use computable data regardless of the data’s origin 
or destination or the applications employed, and
581 
without additional intervention by the end user, in-
cluding— 
(A) the capability to reliably exchange in-
formation without error; 
(B) the ability to interpret and to make ef-
fective use of the information so exchanged; and 
(C) the ability for information that can be 
used to advance patient care to move between 
health care entities, regardless of the technology 
platform in place or the location where care was 
provided. 
(5) The term ‘‘seamless health care’’ means 
health care which is optimized through access by pa-
tients and clinicians to integrated, relevant, and 
complete information about the patient’s clinical ex-
periences, social and environmental determinants of 
health, and health trends over time in order to en-
able patients and clinicians to move from task to 
task and encounter to encounter, within and across 
organizational boundaries, such that high-quality de-
cisions may be formed easily and complete plans of 
care may be carried out smoothly. 
(6) The term ‘‘Secretary concerned’’ means—
582 
(A) the Secretary of Defense, with respect 
to matters concerning the Department of De-
fense; 
(B) the Secretary of Veterans Affairs, with 
respect to matters concerning the Department 
of Veterans Affairs; and 
(C) the Secretary of Homeland Security, 
with respect to matters concerning the Coast 
Guard when it is not operating as a service in 
the Department of the Navy. 
(7) The term ‘‘TRICARE program’’ has the 
meaning given that term in section 1072 of title 10, 
United States Code. 
SEC. 715. DEMONSTRATION OF INTEROPERABILITY MILE-
STONES. 
(a) MILESTONES.— 
(1) EVALUATION.—To demonstrate increasing 
levels of interoperability, functionality, and seamless 
health care within the electronic health record sys-
tems of the Department of Defense and the Depart-
ment of Veterans Affairs, the Office shall seek to 
enter into an agreement with an independent entity 
to conduct an evaluation of the following use cases 
of such systems:
583 
(A) By not later than 18 months after the 
date of the enactment of this Act, whether a cli-
nician of the Department of Defense can access 
and meaningfully interact with a complete vet-
eran patient health record from a military med-
ical treatment facility. 
(B) By not later than 18 months after the 
date of the enactment of this Act, whether a cli-
nician of the Department of Veterans Affairs 
can access and meaningfully interact with a 
complete patient health record of a member of 
the Armed Forces serving on active duty from 
a medical center of the Department of Veterans 
Affairs. 
(C) By not later than two years after the 
date of the enactment of this Act, whether a cli-
nician in the Department of Defense and the 
Department of Veterans Affairs can access and 
meaningfully interact with the data elements of 
the health record of a veteran patient or mem-
ber of the Armed Forces which are generated 
when the veteran patient or member of the 
Armed Forces receives health care from a com-
munity care provider of the Department of Vet-
584 
erans Affairs or a TRICARE provider of the 
Department of Defense 
(D) By not later than two years after the 
date of the enactment of this Act, whether a 
community care provider of the Department of 
the Veterans Affairs and a TRICARE provider 
on a Health Information Exchange-supported 
electronic health record can access a veteran 
and active-duty member patient health record 
from the provider’s system. 
(E) By not later than two years after the 
enactment of this Act, and subsequently after 
each significant implementation wave, an as-
sessment of interoperability between the legacy 
electronic health record systems and the future 
electronic health record systems of the Depart-
ment of Veterans Affairs and the Department 
of Defense. 
(F) By not later than two years after the 
enactment of this Act, and subsequently after 
each significant implementation wave, an as-
sessment of the use of interoperable content be-
tween the legacy electronic health record sys-
tems and the future electronic health record 
systems of the Department of Veterans Affairs
585 
and the Department of Defense, and third- 
party applications. 
(2) SUBMISSION.—The Office shall submit to 
the appropriate congressional committees a report 
detailing the evaluation, methodology for testing, 
and findings for each milestone demonstration under 
paragraph (1) by not later than the date specified 
under such paragraph. 
(b) SYSTEM CONFIGURATION MANAGEMENT.—The 
Office shall— 
(1) maintain the common configuration baseline 
for the electronic health record systems of the De-
partment of Defense and the Department of Vet-
erans Affairs; and 
(2) continually evaluate the state of configura-
tion, the impacts on interoperability, and shall pro-
mote the enhancement of such electronic health 
records systems. 
