173
HR 3616 EAS1S
‘‘(1) permit absent uniformed services voters to
use absentee registration procedures and to vote by
absentee ballot in general, special, primary, and run-
off elections for State and local offices; and
‘‘(2) accept and process, with respect to any elec-
tion described in paragraph (1), any otherwise valid
voter registration application from an absent uni-
formed services voter if the application is received by
the appropriate State election official not less than 30
days before the election.’’.
(2) The heading of title I of such Act is amended by
striking out ‘‘FOR FEDERAL OFFICE’’.
TITLE VII—HEALTH CARE
SEC. 701. DEPENDENTS’ DENTAL PROGRAM.
(a) 
INFLATION-INDEXED
PREMIUM.—(1) 
Section
1076a(b)(2) of title 10, United States Code, is amended—
(A) by inserting ‘‘(A)’’ after ‘‘(2)’’; and
(B) by adding at the end the following:
‘‘(B) Effective as of January 1 of each year, the
amount of the premium required under subparagraph (A)
shall be increased by the percent equal to the lesser of—
‘‘(i) the percent by which the rates of basic pay
of members of the uniformed services are increased on
such date; or
174
HR 3616 EAS1S
‘‘(ii) the sum of one-half percent and the percent
computed under section 5303(a) of title 5 for the in-
crease in rates of basic pay for statutory pay systems
for pay periods beginning on or after such date.’’.
(2) The amendment made by subparagraph (B) of
paragraph (1) shall take effect on January 1, 1999, and
shall apply to months after 1998 as if such subparagraph
had been in effect since December 31, 1993.
(b) OFFER OF PLAN UNDER TRICARE.—(1) Section
1097 of such title is amended by adding at the end the fol-
lowing:
‘‘(f) DEPENDENTS’ DENTAL PLAN.—A basic dental
benefits plan established for eligible dependents under sec-
tion 1076a of this title may be offered under the TRICARE
program.’’.
(2) Subsection (e) of such section is amended by add-
ing at the end the following: ‘‘Charges for a basic dental
benefits plan offered under the TRICARE program pursu-
ant to subsection (f) shall be those provided for under sec-
tion 1076a of this title.’’.
175
HR 3616 EAS1S
SEC. 702. EXTENSION OF AUTHORITY FOR USE OF PER-
SONAL SERVICES CONTRACTS FOR PROVI-
SION OF HEALTH CARE AT MILITARY EN-
TRANCE PROCESSING STATIONS AND ELSE-
WHERE OUTSIDE MEDICAL TREATMENT FA-
CILITIES.
Section 1091(a)(2) of title 10, United States Code, is
amended in the second sentence by striking out ‘‘the end
of the one-year period beginning on the date of the enact-
ment of this paragraph’’ and inserting in lieu thereof ‘‘June
30, 1999’’.
SEC. 703. TRICARE PRIME AUTOMATIC ENROLLMENTS AND
RETIREE PAYMENT OPTIONS.
(a) PROCEDURES.—(1) Chapter 55 of title 10, United
States Code, is amended by inserting after section 1097 the
following new section:
‘‘§ 1097a. TRICARE Prime: automatic enrollments;
payment options
‘‘(a) AUTOMATIC ENROLLMENT OF CERTAIN DEPEND-
ENTS.—Each dependent of a member of the uniformed serv-
ices in grade E4 or below who is entitled to medical and
dental care under section 1076(a)(2)(A) of this title and
resides in the catchment area of a facility of a uniformed
service offering TRICARE Prime shall be automatically en-
rolled in TRICARE Prime at the facility. The Secretary
concerned shall provide written notice of the enrollment to
176
HR 3616 EAS1S
the member. The enrollment of a dependent of the member
may be terminated by the member or the dependent at any
time.
‘‘(b) AUTOMATIC RENEWAL OF ENROLLMENTS OF COV-
ERED BENEFICIARIES.—(1) An enrollment of a covered ben-
eficiary in TRICARE Prime shall be automatically re-
newed upon the expiration of the enrollment unless the re-
newal is declined.
‘‘(2) Not later than 15 days before the expiration date
for an enrollment of a covered beneficiary in TRICARE
Prime, the Secretary concerned shall—
‘‘(A) transmit a written notification of the pend-
ing expiration and renewal of enrollment to the cov-
ered beneficiary or, in the case of a dependent of a
member of the uniformed services, to the member; and
‘‘(B) afford the beneficiary or member, as the
case may be, an opportunity to decline the renewal of
enrollment.
‘‘(c) PAYMENT OPTIONS FOR RETIREES.—A member
or former member of the uniformed services eligible for med-
ical care and dental care under section 1074(b) of this title
may elect to have any fee payable by the member or former
member for an enrollment in TRICARE Prime withheld
from the member’s retired pay, retainer pay, or equivalent
pay, as the case may be, or to be paid from a financial
177
HR 3616 EAS1S
institution through electronic transfers of funds. The fee
shall be paid in accordance with the election.
‘‘(d) REGULATIONS.—The administering Secretaries
shall prescribe regulations, including procedures, for carry-
ing out this section.
‘‘(e) DEFINITIONS.—In this section:
‘‘(1) The term ‘TRICARE Prime’ means the
managed care option of the TRICARE program.
‘‘(2) The term ‘catchment area’, with respect to
a facility of a uniformed service, means the service
area of the facility, as designated under regulations
prescribed by the administering Secretaries.’’.
(2) The table of sections at the beginning of such chap-
ter is amended by inserting after the item relating to section
1097 the following new item:
1097a. TRICARE Prime: automatic enrollments; payment options.’’.
(b) DEADLINE FOR IMPLEMENTATION.—The regula-
tions required under subsection (d) of section 1097a of title
10, United States Code (as added by subsection (a)), shall
be prescribed to take effect not later than January 1, 1999.
The section shall be applied under TRICARE Prime on and
after the date on which the regulations take effect.
178
HR 3616 EAS1S
SEC. 704. LIMITED CONTINUED CHAMPUS COVERAGE FOR
PERSONS UNAWARE OF A LOSS OF CHAMPUS
COVERAGE RESULTING FROM ELIGIBILITY
FOR MEDICARE.
