550 
(1) the plans of each military department to en-
sure a comprehensive transition of any military med-
ical research organizations of the military department 
with respect to the establishment of the Defense 
Health Agency Research and Development; and 
(2) any risks involved in such transition that 
may compromise ongoing medical research and devel-
opment activities of the military department. 
SEC. 713. AUTHORIZATION OF PROGRAM TO PREVENT 
FRAUD AND ABUSE IN THE MILITARY HEALTH 
SYSTEM. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1073e 
the following new section: 
‘‘§ 1073f. Health care fraud and abuse prevention pro-
gram 
‘‘(a) PROGRAM AUTHORIZED.—(1) The Secretary of 
Defense may carry out a program under this section to pre-
vent and remedy fraud and abuse in the health care pro-
grams of the Department of Defense. 
‘‘(2) At the discretion of the Secretary, such program 
may be administered jointly by the Inspector General of 
the Department of Defense and the Director of the Defense 
Health Agency. 
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‘‘(3) In carrying out such program, the authorities 
granted to the Secretary of Defense and the Inspector Gen-
eral of the Department of Defense under section 1128A(m) 
of the Social Security Act (42 U.S.C. 1320a–7a(m)) shall 
be available to the Secretary and the Inspector General. 
‘‘(b) CIVIL MONETARY PENALTIES.—(1) Except as 
provided in paragraph (2), the provisions of section 1128A 
of the Social Security Act (42 U.S.C. 1320a–7a) shall apply 
with respect to any civil monetary penalty imposed in car-
rying out the program authorized under subsection (a). 
‘‘(2) Consistent with section 1079a of this title, 
amounts recovered in connection with any such civil mone-
tary penalty imposed— 
‘‘(A) shall be credited to appropriations avail-
able as of the time of the collection for expenses of the 
health care program of the Department of Defense af-
fected by the fraud and abuse for which such penalty 
was imposed; and 
‘‘(B) may be used to support the administration 
of the program authorized under subsection (a), in-
cluding to support any interagency agreements en-
tered into under subsection (d). 
‘‘(c) INTERAGENCY AGREEMENTS.—The Secretary of 
Defense may enter into agreements with the Secretary of 
Health and Human Services, the Attorney General, or the 
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552 
heads of other Federal agencies, for the effective and efficient 
implementation of the program authorized under subsection 
(a). 
‘‘(d) RULE OF CONSTRUCTION.—Joint administration 
of the program authorized under subsection (a) may not 
be construed as limiting the authority of the Inspector Gen-
eral of the Department of Defense under any other provision 
of law. 
‘‘(e) FRAUD AND ABUSE DEFINED.—In this section, 
the term ‘fraud and abuse’ means any conduct specified in 
subsection (a) or (b) of section 1128A of the Social Security 
Act (42 U.S.C. 1320a–7a).’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of such chapter is amended by inserting after 
the item relating to section 1073e the following new item: 
‘‘1073f. Health care fraud and abuse prevention program.’’. 
SEC. 714. MANDATORY REFERRAL FOR MENTAL HEALTH 
EVALUATION. 
Section 1090a of title 10, United States Code, is 
amended— 
(1) by redesignating subsection (e) as subsection 
(f); and 
(2) by inserting after subsection (d) the following 
new subsection: 
‘‘(e) PROCESS APPLICABLE
TO MEMBER DISCLO-
SURE.—The regulations required by subsection (a) shall— 
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‘‘(1) establish a phrase that enables a member of 
the armed forces to trigger a referral of the member 
by a commanding officer or supervisor for a mental 
health evaluation; 
‘‘(2) require a commanding officer or supervisor 
to make such referral as soon as practicable following 
disclosure by the member to the commanding officer 
or supervisor of the phrase established under para-
graph (1); and 
‘‘(3) ensure that the process protects the confiden-
tiality of the member in a manner similar to the con-
fidentiality provided for members making restricted 
reports under section 1565b(b) of this title.’’. 
SEC. 715. INCLUSION OF EXPOSURE TO PERFLUOROALKYL 
AND 
POLYFLUOROALKYL 
SUBSTANCES 
AS 
COMPONENT OF PERIODIC HEALTH ASSESS-
MENTS. 
(a) PERIODIC
HEALTH
ASSESSMENT.—Each Sec-
retary concerned shall ensure that any periodic health as-
sessment provided to a member of the Armed Forces in-
cludes an evaluation of whether the member has been— 
(1) based or stationed at a military installation 
identified by the Secretary concerned as a location 
with a known or suspected release of perfluoroalkyl 
substances or polyfluoroalkyl substances during the 
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period in which the member was based or stationed 
at the military installation; or 
(2) exposed to such substances, including by eval-
uating any information in the health record of the 
member. 
(b) SEPARATION HISTORY AND PHYSICAL EXAMINA-
TIONS.—Section 1145 of title 10, United States Code, is 
amended— 
(1) in subsection (a)(5), by adding at the end the 
following new subparagraph: 
‘‘(D) 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 military installation 
identified by the Secretary concerned as a location 
with a known or suspected release of perfluoroalkyl 
substances or polyfluoroalkyl substances during the 
period in which the member was based or stationed 
at the military installation; or 
‘‘(ii) exposed to such substances, including by as-
sessing any information in the health record of the 
member.’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(g) SECRETARY CONCERNED DEFINED.—In this sec-
tion, the term ‘Secretary concerned’ has the meaning given 
such term in section 101 of this title (and otherwise includes 
the Secretary of the department in which the Coast Guard 
is operating).’’. 
(c) DEPLOYMENT ASSESSMENTS.—Section 1074f of 
title 10, United States Code, is amended— 
(1) in subsection (b)(2), by adding at the end the 
following new subparagraph: 
‘‘(E) An assessment of whether the member 
was— 
‘‘(i) based or stationed at a military instal-
lation identified by the Secretary concerned as a 
location with a known or suspected release of 
perfluoroalkyl substances or polyfluoroalkyl sub-
stances during the period in which the member 
was based or stationed at the military installa-
tion; or 
‘‘(ii) exposed to such substances, including 
by assessing any information in the health 
record of the member.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) SECRETARY CONCERNED DEFINED.—In this sec-
tion, the term ‘Secretary concerned’ has the meaning given 
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such term in section 101 of this title (and otherwise includes 
the Secretary of the department in which the Coast Guard 
is operating).’’. 
(d) PROVISION OF BLOOD TESTING TO DETERMINE 
EXPOSURE
TO
PERFLUOROALKYL
SUBSTANCES
OR 
POLYFLUOROALKYL SUBSTANCES.— 
(1) PROVISION OF BLOOD TESTING.— 
(A) IN GENERAL.—If a covered evaluation 
of a member of the Armed Forces results in a 
positive determination of potential exposure to 
perfluoroalkyl substances or polyfluoroalkyl sub-
stances, the Secretary concerned shall provide to 
that member, during the covered evaluation, 
blood testing to determine and document poten-
tial exposure to such substances. 
(B) INCLUSION IN HEALTH RECORD.—The 
results of blood testing of a member of the Armed 
Forces conducted under subparagraph (A) shall 
be included in the health record of the member. 
(2) DEFINITIONS.—In this section: 
(A) The term ‘‘covered evaluation’’ means— 
(i) a periodic health assessment con-
ducted in accordance with subsection (a); 
(ii) a separation history and physical 
examination 
conducted 
under 
section 
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557 
1145(a)(5) of title 10, United States Code, 
as amended by subsection (b); or 
(iii) a deployment assessment con-
ducted under section 1074f(b)(2) of such 
title, as amended by subsection (c). 
(B) The term ‘‘Secretary concerned’’ has the 
meaning given such term in section 101 of title 
10, United States Code (and otherwise includes 
the Secretary of the department in which the 
Coast Guard is operating). 
SEC. 716. PROHIBITION ON ADVERSE PERSONNEL ACTIONS 
TAKEN AGAINST CERTAIN MEMBERS OF THE 
ARMED 
FORCES 
BASED 
ON 
DECLINING 
COVID–19 VACCINE. 
(a) FINDINGS.—Congress finds the following: 
(1) The Secretary of Defense has announced a 
COVID–19 vaccine mandate will take effect for the 
Department of Defense 
(2) Many Americans have reservations about 
taking a vaccine that has only been available for less 
than a year. 
(3) Reports of adverse actions being taken, or 
threatened, by military leadership at all levels are 
antithetical to our fundamental American values. 
