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SEC. 11405. STUDY ON FOOD SECURITY. 
(a) STUDY.— 
(1) IN GENERAL.—The Commandant shall con-
duct a study on food insecurity among members of the 
Coast Guard. 
(2) ELEMENTS.—The study required under para-
graph (1) shall include the following: 
(A) An analysis of the impact of food 
deserts on members of the Coast Guard and their 
dependents who live in areas with high costs of 
living, including areas with high-density popu-
lations and rural areas. 
(B) A comparison of— 
(i) the current method used by the 
Commandant to determine which areas are 
considered to be high cost-of-living areas; 
(ii) local-level indicators used by the 
Bureau of Labor Statistics to determine a 
cost of living that indicates buying power 
and consumer spending in specific geo-
graphic areas; and 
(iii) indicators of the cost of living 
used by the Department of Agriculture in 
market basket analyses and other measures 
of the local or regional cost of food. 
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(C) An assessment of the accuracy of the 
method and indicators described in subpara-
graph (B) in quantifying high cost of living in 
low-data and remote areas. 
(D) An assessment of the manner in which 
data accuracy and availability affect the accu-
racy of cost-of-living allowance calculations and 
other benefits, as the Commandant considers ap-
propriate. 
(E) Recommendations— 
(i) to improve access to high-quality, 
affordable food within a reasonable distance 
of Coast Guard units located in areas iden-
tified as food deserts; 
(ii) to reduce transit costs for members 
of the Coast Guard and their dependents 
who are required to travel to access high- 
quality, affordable food; and 
(iii) for improving the accuracy of the 
calculations referred to in subparagraph 
(D). 
(F) The estimated costs of implementing 
each recommendation made under subparagraph 
(E). 
(b) PLAN.— 
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(1) IN GENERAL.—The Commandant shall de-
velop a detailed plan to implement the recommenda-
tions of the study conducted under subsection (a). 
(2) REPORT.—Not later than 1 year after date 
of the enactment of this Act, the Commandant shall 
provide to the Committee on Commerce, Science, and 
Transportation of the Senate and the Committee on 
Transportation and Infrastructure of the House of 
Representatives a briefing on the plan required under 
paragraph (1), including the cost of implementation, 
proposals for legislative change, and any other result 
of the study the Commandant considers appropriate. 
(c) FOOD DESERT DEFINED.—In this section, the term 
‘‘food desert’’ means an area, as determined by the Com-
mandant, in which it is difficult, even with a vehicle or 
an otherwise-available mode of transportation, to obtain af-
fordable, high-quality fresh food in the immediate area in 
which members of the Coast Guard serve and reside. 
Subtitle B—Healthcare 
SEC. 11406. DEVELOPMENT OF MEDICAL STAFFING STAND-
ARDS FOR COAST GUARD. 
(a) IN GENERAL.—Not later than 180 days after the 
date of enactment of this Act, the Commandant, in con-
sultation with the Defense Health Agency and any 
healthcare expert the Commandant considers appropriate, 
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shall develop medical staffing standards for the Coast 
Guard that are consistent with the recommendations of the 
Comptroller General of the United States set forth in the 
report titled ‘‘Coast Guard Health Care: Improvements 
Needed for Determining Staffing Needs and Monitoring Ac-
cess to Care’’ and published in February 2022. 
(b) INCLUSIONS.—In developing the standards under 
subsection (a), the Commandant shall address and take into 
consideration the following: 
(1) Current and future operations of healthcare 
personnel in support of Department of Homeland Se-
curity missions, including surge deployments for inci-
dent response. 
(2) Staffing standards for specialized providers, 
including flight surgeons, dentists, behavioral health 
specialists, and physical therapists. 
(3) Staffing levels of medical, dental, and behav-
ioral health providers for the Coast Guard who are— 
(A) members of the Coast Guard; 
(B) assigned to the Coast Guard from the 
Public Health Service; 
(C) Federal civilian employees; or 
(D) contractors hired by the Coast Guard to 
fill vacancies. 
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(4) Staffing levels at medical facilities for Coast 
Guard units in remote locations. 
(5) Any discrepancy between medical staffing 
standards of the Department of Defense and medical 
staffing standards of the Coast Guard. 
(c) REVIEW BY COMPTROLLER GENERAL.—Not later 
than 90 days after the Commandant completes the staffing 
standards required by subsection (a), the Commandant 
shall submit the standards to the Comptroller General, who 
shall review the standards and provide recommendations to 
the Commandant. 
