H. R. 5122—213
Freedom or Operation Enduring Freedom on the members who 
incur such an injury and their families. 
(b) DURATION.—The study required by subsection (a) shall be 
conducted for a period of 15 years. 
(c) ELEMENTS.—The study required by subsection (a) shall 
specifically address the following: 
(1) The long-term physical and mental health effects of 
traumatic brain injuries incurred by members of the Armed 
Forces during service in Operation Iraqi Freedom or Operation 
Enduring Freedom. 
(2) The health care, mental health care, and rehabilitation 
needs of such members for such injuries after the completion 
of inpatient treatment through the Department of Defense, 
the Department of Veterans Affairs, or both. 
(3) The type and availability of long-term care rehabilita-
tion programs and services within and outside the Department 
of Defense and the Department of Veterans Affairs for such 
members for such injuries, including community-based pro-
grams and services and in-home programs and services. 
(4) The effect on family members of a member incurring 
such an injury. 
(d) CONSULTATION.—The Secretary of Defense shall conduct 
the study required by subsection (a) and prepare the reports 
required by subsection (e) in consultation with the Secretary of 
Veterans Affairs. 
(e) PERIODIC AND FINAL REPORTS.—After the third, seventh, 
eleventh, and fifteenth years of the study required by subsection 
(a), the Secretary of Defense shall submit to Congress a comprehen-
sive report on the results of the study during the preceding years. 
Each report shall include the following: 
(1) Current information on the cumulative outcomes of 
the study. 
(2) Such recommendations as the Secretary of Defense 
and the Secretary of Veterans Affairs jointly consider appro-
priate based on the outcomes of the study, including rec-
ommendations for legislative, programmatic, or administrative 
action to improve long-term care and rehabilitation programs 
and services for members of the Armed Forces with traumatic 
brain injuries. 
Subtitle C—Planning, Programming, and 
Management 
SEC. 
731. 
STANDARDIZATION 
OF 
CLAIMS 
PROCESSING 
UNDER 
TRICARE PROGRAM AND MEDICARE PROGRAM. 
(a) IN GENERAL.—Effective beginning with the next contract 
option period for managed care support contracts under the 
TRICARE program, the claims processing requirements under the 
TRICARE program on the matters described in subsection (b) shall 
be identical to the claims processing requirements under the Medi-
care program on such matters. 
(b) COVERED MATTERS.—The matters described in this sub-
section are as follows: 
(1) The utilization of single or multiple provider identifica-
tion numbers for purposes of the payment of health care claims 
by Department of Defense contractors.
H. R. 5122—214
(2) The documentation required to substantiate medical 
necessity for items and services that are covered under both 
the TRICARE program and the Medicare program. 
(c) REPORT
ON COLLECTION
OF AMOUNTS OWED.—Not later 
than March 1, 2007, the Secretary of Defense shall submit to 
the congressional defense committees a report setting forth a 
detailed description of the following: 
(1) All TRICARE policies and directives concerning collec-
tion of amounts owed to the United States pursuant to section 
1095 of title 10, United States Code, from third party payers, 
including—
(A) collection by military treatment facilities from 
third-party payers; and 
(B) collection by contractors providing managed care 
support under the TRICARE program from other insurers 
in cases of private insurance liability for health care costs 
of a TRICARE beneficiary. 
(2) An estimate of the outstanding amounts owed from 
third party payers in each of fiscal years 2002, 2003, and 
2004. 
(3) The amounts collected from third party payers in each 
of fiscal years 2002, 2003, and 2004. 
(4) A plan of action to streamline the business practices 
that underlie the policies and directives described in paragraph 
(1). 
(5) A plan of action to accelerate and increase the collections 
or recoupments of amounts owed from third party payers. 
(d) ANNUAL REPORTS
ON CLAIMS PROCESSING STANDARDIZA-
TION.—
(1) IN
GENERAL.—Not later than October 1, 2007, and 
annually thereafter, the Secretary of Defense shall submit to 
the congressional defense committees a report setting forth 
a complete list of the claims processing requirements under 
the TRICARE program that differ from claims processing 
requirements under the Medicare program. 