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(4) Any discharge other than honorable denotes 
a dereliction of duty or a failure to serve the United 
States and its people to the best of the ability of an 
individual. 
(b) PROHIBITION.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1107a 
the following new section: 
‘‘§ 1107b. Prohibition on certain adverse personnel ac-
tions related to COVID–19 vaccine re-
quirement 
‘‘(a) PROHIBITION.—Notwithstanding any other pro-
vision of law, a member of an Armed Force under the juris-
diction of the Secretary of a military department subject 
to discharge on the basis of the member choosing not to re-
ceive the COVID–19 vaccine may only receive an honorable 
discharge. 
‘‘(b) MEMBER OF AN ARMED FORCE DEFINED.—In 
this section, the term ‘member of an Armed Force’ means 
a member of the Army, Navy, Air Force, Marine Corps, 
or the Space Force.’’. 
(c) CLERICAL AMENDMENT.—The table of sections for 
such chapter is amended by inserting after the item relating 
to section 1107a the following new item: 
‘‘1107b. Prohibition on certain adverse personnel actions related to COVID–19 
vaccine requirement’’. 
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559 
SEC. 717. ESTABLISHMENT OF DEPARTMENT OF DEFENSE 
SYSTEM TO TRACK AND RECORD INFORMA-
TION ON VACCINE ADMINISTRATION. 
(a) ESTABLISHMENT OF SYSTEM.—Section 1110 of 
title 10, United States Code, is amended— 
(1) by redesignating subsections (a) and (b) as 
subsections (b) and (c), respectively; and 
(2) by inserting after the heading the following 
new subsection: 
‘‘(a) SYSTEM TO TRACK AND RECORD VACCINE INFOR-
MATION.—(1) The Secretary of Defense, in coordination 
with the Secretaries of the military departments, shall es-
tablish a system to track and record the following informa-
tion: 
‘‘(A) Each vaccine administered by a health care 
provider of the Department of Defense to a member 
of an armed force under the jurisdiction of the Sec-
retary of a military department. 
‘‘(B) Any adverse reaction of the member related 
to such vaccine. 
‘‘(C) Each refusal of a vaccine by such a member 
on the basis that the vaccine is being administered by 
a health care provider of the Department pursuant to 
an emergency use authorization granted by the Com-
missioner of Food and Drugs under section 564 of the 
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Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
360bbb–3). 
‘‘(2) In carrying out paragraph (1), the Secretary of 
Defense shall ensure that— 
‘‘(A) any electronic health record maintained by 
the Secretary for a member of an armed force under 
the jurisdiction of the Secretary of a military depart-
ment is updated with the information specified in 
such paragraph with respect to the member; and 
‘‘(B) any collection, storage, or use of such infor-
mation is conducted through means involving such 
cyber protections as the Secretary determines nec-
essary to safeguard the personal information of the 
member.’’. 
(b) CONFORMING AMENDMENTS.—Such section is fur-
ther amended— 
(1) in the heading by striking ‘‘Anthrax vac-
cine immunization program; procedures 
for exemptions and monitoring reactions’’ 
and inserting ‘‘System for tracking and re-
cording vaccine information; anthrax vac-
cine immunization program’’; and 
(2) in subsection (b), as redesignated by sub-
section (a)(1), by striking ‘‘Secretary of Defense’’ and 
inserting ‘‘Secretary’’. 
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(c) CLERICAL AMENDMENT.—The table of sections for 
chapter 55 of title 10, United States Code, is amended by 
striking the item relating to section 1110 and inserting the 
following new item: 
‘‘1110. System for tracking and recording vaccine information; anthrax vaccine 
immunization program.’’. 
(d) DEADLINE FOR ESTABLISHMENT OF SYSTEM.— 
The Secretary of Defense shall establish the system under 
section 1110 of title 10, United States Code. as added by 
subsection (a), by not later than January 1, 2023. 
(e) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Defense shall 
submit to the Committees on Armed Services of the House 
of Representatives and the Senate a report on the adminis-
tration of vaccines to members of the Armed Forces under 
the jurisdiction of the Secretary of a military department 
and on the status of establishing the system under section 
1110(a) of title 10, United States Code (as added by sub-
section (a)). Such report shall include information on the 
following: 
(1) The process by which such members receive 
vaccines, and the process by which the Secretary 
tracks, records, and reports on, vaccines received by 
such members (including with respect to any transfers 
by a non-Department provider to the Department of 
vaccination records or other medical information of 
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SEC. 718. AUTHORIZATION OF PROVISION OF INSTRUCTION 
AT UNIFORMED SERVICES UNIVERSITY OF 
THE HEALTH SCIENCES TO CERTAIN FED-
ERAL EMPLOYEES. 
Section 2114(h) of title 10, United States Code, is 
amended— 
(1) by striking ‘‘The Secretary of Defense’’ and 
inserting ‘‘(1) The Secretary of Defense, in coordina-
tion with the Secretary of Health and Human Serv-
ices and the Secretary of Veterans Affairs,’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(2)(A) A covered employee whose employment or serv-
ice with the Department of Veterans Affairs, Public Health 
Service, or Coast Guard (as applicable) is in a position 
relevant to national security or health sciences may receive 
instruction at the University within the scope of such em-
ployment or service. 
‘‘(B) If a covered employee receives instruction at the 
University pursuant to subparagraph (A), the head of the 
Federal agency concerned shall reimburse the University for 
the cost of providing such instruction to the covered em-
ployee. Amounts received by the University under this sub-
paragraph shall be retained by the University to defray the 
costs of such instruction. 
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‘‘(C) Notwithstanding subsections (b) through (e) and 
subsection (i), the head of the Federal agency concerned 
shall determine the service obligations of the covered em-
ployee receiving instruction at the University pursuant to 
subparagraph (A) in accordance with applicable law. 
‘‘(D) In this paragraph— 
‘‘(i) the term ‘covered employee’ means an em-
ployee of the Department of Veterans Affairs, a civil-
ian employee of the Public Health Service, a member 
of the commissioned corps of the Public Health Serv-
ice, a member of the Coast Guard, or a civilian em-
ployee of the Coast Guard; and 
‘‘(ii) the term ‘head of the Federal agency con-
cerned’ means the head of the Federal agency that em-
ploys, or has jurisdiction over the uniformed service 
of, a covered employee permitted to receive instruction 
at the University under subparagraph (A) in the rel-
evant position described in such subparagraph.’’. 
SEC. 719. MANDATORY TRAINING ON HEALTH EFFECTS OF 
BURN PITS. 
The Secretary of Defense shall provide to each medical 
provider of the Department of Defense mandatory training 
with respect to the potential health effects of burn pits. 
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SEC. 720. DEPARTMENT OF DEFENSE PROCEDURES FOR EX-
EMPTIONS FROM MANDATORY COVID–19 VAC-
CINES. 
(a) EXEMPTIONS.—The Secretary of Defense shall es-
tablish uniform procedures under which covered members 
may be exempted from receiving an otherwise mandated 
COVID–19 vaccine for administrative, medical, or religious 
reasons, including on the basis of possessing an antibody 
test result demonstrating previous COVID–19 infection. 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘covered member’’ means a member 
of an Armed Force under the jurisdiction of the Sec-
retary of a military department. 
(2) The term ‘‘COVID–19 vaccine’’ means any 
vaccine for the coronavirus disease 2019 (COVID–19), 
including any subsequent booster shot for COVID–19. 
SEC. 721. MODIFICATIONS AND REPORT RELATED TO RE-
DUCTION OR REALIGNMENT OF MILITARY 
MEDICAL MANNING AND MEDICAL BILLETS. 
(a) MODIFICATIONS TO LIMITATION ON REDUCTION OR 
REALIGNMENT.—Section 719 of the National Defense Au-
thorization Act for Fiscal Year 2020 (Public Law 116–92; 
133 Stat. 1454), as amended by section 717 of the William 
M. (Mac) Thornberry National Defense Authorization Act 
for Fiscal Year 2021 (Public Law 116–283), is further 
amended— 
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(1) in subsection (a), by striking ‘‘180 days fol-
lowing the date of the enactment of the William M. 
(Mac) Thornberry National Defense Authorization Act 
for Fiscal Year 2021’’ and inserting ‘‘the year fol-
lowing the date of the enactment of the National De-
fense Authorization Act for Fiscal Year 2022’’; and 
(2) in subsection (b)(1), by inserting ‘‘, includ-
ing any billet validation requirements determined 
pursuant to estimates provided in the joint medical 
estimate under section 732 of the John S. McCain 
National Defense Authorization Act for Fiscal Year 
2019 (Public Law 115–232),’’ after ‘‘requirements of 
the military department of the Secretary’’. 