(c) REGULAR CLINICAL CONSULTATION.—The Office 
shall convene at least annually a clinical workshop to in-
clude clinical staff from the Department of Defense, the 
Department of Veterans Affairs, the Coast Guard, com-
munity providers, and other leading clinical experts to as-
sess the state of clinical use of the electronic health record 
systems and whether the systems are meeting clinical and
586 
patient needs. The clinical workshop shall make rec-
ommendations to the Office on the need for any improve-
ments or concerns with the electronic health record sys-
tems. 
(d) CLINICIAN AND PATIENT SATISFACTION SUR-
VEY.—Beginning October 1, 2021, on at least a biannual 
basis, the Office shall undertake a clinician and patient 
satisfaction survey regarding clinical use and patient expe-
rience with the electronic health record systems of the De-
partment of Defense and the Department of Veterans Af-
fairs. 
(e) ANNUAL REPORTS.—Not later than September 
30, 2020, and annually thereafter, the Office shall submit 
to the appropriate congressional committees a report on— 
(1) the state of the configuration baseline under 
subsection (b) and any activities which decremented 
or enhanced the state of configuration; and 
(2) the activities, assessments and recommenda-
tions of the clinical workshop under subsection (c) 
and the response of the Office to the workshop rec-
ommendations and any action plans to implement 
the recommendations. 
(f) DEFINITIONS.—In this section: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means the following:
587 
(A) The congressional defense committees. 
(B) The Committees on Veterans’ Affairs 
of the House of Representatives and the Sen-
ate. 
(2) The term ‘‘configuration baseline’’ means a 
fixed reference in the development cycle or an 
agreed-upon specification of a product at a point in 
time. It serves as a documented basis for defining 
incremental change in all aspects of an information 
technology product. 
(3) The term ‘‘interoperability’’ means the abil-
ity of different information systems, devices, or ap-
plications to connect in a coordinated and secure 
manner, within and across organizational bound-
aries, across the complete spectrum of care, includ-
ing all applicable care settings, and with relevant 
stakeholders, including the person whose information 
is being shared, to access, exchange, integrate, and 
use computable data regardless of the data’s origin 
or destination or the applications employed, and 
without additional intervention by the end user, in-
cluding— 
(A) the capability to reliably exchange in-
formation without error;
588 
(B) the ability to interpret and to make ef-
fective use of the information so exchanged; and 
(C) the ability for information that can be 
used to advance patient care to move between 
health care entities, regardless of the technology 
platform in place or the location where care was 
provided. 
(4) The term ‘‘meaningfully interact’’ means 
that information can be viewed, consumed, acted 
upon, and edited in a clinical setting to facilitate 
high quality clinical decision making in a clinical set-
ting. 
(5) The term ‘‘Office’’ means the office estab-
lished by section 1635(b) of the Wounded Warrior 
Act (title XVI of Public Law 110–181; 10 U.S.C. 
1071 note). 
(6) The term ‘‘seamless health care’’ means 
health care which is optimized through access by pa-
tients and clinicians to integrated, relevant, and 
complete information about the patient’s clinical ex-
periences, social and environmental determinants of 
health, and health trends over time in order to en-
able patients and clinicians to move from task to 
task and encounter to encounter, within and across 
organizational boundaries, such that high-quality de-
589 
cisions may be formed easily and complete plans of 
care may be carried out smoothly. 
(7) The term ‘‘TRICARE program’’ has the 
meaning given that term in section 1072 of title 10, 
United States Code. 
SEC. 716. INCLUSION OF BLAST EXPOSURE HISTORY IN 
MEDICAL RECORDS OF MEMBERS OF THE 
ARMED FORCES. 
(a) REQUIREMENT.—The Secretary of Defense, in 
coordination with the Secretaries of the military depart-
ments, shall document blast exposure history in the med-
ical record of a member of the Armed Forces to— 
(1) assist in determining whether a future ill-
ness or injury of the member is service-connected; 
and 
(2) inform future blast exposure risk mitigation 
efforts of the Department of Defense. 
(b) ELEMENTS.—A blast exposure history under sub-
section (a) shall include, at a minimum, the following: 
(1) The date of the exposure. 
(2) The duration of the exposure, and, if 
known, the measured blast pressure experienced by 
the individual during such exposure. 
(3) Whether the exposure occurred during com-
bat or training.
590 
(4) Such other information relating to the expo-
sure as the Secretary of Defense may specify pursu-
ant to the guidance described in subsection (c)(1). 