(a) CONTINUATION OF ELIGIBILITY.—The eligibility of
a person described in subsection (b) for care under
CHAMPUS may be continued under regulations prescribed
by the administering Secretaries if it is determined under
the regulations that the continuation of the eligibility is ap-
propriate in order to ensure that the person has adequate
access to health care.
(b) ELIGIBLE PERSONS.—Subsection (a) applies to a
person who—
(1) has been eligible for health care under
CHAMPUS;
(2) loses eligibility for health care under
CHAMPUS solely by reason of paragraph (1) of sec-
tion 1086(d), United States Code;
(3) is unaware of the loss of eligibility; and
(4) satisfies the conditions set forth in subpara-
graphs (A) and (B) of paragraph (2) of such section
1086(d) at the time health care is provided under
CHAMPUS pursuant to a continuation of eligibility
in accordance with this section.
(c) PERIOD OF CONTINUED ELIGIBILITY.—A continu-
ation of eligibility under this section shall apply with re-
179
HR 3616 EAS1S
gard to health care provided on or after October 1, 1998,
and before July 1, 1999.
(d) DEFINITIONS.—In this section:
(1) The term ‘‘administering Secretaries’’ has the
meaning given such term in paragraph (3) of section
1072 of title 10, United States Code.
(2) The term ‘‘CHAMPUS’’ means the Civilian
Health and Medical Program of the Uniformed Serv-
ices, as defined in paragraph (4) of such section.
SEC. 705. ENHANCED DEPARTMENT OF DEFENSE ORGAN
AND TISSUE DONOR PROGRAM.
(a) FINDINGS.—Congress makes the following find-
ings:
(1) Organ and tissue transplantation is one of
the most remarkable medical success stories in the his-
tory of medicine.
(2) Each year, the number of people waiting for
organ or tissue transplantation increases. It is esti-
mated that there are approximately 39,000 patients,
ranging in age from babies to those in retirement,
awaiting transplants of kidneys, hearts, livers, and
other solid organs.
(3) The Department of Defense has made signifi-
cant progress in increasing the awareness of the im-
180
HR 3616 EAS1S
portance of organ and tissue donations among mem-
bers of the Armed Forces.
(4) The inclusion of organ and tissue donor elec-
tions in the Defense Enrollment Eligibility Reporting
System (DEERS) central database through the Real-
time Automated Personnel Identification System
(RAPIDS) represents a major step in ensuring that
organ and tissue donor elections are a matter of
record and are accessible in a timely manner.
(b) RESPONSIBILITIES OF THE SECRETARY OF DE-
FENSE.—The Secretary of Defense shall ensure that the ad-
vanced systems developed for recording Armed Forces mem-
bers’ personal data and information (such as the
SMARTCARD, MEDITAG, and Personal Information Car-
rier) include the capability to record organ and tissue dona-
tion elections.
(c) RESPONSIBILITIES OF THE SECRETARIES OF THE
MILITARY DEPARTMENTS.—The Secretaries of the military
departments shall ensure that—
(1) appropriate information about organ and
tissue donation is provided to each recruit and officer
candidate of the Armed Forces during initial train-
ing;
(2) members of the Armed Forces are given re-
curring, specific opportunities to elect to be organ or
181
HR 3616 EAS1S
tissue donors during service in the Armed Forces and
upon retirement; and
(3) members of the Armed Forces electing to be
organ or tissue donors are encouraged to advise their
next of kin concerning the donation decision and any
subsequent change of that decision.
(d) RESPONSIBILITIES OF THE SURGEONS GENERAL
OF THE MILITARY DEPARTMENT.—The Surgeons General
of the Armed Forces shall ensure that—
(1) appropriate training is provided to enlisted
and officer medical personnel to facilitate the effective
operation of organ and tissue donation activities
under garrison conditions and, to the extent possible,
under operational conditions; and
(2) medical logistical activities can, to the extent
possible without jeopardizing operational require-
ments, support an effective organ and tissue donation
program.
(e) REPORT.—Not later than September 1, 1999, the
Secretary of Defense shall submit to the Committee on
Armed Services of the Senate and the Committee on Na-
tional Security of the House of Representatives a report on
the status of the implementation of this section.
182
HR 3616 EAS1S
SEC. 706. JOINT DEPARTMENT OF DEFENSE AND DEPART-
MENT OF VETERANS AFFAIRS REVIEWS RE-
LATING TO INTERDEPARTMENTAL COOPERA-
TION IN THE DELIVERY OF MEDICAL CARE.
(a) FINDINGS.—Congress makes the following findings:
(1) The military health care system of the De-
partment of Defense and the Veterans Health Admin-
istration of the Department of Veterans Affairs are
national institutions that collectively manage more
than 1,500 hospitals, clinics, and health care facilities
worldwide to provide services to more than 11,000,000
beneficiaries.
(2) In the post-Cold War era, these institutions
are in a profound transition that involves challenging
opportunities.
(3) During the period from 1988 to 1998, the
number of military medical personnel has declined by
15 percent and the number of military hospitals has
been reduced by one-third.
(4) During the two years since 1996, the Depart-
ment of Veterans Affairs has revitalized its structure
by decentralizing authority into 22 Veterans Inte-
grated Service Networks.
(5) In the face of increasing costs of medical
care, increased demands for health care services, and
increasing budgetary constraints, the Department of
183
HR 3616 EAS1S
Defense and the Department of Veterans Affairs have
embarked on a variety of dynamic and innovative co-
operative programs ranging from shared services to
joint venture operations of medical facilities.
(6) In 1984, there was a combined total of 102
Department of Veterans Affairs and Department of
Defense facilities with sharing agreements. By 1997,
that number had grown to 420. During the six years
from fiscal year 1992 through fiscal year 1997, shared
services increased from slightly over 3,000 services to
more than 6,000 services ranging from major medical
and surgical services, laundry, blood, and laboratory
services to unusual speciality care services.