(d) REPORT TO CONGRESS.—Not later than 180 days 
after developing the standards developed under subsection 
(a), the Commandant shall submit to the Committee on 
Commerce, Science, and Transportation of the Senate and 
the Committee on Transportation and Infrastructure of the 
House of Representatives a report on the standards devel-
oped under subsection (a) and the recommendations pro-
vided under subsection (c) that includes a plan and a de-
scription of the resources and budgetary needs required to 
implement the standards. 
(e) MODIFICATION, IMPLEMENTATION, AND PERIODIC 
UPDATES.—The Commandant shall— 
(1) modify such standards, as necessary, based 
on the recommendations under subsection (c); 
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(2) implement the standards; and 
(3) review and update the standards not less fre-
quently than every 4 years. 
SEC. 11407. HEALTHCARE SYSTEM REVIEW AND STRATEGIC 
PLAN. 
(a) IN GENERAL.—Not later than 270 days after the 
completion of the studies conducted by the Comptroller Gen-
eral of the United States under sections 8259 and 8260 of 
the William M. (Mac) Thornberry National Defense Author-
ization Act of Fiscal Year 2021 (Public Law 116–283; 134 
Stat. 4679), the Commandant shall— 
(1) conduct a comprehensive review of the Coast 
Guard healthcare system; and 
(2) develop a strategic plan for improvements to, 
and the modernization of, such system to ensure ac-
cess to high-quality, timely healthcare for members of 
the Coast Guard, their dependents, and applicable 
Coast Guard retirees. 
(b) PLAN.— 
(1) IN GENERAL.—The strategic plan developed 
under subsection (a) shall seek to— 
(A) maximize the medical readiness of 
members of the Coast Guard; 
(B) optimize delivery of healthcare benefits; 
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(C) ensure high-quality training of Coast 
Guard medical personnel; and 
(D) prepare for the future needs of the Coast 
Guard. 
(2) ELEMENTS.—The plan shall address, at a 
minimum, the following: 
(A) Improving access to healthcare for mem-
bers of the Coast Guard, their dependents, and 
applicable Coast Guard retirees. 
(B) Quality of healthcare. 
(C) The experience and satisfaction of mem-
bers of the Coast Guard and their dependents 
with the Coast Guard healthcare system. 
(D) The readiness of members of the Coast 
Guard and Coast Guard medical personnel. 
(c) REVIEW COMMITTEE.— 
(1) ESTABLISHMENT.—The Commandant shall 
establish a review committee to conduct a comprehen-
sive analysis of the Coast Guard healthcare system 
(referred to in this section as the ‘‘Review Com-
mittee’’). 
(2) MEMBERSHIP.—The Review Committee shall 
be composed of members selected by the Commandant, 
including— 
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(A) 1 or more members of the uniformed 
services (as defined in section 101 of title 10, 
United States Code) or Federal employees, either 
of which have expertise in— 
(i) the medical, dental, pharmacy, or 
behavioral health fields; or 
(ii) any other field the Commandant 
considers appropriate; 
(B) 1 representative of the Defense Health 
Agency; and 
(C) 1 medical representative from each 
Coast Guard district. 
(3) CHAIRPERSON.—The chairperson of the Re-
view Committee shall be the Director of the Health, 
Safety, and Work Life Directorate of the Coast 
Guard. 
(4) STAFF.—The Review Committee shall be 
staffed by employees of the Coast Guard. 
(5) REPORT TO COMMANDANT.—Not later than 1 
year after the Review Committee is established, the 
Review Committee shall submit to the Commandant 
a report that— 
(A) assesses, taking into consideration the 
medical staffing standards developed under sec-
tion 11406, the recommended medical staffing 
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standards set forth in the Comptroller General 
study required by section 8260 of the William M. 
(Mac) Thornberry National Defense Authoriza-
tion Act for Fiscal Year 2021 (Public Law 116– 
283; 134 Stat. 4679), and compares such stand-
ards to the medical staffing standards of the De-
partment of Defense and the private sector; 
(B) addresses improvements needed to en-
sure continuity of care for members of the Coast 
Guard, including by evaluating the feasibility of 
having a dedicated primary care manager for 
each such member while the member is stationed 
at a duty station; 
(C) evaluates the effects of increased surge 
deployments of medical personnel on staffing 
needs at Coast Guard clinics; 
(D) identifies ways to improve access to 
care for members of the Coast Guard and their 
dependents who are stationed in remote areas, 
including methods to expand access to providers 
in the available network; 
(E) identifies ways the Coast Guard may 
better use Department of Defense Military 
Health System resources for members of the 
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Coast Guard, their dependents, and applicable 
Coast Guard retirees; 
(F) identifies barriers to participation in 
the Coast Guard healthcare system and ways the 
Coast Guard may better use patient feedback to 
improve quality of care at Coast Guard-owned 
facilities, military treatment facilities, and spe-
cialist referrals; 
(G) includes recommendations to improve 
the Coast Guard healthcare system; and 
(H) any other matter the Commandant or 
the Review Committee considers appropriate. 