(c) COLLECTION OF EXPOSURE INFORMATION.—The 
Secretary of Defense shall collect blast exposure informa-
tion with respect to a member of the Armed Forces in 
a manner— 
(1) consistent with blast exposure measurement 
training guidance of the Department, including any 
new guidance developed pursuant to— 
(A) the study on blast pressure exposure 
required by section 734 of the National Defense 
Authorization Act for Fiscal Year 2018 (Public 
Law 115–91; 131 Stat. 1444); and 
(B) the review of guidance on blast expo-
sure during training required by section 253 of 
the John S. McCain National Defense Author-
ization Act for Fiscal Year 2019 (Public Law 
115–232; 132 Stat. 1704, 10 U.S.C. 2001 
note); 
(2) compatible with training and operational ob-
jectives; and 
(3) that is automated, to the extent practicable, 
to minimize the reporting burden of unit com-
manders.
591 
(d) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary of Defense 
shall submit to the Committees on Armed Services of the 
Senate and the House of Representatives a report on the 
types of information included in a blast exposure history 
under subsection (a). 
SEC. 717. COMPREHENSIVE POLICY FOR PROVISION OF 
MENTAL HEALTH CARE TO MEMBERS OF THE 
ARMED FORCES. 
(a) POLICY REQUIRED.—Not later than 180 days 
after the date of the enactment of this Act, the Secretary 
of Defense, acting through the Under Secretary of De-
fense for Personnel and Readiness, shall develop and im-
plement a comprehensive policy for the provision of mental 
health care to members of the Armed Forces. 
(b) ELEMENTS.—The policy under subsection (a) 
shall address each of the following: 
(1) The compliance of health professionals in 
the military health system engaged in the provision 
of health care services to members with clinical prac-
tice guidelines for— 
(A) suicide prevention; 
(B) medication-assisted therapy for alcohol 
use disorders; and
592 
(C) medication-assisted therapy for opioid 
use disorders. 
(2) The access and availability of mental health 
care services to members who are victims of sexual 
assault or domestic violence. 
(3) The availability of naloxone reversal capa-
bility on military installations. 
(4) The promotion of referrals of members by 
civilian health care providers to military medical 
treatment facilities when such members are— 
(A) at high risk for suicide and diagnosed 
with a psychiatric disorder; or 
(B) receiving treatment for opioid use dis-
orders. 
(5) The provision of comprehensive behavioral 
health treatment to members of the reserve compo-
nents that takes into account the unique challenges 
associated with the deployment pattern of such 
members and the difficulty such members encounter 
post-deployment with respect to accessing such 
treatment in civilian communities. 
(c) CONSIDERATION.—In developing the policy under 
subsection (a), the Secretary of Defense shall solicit and 
consider recommendations from the Secretaries of the 
military departments and the Chairman of the Joint
593 
Chiefs of Staff regarding the feasibility of implementation 
and execution of particular elements of the policy. 
(d) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary of Defense 
shall submit to the Committees on Armed Services of the 
Senate and the House of Representatives a report on the 
implementation of the policy under subsection (a). 
SEC. 718. LIMITATION ON THE REALIGNMENT OR REDUC-
TION OF MILITARY MEDICAL MANNING END 
STRENGTH. 
(a) LIMITATION.—Except as provided by subsection 
(d), the Secretary of Defense and the Secretaries con-
cerned may not realign or reduce military medical end 
strength authorizations until— 
(1) each review is conducted under paragraph 
(1) of subsection (b); 
(2) each analysis is conducted under paragraph 
(2) of such subsection; 
(3) the measurement is developed under para-
graph (3) of such subsection; 
(4) each plan and forum is provided under 
paragraph (4) of such subsection; and 
(5) a period of 90 days elapses following the 
date on which the Secretary submits the report 
under subsection (c).
594 
(b) REVIEWS, ANALYSES, AND OTHER INFORMA-
TION.— 
(1) REVIEW.—Each Secretary concerned, in co-
ordination with the Chairman of the Joint Chiefs of 
Staff, shall conduct a review of the medical man-
power requirements of the military department of 
the Secretary that accounts for all national defense 
strategy scenarios. 
(2) ANALYSES.—With respect to each military 
medical treatment facility that would be affected by 
a proposed military medical end strength realign-
ment or reduction, the Secretary concerned shall 
conduct an analysis that— 
(A) identifies affected billets; and 
(B) includes a plan for mitigating any po-
tential gap in health care services caused by 
such realignment or reduction. 