(b) GAO REPORT ON REDUCTION OR REALIGNMENT 
OF MILITARY MEDICAL MANNING
AND MEDICAL BIL-
LETS.— 
(1) REPORT.—Not later than one year after the 
date of the enactment of this Act, the Comptroller 
General of the United States shall submit to the Com-
mittees on Armed Services of the House of Represent-
atives and the Senate a report on the analyses used 
to support any reduction or realignment of military 
medical manning, including any reduction or re-
alignment of medical billets of the military depart-
ments. 
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(2) ELEMENTS.—The report under paragraph 
(1) shall include the following: 
(A) An analysis of the use of the joint med-
ical estimate under section 732 of the John S. 
McCain National Defense Authorization Act for 
Fiscal Year 2019 (Public Law 115–232; 132 
Stat. 1817) and wartime scenarios to determine 
military medical manpower requirements, in-
cluding with respect to pandemic influenza and 
homeland defense missions. 
(B) An assessment of whether the Secre-
taries of the military departments have used the 
processes under section 719(b) of the National 
Defense Authorization Act for Fiscal Year 2020 
(Public Law 116–92; 133 Stat. 1454) to ensure 
that a sufficient combination of skills, special-
ties, and occupations are validated and filled 
prior to the transfer of any medical billets of a 
military department to fill other military med-
ical manpower needs. 
(C) An assessment of the effect of the reduc-
tion or realignment of such billets on local health 
care networks and whether the Director of the 
Defense Health Agency has conducted such an 
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assessment in coordination with the Secretaries 
of the military departments. 
SEC. 
722. 
CROSS-FUNCTIONAL 
TEAM 
FOR 
EMERGING 
THREAT RELATING TO ANOMALOUS HEALTH 
INCIDENTS. 
(a) ESTABLISHMENT.—Using the authority provided 
under section 911(c) of the National Defense Authorization 
Act for Fiscal Year 2017 (Public Law 114–328; 10 U.S.C. 
111 note), the Secretary of Defense shall establish a cross- 
functional team to address national security challenges 
posed by anomalous health incidents (as defined by the Sec-
retary) and ensure that individuals affected by anomalous 
health incidents receive timely and comprehensive health 
care and treatment pursuant to title 10, United States 
Code, or other provisions of law administered by the Sec-
retary, for symptoms consistent with an anomalous health 
incident. 
(b) DUTIES.—The duties of the cross-functional team 
established under subsection (a) shall be— 
(1) to assist the Secretary of Defense with ad-
dressing the challenges posed by anomalous health in-
cidents and any other efforts regarding such incidents 
that the Secretary determines necessary; and 
(2) to integrate the efforts of the Department of 
Defense regarding anomalous health incidents with 
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the efforts of other departments or agency of the Fed-
eral Government regarding such incidents. 
(c) TEAM LEADER.—The Secretary shall select an 
Under Secretary of Defense to lead the cross-functional team 
and a senior military officer to serve as the deputy to the 
Under Secretary so selected. 
(d) DETERMINATION OF ORGANIZATIONAL ROLES AND 
RESPONSIBILITIES.—The Secretary, in coordination with 
the Director of National Intelligence and acting through the 
cross-functional team established under subsection (a), shall 
determine the roles and responsibilities of the organizations 
and elements of the Department of Defense with respect to 
addressing anomalous health incidents, including the roles 
and responsibilities of the Office of the Secretary of Defense, 
the intelligence components of the Department, Defense 
agencies, and Department of Defense field activities, the 
military departments, combatant commands, and the Joint 
Staff. 
(e) BRIEFINGS.— 
(1) INITIAL BRIEFING.—Not later than 30 days 
after the date of the enactment of this Act, the Sec-
retary shall provide to the appropriate congressional 
committees a briefing on— 
(A) the progress of the Secretary in estab-
lishing the cross-functional team; and 
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(B) the progress the team has made in— 
(i) determining the roles and respon-
sibilities of the organizations and elements 
of the Department of Defense with respect 
the cross-functional team; and 
(ii) carrying out the duties under sub-
section (b). 
(2) UPDATES.—Not later than 75 days after the 
date of the enactment of this Act, and once every 45 
days thereafter during the one-year period following 
such date of enactment, the Secretary shall provide to 
the appropriate congressional committees a briefing 
containing updates with respect to the efforts of the 
Department regarding anomalous health incidents. 
(f) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congres-
sional committees’’ means— 
(1) the congressional defense committees; and 
(2) the Permanent Select Committee on Intel-
ligence of the House of Representatives and the Select 
Committee on Intelligence of the Senate. 
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SEC. 723. IMPLEMENTATION OF INTEGRATED PRODUCT 
FOR MANAGEMENT OF POPULATION HEALTH 
ACROSS MILITARY HEALTH SYSTEM. 
(a) INTEGRATED PRODUCT.—The Secretary of Defense 
shall develop and implement an integrated product for the 
management of population health across the military health 
system. Such integrated product shall serve as a repository 
for the health care, demographic, and other relevant data 
of all covered beneficiaries, including with respect to data 
on health care services furnished to such beneficiaries 
through the purchased care and direct care components of 
the TRICARE program, and shall— 
(1) be compatible with the electronic health 
record system maintained by the Secretary for mem-
bers of the Armed Forces; 
(2) enable the coordinated case management of 
covered beneficiaries with respect to health care serv-
ices furnished to such beneficiaries at military med-
ical treatment facilities and at private sector facilities 
through health care providers contracted by the De-
partment of Defense; 
(3) enable the collection and stratification of 
data from multiple sources to measure population 
health goals, facilitate disease management programs 
of the Department, improve patient education, and 
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integrate wellness services across the military health 
system; and 
(4) enable predictive modeling to improve health 
outcomes for patients and to facilitate the identifica-
tion and correction of medical errors in the treatment 
of patients, issues regarding the quality of health care 
services provided, and gaps in health care coverage. 
(b) DEFINITIONS.—In this section: 
(1) 
The 
terms 
‘‘covered 
beneficiary’’ 
and 
‘‘TRICARE program’’ have the meanings given such 
terms in section 1072 of title 10, United States Code. 
(2) The term ‘‘integrated product’’ means an 
electronic system of systems (or solutions or products) 
that provides for the integration and sharing of data 
to meet the needs of an end user in a timely and cost 
effective manner. 
SEC. 724. DIGITAL HEALTH STRATEGY OF DEPARTMENT OF 
DEFENSE. 
(a) DIGITAL HEALTH STRATEGY.— 
(1) STRATEGY.—Not later than April 1, 2022, 
the Secretary of Defense shall develop a digital health 
strategy of the Department of Defense to incorporate 
new and emerging technologies and methods (includ-
ing three-dimensional printing, virtual reality, wear-
able devices, big data and predictive analytics, and 
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other innovative methods that leverage new or emerg-
ing technologies) in the provision of clinical care 
within the military health system. 
(2) ELEMENTS.—The strategy under paragraph 
(1) shall address, with respect to future use within the 
military health system, the following: 
(A) Emerging technology to improve the de-
livery of clinical care and health services. 
(B) Design thinking to improve the delivery 
of clinical care and health services. 
(C) Advanced clinical decision support sys-
tems. 
(D) Simulation technologies for clinical 
training 
(including 
through 
simulation 
immersive training) and clinical education, and 
for the training of health care personnel in the 
adoption of emerging technologies for clinical 
care delivery. 
(E) Wearable devices. 
(F) Three-dimensional printing and related 
technologies. 
(G) Data-driven decision making, including 
through the use of big data and predictive ana-
lytics, in the delivery of clinical care and health 
services. 
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(b) REPORT.—Not later than July 1, 2022, the Sec-
retary shall submit to the Committees on Armed Services 
of the House of Representatives and the Senate a report set-
ting forth— 
(1) the strategy under subsection (a); and 
(2) a plan to implement such strategy, including 
the estimated timeline and cost for such implementa-
tion. 
SEC. 725. DEVELOPMENT AND UPDATE OF CERTAIN POLI-
CIES RELATING TO MILITARY HEALTH SYS-
TEM 
AND 
INTEGRATED 
MEDICAL 
OPER-
ATIONS. 