(2) ELEMENTS.—Each report under paragraph (1) shall 
include, for each claims processing requirement listed in such 
report, a business case that justifies maintaining such require-
ment under the TRICARE program as a different claims proc-
essing requirement than that required under the Medicare 
program. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘Medicare program’’ means the program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). 
(2) The term ‘‘TRICARE program’’ has the meaning given 
that term in section 1072(7) of title 10, United States Code. 
SEC. 732. REQUIREMENTS FOR SUPPORT OF MILITARY TREATMENT 
FACILITIES BY CIVILIAN CONTRACTORS UNDER TRICARE. 
(a) ANNUAL INTEGRATED REGIONAL REQUIREMENTS
ON SUP-
PORT.—The Regional Director of each region under the TRICARE 
program shall develop each year integrated, comprehensive require-
ments for the support of military treatment facilities in such region 
that is provided by contract civilian health care and administrative 
personnel under the TRICARE program. 
(b) PURPOSES.—The purposes of the requirements established 
under subsection (a) shall be as follows:
H. R. 5122—215
(1) To ensure consistent standards of quality in the support 
of military treatment facilities by contract civilian health care 
personnel under the TRICARE program. 
(2) To identify targeted, actionable opportunities through-
out each region of the TRICARE program for the most efficient 
and cost effective delivery of health care and support of military 
treatment facilities. 
(3) To ensure the most effective use of various available 
contracting methods in securing support of military treatment 
facilities by civilian health care personnel under the TRICARE 
program, including resource-sharing and clinical support agree-
ments, direct contracting, and venture capital investments. 
(c) FACILITATION
AND ENHANCEMENT
OF CONTRACTOR SUP-
PORT.—
(1) IN
GENERAL.—The Secretary of Defense shall take 
appropriate actions to facilitate and enhance the support of 
military treatment facilities under the TRICARE program in 
order to assure maximum quality and productivity. 
(2) ACTIONS.—In taking actions under paragraph (1), the 
Secretary shall—
(A) require consistent standards of quality for contract 
civilian health care personnel providing support of military 
treatment 
facilities 
under 
the 
TRICARE 
program, 
including—
(i) consistent credentialing requirements among 
military treatment facilities; 
(ii) consistent performance standards for private 
sector companies providing health care staffing services 
to military treatment facilities and clinics, including, 
at a minimum, those standards established for accredi-
tation of health care staffing firms by the Joint 
Commission on the Accreditation of Health Care 
Organizations Health Care Staffing Standards; and 
(iii) additional standards covering—
(I) financial stability; 
(II) medical management; 
(III) continuity of operations; 
(IV) training; 
(V) employee retention; 
(VI) access to contractor data; and 
(VII) fraud prevention; 
(B) ensure the availability of adequate and sustainable 
funding support for projects which produce a return on 
investment to the military treatment facilities; 
(C) ensure that a portion of any return on investment 
is returned to the military treatment facility to which such 
savings are attributable; 
(D) remove financial disincentives for military treat-
ment facilities and civilian contractors to initiate and sus-
tain agreements for the support of military treatment facili-
ties by such contractors under the TRICARE program; 
(E) provide for a consistent methodology across all 
regions of the TRICARE program for developing cost benefit 
analyses of agreements for the support of military treat-
ment facilities by civilian contractors under the TRICARE 
program based on actual cost and utilization data within 
each region of the TRICARE program; and
H. R. 5122—216
(F) provide for a system for monitoring the performance 
of significant projects for support of military treatment 
facilities by a civilian contractor under the TRICARE pro-
gram. 
(d) REPORTS TO CONGRESS.—
(1) ANNUAL REPORTS REQUIRED.—Not later than February 
1, 2008, and each year thereafter, the Secretary, in coordination 
with the military departments, shall submit to the Committees 
on Armed Services of the Senate and the House of Representa-
tives a report on the support of military treatment facilities 
by civilian contractors under the TRICARE program during 
the preceding fiscal year. 