(7) The Department of Defense and the Depart-
ment of Veterans Affairs are conducting four health
care joint ventures in New Mexico, Nevada, Texas,
Oklahoma, and are planning to conduct four more
such ventures in Alaska, Florida, Hawaii, and Cali-
fornia.
(b) SENSE OF CONGRESS.—It is the sense of Congress
that—
(1) the Department of Defense and the Depart-
ment of Veterans Affairs are to be commended for the
cooperation between the two departments in the deliv-
ery of medical care, of which the cooperation involved
184
HR 3616 EAS1S
in the establishment and operation of the Department
of Defense and the Department of Veterans Affairs
Executive Council is a praiseworthy example;
(2) the two departments are encouraged to con-
tinue to explore new opportunities to enhance the
availability and delivery of medical care to bene-
ficiaries by further enhancing the cooperative efforts
of the departments; and
(3) enhanced cooperation is encouraged for—
(A) the general areas of access to quality
medical care, identification and elimination of
impediments to enhanced cooperation, and joint
research and program development; and
(B) the specific areas in which there is sig-
nificant potential to achieve progress in coopera-
tion in a short term, including computerization
of patient records systems, participation of the
Department of Veterans Affairs in the TRICARE
program, pharmaceutical programs, and joint
physical examinations.
(c) JOINT SURVEY OF POPULATIONS SERVED.—(1)
The Secretary of Defense and the Secretary of Veterans Af-
fairs shall jointly conduct a survey of their respective medi-
cal care beneficiary populations to identify, by category of
beneficiary (defined as the Secretaries consider appro-
185
HR 3616 EAS1S
priate), the expectations of, requirements for, and behavior
patterns of the beneficiaries with respect to medical care.
The two Secretaries shall develop the protocol for the survey
jointly, but shall obtain the services of an entity independ-
ent of the Department of Defense and the Department of
Veterans Affairs for carrying out the survey.
(2) The survey shall include the following:
(A) Demographic characteristics, economic char-
acteristics, and geographic location of beneficiary
populations with regard to catchment or service
areas.
(B) The types and frequency of care required by
veterans, retirees, and dependents within catchment
or service areas of Department of Defense and Veter-
ans Affairs medical facilities and outside those areas.
(C) The numbers of, characteristics of, and types
of medical care needed by the veterans, retirees, and
dependents who, though eligible for medical care in
Department of Defense or Department of Veterans Af-
fairs treatment facilities or other federally funded
medical programs, choose not to seek medical care
from those facilities or under those programs, and the
reasons for that choice.
186
HR 3616 EAS1S
(D) The obstacles or disincentives for seeking
medical care from such facilities or under such pro-
grams that veterans, retirees, and dependents perceive.
(E) Any other matters that the Secretary of De-
fense and the Secretary of Veterans Affairs consider
appropriate for the survey.
(3) The Secretary of Defense and the Secretary of Vet-
erans Affairs shall submit a report on the results of the sur-
vey to the appropriate committees of Congress. The report
shall contain the matters described in paragraph (2) and
any proposals for legislation that the Secretaries rec-
ommend for enhancing Department of Defense and Depart-
ment of Veterans Affairs cooperative efforts with respect to
the delivery of medical care.
(d) REVIEW OF LAW AND POLICIES.—(1) The Sec-
retary of Defense and the Secretary of Veterans Affairs shall
jointly conduct a review to identify impediments to co-
operation between the Department of Defense and the De-
partment of Veterans Affairs regarding the delivery of medi-
cal care. The matters reviewed shall include the following:
(A) All laws, policies, and regulations, and any
attitudes of beneficiaries of the health care systems of
the two departments, that have the effect of preventing
the establishment, or limiting the effectiveness, of co-
operative health care programs of the departments.
187
HR 3616 EAS1S
(B) The requirements and practices involved in
the credentialling and licensure of health care provid-
ers.
(C) The perceptions of beneficiaries in a variety
of categories (defined as the Secretaries consider ap-
propriate) regarding the various Federal health care
systems available for their use.
(2) The Secretaries shall jointly submit a report on
the results of the review to the appropriate committees of
Congress. The report shall include any proposals for legisla-
tion that the Secretaries recommend for eliminating or re-
ducing impediments to interdepartmental cooperation that
are identified during the review.
(e) PARTICIPATION IN TRICARE.—(1) The Secretary
of Defense shall review the TRICARE program to identify
opportunities for increased participation by the Depart-
ment of Veterans Affairs in that program. The ongoing col-
laboration between Department of Defense officials and De-
partment of Veterans Affairs officials regarding increasing
the participation shall be included among the matters re-
viewed.
(2) The Secretary of Defense and the Secretary of Vet-
erans Affairs shall jointly submit to the appropriate com-
mittees of Congress a semiannual report on the status of
the review and on efforts to increase the participation of
188
HR 3616 EAS1S
the Department of Veterans Affairs in the TRICARE pro-
gram. No report is required under this paragraph after the
submission of a semiannual report in which the Secretaries
declare that the Department of Veterans Affairs is partici-
pating in the TRICARE program to the extent that can
reasonably be expected to be attained.
(f) PHARMACEUTICAL BENEFITS AND PROGRAMS.—(1)
The Federal Pharmaceutical Steering Committee shall—
(A) undertake a comprehensive examination of
existing pharmaceutical benefits and programs for
beneficiaries of Federal medical care programs, in-
cluding matters relating to the purchasing, distribu-
tion, and dispensing of pharmaceuticals and the
management of mail order pharmaceuticals programs;
and
(B) review the existing methods for contracting
for and distributing medical supplies and services.
(2) The committee shall submit a report on the results
of the examination to the appropriate committees of Con-
gress.
(g) STANDARDIZATION OF PHYSICAL EXAMINATIONS
FOR DISABILITY.—The Secretary of Defense and the Sec-
retary of Veterans Affairs shall submit to the appropriate
committees of Congress a report on the status of the efforts
of the Department of Defense and the Department of Veter-
189
HR 3616 EAS1S
ans Affairs to standardize physical examinations adminis-
tered by the two departments for the purpose of determining
or rating disabilities.