(a) IN GENERAL.—By not later than October 1, 2022, 
the Secretary of Defense, in coordination with the Secre-
taries of the military departments and the Chairman of the 
Joint Chiefs of Staff, shall develop and update certain poli-
cies relating to the military health system and integrated 
medical operations of the Department of Defense as follows: 
(1) UPDATED
PLAN
ON
INTEGRATED
MEDICAL 
OPERATIONS IN CONTINENTAL UNITED STATES.—The 
Secretary of Defense shall develop an updated plan on 
integrated medical operations in the continental 
United States and update the Department of Defense 
Instruction 6010.22, titled ‘‘National Disaster Med-
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ical System (NDMS)’’ (or such successor instruction) 
accordingly. Such updated plan shall— 
(A) be informed by the operational plans of 
the combatant commands and by the joint med-
ical estimate under section 732 of the John S. 
McCain National Defense Authorization Act for 
Fiscal Year 2019 (Public Law 115–232; 132 
Stat. 1817); 
(B) include a determination as to whether 
combat casualties should receive medical care 
under the direct care or purchased care compo-
nent of the military health system and a risk 
analysis in support of such determination; 
(C) identify the manning levels required to 
furnish medical care under the updated plan, in-
cluding with respect to the levels of military per-
sonnel, civilian employees of the Department, 
and contractors of the Department; and 
(D) include a cost estimate for the 
furnishment of such medical care. 
(2) UPDATED PLAN ON GLOBAL PATIENT MOVE-
MENT.—The Secretary of Defense shall develop an up-
dated plan on global patient movement and update 
the Department of Defense Instruction 5154.06, relat-
ing to medical military treatment facilities and pa-
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tient movement (or such successor instruction) accord-
ingly. Such updated plan shall— 
(A) be informed by the operational plans of 
the combatant commands and by the joint med-
ical estimate under section 732 of the John S. 
McCain National Defense Authorization Act for 
Fiscal Year 2019 (Public Law 115–232; 132 
Stat. 1817); 
(B) include a risk assessment with respect 
to patient movement compared against overall 
operational plans; 
(C) include a description of any capabili-
ties-based assessment of the Department that in-
formed the updated plan or that was in progress 
during the time period in which the updated 
plan was developed; and 
(D) identify the manning levels, equipment 
and consumables, and funding levels, required to 
carry out the updated plan. 
(3) ASSESSMENT
OF
BIOSURVEILLANCE
AND 
MEDICAL RESEARCH CAPABILITIES.—The Secretary of 
Defense shall conduct an assessment of biosurveillance 
and medical research capabilities of the Department 
of Defense. Such assessment shall include the fol-
lowing: 
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(A) An identification of the location and 
strategic value of the overseas medical labora-
tories and overseas medical research programs of 
the Department. 
(B) An assessment of the current capabili-
ties of such laboratories and programs with re-
spect to force health protection and evidence- 
based medical research. 
(C) A determination as to whether such lab-
oratories and programs have the capabilities, in-
cluding as a result of the geographic location of 
such laboratories and programs, to provide force 
health protection and evidence-based medical re-
search, including by actively monitoring for fu-
ture pandemics, infectious diseases, and other 
potential health threats to members of the Armed 
Forces. 
(D) The current capabilities, with respect to 
biosurveillance and medical research, of the fol-
lowing entities: 
(i) The Army Medical Research Devel-
opment Command. 
(ii) The Navy Medical Research Com-
mand. 
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(iii) The Air Force Medical Readiness 
Agency. 
(iv) The Walter Reed Army Institute of 
Research. 
(v) The United States Army Medical 
Research Institute of Infectious Disease. 
(vi) The Armed Forces Health Surveil-
lance Branch (including the Global Emerg-
ing Infectious Surveillance program). 
(vii) Such other entities as the Sec-
retary may determine appropriate. 
(E) A determination as to whether the enti-
ties specified in subparagraph (D) have the ca-
pabilities, including as a result of the geographic 
location of the entity, to provide force health pro-
tection and evidence-based medical research, in-
cluding by actively monitoring for future 
pandemics, infectious diseases, and other poten-
tial health threats to members of the Armed 
Forces. 
(F) The current manning levels of the enti-
ties specified in subparagraph (D), including an 
assessment of whether such entities are manned 
at a level necessary to support the missions of 
the combatant commands (including with respect 
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579 
to missions related to pandemic influenza or 
homeland defense). 
(G) The current funding levels of the enti-
ties specified in subparagraph (D), including a 
risk assessment as to whether such funding is 
sufficient to sustain the manning levels necessary 
to support missions as specified in subparagraph 
(F). 
(4) ANALYSIS OF MILITARY HEALTH SYSTEM OR-
GANIZATION.—The Secretary of Defense shall conduct 
an analysis to determine whether the current organi-
zational structure of the military health system allows 
for the implementation of the updated plans under 
paragraphs (1) and (2) and of any recommendations 
made by the Secretary as a result of the assessment 
under paragraph (3). Such analysis shall include— 
(A) an assessment of how the Secretary may 
leverage TRICARE Regional Offices, TRICARE 
managed care support contractors, and local or 
regional health care systems, to address any po-
tential gaps in the provision of medical care 
under the military health system that may limit 
the progress of such implementation or may 
arise as the result of such implementation; and 
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580 
(B) recommendations on any organizational 
changes to the military health system that would 
be necessary for such implementation. 
(b) INTERIM BRIEFING.—Not later than April 1, 2022, 
the Secretary of Defense, in coordination with the Secre-
taries of the military departments and the Chairman of the 
Joint Chiefs of Staff, shall provide to the Committees on 
Armed Services of the House of Representatives and the 
Senate an interim briefing on the progress of implementa-
tion of the plans, assessment, and analysis required under 
subsection (a). 
(c) REPORT.—Not later than December 1, 2022, the 
Secretary of Defense shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate a report describing each updated plan, assessment, 
and analysis required under subsection (a). 
SEC. 726. STANDARDIZATION OF DEFINITIONS USED BY 
THE DEPARTMENT OF DEFENSE FOR TERMS 
RELATED TO SUICIDE. 
(a) STANDARDIZATION OF DEFINITIONS.—Not later 
than 90 days after the date of the enactment of this Act, 
the Secretary of Defense, in coordination with the Secre-
taries of the military departments, shall develop standard-
ized definitions for the following terms: 
(1) ‘‘Suicide’’. 
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(3) an implementation plan to ensure the use of 
such definitions as required pursuant to subsection 
(b). 
Subtitle C—Reports and Other 
Matters 
SEC. 731. GRANT PROGRAM FOR INCREASED COOPERATION 
ON POST-TRAUMATIC STRESS DISORDER RE-
SEARCH 
BETWEEN 
UNITED 
STATES 
AND 
ISRAEL. 
(a) SENSE OF CONGRESS.—It is the sense of Congress 
that the Secretary of Defense, acting through the Psycho-
logical Health and Traumatic Brain Injury Research Pro-
gram, should seek to explore scientific collaboration between 
American academic institutions and nonprofit research en-
tities, and Israeli institutions with expertise in researching, 
diagnosing, and treating post-traumatic stress disorder. 
(b) GRANT PROGRAM.—The Secretary of Defense, in 
coordination with the Secretary of State, shall award 
grants to eligible entities to carry out collaborative research 
between the United States and Israel with respect to post- 
traumatic stress disorders. The Secretary of Defense shall 
carry out the grant program under this section in accord-
ance with the agreement titled ‘‘Agreement Between the 
Government of the United States of America and the Gov-
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583 
ernment of Israel on the United States-Israel Binational 
Science Foundation’’, dated September 27, 1972. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall be an academic 
institution or a nonprofit entity located in the United 
States. 
(d) AWARD.—The Secretary shall award grants under 
this section to eligible entities that— 
(1) carry out a research project that— 
(A) addresses a requirement in the area of 
post-traumatic stress disorders that the Secretary 
determines appropriate to research using such 
grant; and 
(B) is conducted by the eligible entity and 
an entity in Israel under a joint research agree-
ment; and 
(2) meet such other criteria that the Secretary 
may establish. 
(e) APPLICATION.—To be eligible to receive a grant 
under this section, an eligible entity shall submit an appli-
cation to the Secretary at such time, in such manner, and 
containing such commitments and information as the Sec-
retary may require. 
(f) GIFT AUTHORITY.—The Secretary may accept, 
hold, and administer, any gift of money made on the condi-
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tion that the gift be used for the purpose of the grant pro-
gram under this section. Such gifts of money accepted under 
this subsection shall be deposited in the Treasury in the De-
partment of Defense General Gift Fund and shall be avail-
able, subject to appropriation, without fiscal year limita-
tion. 