(3) MEASUREMENT.—The Secretary of Defense 
shall— 
(A) develop a standard measurement for 
network adequacy to determine the capacity of 
the local health care network to provide care for 
covered beneficiaries in the area of a military 
medical treatment facility that would be af-
596 
(2) a description of the actions the Secretary 
plans to take with respect to such proposed realign-
ments or reductions. 
(d) EXCEPTION.—The limitation in subsection (a) 
shall not apply to billets of a medical department of a mili-
tary department that have remained unfilled since at least 
October 1, 2018. The Secretary concerned may realign or 
reduce such a billet if the Secretary determines that such 
realignment or reduction does not affect the provision of 
health care services to members of the Armed Forces or 
covered beneficiaries. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘covered beneficiary’’ has the 
meaning given that term in section 1072 of title 10, 
United States Code. 
(2) The term ‘‘proposed military medical end 
strength realignment or reduction’’ means a realign-
ment or reduction of military medical end strength 
authorizations as proposed by the budget of the 
President for fiscal year 2020 submitted to Congress 
pursuant to section 1105 of title 31, United States 
Code. 
(3) The term ‘‘Secretary concerned’’ means— 
(A) the Secretary of the Army, with re-
spect to matters concerning the Army;
597 
(B) the Secretary of the Navy, with re-
spect to matters concerning the Navy, the Ma-
rine Corps, and the Coast Guard when it is op-
erating as a service in the Department of the 
Navy; and 
(C) the Secretary of the Air Force, with 
respect to matters concerning the Air Force. 
SEC. 719. STRATEGY TO RECRUIT AND RETAIN MENTAL 
HEALTH PROVIDERS. 
Not later than 180 days after the date of the enact-
ment of this Act, the Secretary of Defense shall submit 
to the congressional defense committees a report that— 
(1) describes the shortage of mental health pro-
viders of the Department of Defense; 
(2) explains the reasons for such shortage; 
(3) explains the effect of such shortage on 
members of the Armed Forces; and 
(4) contains a strategy to better recruit and re-
tain mental health providers, including with respect 
to psychiatrists, psychologists, mental health nurse 
practitioners, licensed social workers, and other li-
censed providers of the military health system, in a 
manner that addresses the need for cultural com-
petence and diversity among such mental health pro-
viders.
598 
SEC. 720. MONITORING MEDICATION PRESCRIBING PRAC-
TICES FOR THE TREATMENT OF POST-TRAU-
MATIC STRESS DISORDER. 
(a) REPORT.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of enactment of this Act, the Sec-
retary of Defense shall submit to the Committees on 
Armed Services of the House of Representatives and 
the Senate a report on the practices for prescribing 
medication during the period beginning January 1, 
2012, and ending December 31, 2017, that were in-
consistent with the post-traumatic stress disorder 
medication guidelines developed by the Department 
of Defense and the Veterans Health Administration. 
(2) CONTENTS.—The report under this sub-
section shall include the following: 
(A) A summary of the practices of the 
Army, Navy, and the Air Force, for prescribing 
medication during the period referred to in 
paragraph (1) that were inconsistent with the 
post-traumatic stress disorder medication guide-
lines developed by the Department of Defense 
and the Veterans Health Administration. 
(B) Identification of medical centers serv-
ing members of the Armed Forces found to 
having higher than average incidences of pre-
599 
scribing medication during the period referred 
to in paragraph (1) that were inconsistent with 
the post-traumatic stress disorder guidelines. 
(C) A plan for such medical centers to re-
duce the prescribing of medications that are in-
consistent with the post-traumatic stress dis-
order guidelines. 
(D) A plan for ongoing monitoring of med-
ical centers found to have higher than average 
incidences of prescribing medication that were 
inconsistent with the post-traumatic stress dis-
order guidelines by the Department of Defense 
and the Veterans Health Administration. 
(b) MONITORING PROGRAM.—Based on the findings 
of the report under subsection (a), the Secretaries of the 
Army, the Navy, and the Air Force shall each establish 
a monitoring program carried out with respect to such 
branch of the Armed Forces that shall provide as follows: 
(1) The monitoring program shall provide for 
the conduct of periodic reviews, beginning October 1, 
2019, of medication prescribing practices of its own 
providers. 
(2) The monitoring program shall provide for 
regular reports, beginning October 1, 2020, to the 
Department of Defense and the Veterans Health Ad-
600 
ministration, of the results of the periodic reviews 
pursuant to paragraph (1) of this subsection. 