(h) APPROPRIATE COMMITTEES OF CONGRESS DE-
FINED.—For the purposes of this section, the appropriate
committees of Congress are as follows:
(1) The Committee on Armed Services and the
Committee on Veterans’ Affairs of the Senate.
(2) The Committee on National Security and the
Committee on Veterans’ Affairs of the House of Rep-
resentatives.
(i) DEADLINES FOR SUBMISSION OF REPORTS.—(1)
The report required by subsection (c)(3) shall be submitted
not later than January 1, 2000.
(2) The report required by subsection (d)(2) shall be
submitted not later than March 1, 1999.
(3) The semiannual report required by subsection
(e)(2) shall be submitted not later than March 1 and Sep-
tember 1 of each year.
(4) The report on the examination required under sub-
section (f) shall be submitted not later than 60 days after
the completion of the examination.
(5) The report required by subsection (g) shall be sub-
mitted not later than March 1, 1999.
190
HR 3616 EAS1S
SEC. 707. DEMONSTRATION 
PROJECTS 
TO 
PROVIDE
HEALTH CARE TO CERTAIN MEDICARE-ELIGI-
BLE 
BENEFICIARIES 
OF 
THE 
MILITARY
HEALTH CARE SYSTEM.
(a) IN GENERAL.—(1) The Secretary of Defense shall,
after consultation with the other administering Secretaries,
carry out three demonstration projects (described in sub-
sections (d), (e), and (f)) in order to assess the feasibility
and advisability of providing certain medical care coverage
to the medicare-eligible individuals described in subsection
(b).
(2) The Secretary shall commence the demonstration
projects not later than January 1, 2000, and shall termi-
nate the demonstration projects not later than December 31,
2003.
(3) The aggregate costs incurred by the Secretary
under the demonstration projects in any year may not ex-
ceed $60,000,000.
(b) ELIGIBLE INDIVIDUALS.—An individual eligible to
participate in a demonstration project under subsection (a)
is a member or former member of the uniformed services
described in section 1074(b) of title 10, United States Code,
a 
dependent 
of 
the 
member 
described 
in 
section
1076(a)(2)(B) or 1076(b) of that title, or a dependent of
a member of the uniformed services who died while on active
duty for a period of more than 30 days, who—
191
HR 3616 EAS1S
(1) is 65 years of age or older;
(2) is entitled to hospital insurance benefits
under part A of title XVIII of the Social Security Act
(42 U.S.C. 1395c et seq.);
(3) is enrolled in the supplemental medical in-
surance program under part B of such title XVIII (42
U.S.C. 1395j et seq.); and
(4) resides in an area of the demonstration
project selected by the Secretary under subsection (c).
(c) AREAS OF DEMONSTRATION PROJECTS.—(1) Sub-
ject to paragraph (3), the Secretary shall carry out each
demonstration project under this section in two separate
areas selected by the Secretary.
(2) Of the two areas selected for each demonstration
project—
(A) one shall be an area outside the catchment
area of a military medical treatment facility in
which—
(i) no eligible organization has a contract
in effect under section 1876 of the Social Secu-
rity 
Act 
(42 
U.S.C. 
1395mm) 
and 
no
Medicare+Choice organization has a contract in
effect under part C of title XVIII of that Act (42
U.S.C. 1395w–21); or
192
HR 3616 EAS1S
(ii) the aggregate number of enrollees with
an eligible organization with a contract in effect
under section 1876 of that Act or with a
Medicare+Choice organization with a contract
in effect under part C of title XVIII of that Act
is less than 2.5 percent of the total number of in-
dividuals in the area who are entitled to hospital
insurance benefits under part A of title XVIII of
that Act; and
(B) one shall be an area outside the catchment
area of a military medical treatment facility in
which—
(i) at least one eligible organization has a
contract in effect under section 1876 of that Act
or one Medicare+Choice organization has a con-
tract in effect under part C of title XVIII of that
Act; and
(ii) the aggregate number of enrollees with
an eligible organization with a contract in effect
under section 1876 of that Act or with a
Medicare+Choice organization with a contract
in effect under part C of title XVIII of that Act
exceeds 10 percent of the total number of individ-
uals in the area who are entitled to hospital in-
193
HR 3616 EAS1S
surance benefits under part A of title XVIII of
that Act.
(3) The Secretary may not carry out a demonstration
project under this section in any area in which the Sec-
retary is carrying out any other medical care demonstra-
tion project unless the Secretary determines that the conduct
of such other medical care demonstration project will not
interfere with the conduct or evaluation of the demonstra-
tion project under this section.
(d) FEHBP AS SUPPLEMENT TO MEDICARE DEM-
ONSTRATION.—(1)(A) Under one of the demonstration
projects under this section, the Secretary shall permit eligi-
ble individuals described in subsection (b) who reside in the
areas of the demonstration project selected under subsection
(c) to enroll in the health benefits plans offered through the
Federal Employees Health Benefits program under chapter
89 of title 5, United States Code.
(B) The Secretary shall carry out the demonstration
project under this subsection under an agreement with the
Office of Personnel Management.
(2)(A) An eligible individual described in paragraph
(1) shall not be required to satisfy any eligibility criteria
specified in chapter 89 of title 5, United States Code, as
a condition for enrollment in the health benefits plans of-
194
HR 3616 EAS1S
fered through the Federal Employee Health Benefits pro-
gram under the demonstration project under this subsection.
(B) Each eligible individual who enrolls in a health
benefits plan under the demonstration project shall be re-
quired to remain enrolled in the supplemental medical in-
surance program under part B of title XVIII of the Social
Security Act while participating in the demonstration
project.
(3)(A) The authority responsible for approving retired
or retainer pay or equivalent pay in the case of a member
or former member shall manage the participation of the
members or former members who enroll in health benefits
plans offered through the Federal Employee Health Benefits
program pursuant to paragraph (1).
(B) Such authority shall distribute program informa-
tion to eligible individuals, process enrollment applications,
forward all required contributions to the Employees Health
Benefits Fund established under section 8909 of title 5,
United States Code, in a timely manner, assist in the rec-
onciliation of enrollment records with health plans, and
prepare such reports as the Office of Personnel Management
may require in its administration of chapter 89 of such
title.