(g) REPORTS.—Not later than 180 days after the date 
on which an eligible entity completes a research project 
using a grant under this section, the Secretary shall submit 
to Congress a report that contains— 
(1) a description of how the eligible entity used 
the grant; and 
(2) an evaluation of the level of success of the re-
search project. 
(h) TERMINATION.—The authority to award grants 
under this section shall terminate on the date that is seven 
years after the date on which the first such grant is award-
ed. 
SEC. 732. PILOT PROGRAM ON CARDIAC SCREENING AT 
CERTAIN MILITARY SERVICE ACADEMIES. 
(a) PILOT PROGRAM.—The Secretary of Defense shall 
establish a pilot program to furnish mandatory electro-
cardiograms to candidates who are seeking admission to a 
covered military service academy in connection with the 
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military accession screening process, at no cost to such can-
didates. 
(b) SCOPE.—The scope of the pilot program under sub-
section (a) shall include at least 25 percent of the incoming 
class of candidates who are seeking admission to a covered 
military service academy during the first fall semester that 
follows the date of the enactment of this Act, and the pilot 
program shall terminate on the date on which the Secretary 
determines the military accession screening process for such 
class has concluded. 
(c) FACILITIES.—In carrying out the pilot program 
under subsection (a), the Secretary shall furnish each man-
datory electrocardiogram under the pilot program in a fa-
cility of the Department of Defense, to the extent prac-
ticable, but may furnish such electrocardiograms in a non- 
Department facility as determined necessary by the Sec-
retary. 
(d) REPORT.—Not later than 180 days after the date 
on which the pilot program under subsection (a) terminates, 
the Secretary shall submit to the Committees on Armed 
Services of the Senate and the House of Representatives a 
report on the pilot program. Such report shall include the 
following: 
(1) The results of all electrocardiograms fur-
nished to candidates under the pilot program, 
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disaggregated by military service academy, race, and 
gender. 
(2) The rate of significant cardiac issues detected 
pursuant to electrocardiograms furnished under the 
pilot program, disaggregated by military service 
academy, race, and gender. 
(3) The cost of carrying out the pilot program. 
(4) The number of candidates, if any, who were 
disqualified from admission based solely on the result 
of an electrocardiogram furnished under the pilot pro-
gram. 
(e) COVERED
MILITARY
SERVICE
ACADEMY
DE-
FINED.—In this section, the term ‘‘covered military service 
academy’’ does not include the Untied States Coast Guard 
Academy or the United States Merchant Marine Academy. 
SEC. 733. 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 
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participating member of the Armed Forces under sub-
section (a), at no cost to the member, in a facility of 
the Department of Defense or at a private entity pur-
suant 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. 
(2) CONTINUED CRYOPRESERVATION AND STOR-
AGE.—At the end of the one-year period specified in 
paragraph (1), the Secretary shall authorize an indi-
vidual whose gametes were cryopreserved and stored 
in a facility of the Department as described in that 
paragraph to select, including pursuant to an ad-
vance medical directive or military testamentary in-
strument completed under subsection (c), one of the 
following options: 
(A) To continue such cryopreservation and 
storage in such facility with the cost of such 
cryopreservation and storage borne by the indi-
vidual. 
(B) To transfer the gametes to a private 
cryopreservation and storage facility selected by 
the individual. 
(C) To authorize the Secretary to dispose of 
the gametes of the individual not earlier than the 
date that is 90 days after the end of the one-year 
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period specified in paragraph (1) with respect to 
the individual. 
(c) ADVANCE MEDICAL DIRECTIVE
AND MILITARY 
TESTAMENTARY INSTRUMENT.—A member of the Armed 
Forces who elects to cryopreserve and store their gametes 
under this section shall complete an advance medical direc-
tive described in section 1044c(b) of title 10, United States 
Code, and a military testamentary instrument described in 
section 1044d(b) of such title, that explicitly specifies the 
use of their cryopreserved and stored gametes if such mem-
ber dies or otherwise loses the capacity to consent to the 
use of their cryopreserved and stored gametes. 
(d) AGREEMENTS.—To carry out this section, the Sec-
retary may enter into agreements with private entities that 
provide cryopreservation and storage services for gametes. 
SEC. 734. PILOT PROGRAM ON ASSISTANCE FOR MENTAL 
HEALTH 
APPOINTMENT 
SCHEDULING 
AT 
MILITARY MEDICAL TREATMENT FACILITIES. 
(a) PILOT PROGRAM.—The Secretary of Defense shall 
carry out a pilot program to provide direct assistance for 
mental health appointment scheduling at military medical 
treatment facilities and clinics selected by the Secretary for 
participation in the pilot program in a number determined 
by the Secretary. 
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(b) REPORT.—Not later than 90 days after the date 
on which the pilot program terminates, the Secretary shall 
submit to the Committees on Armed Services of the House 
of Representatives and the Senate a report on the pilot pro-
gram. Such report shall include an assessment of— 
(1) the effectiveness of the pilot program with re-
spect to improved access to mental health appoint-
ments; and 
(2) any barriers to scheduling mental health ap-
pointments under the pilot program observed by 
health care professionals or other individuals involved 
in scheduling such appointments. 
(c) TERMINATION.—The authority to carry out the 
pilot program under subsection (a) shall terminate on the 
date that is one year after the commencement of the pilot 
program. 
SEC. 735. PILOT PROGRAM ON ORAL REHYDRATION SOLU-
TIONS. 
(a) PILOT PROGRAM.—The Secretary of Defense may 
carry out a pilot program under which the Secretary shall 
furnish medically approved oral rehydration solutions to 
members of the Armed Forces. 
(b) DISTRIBUTION.—Oral rehydration solutions fur-
nished under the pilot program carried out pursuant to sub-
section (a) shall be distributed to members of the Armed 
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Forces at the brigade level, through the Airborne and Rang-
er Training Brigade, the Maneuver Center of Excellence of 
the Army, and the United States Army Training and Doc-
trine Command. Such distribution shall be carried out dur-
ing a period of summer months, as determined by the Sec-
retary. 
(c) REPORT.—Not later than 60 after the date of the 
conclusion of the pilot program carried out pursuant to sub-
section (a), the Secretary shall submit to the Committees 
on Armed Services of the House of Representatives and the 
Senate a report on the effectiveness of the oral rehydration 
solutions furnished under the pilot program. Such report 
shall include— 
(1) all data tracking the prevention of heat cas-
ualties and hyponatremia among participants under 
the pilot program; and 
(2) any other benefits realized under the pilot 
program, including benefits related to cost savings, 
readiness, or wellness of members of the Armed 
Forces. 
SEC. 736. AUTHORIZATION OF PILOT PROGRAM TO SURVEY 
ACCESS TO MENTAL HEALTH CARE UNDER 
MILITARY HEALTH SYSTEM. 
(a) FINDINGS; SENSE OF CONGRESS.— 
(1) FINDINGS.—Congress finds that— 
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(A) there is a connection between stigma, 
mental health care access, and death by suicide; 
and 
(B) current command climate surveys lack 
sufficient questions regarding mental health stig-
ma. 
(2) SENSE
OF
CONGRESS.—It is the sense of 
Congress that— 
(A) military research and research of the 
Department of Veterans Affairs significantly 
contribute to overall health care research useful 
for all individuals; and 
(B) command climate surveys provide an 
important function for ensuring safe command 
environments. 
(b) AUTHORIZATION OF PILOT PROGRAM TO SURVEY 
ACCESS
TO MENTAL HEALTH CARE UNDER MILITARY 
HEALTH SYSTEM.— 
(1) PILOT
PROGRAM
AUTHORIZED.—The Sec-
retary of Defense may carry out a pilot program to 
survey access to mental health care under the military 
health system. 
(2) ELEMENTS.—In carrying out a pilot pro-
gram pursuant to paragraph (1), the Secretary shall 
ensure that an adequate number of command climate 
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surveys that include questions on access to mental 
health care under the military health system are ad-
ministered to a representative sample of active duty 
members of the Armed Forces across each military de-
partment. Such questions shall be developed by the 
survey administrator of the Defense Organizational 
Climate Survey and shall address, at a minimum, the 
following matters: 
(A) The perceived ability of the respondent 
to access mental health care under the military 
health system. 
(B) Whether the respondent has previously 
been prohibited from, or advised against, access-
ing such care. 