(3) The monitoring program shall establish in-
ternal procedures, not later than October 1, 2020, to 
address practices for prescribing medication that are 
inconsistent with the post-traumatic stress disorder 
medication guidelines developed by the Department 
of Defense and the Veterans Health Administration. 
(c) REPORT ON IMPLEMENTATION OF GUIDANCE ON 
OPIOID PRESCRIPTIONS FOR PAIN FROM MINOR OUT-
PATIENT PROCEDURES.—Not later than 6 months after 
the date of enactment of this Act, the Secretary of De-
fense, acting in conjunction with the Director of the De-
fense Health Agency, shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate a report on the implementation and results of the 
Defense Health Agency’s guidance on opioid prescriptions 
for pain from minor outpatient procedures in Guidance 
Report entitled ‘‘Pain Management and Opioid Safety in 
the Military Health System (MHS)’’ (DHA–PI 6025.04, 
issued on June 8, 2018).
601 
SEC. 720A. MAINTENANCE OF CERTAIN MEDICAL SERVICES 
AT MILITARY MEDICAL TREATMENT FACILI-
TIES AT SERVICE ACADEMIES. 
Section 1073d of title 10, United States Code, is 
amended by adding at the end the following new sub-
section: 
‘‘(f) MAINTENANCE OF CERTAIN MEDICAL SERVICES 
AT SERVICE ACADEMIES.—(1) In carrying out subsection 
(a), the Secretary of Defense shall ensure that each mili-
tary medical treatment facility located at a Service Acad-
emy (as defined in section 347 of this title) provides each 
covered medical service unless the Secretary determines 
that a civilian health care facility located not fewer than 
five miles from the Service Academy provides the covered 
medical service. 
‘‘(2) In this subsection, the term ‘covered medical 
service’ means the following: 
‘‘(A) Emergency room services. 
‘‘(B) Orthopedic services. 
‘‘(C) General surgery services. 
‘‘(D) Ear, nose, and throat services. 
‘‘(E) Gynecological services. 
‘‘(F) Ophthalmology services. 
‘‘(G) In-patient services. 
‘‘(H) Any other medical services that the rel-
evant Superintendent of the Service Academy deter-
602 
mines necessary to maintain the readiness and 
health of the cadets or midshipmen and members of 
the armed forces at the Service Academy.’’. 
SEC. 720B. DEVELOPMENT OF PARTNERSHIPS TO IMPROVE 
COMBAT CASUALTY CARE FOR PERSONNEL 
OF THE ARMED FORCES. 
(a) PARTNERSHIPS.— 
(1) IN
GENERAL.—The Secretary of Defense 
shall, through the Joint Trauma Education and 
Training Directorate established under section 708 
of the National Defense Authorization Act for Fiscal 
Year 2017 (Public Law 114–328; 10 U.S.C. 1071 
note), develop partnerships with civilian academic 
medical centers and large metropolitan teaching hos-
pitals to improve combat casualty care for personnel 
of the Armed Forces. 
(2) PARTNERSHIPS
WITH
LEVEL
I
TRAUMA 
CENTERS.—In carrying out partnerships under para-
graph (1), trauma surgeons and physicians of the 
Department of Defense shall partner with level I ci-
vilian trauma centers to provide adequate training 
and readiness for the next generation of medical 
providers to treat critically injured burn patients. 
(b) SUPPORT OF PARTNERSHIPS.—The Secretary of 
Defense shall make every effort to support partnerships
603 
under the Joint Trauma Education and Training Direc-
torate with academic institutions that have level I civilian 
trauma centers, specifically those centers with a burn cen-
ter, that offer burn rotations and clinical experience to 
provide adequate training and readiness for the next gen-
eration of medical providers to treat critically injured burn 
patients. 
(c) LEVEL I CIVILIAN TRAUMA CENTER DEFINED.— 
In this section, the term ‘‘level I civilian trauma center’’ 
has the meaning given that term in section 708 of the 
National Defense Authorization Act for Fiscal Year 2017 
(Public Law 114–328; 10 U.S.C. 1071 note). 
(d) EFFECTIVE DATE.—This section shall take effect 
on October 1, 2020. 
SEC. 720C. MODIFICATION TO REFERRALS FOR MENTAL 
HEALTH SERVICES. 