(6) TERMINATION.—The Review Committee shall 
terminate on the date that is 1 year after the date on 
which the Review Committee submits the report re-
quired under paragraph (5). 
(7) INAPPLICABILITY
OF
FEDERAL
ADVISORY 
COMMITTEE ACT.—The Federal Advisory Committee 
Act (5 U.S.C. App.) shall not apply to the Review 
Committee. 
(d) REPORT TO CONGRESS.—Not later than 2 years 
after the date of enactment of this Act, the Commandant 
shall submit to the Committee on Commerce, Science, and 
Transportation of the Senate and the Committee on Trans-
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portation and Infrastructure of the House of Representa-
tives— 
(1) the strategic plan for the Coast Guard med-
ical system required under subsection (a); 
(2) the report of the Review Committee submitted 
to the Commandant under subsection (c)(5); and 
(3) a description of the manner in which the 
Commandant plans to implement the recommenda-
tions of the Review Committee. 
SEC. 11408. DATA COLLECTION AND ACCESS TO CARE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of enactment of this Act, the Commandant, in con-
sultation with the Defense Health Agency and any 
healthcare expert the Commandant considers appropriate, 
shall develop, and make publicly available, a policy to re-
quire the collection of data regarding access by members 
of the Coast Guard and their dependents to medical, dental, 
and behavioral healthcare as recommended by the Comp-
troller General of the United States in the report entitled 
‘‘Coast Guard Health Care: Improvements Needed for De-
termining Staffing Needs and Monitoring Access to Care’’, 
published in February 2022. 
(b) ELEMENTS.—The policy required by subsection (a) 
shall address the following: 
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(1) Methods to collect data on access to care 
for— 
(A) routine annual physical health assess-
ments; 
(B) flight physicals for aviators or prospec-
tive aviators; 
(C) sick call; 
(D) injuries; 
(E) dental health; and 
(F) behavioral health conditions. 
(2) Collection of data on access to care for refer-
rals. 
(3) Collection of data on access to care for mem-
bers of the Coast Guard stationed at remote units, 
aboard Coast Guard cutters, and on deployments. 
(4) Use of the electronic health record system to 
improve data collection on access to care. 
(5) Use of data for addressing the standards of 
care, including time between requests for appoint-
ments and actual appointments, including appoint-
ments made with referral services. 
(c) PUBLICATION AND REPORT TO CONGRESS.—Not 
later than 90 days after the policy under subsection (a) is 
completed, or any subsequent updates to such policy, the 
Commandant shall— 
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(1) publish the policy on a publicly accessible 
internet website of the Coast Guard; and 
(2) submit to the Committee on Commerce, 
Science, and Transportation of the Senate and the 
Committee on Transportation and Infrastructure of 
the House of Representatives a report on the policy 
and the manner in which the Commandant plans to 
address access-to-care deficiencies. 
(d) PERIODIC UPDATES.—Not less frequently than 
every 5 years, the Commandant shall review and update 
the policy required under subsection (a). 
SEC. 11409. BEHAVIORAL HEALTH POLICY. 
(a) INTERIM BEHAVIORAL HEALTH POLICY.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of enactment of this Act, the Commandant 
shall establish an interim behavioral health policy for 
members of the Coast Guard that is in parity with 
section 5.28 (relating to behavioral health) of Depart-
ment of Defense Instruction 6130.03, volume 2, ‘‘Med-
ical Standards for Military Service: Retention’’. 
(2) TERMINATION.—The interim policy estab-
lished under paragraph (1) shall remain in effect 
until the date on which the Commandant issues a 
permanent behavioral health policy for members of 
the Coast Guard. 
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(b) PERMANENT POLICY.—In developing a permanent 
policy with respect to retention and behavioral health, the 
Commandant shall ensure that, to the extent practicable, 
the policy of the Coast Guard is in parity with section 5.28 
(relating to behavioral health) of Department of Defense In-
struction 6130.03, volume 2, ‘‘Medical Standards for Mili-
tary Service: Retention’’. 