(C) Any overall stigma perceived by the re-
spondent with respect to such care. 
(D) The belief of the respondent that receiv-
ing care from a mental health care provider may 
harm the career, or the ability to obtain a secu-
rity clearance, of the respondent. 
(E) The belief of the respondent that receiv-
ing a mental health diagnosis may harm the ca-
reer, or the ability to obtain a security clearance, 
of the respondent. 
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(3) TERMINATION.—The authority to carry out a 
pilot program under paragraph (1) shall terminate 
on September 1, 2023. 
(4) REPORT.—Not later than 90 days after the 
date on which a pilot program carried out pursuant 
to paragraph (1) terminates, the Secretary shall sub-
mit to the Committees on Armed Services of the 
House of Representatives and the Senate a report on 
the results of the updated surveys administered pursu-
ant to the pilot program. 
(c) DEFINITIONS.—In this section, the terms ‘‘active 
duty’’, ‘‘Armed Forces’’, and ‘‘military departments’’ have 
the meanings given those terms in section 101 of title 10, 
United States Code. 
SEC. 737. PROHIBITION ON AVAILABILITY OF FUNDS FOR 
RESEARCH CONNECTED TO CHINA. 
(a) PROHIBITION.—None of the funds authorized to be 
appropriated by this Act or otherwise made available for 
fiscal year 2022 for the Department of Defense may be obli-
gated or expended— 
(1) to conduct research in China, including bio-
medical, infectious disease, gene editing, genetics, 
virus, or military medical research, whether directly 
or through a third-party entity; or 
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(F) any other information the Secretary de-
termines appropriate. 
SEC. 738. INDEPENDENT ANALYSIS OF DEPARTMENT OF DE-
FENSE COMPREHENSIVE AUTISM CARE DEM-
ONSTRATION PROGRAM. 
(a) AGREEMENT.— 
(1) IN GENERAL.—The Secretary of Defense shall 
seek to enter into an agreement with the National 
Academies of Sciences, Engineering, and Medicine (in 
this section referred to as the ‘‘National Academies’’) 
for the National Academies to carry out the activities 
described in subsections (b) and (c). 
(2) TIMING.—The Secretary shall seek to enter 
into the agreement described in paragraph (1) not 
later than 60 days after the date of the enactment of 
this Act. 
(b) ANALYSIS BY THE NATIONAL ACADEMIES.— 
(1) ANALYSIS.—Under an agreement between the 
Secretary and the National Academies entered into 
pursuant to subsection (a), the National Academies 
shall conduct an analysis of the effectiveness of the 
Department of Defense Comprehensive Autism Care 
Demonstration program (in this section referred to as 
the ‘‘demonstration program’’) and develop rec-
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ommendations for the Secretary based on such anal-
ysis. 
(2) ELEMENTS.—The analysis conducted and 
recommendations developed under paragraph (1) shall 
include the following: 
(A) An assessment of the Pervasive Develop-
mental Disabilities Behavior Inventory as a 
measure to assist in the assessment of domains 
related to autism spectrum disorder, and a deter-
mination as to whether the Secretary is applying 
such inventory appropriately under the dem-
onstration project. 
(B) An assessment of the methods used 
under the demonstration project to measure the 
effectiveness of applied behavior analysis in the 
treatment of autism spectrum disorder. 
(C) A review of any guidelines or industry 
standards of care adhered to in the provision of 
applied behavior analysis services under the 
demonstration program, including a review of 
the effects of such adherence with respect to dose- 
response or expected health outcomes for an indi-
vidual who has received such services. 
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(D) A review of the expected health out-
comes for an individual who has received ap-
plied behavior analysis treatments over time. 
(E) An analysis of the increased utilization 
of the demonstration program by beneficiaries 
under the TRICARE program, to improve un-
derstanding of such utilization. 
(F) Such other analyses to measure the ef-
fectiveness of the demonstration program as may 
be determined appropriate by the National Acad-
emies. 
(G) An analysis on whether the incidence of 
autism is higher among the children of military 
families. 
(H) The development of a list of findings 
and recommendations related to the measure-
ment, effectiveness, and increased understanding 
of the demonstration program and its effect on 
beneficiaries under the TRICARE program. 
(c) REPORT.—Under an agreement entered into be-
tween the Secretary and the National Academies under sub-
section (a), the National Academies, not later than nine 
months after the date of the execution of the agreement, 
shall— 
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(1) submit to the congressional defense commit-
tees a report on the findings of the National Acad-
emies with respect to the analysis conducted and rec-
ommendations developed under subsection (b); and 
(2) make such report available on a public 
website in unclassified form. 
SEC. 739. INDEPENDENT REVIEW OF SUICIDE PREVENTION 
AND 
RESPONSE 
AT 
MILITARY 
INSTALLA-
TIONS. 
(a) ESTABLISHMENT OF COMMITTEE.—Not later than 
90 days after the date of the enactment of this Act, the Sec-
retary of Defense shall establish an independent suicide pre-
vention and response review committee. 
(b) MEMBERSHIP.—The committee established under 
subsection (a) shall be composed of not fewer than five indi-
viduals— 
(1) designated by the Secretary; 
(2) with expertise determined to be relevant by 
the Secretary, including at least one individual who 
is an experienced provider of mental health services 
and at least one individual who is an experienced 
criminal investigator; 
(3) none of whom may be a member of an Armed 
Force or a civilian employee of the Department of De-
fense. 
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(c) SELECTION OF MILITARY INSTALLATIONS.—The 
Secretary shall select, for review by the committee estab-
lished under subsection (a), not fewer than three military 
installations that have a higher-than-average incidence of 
suicide by members of the Armed Forces serving at the in-
stallation. The Secretary shall ensure that at least one of 
the installations selected under this subsection is a remote 
installation of the Department of Defense located outside 
the contiguous United States. 
(d) DUTIES.—The committee established under sub-
section (a) shall review the suicide prevention and response 
programs and other factors that may contribute to the inci-
dence or prevention of suicide at the military installations 
selected for review pursuant to subsection (c). Such review 
shall be conducted through means including— 
(1) a confidential survey; 
(2) focus groups; and 
(3) individual interviews. 
(e) COORDINATION.—In carrying out this section, the 
Secretary shall ensure that the Director of the Office of Peo-
ple Analytics of the Department of Defense and the Director 
of the Office of Force Resiliency of the Department of De-
fense coordinate and cooperate with the committee estab-
lished under subsection (a). 
(f) REPORTS.— 
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(1) INITIAL REPORT.—Not later than 270 days 
after the establishment of the committee under sub-
section (a), the committee shall submit to the Sec-
retary a report containing the results of the reviews 
conducted by the committee and recommendations of 
the committee to reduce the incidence of suicide at the 
military installations reviewed. 
(2) REPORT TO CONGRESS.—Not later than 330 
days after the establishment of the committee under 
subsection (a), the committee shall submit to the Com-
mittees on Armed Services of the House of Represent-
atives and the Senate the report under paragraph (1). 
SEC. 740. FEASIBILITY AND ADVISABILITY STUDY ON ES-
TABLISHMENT OF AEROMEDICAL SQUADRON 
AT JOINT BASE PEARL HARBOR-HICKAM. 
(a) STUDY.—Not later than April 1, 2022, the Sec-
retary of Defense, in consultation with the Chief of the Na-
tional Guard Bureau and the Director of the Air National 
Guard, shall complete a study on the feasibility and advis-
ability of establishing at Joint Base Pearl Harbor-Hickam 
an aeromedical squadron of the Air National Guard in Ha-
waii to support the aeromedical mission needs of the State 
of Hawaii and the United States Indo-Pacific Command. 
(b) ELEMENTS.—The study under subsection (a) shall 
assess the following: 
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(1) The manpower required for the establishment 
of an aeromedical squadron of the Air National 
Guard in Hawaii as specified in subsection (a). 
(2) The overall cost of such establishment. 
(3) The length of time required for such estab-
lishment. 
(4) The mission requirements for such establish-
ment. 
(5) Such other matters as may be determined rel-
evant by the Secretary. 
(c) SUBMISSION TO CONGRESS.—Not later than April 
1, 2022, the Secretary shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate a report containing the findings of the feasibility 
and advisability study under subsection (a), including with 
respect to each element specified in subsection (b). 
SEC. 741. PLAN TO ADDRESS FINDINGS RELATED TO AC-
CESS TO CONTRACEPTION FOR MEMBERS OF 
THE ARMED FORCES. 