(2) ELEMENTS.—Each report shall set forth, for the fiscal 
year covered by such report, the following: 
(A) The level of support of military health treatment 
facilities that is provided by contract civilian health care 
personnel under the TRICARE program in each region 
of the TRICARE program. 
(B) An assessment of the compliance of such support 
with regional requirements under subsection (a). 
(C) The number and type of agreements for the support 
of military treatment facilities by contract civilian health 
care personnel. 
(D) The standards of quality in effect under the require-
ments under subsection (a). 
(E) The savings anticipated, and any savings achieved, 
as a result of the implementation of the requirements 
under subsection (a). 
(F) An assessment of the compliance of contracts for 
health care staffing services for Department of Defense 
facilities with the requirements of subsection (c)(2)(A). 
(e) EFFECTIVE DATE.—This section shall take effect on October 
1, 2006. 
SEC. 733. STANDARDS AND TRACKING OF ACCESS TO HEALTH CARE 
SERVICES 
FOR 
WOUNDED, 
INJURED, 
OR 
ILL 
SERVICEMEMBERS RETURNING TO THE UNITED STATES 
FROM A COMBAT ZONE. 
(a) REPORT ON UNIFORM STANDARDS FOR ACCESS.—Not later 
than 90 days after the date of the enactment of this Act, the 
Secretary of Defense shall submit to the Committees on Armed 
Services of the Senate and the House of Representatives a report 
on uniform standards for the access of wounded, injured, or ill 
members of the Armed Forces to health care services in the United 
States following return from a combat zone. 
(b) MATTERS COVERED.—The report required by subsection (a) 
shall describe in detail policies with respect to the following: 
(1) The access of wounded, injured, or ill members of the 
Armed Forces to emergency care. 
(2) The access of such members to surgical services. 
(3) Waiting times for referrals and consultations of such 
members by medical personnel, dental personnel, mental health 
specialists, and rehabilitative service specialists, including per-
sonnel and specialists with expertise in prosthetics and in 
the treatment of head, vision, and spinal cord injuries. 
(4) Waiting times of such members for acute care and 
for routine follow-up care.
H. R. 5122—217
(c) REFERRAL TO PROVIDERS OUTSIDE MILITARY HEALTH CARE 
SYSTEM.—The Secretary shall require that health care services 
and rehabilitation needs of members described in subsection (a) 
be met through whatever means or mechanisms possible, including 
through the referral of members described in that subsection to 
health care providers outside the military health care system. 
(d) UNIFORM SYSTEM FOR TRACKING OF PERFORMANCE.—The 
Secretary shall establish a uniform system for tracking the perform-
ance of the military health care system in meeting the requirements 
for access of wounded, injured, or ill members of the Armed Forces 
to health care services described in subsection (a). 
(e) REPORTS.—
(1) TRACKING SYSTEM.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary shall submit 
to the Committees on Armed Services of the Senate and the 
House of Representatives a report on the system established 
under subsection (d). 
(2) ACCESS.—Not later than October 1, 2006, and each 
quarter thereafter during fiscal year 2007, the Secretary shall 
submit to such committees a report on the performance of 
the health care system in meeting the access standards 
described in the report required by subsection (a). 
SEC. 734. DISEASE AND CHRONIC CARE MANAGEMENT. 
(a) PROGRAM DESIGN AND DEVELOPMENT REQUIRED.—Not later 
than October 1, 2007, the Secretary of Defense shall design and 
develop a fully integrated program on disease and chronic care 
management for the military health care system that provides, 
to the extent practicable, uniform policies and practices on disease 
management and chronic care management throughout that system, 
including both military hospitals and clinics and civilian healthcare 
providers within the TRICARE network. 
(b) PURPOSES
OF PROGRAM.—The purposes of the program 
required by subsection (a) are as follows: 
(1) To facilitate the improvement of the health status of 
individuals under care in the military health care system. 
(2) To ensure the availability of effective health care serv-
ices in that system for individuals with diseases and other 
chronic conditions. 