(4)(A) The Office of Personnel Management shall re-
quire health benefits plans under chapter 89 of title 5,
195
HR 3616 EAS1S
United States Code, that participate in the demonstration
project to maintain a separate risk pool for purposes of es-
tablishing premium rates for eligible individuals who enroll
in such plans in accordance with this subsection.
(B) The Office shall determine total subscription
charges for self only or for family coverage for eligible indi-
viduals who enroll in a health benefits plan under chapter
89 of such title in accordance with this subsection, which
shall include premium charges paid to the plan and
amounts described in section 8906(c) of title 5, United
States Code, for administrative expenses and contingency
reserves.
(5) The Secretary shall be responsible for the Govern-
ment contribution for an eligible individual who enrolls in
a health benefits plan under chapter 89 of title 5, United
States Code, in accordance with this subsection, except that
the amount of the contribution may not exceed the amount
of the Government contribution which would be payable if
such individual were an employee enrolled in the same
health benefits plan and level of benefits.
(6) The cancellation by a eligible individual of cov-
erage under the Federal Employee Health Benefits program
shall be irrevocable during the term of the demonstration
project under this subsection.
196
HR 3616 EAS1S
(e) TRICARE AS SUPPLEMENT TO MEDICARE DEM-
ONSTRATION.—(1) Under one of the demonstration projects
under this section, the Secretary shall permit eligible indi-
viduals described in subsection (b) who reside in each area
of the demonstration project selected under subsection (c)
to enroll in the TRICARE program. The demonstration
project under this subsection shall be known as the
‘‘TRICARE Senior Supplement’’.
(2) Payment for care and services received by eligible
individuals who enroll in the TRICARE program under the
demonstration project shall be made as follows:
(A) First, under title XVIII of the Social Secu-
rity Act, but only the extent that payment for such
care and services is provided for under that title.
(B) Second, under the TRICARE program, but
only to the extent that payment for such care and
services is provided under that program and is not
provided for under subparagraph (A).
(C) Third, by the eligible individual concerned,
but only to the extent that payment for such care and
services is not provided for under subparagraphs (B)
and (C).
(3)(A) The Secretary shall require each eligible indi-
vidual who enrolls in the TRICARE program under the
demonstration project to pay an enrollment fee. The Sec-
197
HR 3616 EAS1S
retary may provide for payment of the enrollment fee on
a periodic basis.
(B) The amount of the enrollment fee of an eligible
individual under subparagraph (A) in any year may not
exceed an amount equal to 75 percent of the total subscrip-
tion charges in that year for self-only or family, fee-for-
service coverage under the health benefits plan under the
Federal Employees Health Benefits program under chapter
89 of title 5, United States Code, that is most similar in
coverage to the TRICARE program.
(f) TRICARE MAIL ORDER PHARMACY BENEFIT SUP-
PLEMENT TO MEDICARE DEMONSTRATION.—(1) Under one
of the demonstration projects under this section, the Sec-
retary shall permit eligible individuals described in sub-
section (b) who reside in each area of the demonstration
project selected under subsection (c) to participate in the
mail order pharmacy benefit available under the TRICARE
program.
(2) The Secretary may collect from eligible individuals
who participate in the mail order pharmacy benefit under
the demonstration project any premiums, deductibles, co-
payments, or other charges that the Secretary would other-
wise collect from individuals similar to such eligible indi-
viduals for participation in the benefit.
198
HR 3616 EAS1S
(g) INDEPENDENT EVALUATION.—(1) The Secretary
shall provide for an evaluation of the demonstration
projects conducted under this section by an appropriate
person or entity that is independent of the Department of
Defense.
(2) The evaluation shall include the following:
(A) An analysis of the costs of each demonstra-
tion project to the United States and to the eligible
individuals who enroll or participate in such dem-
onstration project.
(B) An assessment of the extent to which each
demonstration project satisfied the requirements of
such eligible individuals for the health care services
available under such demonstration project.
(C) An assessment of the effect, if any, of each
demonstration project on military medical readiness.
(D) A description of the rate of the enrollment
or participation in each demonstration project of the
individuals who were eligible to enroll or participate
in such demonstration project.
(E) An assessment of which demonstration
project provides the most suitable model for a pro-
gram to provide adequate health care services to the
population of individuals consisting of the eligible in-
dividuals.
199
HR 3616 EAS1S
(F) An evaluation of any other matters that the
Secretary considers appropriate.
(3) The Comptroller General shall review the evalua-
tion conducted under paragraph (1). In carrying out the
review, the Comptroller General shall—
(A) assess the validity of the processes used in
the evaluation; and
(B) assess the validity of any findings under the
evaluation.
(4)(A) The Secretary shall submit a report on the re-
sults of the evaluation under paragraph (1), together with
the evaluation, to the Committee on Armed Services of the
Senate and the Committee on National Security of the
House of Representatives not later than December 31, 2003.
(B) The Comptroller General shall submit a report on
the results of the review under paragraph (3) to the commit-
tees referred to in subparagraph (A) not later than Feb-
ruary 15, 2004.
(h) 
ADDITIONAL
REQUIREMENTS
RELATING
TO
FEHBP DEMONSTRATION PROJECT.—(1) Notwithstanding
subsection (a)(2), the Secretary shall commence the dem-
onstration project under subsection (d) on July 1, 1999.
(2) Notwithstanding subsection (c), the Secretary shall
carry out the demonstration project under subsection (d)
in four separate areas, of which—
200
HR 3616 EAS1S
(A) two shall meet the requirements of subsection
(c)(1)(A); and
(B) two others shall meet the requirements of
subsection (c)(1)(B).
(3)(A) Notwithstanding subsection (f), the Secretary
shall provide for an annual evaluation of the demonstration
project under subsection (d) that meets the requirements of
subsection (f)(2).
(B) The Comptroller shall review each evaluation pro-
vided for under subparagraph (A).