(a) PLAN REQUIRED.—The Secretary of Defense (in 
coordination with the Secretaries of the military depart-
ments) shall develop and implement a plan to address the 
findings of the report of the Department of Defense on the 
status of implementation of guidance for ensuring access 
to contraception published in response to pages 155 through 
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156 of the report of the Committee on Armed Services of 
the House of Representatives accompanying H.R. 6395 of 
the 116th Congress (H. Rept. 116-617). 
(b) ELEMENTS.—The plan under subsection (a) shall 
address— 
(1) the barriers and challenges to implementa-
tion identified in the report of the Department speci-
fied in such subsection; and 
(2) the inability of certain members of the 
Armed Forces to access their preferred method of con-
traception and have ongoing access during deploy-
ment. 
(c) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary shall submit to 
the appropriate congressional committees a report on the 
plan under subsection (a) and any progress made pursuant 
to such plan. 
(d) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congres-
sional committees’’ means— 
(1) the Committee on Armed Services and the 
Committee on Transportation and Infrastructure of 
the House of Representatives; and 
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(2) the Committee on Armed Services and the 
Committee on Commerce, Science, and Transpor-
tation of the Senate. 
SEC. 742. GAO BIENNIAL STUDY ON INDIVIDUAL LONGITU-
DINAL EXPOSURE RECORD PROGRAM. 
(a) STUDIES AND REPORTS REQUIRED.—Not later 
than December 31, 2022, and once every two years there-
after until December 31, 2030, the Comptroller General of 
the United States shall— 
(1) conduct a study on the implementation and 
effectiveness of the Individual Longitudinal Exposure 
Record program of the Department of Defense and the 
Department of Veterans Affairs; and 
(2) submit to the appropriate congressional com-
mittees a report containing the findings of the most 
recently conducted study. 
(b) ELEMENTS.—The biennial studies under subsection 
(a) shall include an assessment of elements as follows: 
(1) INITIAL STUDY.—The initial study conducted 
under subsection (a) shall assess, at a minimum, the 
following: 
(A) Statistics relating to use of the Indi-
vidual Longitudinal Exposure Record program, 
including the total number of individuals the 
records of whom are contained therein and the 
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total number of records accessible under the pro-
gram. 
(B) Costs associated with the program, in-
cluding any cost overruns associated with the 
program. 
(C) The capacity to expand the program to 
include the medical records of veterans who 
served prior to the establishment of the program. 
(D) Any illness recently identified as relat-
ing to a toxic exposure (or any guidance relating 
to such an illness recently issued) by either the 
Secretary of Defense or the Secretary of Veterans 
Affairs, including any such illness or guidance 
that relates to open burn pit exposure. 
(E) How the program has enabled (or failed 
to enable) the discovery, notification, and med-
ical care of individuals affected by an illness de-
scribed in subparagraph (D). 
(F) Physician and patient feedback on the 
program, particularly feedback that relates to 
ease of use. 
(G) Cybersecurity and privacy protections 
of patient data stored under the program, in-
cluding whether any classified or restricted data 
has been stored under the program (such as data 
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relating to deployment locations or duty sta-
tions). 
(H) Any technical or logistical impediments 
to the implementation or expansion of the pro-
gram, including any impediments to the inclu-
sion in the program of databases or materials 
originally intended to be included. 
(I) Any issues relating to read-only access 
to data under the program by veterans. 
(J) Any issues relating to the interoper-
ability of the program between the Department 
of Defense and the Department of Veterans Af-
fairs. 
(2) SUBSEQUENT STUDIES.—Except as provided 
in paragraph (3), each study conducted under sub-
section (a) following the initial study specified in 
paragraph (1) shall assess— 
(A) statistics relating to use of the Indi-
vidual Longitudinal Exposure Record program, 
including the total number of individuals the 
records of whom are contained therein and the 
total number of records accessible under the pro-
gram; and 
(B) such other elements as the Comptroller 
General determines appropriate, which may in-
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clude any other element specified in paragraph 
(1). 
(3) FINAL STUDY.—The final study conducted 
under subsection (a) shall assess— 
(A) the elements specified in subparagraphs 
(A), (B), (D), (E), (F), and (H) of paragraph 
(1); and 
(B) such other elements as the Comptroller 
General determines appropriate, which may in-
clude any other element specified in paragraph 
(1). 
(c) ACCESS BY COMPTROLLER GENERAL.— 
(1) INFORMATION
AND
MATERIALS.—Upon re-
quest of the Comptroller General, the Secretary of De-
fense and the Secretary of Veterans Affairs shall make 
available to the Comptroller General any information 
or other materials necessary for the conduct of each 
biennial study under subsection (a). 
(2) INTERVIEWS.—In addition to such other au-
thorities as are available, the Comptroller General 
shall have the right to interview officials and employ-
ees of the Department of Defense and the Department 
of Veterans Affairs (including clinicians, claims adju-
dicators, and researchers) as necessary for the conduct 
of each biennial study under subsection (a). 
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(3) INFORMATION FROM PATIENTS AND FORMER 
PATIENTS.— 
(A) DEVELOPMENT OF QUESTIONNAIRE.—In 
carrying out each biennial study under sub-
section (a), the Comptroller General may develop 
a questionnaire for individuals the records of 
whom are contained in the Individual Longitu-
dinal Exposure Record, to obtain the informa-
tion necessary for the conduct of the study. 
(B) DISTRIBUTION.—The Secretary con-
cerned shall ensure that any questionnaire devel-
oped pursuant to subparagraph (A) is distrib-
uted to individuals the records of whom are con-
tained in the Individual Longitudinal Exposure 
Record. 
(d) DEFINITIONS.—In this Act: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committee on Armed Services and 
the Committee on Veterans’ Affairs of the House 
of Representatives; and 
(B) the Committee on Armed Services and 
the Committee on Veterans’ Affairs of the Senate. 
(2) The term ‘‘Secretary concerned’’ means— 
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(A) the Secretary of Defense, with respect to 
matters concerning the Department of Defense; 
and 
(B) the Secretary of Veterans Affairs, with 
respect to matters concerning the Department of 
Veterans Affairs. 
SEC. 743. GAO STUDY ON EXCLUSION OF CERTAIN REMAR-
RIED INDIVIDUALS FROM MEDICAL AND DEN-
TAL COVERAGE UNDER TRICARE PROGRAM. 
(a) GAO STUDY.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the purpose 
and effects of limiting medical and dental coverage 
under the TRICARE program to exclude remarried 
widows, widowers, and former spouses of members or 
former members of the uniformed services. 
(2) ELEMENTS.—The study under paragraph (1) 
shall include the following: 
(A) A census of the widows and widowers 
who currently qualify as a dependent under the 
TRICARE program pursuant to subparagraph 
(B) or (C) of section 1072(2) of title 10, United 
States Code. 
(B) A census of the former spouses who cur-
rently qualify as a dependent under the 
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TRICARE program pursuant to subparagraph 
(F), (G), or (H) of such section. 
(C) An identification of the number of such 
widows, widowers, and former spouses who in-
tend to remarry, and an assessment of whether 
potential loss of coverage under the TRICARE 
program has affected the decisions of such indi-
viduals to remarry or remain unremarried. 
(D) An assessment of the effect, if any, on 
the military and local communities of an indi-
vidual who formerly qualified as a dependent 
under the TRICARE program by reason of being 
an unremarried widow, widower, or former 
spouse, as specified in section 1072(2) of title 10, 
United States Code, when the individual remar-
ries and loses such coverage. 
(E) A cost analysis of the expansion of med-
ical and dental coverage under the TRICARE 
program to include remarried individuals who, 
but for their remarried status, would otherwise 
qualify as a dependent under such program. 
(b) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Comptroller General shall 
submit to the Committees on Armed Services of the House 
of Representatives and the Senate a report containing— 
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(1) the findings and conclusions of the study 
under subsection (a); and 
(2) recommendations based on such findings and 
conclusions to improve the dependent categories speci-
fied in section 1072(2) of title 10, United States Code, 
including with respect to whether remarried widows, 
widowers, and former spouses of members or former 
members of the uniformed services should remain ex-
cluded from coverage under the TRICARE program 
pursuant to such section. 
(c) DEFINITIONS.—In this section, the terms ‘‘depend-
ent’’ and ‘‘TRICARE program’’ have the meanings given 
such terms in section 1072 of title 10, United States Code. 