(3) To ensure the proper allocation of health care resources 
for individuals who need care for disease or other chronic 
conditions. 
(c) ELEMENTS
OF
PROGRAM
DESIGN.—The program design 
required by subsection (a) shall meet the following requirements: 
(1) Based on uniform policies prescribed by the Secretary, 
the program shall, at a minimum, address the following chronic 
diseases and conditions: 
(A) Diabetes. 
(B) Cancer. 
(C) Heart disease. 
(D) Asthma. 
(E) Chronic obstructive pulmonary disorder. 
(F) Depression and anxiety disorders. 
(2) The program shall meet nationally recognized accredita-
tion standards for disease and chronic care management. 
(3) The program shall include specific outcome measures 
and objectives on disease and chronic care management.
H. R. 5122—218
(4) The program shall include strategies for disease and 
chronic care management for all beneficiaries, including bene-
ficiaries eligible for benefits under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), 
for whom the TRICARE program is not the primary payer 
for health care benefits. 
(5) Activities under the program shall conform to applicable 
laws and regulations relating to the confidentiality of health 
care information. 
(d) IMPLEMENTATION PLAN REQUIRED.—Not later than February 
1, 2008, the Secretary of Defense, in coordination with the Secre-
taries of the military departments, shall develop an implementation 
plan for the disease and chronic care management program. In 
order to facilitate the carrying out of the program, the plan devel-
oped by the Secretary shall—
(1) require a comprehensive analysis of the disease and 
chronic care management opportunities within each region of 
the TRICARE program, including within military treatment 
facilities and through contractors under the TRICARE program; 
(2) ensure continuous, adequate funding of disease and 
chronic care management activities throughout the military 
health care system in order to achieve maximum health out-
comes and cost avoidance; 
(3) eliminate, to the extent practicable, any financial dis-
incentives to sustained investment by military hospitals and 
health care services contractors of the Department of Defense 
in the disease and chronic care management activities of the 
Department; 
(4) ensure that appropriate clinical and claims data, 
including pharmacy utilization data, is available for use in 
implementing the program; 
(5) ensure outreach to eligible beneficiaries who, on the 
basis of their clinical conditions, are candidates for the program 
utilizing print and electronic media, telephone, and personal 
interaction; and 
(6) provide a system for monitoring improvements in health 
status and clinical outcomes under the program and savings 
associated with the program. 
(e) REPORT.—
(1) IN GENERAL.—Not later than March 1, 2008, the Sec-
retary of Defense shall submit to the Committees on Armed 
Services of the Senate and the House of Representatives a 
report on the design, development, and implementation of the 
program on disease and chronic care management required 
by this section. 
(2) REPORT ELEMENTS.—The report required by paragraph 
(1) shall include the following: 
(A) A description of the design and development of 
the program required by subsection (a). 
(B) A description of the implementation plan required 
by subsection (d). 
(C) A description and assessment of improvements in 
health status and clinical outcomes that are anticipated 
as a result of implementation of the program. 
(D) A description of the savings and return on invest-
ment associated with the program.
H. R. 5122—219
(E) A description of an investment strategy to assure 
the sustainment of the disease and chronic care manage-
ment programs of the Department of Defense. 
SEC. 735. ADDITIONAL ELEMENTS OF ASSESSMENT OF DEPARTMENT 
OF DEFENSE TASK FORCE ON MENTAL HEALTH RELATING 
TO MENTAL HEALTH OF MEMBERS WHO WERE DEPLOYED 
IN 
OPERATION 
IRAQI 
FREEDOM 
AND 
OPERATION 
ENDURING FREEDOM. 