(C) Not later than September 15 in each of 2000
through 2004, the Secretary shall submit a report on the
results of the evaluation under subparagraph (A) during
such year, together with the evaluation, to the Committee
on Armed Services of the Senate and the Committee on Na-
tional Security of the House of Representatives.
(D) Not later than December 31 in each of 2000
through 2004, the Comptroller General shall submit a report
on the results of the review under subparagraph (B) during
such year to the committees referred to in subparagraph
(C).
(i) DEFINITIONS.—In this section:
(1) The term ‘‘administering Secretaries’’ has the
meaning given that term in section 1072(3) of title
10, United States Code.
201
HR 3616 EAS1S
(2) The term ‘‘TRICARE program’’ has the
meaning given that term in section 1072(7) of title
10, United States Code.
(j) COMPETITION FOR SERVICES.—The program under
this section will allow retail to compete for services in deliv-
ery of pharmacy benefits without increasing costs to the
Government or the beneficiaries.
SEC. 708. PROFESSIONAL QUALIFICATIONS OF PHYSICIANS
PROVIDING MILITARY HEALTH CARE.
(a) REQUIREMENT FOR UNRESTRICTED LICENSE.—
Section 1094(a)(1) of title 10, United States Code, is
amended by adding at the end the following: ‘‘In the case
of a physician, the physician may not provide health care
as a physician under this chapter unless the current license
is an unrestricted license that is not subject to limitation
on the scope of practice ordinarily granted to other physi-
cians for a similar specialty by the jurisdiction that grant-
ed the license.’’.
(b) SATISFACTION
OF CONTINUING MEDICAL EDU-
CATION REQUIREMENTS.—(1) Chapter 55 of title 10,
United States Code, is amended by inserting after section
1094 the following new section:
202
HR 3616 EAS1S
‘‘§ 1094a. Continuing medical education requirements:
system for monitoring physician compli-
ance
‘‘The Secretary of Defense shall establish a mechanism
for ensuring that each person under the jurisdiction of the
Secretary of a military department who provides health
care under this chapter as a physician satisfies the continu-
ing medical education requirements applicable to the physi-
cian.’’.
(2) The table of sections at the beginning of such chap-
ter is amended by adding at the end the following new item:
‘‘1094a. Continuing medical education requirements: system for monitoring phy-
sician compliance.’’.
(c) EFFECTIVE DATES.—(1) The amendment made by
subsection (a) shall take effect on October 1, 1998.
(2) The system required by section 1094a of title 10,
United States Code (as added by subsection (b)), shall take
effect on the date that is three years after the date of the
enactment of this Act.
203
HR 3616 EAS1S
SEC. 709. ASSESSMENT OF ESTABLISHMENT OF INDEPEND-
ENT ENTITY TO EVALUATE POST-CONFLICT
ILLNESSES AMONG MEMBERS OF THE ARMED
FORCES AND HEALTH CARE PROVIDED BY
THE DEPARTMENT OF DEFENSE AND DEPART-
MENT OF VETERANS AFFAIRS BEFORE AND
AFTER DEPLOYMENT OF SUCH MEMBERS.
(a) AGREEMENT FOR ASSESSMENT.—The Secretary of
Defense shall seek to enter into an agreement with the Na-
tional Academy of Sciences, or other appropriate independ-
ent organization, under which agreement the Academy shall
carry out the assessment referred to in subsection (b).
(b) ASSESSMENT.—(1) Under the agreement, the Acad-
emy shall assess the need for and feasibility of establishing
an independent entity to—
(A) evaluate and monitor interagency coordina-
tion on issues relating to the post-deployment health
concerns of members of the Armed Forces, including
coordination relating to outreach and risk commu-
nication, recordkeeping, research, utilization of new
technologies, international cooperation and research,
health surveillance, and other health-related activities;
(B) evaluate the health care (including preven-
tive care and responsive care) provided to members of
the Armed Forces both before and after their deploy-
ment on military operations;
204
HR 3616 EAS1S
(C) monitor and direct government efforts to
evaluate the health of members of the Armed Forces
upon their return from deployment on military oper-
ations for purposes of ensuring the rapid identifica-
tion of any trends in diseases or injuries among such
members as a result of such operations;
(D) provide and direct the provision of ongoing
training of health care personnel of the Department
of Defense and the Department of Veterans Affairs in
the evaluation and treatment of post-deployment dis-
eases and health conditions, including nonspecific and
unexplained illnesses; and
(E) make recommendations to the Department of
Defense and the Department of Veterans Affairs re-
garding improvements in the provision of health care
referred to in subparagraph (B), including improve-
ments in the monitoring and treatment of members
referred to in that subparagraph.
(2) The assessment shall cover the health care provided
by the Department of Defense and, where applicable, by the
Department of Veterans Affairs.
(c) REPORT.—(1) The agreement shall require the
Academy to submit to the committees referred to in para-
graph (3) a report on the results of the assessment under
205
HR 3616 EAS1S
this section not later than one year after the date of enact-
ment of this Act.
(2) The report shall include the following:
(A) The recommendation of the Academy as to
the need for and feasibility of establishing an inde-
pendent entity as described in subsection (b) and a
justification of such recommendation.
(B) If the Academy recommends that an entity
be established, the recommendations of the Academy
as to—
(i) the organizational placement of the en-
tity;
(ii) the personnel and other resources to be
allocated to the entity;
(iii) the scope and nature of the activities
and responsibilities of the entity; and
(iv) mechanisms for ensuring that any rec-
ommendations of the entity are carried out by
the Department of Defense and the Department
of Veterans Affairs.
(3) The report shall be submitted to the following:
(A) The Committee on Armed Services and the
Committee on Veterans’ Affairs of the Senate.
206
HR 3616 EAS1S
(B) The Committee on National Security and the
Committee on Veterans’ Affairs of the House of Rep-
resentatives.
SEC. 710. LYME DISEASE.
Of the amounts authorized to be appropriated by this
Act for Defense Health Programs, $3,000,000 shall be avail-
able for research and surveillance activities relating to
Lyme disease and other tick-borne diseases.
SEC. 711. ACCESSIBILITY TO CARE UNDER TRICARE.