If the Secretary of Defense is unable to provide men-
tal health services in a military medical treatment facility 
to a member of the Armed Forces within 15 days of the 
date on which such services are first requested by the 
member, the Secretary may refer the member to a pro-
vider under the TRICARE program (as that term is de-
fined in section 1072 of title 10, United States Code) to 
receive such services.
604 
Subtitle C—Reports and Other 
Matters 
SEC. 721. ESTABLISHMENT OF MILITARY DENTAL RE-
SEARCH PROGRAM. 
(a) IN GENERAL.—Chapter 104 of title 10, United 
States Code, is amended by inserting after section 2116 
the following new section: 
‘‘§ 2116a. Military dental research 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) The term ‘military dental research’ means 
research on the furnishing of dental care and serv-
ices by dentists in the armed forces. 
‘‘(2) The term ‘TriService Dental Research 
Program’ means the program of military dental re-
search authorized under this section. 
‘‘(b) PROGRAM AUTHORIZED.—The Secretary of De-
fense may establish at the University a program of mili-
tary dental research. 
‘‘(c) 
TRISERVICE
RESEARCH
GROUP.—The 
TriService Dental Research Program shall be adminis-
tered by a TriService Dental Research Group composed 
of Army, Navy, and Air Force dentists who are involved 
in military dental research and are designated by the Sec-
retary concerned to serve as members of the group.
605 
‘‘(d) DUTIES OF GROUP.—The TriService Dental Re-
search Group described in subsection (c) shall— 
‘‘(1) develop for the Department of Defense 
recommended guidelines for requesting, reviewing, 
and funding proposed military dental research 
projects; and 
‘‘(2) make available to Army, Navy, and Air 
Force dentists and officials of the Department of 
Defense who conduct military dental research— 
‘‘(A) information about dental research 
projects that are being developed or carried out 
in the Army, Navy, and Air Force; and 
‘‘(B) expertise and information beneficial 
to the encouragement of meaningful dental re-
search. 
‘‘(e) RESEARCH TOPICS.—For purposes of this sec-
tion, military dental research includes research on the fol-
lowing issues: 
‘‘(1) Issues regarding how to ensure the readi-
ness of members of the armed forces on active duty 
and in the reserve components with respect to the 
provision of dental care and services. 
‘‘(2) Issues regarding preventive dentistry and 
disease management, including early detection of 
needs.
606 
‘‘(3) Issues regarding how to improve the re-
sults of dental care and services provided in the 
armed forces in time of peace. 
‘‘(4) Issues regarding how to improve the re-
sults of dental care and services provided in the 
armed forces in time of war. 
‘‘(5) Issues regarding minimizing or eliminating 
emergent dental conditions and dental disease and 
non-battle injuries in deployed settings. 
‘‘(6) Issues regarding how to prevent complica-
tions associated with dental-related battle injuries. 
‘‘(7) Issues regarding how to prevent complica-
tions associated with the transportation of dental pa-
tients in the military medical evacuation system. 
‘‘(8) Issues regarding the use of technological 
advances, including teledentistry. 
‘‘(9) Issues regarding psychological distress in 
receiving dental care and services. 
‘‘(10) Issues regarding how to improve methods 
of training dental personnel, including dental assist-
ants and dental extenders. 
‘‘(11) Wellness issues relating to dental care 
and services. 
‘‘(12) Case management issues relating to den-
tal care and services.
607 
‘‘(13) Issues regarding the use of alternate den-
tal care delivery systems, including the employment 
of interprofessional practice models incorporating 
multiple health professions.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 104 of such title is amended 
by inserting after the item relating to section 2116 the 
following new item: 
‘‘2116a. Military dental research.’’. 
SEC. 722. PILOT PROGRAM ON CRYOPRESERVATION AND 
STORAGE. 
(a) PILOT PROGRAM.—The Secretary of Defense 
shall establish a pilot program to provide not more than 
1,000 members of the Armed Forces serving on active 
duty with the opportunity to cryopreserve and store their 
gametes prior to deployment to a combat zone. 
(b) PERIOD.— 
(1) IN GENERAL.—The Secretary shall provide 
for the cryopreservation and storage of gametes of 
a participating member of the Armed Forces under 
subsection (a), at no cost to the member, in a facil-
ity of the Department of Defense or at a private en-
tity pursuant to a contract under subsection (d) 
until the date that is one year after the retirement, 
separation, or release of the member from the 
Armed Forces.