SEC. 
11410. 
MEMBERS 
ASSERTING 
POST-TRAUMATIC 
STRESS DISORDER OR TRAUMATIC BRAIN IN-
JURY. 
(a) IN GENERAL.—Subchapter I of chapter 25 of title 
14, United States Code, is further amended by adding at 
the end the following: 
‘‘§ 2516. Members asserting post-traumatic stress dis-
order or traumatic brain injury 
‘‘(a) MEDICAL EXAMINATION REQUIRED.— 
‘‘(1) IN GENERAL.—The Secretary shall ensure 
that a member of the Coast Guard who has performed 
Coast Guard operations or has been sexually as-
saulted during the preceding 2-year period, and who 
is diagnosed by an appropriate licensed or certified 
healthcare professional as experiencing post-traumatic 
stress disorder or traumatic brain injury or who oth-
erwise alleges, based on the service of the member or 
based on such sexual assault, the influence of such a 
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condition, receives a medical examination to evaluate 
a diagnosis of post-traumatic stress disorder or trau-
matic brain injury. 
‘‘(2) RESTRICTION ON ADMINISTRATIVE SEPARA-
TION.—A member described in paragraph (1) shall 
not be administratively separated under conditions 
other than honorable, including an administrative 
separation in lieu of a court-martial, until the results 
of the medical examination have been reviewed by ap-
propriate authorities responsible for evaluating, re-
viewing, and approving the separation case, as deter-
mined by the Secretary. 
‘‘(3) POST-TRAUMATIC STRESS DISORDER.—In a 
case involving post-traumatic stress disorder under 
this subsection, a medical examination shall be— 
‘‘(A) performed by— 
‘‘(i) a board-certified or board-eligible 
psychiatrist; or 
‘‘(ii) a licensed doctorate-level psychol-
ogist; or 
‘‘(B) performed under the close supervision 
of— 
‘‘(i) a board-certified or board-eligible 
psychiatrist; or 
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‘‘(ii) a licensed doctorate-level psychol-
ogist, a doctorate-level mental health pro-
vider, a psychiatry resident, or a clinical or 
counseling psychologist who has completed a 
1-year internship or residency. 
‘‘(4) TRAUMATIC BRAIN INJURY.—In a case in-
volving traumatic brain injury under this subsection, 
a medical examination shall be performed by a 
physiatrist, psychiatrist, neurosurgeon, or neurologist. 
‘‘(b) PURPOSE OF MEDICAL EXAMINATION.—The med-
ical examination required under subsection (a) shall assess 
whether the effects of mental or neurocognitive disorders, in-
cluding post-traumatic stress disorder and traumatic brain 
injury, constitute matters in extenuation that relate to the 
basis for administrative separation under conditions other 
than honorable or the overall characterization of the service 
of the member as other than honorable. 
‘‘(c) INAPPLICABILITY TO PROCEEDINGS UNDER UNI-
FORM CODE OF MILITARY JUSTICE.—The medical exam-
ination and procedures required by this section do not 
apply to courts-martial or other proceedings conducted pur-
suant to the Uniform Code of Military Justice. 
‘‘(d) COAST GUARD OPERATIONS DEFINED.—In this 
section, the term ‘Coast Guard operations’ has the meaning 
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4185 
given that term in section 888(a) of the Homeland Security 
Act of 2002 (6 U.S.C. 468(a)).’’. 
(b) CLERICAL AMENDMENT.—The analysis for chapter 
25 of title 14, United States Code, is amended by inserting 
after the item relating to section 2515 (as added by this 
Act) the following: 
‘‘2516. Members asserting post-traumatic stress disorder or traumatic brain in-
jury.’’. 
SEC. 11411. IMPROVEMENTS TO PHYSICAL DISABILITY 
EVALUATION SYSTEM AND TRANSITION PRO-
GRAM. 
(a) TEMPORARY POLICY.—Not later than 60 days after 
the date of enactment of this Act, the Commandant shall 
develop a temporary policy that— 
(1) improves timeliness, communication, and 
outcomes for members of the Coast Guard undergoing 
the Physical Disability Evaluation System, or a re-
lated formal or informal process; 
(2) affords maximum career transition benefits 
to members of the Coast Guard determined by a Med-
ical Evaluation Board to be unfit for retention in the 
Coast Guard; and 
(3) maximizes the potential separation and ca-
reer transition benefits for members of the Coast 
Guard undergoing the Physical Disability Evaluation 
System, or a related formal or informal process. 
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