SEC. 744. STUDY ON JOINT FUND OF THE DEPARTMENT OF 
DEFENSE AND THE DEPARTMENT OF VET-
ERANS AFFAIRS FOR FEDERAL ELECTRONIC 
HEALTH RECORD MODERNIZATION OFFICE. 
(a) STUDY.—The Secretary of Defense, in coordination 
with the Secretary of Veterans Affairs, shall conduct a study 
on— 
(1) the development of a joint fund of the De-
partment of Defense and the Department of Veterans 
Affairs for the Federal Electronic Health Record Mod-
ernization Office; and 
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(2) the operations of the Federal Electronic 
Health Record Modernization Office since its estab-
lishment, including how the Office has supported the 
implementation of the Individual Longitudinal Expo-
sure Record program of the Department of Defense 
and the Department of Veterans Affairs. 
(b) ELEMENTS.—The study under subsection (a) shall 
assess the following: 
(1) Justifications for the development of the joint 
fund. 
(2) Options for the governance structure of the 
joint fund, including how accountability would be di-
vided between the Department of Defense and the De-
partment of Veterans Affairs. 
(3) An estimated timeline for implementation of 
the joint fund. 
(4) The anticipated contents of the joint fund, 
including the anticipated process for annual transfers 
to the joint fund from the Department of Defense and 
the Department of Veterans Affairs, respectively. 
(5) The progress and accomplishments of the 
Federal Electronic Health Record Modernization Of-
fice during fiscal year 2021 in fulfilling the purposes 
specified in subparagraphs (C) through (R) of section 
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1635(b)(2) of the Wounded Warrior Act (title XVI of 
Public Law 110–181; 10 U.S.C. 1071 note). 
(6) The role and contributions of the Federal 
Electronic Health Record Modernization Office with 
respect to— 
(A) the current implementation of the Elec-
tronic Health Record Modernization Program at 
the Mann-Grandstaff Department of Veterans Af-
fairs Medical Center located in Spokane, Wash-
ington; and 
(B) the strategic review of the Electronic 
Health Record Modernization Program con-
ducted by the Department of Veterans Affairs. 
(7) How dedicated funding for the Federal Elec-
tronic Health Record Modernization Office would 
have affected or altered the role and contributions 
specified in paragraph (6). 
(8) An estimated timeline for the completion of 
the implementation milestones under section 1635(e) 
of the Wounded Warrior Act (title XVI of Public Law 
110–181; 10 U.S.C. 1071 note), taking into account 
delays in the implementation of the Electronic Health 
Record Modernization Program. 
(c) REPORT.—Not later than April 1, 2022, the Sec-
retary of Defense, in coordination with the Secretary of Vet-
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erans Affairs, shall submit to the appropriate congressional 
committees a report on the findings of the study under sub-
section (a), including recommendations on the development 
of the joint fund specified in such subsection. Such rec-
ommendations shall address— 
(1) the purpose of the joint fund; and 
(2) requirements related to the joint fund. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committees on Armed Services of 
the House of Representatives and the Senate; and 
(B) the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate. 
(2) The term ‘‘Electronic Health Record Mod-
ernization Program’’ has the meaning given such 
term in section 503(e) of the Veterans Benefits and 
Transition Act of 2018 (Public Law 115–407; 132 
Stat. 5376). 
(3) The term ‘‘Federal Electronic Health Record 
Modernization Office’’ means the Office established 
under section 1635(b) of the Wounded Warrior Act 
(title XVI of Public Law 110–181; 10 U.S.C. 1071 
note). 
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SEC. 745. BRIEFING ON DOMESTIC PRODUCTION OF CRIT-
ICAL 
ACTIVE 
PHARMACEUTICAL 
INGREDI-
ENTS. 
Not later than April 1, 2022, the Secretary of Defense 
shall provide to the Committees on Armed Services of the 
House of Representatives and the Senate a briefing on the 
development of a domestic production capability for critical 
active pharmaceutical ingredients and drug products in 
finished dosage form. Such briefing shall include a descrip-
tion of the following: 
(1) The anticipated cost over the period covered 
by the most recent future-years defense program sub-
mitted under section 221 of title 10, United States 
Code (as of the date of the briefing), to develop a do-
mestic production capability for critical active phar-
maceutical ingredients. 
(2) The cost of producing critical active pharma-
ceutical ingredients through such a domestic produc-
tion capability, as compared with the cost of standard 
manufacturing processes used by the pharmaceutical 
industry. 
(3) The average time to produce critical active 
pharmaceutical ingredients through such a domestic 
production capability, as compared with the average 
time to produce such ingredients through standard 
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manufacturing processes used by the pharmaceutical 
industry. 
(4) Any intersections between the development of 
such a domestic production capability, the military 
health system, and defense-related medical research or 
operational medical requirements. 
(5) Lessons learned from the progress made in 
developing such a domestic production capability as 
of the date of the briefing, including from any con-
tracts entered into by the Secretary with respect to 
such a domestic production capability. 
(6) Any critical active pharmaceutical ingredi-
ents that are under consideration by the Secretary for 
future domestic production as of the date of the brief-
ing. 
(7) The plan of the Secretary regarding the fu-
ture use of domestic production capability for critical 
active pharmaceutical ingredients. 
SEC. 746. BRIEFING ON ANOMALOUS HEALTH INCIDENTS 
INVOLVING 
MEMBERS 
OF 
THE 
ARMED 
FORCES. 
(a) BRIEFING.—Not later than March 1, 2022, the Sec-
retary of Defense shall provide to the appropriate congres-
sional committees a briefing on anomalous health incidents 
affecting members of the Armed Forces and civilian employ-
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ees of the Department of Defense, any ongoing efforts car-
ried out by the Secretary to protect such members and em-
ployees from the effects of anomalous health incidents, and 
the extent and nature of engagement by the Secretary with 
the heads of other Federal departments and agencies regard-
ing anomalous health incidents affecting the employees of 
such other departments and agencies. 
(b) MATTERS.—The briefing provided under subsection 
(a) shall include, at a minimum, the following: 
(1) Information on cases of confirmed or sus-
pected anomalous health incidents affecting members 
of the Armed Forces or civilian employees of the De-
partment. 
(2) An update on the strategy of the Department 
to protect such members and employees from the ef-
fects of anomalous health incidents, including any ef-
forts carried out by the Secretary to ensure that— 
(A) suspected anomalous health incidents 
are promptly reported; and 
(B) victims of anomalous health incidents 
are provided immediate and long-term medical 
treatment. 
(3) The current efforts of the Department to con-
tribute to the overall approach of the U.S. Govern-
ment to address, prevent, and respond to, anomalous 
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health incidents, including such contributed efforts of 
the Department to defend against anomalous health 
incident attacks against personnel of the U.S. Govern-
ment and United States citizens. 
(4) The current efforts of the Department to pre-
pare members of the Armed Forces and civilian em-
ployees of the Department for the effects of anomalous 
health incidents, including prior to deployment. 
(5) Recommendations on how to improve the 
identification and reporting of anomalous health inci-
dents affecting such members and employees, includ-
ing a recommendation on whether to conduct a health 
assessment prior to the deployment of such members 
or employees if the prospective deployment is to an 
embassy of the United States (or to another location 
that the Secretary determines may present a height-
ened risk of anomalous health incidents), to establish 
a medical baseline against which medical data of the 
member or employee may be compared following a 
suspected anomalous health incident. 
(6) An identification by the Secretary of a senior 
official of the Department who has been designated by 
the Secretary as the official with principal responsi-
bility for leading the efforts of the Department regard-
ing anomalous health incidents (and related issues 
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ficer a notice of the receipt of such payment, al-
lowance, or credit— 
‘‘(i) prior to the execution of a contract 
modification providing such reimbursement; 
and 
‘‘(ii) not later than 30 days after such 
receipt. 
‘‘(C) POST REIMBURSEMENT.—A contractor 
that receives a payment, allowance, or credit de-
scribed in subparagraph (A) for a cost after the 
execution of a contract modification under sub-
section (a) or (b) reimbursing such cost, or that 
is unable to provide the notice required under 
subparagraph (B) in accordance with clause (i) 
of such subparagraph, shall— 
‘‘(i) not later than 30 days after the re-
ceipt of the payment, allowance, or credit, 
notify the relevant contracting officer in 
writing of such receipt; and 
‘‘(ii) agree to execute a contract modi-
fication to reduce the amount reimbursed 
under subsections (a) and (b) by the 
amount of such payment, allowance, or 
credit. 
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