(a) REHABILITATIVE SERVICES
FOR HEAD INJU-
RIES.—The Secretary of Defense shall revise the TRICARE
policy manual to clarify that rehabilitative services are
available to a patient for a head injury when the treating
physician certifies that such services would be beneficial for
the patient and there is potential for the patient to recover
from the injury.
(b) REVIEW OF ADEQUACY OF PROVIDER NETWORK.—
The Secretary of Defense shall review the administration
of the TRICARE Prime health plans to determine whether,
for the region covered by each such plan, there is a sufficient
number, distribution, and variety of qualified participating
health care providers to ensure that all covered health care
services, including specialty services, are available and ac-
cessible in a timely manner to all persons covered by the
plan. If the Secretary determines during the review that,
207
HR 3616 EAS1S
in the region, there is an inadequate network of providers
to provide the covered benefits in proximity to the perma-
nent duty stations of covered members of the uniformed
services in the region, or in proximity to the residences of
other persons covered by the plan in the region, the Sec-
retary shall take such actions as are necessary to ensure
that the TRICARE Prime plan network of providers in the
region is adequate to provide for all covered benefits to be
available and accessible in a timely manner to all persons
covered by the plan.
SEC. 712. HEALTH BENEFITS FOR ABUSED DEPENDENTS OF
MEMBERS OF THE ARMED FORCES.
Paragraph (1) of section 1076(e) of title 10, United
States Code, is amended to read as follows:
‘‘(1) The administering Secretary shall furnish
an abused dependent of a former member of a uni-
formed service described in paragraph (4), during
that period that the abused dependent is in receipt of
transitional compensation under section 1059 of this
title, with medical and dental care, including mental
health services, in facilities of the uniformed services
in accordance with the same eligibility and benefits
as were applicable for that abused dependent during
the period of active service of the former member.’’.
208
HR 3616 EAS1S
SEC. 713. PROCESS FOR WAIVING INFORMED CONSENT RE-
QUIREMENT FOR ADMINISTRATION OF CER-
TAIN 
DRUGS 
TO 
MEMBERS 
OF 
ARMED
FORCES.
(a) LIMITATION AND WAIVER.—(1) Section 1107 of
title 10, United States Code, is amended—
(A) by redesignating subsection (f) as subsection
(g); and
(B) by inserting after subsection (e) the following
new subsection (f):
‘‘(f) LIMITATION AND WAIVER.—(1) An investigational
new drug or a drug unapproved for its applied use may
not be administered to a member of the armed forces pursu-
ant to a request or requirement referred to in subsection
(a) unless—
‘‘(A) the member provides prior consent to re-
ceive the drug in accordance with the requirements
imposed under the regulations required under para-
graph (4) of section 505(i) of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 355(i)); or
‘‘(B) the Secretary obtains—
‘‘(i) under such section a waiver of such re-
quirements; and
‘‘(ii) a written statement that the President
concurs in the determination of the Secretary re-
209
HR 3616 EAS1S
quired under paragraph (2) and with the Sec-
retary’s request for the waiver.
‘‘(2) The Secretary of Defense may request a waiver
referred to in paragraph (1)(B) in the case of any request
or requirement to administer a drug under this section if
the Secretary determines that obtaining consent is not fea-
sible, is contrary to the best interests of the members in-
volved, or is not in the best interests of national security.
Only the Secretary may exercise the authority to make the
request for the Department of Defense, and the Secretary
may not delegate that authority.
‘‘(3) The Secretary shall submit to the chairman and
ranking minority member of each congressional defense
committee a notification of each waiver granted pursuant
to a request of the Secretary under paragraph (2), together
with the concurrence of the President under paragraph
(1)(B) that relates to the waiver and the justification for
the request or requirement under subsection (a) for a mem-
ber to receive the drug covered by the waiver.
‘‘(4) In this subsection, the term ‘congressional defense
committee’ means each of the following:
‘‘(A) The Committee on Armed Services and the
Committee on Appropriations of the Senate.
210
HR 3616 EAS1S
‘‘(B) The Committee on National Security and
the Committee on Appropriations of the House of
Representatives.’’.
(2) The requirements for a concurrence of the President
and a notification of committees of Congress that are set
forth in section 1107(f) of title 10, United States Code (as
added by paragraph (1)(B)) shall apply with respect to—
(A) each waiver of the requirement for prior con-
sent imposed under the regulations required under
paragraph (4) of section 505(i) of the Federal Food,
Drug, and Cosmetic Act (or under any antecedent
provision of law or regulations) that—
(i) has been granted under that section (or
antecedent provision of law or regulations) before
the date of the enactment of this Act; and
(ii) is applied after that date; and
(B) each waiver of such requirement that is
granted on or after that date.
(b) TIME AND FORM OF NOTICE.—(1) Subsection (b)
of such section is amended by striking out ‘‘, if practicable’’
and all that follows through ‘‘first administered to the mem-
ber’’.
(2) Subsection (c) of such section is amended by strik-
ing out ‘‘unless the Secretary of Defense determines’’ and
all that follows through ‘‘alternative method’’.
211
HR 3616 EAS1S
TITLE VIII—ACQUISITION POL-
ICY, ACQUISITION MANAGE-
MENT, AND RELATED MAT-
TERS
SEC. 801. PARA-ARAMID FIBERS AND YARNS.
(a) AUTHORIZED SOURCES.—Chapter 141 of title 10,
United States Code is amended by adding at the end the
following:
‘‘§ 2410n. Foreign manufactured para-aramid fibers
and yarns: procurement
‘‘(a) AUTHORITY.—The Secretary of Defense may pro-
cure articles containing para-aramid fibers and yarns
manufactured in a foreign country referred to in subsection
(b).
‘‘(b) FOREIGN COUNTRIES COVERED.—The authority
under subsection (a) applies with respect to a foreign coun-
try that—
‘‘(1) is a party to a defense memorandum of un-
derstanding entered into under section 2531 of this
title; and
‘‘(2) permits United States firms that manufac-
ture para-aramid fibers and yarns to compete with
foreign firms for the sale of para-aramid fibers and
yarns in that country, as determined by the Secretary
of Defense.