Section 723(c) of the National Defense Authorization Act for 
Fiscal Year 2006 (Public Law 109–163; 119 Stat. 3348) is amended 
by adding at the end the following new paragraph: 
‘‘(4) MENTAL
HEALTH
NEEDS
OF
MEMBERS
WHO
WERE 
DEPLOYED IN OIF OR OEF.—As part of the assessment required 
by paragraph (1) of the efficacy of mental health services pro-
vided to members of the Armed Forces by the Department 
of Defense, the task force shall consider the specific needs 
with respect to mental health of members who were deployed 
in Operation Iraqi Freedom or Operation Enduring Freedom 
upon their return from such deployment, including the fol-
lowing: 
‘‘(A) An identification of mental health conditions and 
disorders (including Post Traumatic Stress Disorder, sui-
cide attempts, and suicide) occurring among members who 
have undergone multiple deployments in Operation Iraqi 
Freedom or Operation Enduring Freedom. 
‘‘(B) An evaluation of the availability to members of 
assessments under the Mental Health Self-Assessment Pro-
gram of the Department of Defense to ensure the long-
term availability of the diagnostic mechanisms of the 
assessment to detect mental health conditions that may 
emerge in such members over time. 
‘‘(C) The availability of programs and services under 
the Mental Health Self-Assessment Program to address 
the mental health of dependent children of members who 
were deployed in Operation Iraqi Freedom or Operation 
Enduring Freedom. 
‘‘(D) Recommendations on mechanisms for improving 
the mental health services available to members who were 
deployed in Operation Iraqi Freedom or Operation 
Enduring Freedom, including members who have under-
gone multiple deployments.’’. 
SEC. 736. ADDITIONAL AUTHORIZED OPTION PERIODS FOR EXTENSION 
OF CURRENT CONTRACTS UNDER TRICARE. 
(a) ADDITIONAL NUMBER OF AUTHORIZED PERIODS.—
(1) IN GENERAL.—The Secretary of Defense, after consulting 
with the other administering Secretaries, may extend any con-
tract for the delivery of health care entered into under section 
1097 of title 10, United States Code, that is in force on the 
date of the enactment of this Act by one year, and upon expira-
tion of such extension by one additional year, if the Secretary 
determines that such extension—
(A) is in the best interests of the Department of Defense 
and covered beneficiaries; 
(B) is cost effective; and 
(C) will—
H. R. 5122—220
(i) facilitate the effective administration of the 
TRICARE program; or 
(ii) ensure continuity in the delivery of health care 
under the TRICARE program. 
(2) LIMITATION
ON
NUMBER
OF
EXTENSIONS.—The total 
number of one-year extensions of a contract that may be 
granted under paragraph (1) may not exceed two extensions. 
(3) NOTICE AND WAIT.—The Secretary may not commence 
the exercise of the authority in paragraph (1) with respect 
to a contract covered by that paragraph until 30 days after 
the date on which the Secretary submits to the Committees 
on Armed Services of the Senate and House of Representatives 
a report setting forth the following: 
(A) The minimum level of performance, including bene-
ficiary satisfaction and cost, by the incumbent contractor 
under the contract that will be required by the Secretary 
in order to be eligible for an extension authorized by such 
paragraph. 
(B) The justification for such extension based on each 
of the criteria in paragraph (1). 
(C) The justification for such extension based on a 
cost-benefit analysis. 
(4) DEFINITIONS.—In this subsection, the terms ‘‘admin-
istering Secretaries’’, ‘‘covered beneficiary’’, and ‘‘TRICARE pro-
gram’’ have the meaning given such terms in section 1072 
of title 10, United States Code. 
(b) REPORT ON CONTRACTING MECHANISMS FOR HEALTH CARE 
SERVICE SUPPORT CONTRACTS.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary shall submit to 
the Committees on Armed Services of the Senate and House of 
Representatives a report on contracting mechanisms under consider-
ation for future contracts for health care service support under 
section 1097 of title 10, United States Code. The report shall include 
an assessment of the advantages and disadvantages for the Depart-
ment of Defense (including the potential for stimulating competition 
and the effect on health care beneficiaries of the Department) 
of providing in such contracts for a single term of 5 years, with 
a single optional period of extension of an additional 5 years if 
performance under such contract is rated as ‘‘excellent’’. 
SEC. 737. MILITARY VACCINATION MATTERS. 