212
HR 3616 EAS1S
‘‘(c) APPLICABILITY TO SUBCONTRACTS.—The author-
ity under subsection (a) applies with respect to subcontracts
under Department of Defense contracts as well as to such
contracts.
‘‘(d) DEFINITIONS.—In this section, the terms ‘United
States firm’ and ‘foreign firm’ have the meanings given
such terms in section 2532(d) of this title.’’.
(b) CLERICAL AMENDMENT.—The table of sections at
the beginning of such chapter is amended by adding at the
end the following:
‘‘2410n. Foreign manufactured para-aramid fibers and yarns: procurement.’’.
SEC. 802. PROCUREMENT OF TRAVEL SERVICES FOR OFFI-
CIAL AND UNOFFICIAL TRAVEL UNDER ONE
CONTRACT.
(a) AUTHORITY.—Chapter 147 of title 10, United
States Code, is amended by inserting after section 2490a
the following new section:
‘‘§ 2490b. Travel services: procurement for official and
unofficial travel under one contract
‘‘(a) AUTHORITY.—The head of an agency may enter
into a contract for travel-related services that provides for
the contractor to furnish services for both official travel and
unofficial travel.
‘‘(b) CREDITS, DISCOUNTS, COMMISSIONS, FEES.—(1)
A contract entered into under this section may provide for
credits, discounts, or commissions or other fees to accrue
213
HR 3616 EAS1S
to the Department of Defense. The accrual and amounts of
credits, discounts, or commissions or other fees may be de-
termined on the basis of the volume (measured in the num-
ber or total amount of transactions or otherwise) of the trav-
el-related sales that are made by the contractor under the
contract.
‘‘(2) The evaluation factors applicable to offers for a
contract under this section may include a factor that relates
to the estimated aggregate value of any credits, discounts,
commissions, or other fees that would accrue to the Depart-
ment of Defense for the travel-related sales made under the
contract.
‘‘(3) Commissions or fees received by the Department
of Defense as a result of travel-related sales made under a
contract entered into under this section shall be distributed
as follows:
‘‘(A) For amounts relating to sales for official
travel, credit to appropriations available for official
travel for the fiscal year in which the amounts were
charged.
‘‘(B) For amounts relating to sales for unofficial
travel, deposit in nonappropriated fund accounts
available for morale, welfare, and recreation pro-
grams.
‘‘(c) DEFINITIONS.—In this section:
214
HR 3616 EAS1S
‘‘(1) The term ‘head of an agency’ has the mean-
ing given that term in section 2302(1) of this title.
‘‘(2) The term ‘official travel’ means travel at the
expense of the Federal Government.
‘‘(3) The term ‘unofficial travel’ means personal
travel or other travel that is not paid for or reim-
bursed by the Federal Government out of appro-
priated funds.
‘‘(d) 
INAPPLICABILITY
TO
COAST
GUARD
AND
NASA.—This section does not apply to the Coast Guard
when it is not operating as a service in the Navy, nor to
the National Aeronautics and Space Administration.’’.
(b) CLERICAL AMENDMENT.—The table of sections at
the beginning of such chapter is amended by adding at the
end the following:
‘‘2490b. Travel services: procurement for official and unofficial travel under one
contract.’’.
SEC. 803. LIMITATION ON USE OF PRICE PREFERENCE
UPON ATTAINMENT OF CONTRACT GOAL FOR
SMALL AND DISADVANTAGED BUSINESSES.
Section 2323(e)(3) of title 10, United States Code, is
amended—
(1) by inserting ‘‘(A)’’ after ‘‘(3)’’;
(2) by inserting ‘‘, except as provided in (B),’’
after ‘‘the head of an agency may’’ in the first sen-
tence; and
215
HR 3616 EAS1S
(3) by adding at the end the following:
‘‘(B) The head of an agency may not exercise the au-
thority under subparagraph (A) to enter into a contract
for a price exceeding fair market cost in the fiscal year fol-
lowing a fiscal year in which the Department of Defense
attained the 5 percent goal required by subsection (a).’’.
SEC. 804. DISTRIBUTION OF ASSISTANCE UNDER THE PRO-
CUREMENT TECHNICAL ASSISTANCE COOP-
ERATIVE AGREEMENT PROGRAM.
(a) CORRECTION OF DESCRIPTION OF GEOGRAPHIC
UNIT.—Section 2413(c) of title 10, United States Code, is
amended by striking out ‘‘region’’ and inserting in lieu
thereof ‘‘district’’.
(b) ALLOCATION OF FUNDS.—(1) Section 2415 of title
10, United States Code, is repealed.
(2) The table of sections at the beginning of chapter
142 of such title is amended by striking the item relating
to section 2415.
SEC. 805. DEFENSE COMMERCIAL PRICING MANAGEMENT
IMPROVEMENT.
(a) SHORT TITLE.—This section may be cited as the
‘‘Defense Commercial Pricing Management Improvement
Act of 1998’’.
(b) COMMERCIAL ITEMS EXEMPT FROM COST
OR
PRICING DATA CERTIFICATION REQUIREMENTS.—For the
387
HR 3616 EAS1S
reduction and ultimate withdrawal of United States
ground combat forces from Bosnia and Herzegovina.
(c) ONE-TIME REPORTS.—The President shall submit
to Congress the following reports:
(1) Not later than September 30, 1998, a report
containing a discussion of the likely impact on the se-
curity situation in Bosnia and Herzegovina and on
the prospects for establishing self-sustaining peace
and stable local government there that would result
from a phased reduction in the number of United
States military personnel stationed in Bosnia and
Herzegovina under the following alternatives:
(A) A phased reduction to 5,000 by Feb-
ruary 2, 1999, to 3,500 by June 30, 1999, and
to 2,500 by February 2, 2000.
(B) A phased reduction by February 2,
2000, to the number of personnel that is approxi-
mately equal to the mean average of—
(i) the number of military personnel of
the United Kingdom that are stationed in
Bosnia and Herzegovina on that date;
(ii) the number of military personnel
of Germany that are stationed there on that
date;