(a) ADDITIONAL ELEMENT FOR COMPTROLLER GENERAL STUDY 
AND REPORT ON VACCINE HEALTHCARE CENTERS.—Section 736(b) 
of the National Defense Authorization Act for Fiscal Year 2006 
(Public Law 109–163; 119 Stat. 3356) is amended by adding at 
the end the following new paragraph: 
‘‘(10) The feasibility and advisability of transferring direct 
responsibility for the Centers from the Army Medical Command 
to the Under Secretary of Defense for Personnel and Readiness 
and the Deputy Assistant Secretary of Defense for Force Health 
Protection and Readiness.’’. 
(b) LIMITATION ON RESTRUCTURING OF VACCINE HEALTHCARE 
CENTERS.—The Secretary of Defense may not downsize or otherwise 
restructure the Vaccine Healthcare Centers of the Department of 
Defense during fiscal year 2007. The Secretary shall ensure that 
the Secretary of each military department shall, from amounts 
allocated during fiscal year 2007 from the Defense Health Program,
H. R. 5122—221
fund and maintain the Vaccine Healthcare Center of the military 
department concerned. 
SEC. 738. ENHANCED MENTAL HEALTH SCREENING AND SERVICES 
FOR MEMBERS OF THE ARMED FORCES. 
(a) ADDITIONAL REQUIRED ELEMENTS FOR PREDEPLOYMENT AND 
POSTDEPLOYMENT MEDICAL EXAMINATIONS.—Subsection (b) of sec-
tion 1074f of title 10, United States Code, is amended—
(1) by inserting ‘‘(1)’’ before ‘‘The system’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(2) The predeployment and postdeployment medical examina-
tion of a member of the armed forces required under paragraph 
(1) shall include the following: 
‘‘(A) An assessment of the current treatment of the member 
and any use of psychotropic medications by the member for 
a mental health condition or disorder. 
‘‘(B) An assessment of traumatic brain injury.’’. 
(b) CRITERIA FOR REFERRAL FOR FURTHER EVALUATIONS.—Such 
section is further amended by adding at the end the following: 
‘‘(e) CRITERIA FOR REFERRAL FOR FURTHER EVALUATIONS.—The 
system described in subsection (a) shall include—
‘‘(1) development of clinical practice guidelines to be utilized 
by healthcare providers in determining whether to refer a 
member of the armed forces for further evaluation relating 
to mental health (including traumatic brain injury); 
‘‘(2) mechanisms to ensure that healthcare providers are 
trained in the application of such clinical practice guidelines; 
and 
‘‘(3) mechanisms for oversight to ensure that healthcare 
providers apply such guidelines consistently.’’. 
(c) MINIMUM MENTAL HEALTH STANDARDS FOR DEPLOYMENT.—
Such section is further amended by adding at the end the following: 
‘‘(f) MINIMUM MENTAL HEALTH STANDARDS FOR DEPLOYMENT.—
(1) The Secretary of Defense shall prescribe in regulations minimum 
standards for mental health for the eligibility of a member of 
the armed forces for deployment to a combat operation or contin-
gency operation. 
‘‘(2) The standards required by paragraph (1) shall include 
the following: 
‘‘(A) A specification of the mental health conditions, treat-
ment for such conditions, and receipt of psychotropic medica-
tions for such conditions that preclude deployment of a member 
of the armed forces to a combat operation or contingency oper-
ation, or to a specified type of such operation. 
‘‘(B) Guidelines for the deployability and treatment of mem-
bers of the armed forces diagnosed with a severe mental illness 
or post traumatic stress disorder. 
‘‘(3) The Secretary shall take appropriate actions to ensure 
the utilization of the standards prescribed under paragraph (1) 
in the making of determinations regarding the deployability of 
members of the armed forces to a combat operation or continency 
operation.’’. 
(d) QUALITY ASSURANCE.—Subsection (d) of such section is 
amended—
(1) by inserting ‘‘(1)’’ before ‘‘The Secretary of Defense’’; 
and 
(2) by adding at the end the following new paragraphs: