695 
(4) by adding at the end the following new 
paragraph: 
‘‘(3) input from covered beneficiaries who have 
participated in the pilot program regarding their 
satisfaction with, and any benefits attained from, 
such participation.’’. 
SEC. 705. TEMPORARY REQUIREMENT FOR CONTRACEP-
TION 
COVERAGE 
PARITY 
UNDER 
THE 
TRICARE PROGRAM. 
(a) IN GENERAL.—The Secretary of Defense shall 
ensure that, during the one-year period beginning on the 
date that is 30 days after the date of the enactment of 
the Act, the imposition or collection of cost-sharing for 
certain services is prohibited as follows: 
(1) PHARMACY BENEFITS PROGRAM.—Notwith-
standing subparagraphs (A), (B), and (C), of section 
1074g(a)(6) of title 10, United States Code, cost- 
sharing may not be imposed or collected with respect 
to any eligible covered beneficiary for any prescrip-
tion contraceptive on the uniform formulary pro-
vided through a retail pharmacy described in section 
1074(a)(2)(E)(ii) of such title or through the na-
tional 
mail-order 
pharmacy 
program 
of 
the 
TRICARE Program.
696 
(2) TRICARE SELECT.—Notwithstanding any 
provision under section 1075 of title 10, United 
States Code, cost-sharing may not be imposed or 
collected with respect to any beneficiary under such 
section for a covered service that is provided by a 
network provider under the TRICARE program. 
(3) TRICARE PRIME.—Notwithstanding sub-
sections (a), (b), and (c) of section 1075a of title 10, 
United States Code, cost-sharing may not be im-
posed or collected with respect to any beneficiary 
under such section for a covered service that is pro-
vided under TRICARE Prime. 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘covered service’’ means any 
method of contraception approved by the Food and 
Drug Administration, any contraceptive care (includ-
ing with respect to insertion, removal, and follow 
up), any sterilization procedure, or any patient edu-
cation or counseling service provided in connection 
with any such method, care, or procedure. 
(2) The term ‘‘eligible covered beneficiary’’ has 
the meaning given such term in section 1074g of 
title 10, United States Code. 
(3) The terms ‘‘TRICARE Program’’ and 
‘‘TRICARE Prime’’ have the meaning given such
697 
terms in section 1072 of title 10, United States 
Code. 
SEC. 706. AVAILABILITY OF CERTAIN PRECONCEPTION AND 
PRENATAL 
CARRIER 
SCREENING 
TESTS 
UNDER THE TRICARE PROGRAM. 
(a) TESTS AVAILABLE.—Section 1079(a) of title 10, 
United States Code, is amended by adding at the end the 
following new paragraph: 
‘‘(18) 
Preconception 
and 
prenatal 
carrier 
screening tests shall be provided to covered bene-
ficiaries upon the request of the beneficiary, with a 
limit per beneficiary of one test per condition per 
lifetime, for the following conditions: 
‘‘(A) Cystic Fibrosis. 
‘‘(B) Spinal Muscular Atrophy. 
‘‘(C) Fragile X Syndrome. 
‘‘(D) Tay-Sachs Disease. 
‘‘(E) Hemoglobinopathies. 
‘‘(F) Conditions linked with Ashkenazi 
Jewish descent.’’. 
(b) REPORT.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Defense shall provide to the congressional 
defense committees a report identifying the number
698 
of beneficiaries under the TRICARE program who 
have received a screening test under section 
1079(a)(18) of title 10, United States Code, as 
added by subsection (a), disaggregated by type of 
beneficiary and whether the test was provided under 
the direct care or purchased care component of the 
TRICARE program. 
(2) TRICARE PROGRAM
DEFINED.—In this 
subsection, the term ‘‘TRICARE program’’ has the 
meaning given such term in section 1072 of title 10, 
United States Code. 
Subtitle B—Health Care 
Administration 
SEC. 711. MODIFICATION OF CERTAIN DEFENSE HEALTH 
AGENCY ORGANIZATION REQUIREMENTS. 
Section 1073c(c)(5) of title 10, United States Code, 
is amended by striking ‘‘paragraphs (1) through (4)’’ and 
inserting ‘‘paragraph (3) or (4)’’. 
SEC. 712. REQUIREMENT FOR CONSULTATIONS RELATED 
TO MILITARY MEDICAL RESEARCH AND DE-
FENSE HEALTH AGENCY RESEARCH AND DE-
VELOPMENT. 
(a) CONSULTATIONS REQUIRED.—Section 1073c of 
title 10, United States Code, is amended—
699 
(1) by redesignating subsections (f) and (g) as 
subsections (g) and (h); and 
(2) by inserting after subsection (e) the fol-
lowing new subsection: 
‘‘(f) CONSULTATIONS ON MEDICAL RESEARCH OF 
MILITARY DEPARTMENTS.—In implementing subsection 
(e)(1) (and on an ongoing basis after the establishment 
of the Defense Health Agency Research and Development 
pursuant to such subsection), the Secretary of Defense, 
acting through the Secretaries of the military depart-
ments, shall ensure that periodic consultations are carried 
out within each military department regarding the plans 
and requirements for military medical research organiza-
tions and activities of the military department.’’. 
(b) REQUIREMENTS FOR INITIAL CONSULTATIONS.— 
The Secretary of Defense shall ensure that initial con-
sultations under section 1073c(f) of title 10, United States 
Code (as added by subsection (a)), are carried out prior 
to the establishment of the Defense Health Agency Re-
search and Development and address— 
(1) the plans of each military department to en-
sure a comprehensive transition of any military med-
ical research organizations of the military depart-
ment with respect to the establishment of the De-
700 
fense Health Agency Research and Development; 
and 
(2) any risks involved in such transition that 
may compromise ongoing medical research and de-
velopment activities of the military department. 
SEC. 713. AUTHORIZATION OF PROGRAM TO PREVENT 
FRAUD 
AND 
ABUSE 
IN 
THE 
MILITARY 
HEALTH SYSTEM. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1073e 
the following new section: 
‘‘§ 1073f. Health care fraud and abuse prevention pro-
gram 
‘‘(a) PROGRAM AUTHORIZED.—(1) The Secretary of 
Defense may carry out a program under this section to 
prevent and remedy fraud and abuse in the health care 
programs of the Department of Defense. 
‘‘(2) At the discretion of the Secretary, such program 
may be administered jointly by the Inspector General of 
the Department of Defense and the Director of the De-
fense Health Agency. 
‘‘(3) In carrying out such program, the authorities 
granted to the Secretary of Defense and the Inspector 
General of the Department of Defense under section 
1128A(m) of the Social Security Act (42 U.S.C. 1320a–
701 
7a(m)) shall be available to the Secretary and the Inspec-
tor General. 
‘‘(b) CIVIL MONETARY PENALTIES.—(1) Except as 
provided in paragraph (2), the provisions of section 1128A 
of the Social Security Act (42 U.S.C. 1320a–7a) shall 
apply with respect to any civil monetary penalty imposed 
in carrying out the program authorized under subsection 
(a). 
‘‘(2) Consistent with section 1079a of this title, 
amounts recovered in connection with any such civil mone-
tary penalty imposed— 
‘‘(A) shall be credited to appropriations avail-
able as of the time of the collection for expenses of 
the health care program of the Department of De-
fense affected by the fraud and abuse for which such 
penalty was imposed; and 
‘‘(B) may be used to support the administration 
of the program authorized under subsection (a), in-
cluding to support any interagency agreements en-
tered into under subsection (d). 
‘‘(c) INTERAGENCY AGREEMENTS.—The Secretary of 
Defense may enter into agreements with the Secretary of 
Health and Human Services, the Attorney General, or the 
heads of other Federal agencies, for the effective and effi-
702 
cient implementation of the program authorized under 
subsection (a). 
‘‘(d) RULE OF CONSTRUCTION.—Joint administra-
tion of the program authorized under subsection (a) may 
not be construed as limiting the authority of the Inspector 
General of the Department of Defense under any other 
provision of law. 
‘‘(e) FRAUD AND ABUSE DEFINED.—In this section, 
the term ‘fraud and abuse’ means any conduct specified 
in subsection (a) or (b) of section 1128A of the Social 
Security Act (42 U.S.C. 1320a–7a).’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1073e the following new 
item: 
‘‘1073f. Health care fraud and abuse prevention program.’’. 
SEC. 714. MANDATORY REFERRAL FOR MENTAL HEALTH 
EVALUATION. 
Section 1090a of title 10, United States Code, is 
amended— 
(1) by redesignating subsection (e) as sub-
section (f); and 
(2) by inserting after subsection (d) the fol-
lowing new subsection: 
‘‘(e) PROCESS APPLICABLE
TO MEMBER DISCLO-
SURE.—The regulations required by subsection (a) shall—
703 
‘‘(1) establish a phrase that enables a member 
of the armed forces to trigger a referral of the mem-
ber by a commanding officer or supervisor for a 
mental health evaluation; 
‘‘(2) require a commanding officer or supervisor 
to make such referral as soon as practicable fol-
lowing disclosure by the member to the commanding 
officer or supervisor of the phrase established under 
paragraph (1); and 
‘‘(3) ensure that the process protects the con-
fidentiality of the member in a manner similar to 
the confidentiality provided for members making re-
stricted reports under section 1565b(b) of this 
title.’’. 
SEC. 715. INCLUSION OF EXPOSURE TO PERFLUOROALKYL 
AND POLYFLUOROALKYL SUBSTANCES AS 
COMPONENT OF PERIODIC HEALTH ASSESS-
MENTS. 
(a) PERIODIC HEALTH ASSESSMENT.—Each Sec-
retary concerned shall ensure that any periodic health as-
sessment provided to a member of the Armed Forces in-
cludes an evaluation of whether the member has been— 
(1) based or stationed at a military installation 
identified by the Secretary concerned as a location 
with a known or suspected release of perfluoroalkyl
704 
substances or polyfluoroalkyl substances during the 
period in which the member was based or stationed 
at the military installation; or 
(2) exposed to such substances, including by 
evaluating any information in the health record of 
the member. 
(b) SEPARATION HISTORY AND PHYSICAL EXAMINA-
TIONS.—Section 1145 of title 10, United States Code, is 
amended— 
(1) in subsection (a)(5), by adding at the end 
the following new subparagraph: 
‘‘(D) The Secretary concerned shall ensure that each 
physical examination of a member under subparagraph 
(A) includes an assessment of whether the member was— 
‘‘(i) based or stationed at a military installation 
identified by the Secretary concerned as a location 
with a known or suspected release of perfluoroalkyl 
substances or polyfluoroalkyl substances during the 
period in which the member was based or stationed 
at the military installation; or 
‘‘(ii) exposed to such substances, including by 
assessing any information in the health record of the 
member.’’; and 
(2) by adding at the end the following new sub-
section:
705 
‘‘(g) SECRETARY CONCERNED DEFINED.—In this 
section, the term ‘Secretary concerned’ has the meaning 
given such term in section 101 of this title (and otherwise 
includes the Secretary of the department in which the 
Coast Guard is operating).’’. 
(c) DEPLOYMENT ASSESSMENTS.—Section 1074f of 
title 10, United States Code, is amended— 
(1) in subsection (b)(2), by adding at the end 
the following new subparagraph: 
‘‘(E) An assessment of whether the member 
was— 
‘‘(i) based or stationed at a military instal-
lation identified by the Secretary concerned as 
a location with a known or suspected release of 
perfluoroalkyl substances or polyfluoroalkyl sub-
stances during the period in which the member 
was based or stationed at the military installa-
tion; or 
‘‘(ii) exposed to such substances, including 
by assessing any information in the health 
record of the member.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) SECRETARY CONCERNED DEFINED.—In this 
section, the term ‘Secretary concerned’ has the meaning
706 
given such term in section 101 of this title (and otherwise 
includes the Secretary of the department in which the 
Coast Guard is operating).’’. 
(d) PROVISION OF BLOOD TESTING TO DETERMINE 
EXPOSURE
TO
PERFLUOROALKYL
SUBSTANCES
OR 
POLYFLUOROALKYL SUBSTANCES.— 
(1) PROVISION OF BLOOD TESTING.— 
(A) IN GENERAL.—If a covered evaluation 
of a member of the Armed Forces results in a 
positive determination of potential exposure to 
perfluoroalkyl substances or polyfluoroalkyl sub-
stances, the Secretary concerned shall provide 
to that member, during the covered evaluation, 
blood testing to determine and document poten-
tial exposure to such substances. 
(B) INCLUSION IN HEALTH RECORD.—The 
results of blood testing of a member of the 
Armed Forces conducted under subparagraph 
(A) shall be included in the health record of the 
member. 
(2) DEFINITIONS.—In this section: 
(A) 
The 
term 
‘‘covered 
evaluation’’ 
means— 
(i) a periodic health assessment con-
ducted in accordance with subsection (a);
707 
(ii) a separation history and physical 
examination 
conducted 
under 
section 
1145(a)(5) of title 10, United States Code, 
as amended by subsection (b); or 
(iii) a deployment assessment con-
ducted under section 1074f(b)(2) of such 
title, as amended by subsection (c). 
(B) The term ‘‘Secretary concerned’’ has 
the meaning given such term in section 101 of 
title 10, United States Code (and otherwise in-
cludes the Secretary of the department in which 
the Coast Guard is operating). 
SEC. 716. PROHIBITION ON ADVERSE PERSONNEL ACTIONS 
TAKEN AGAINST CERTAIN MEMBERS OF THE 
ARMED 
FORCES 
BASED 
ON 
DECLINING 
COVID–19 VACCINE. 
(a) FINDINGS.—Congress finds the following: 
(1) The Secretary of Defense has announced a 
COVID–19 vaccine mandate will take effect for the 
Department of Defense 
(2) Many Americans have reservations about 
taking a vaccine that has only been available for less 
than a year.
708 
(3) Reports of adverse actions being taken, or 
threatened, by military leadership at all levels are 
antithetical to our fundamental American values. 
(4) Any discharge other than honorable denotes 
a dereliction of duty or a failure to serve the United 
States and its people to the best of the ability of an 
individual. 
(b) PROHIBITION.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1107a 
the following new section: 
‘‘§ 1107b. Prohibition on certain adverse personnel 
actions related to COVID–19 vaccine re-
quirement 
‘‘(a) PROHIBITION.—Notwithstanding any other pro-
vision of law, a member of an Armed Force under the ju-
risdiction of the Secretary of a military department sub-
ject to discharge on the basis of the member choosing not 
to receive the COVID–19 vaccine may only receive an hon-
orable discharge. 
‘‘(b) MEMBER OF AN ARMED FORCE DEFINED.—In 
this section, the term ‘member of an Armed Force’ means 
a member of the Army, Navy, Air Force, Marine Corps, 
or the Space Force.’’.
709 
(c) CLERICAL AMENDMENT.—The table of sections 
for such chapter is amended by inserting after the item 
relating to section 1107a the following new item: 
‘‘1107b. Prohibition on certain adverse personnel actions related to COVID–19 
vaccine requirement’’. 
SEC. 717. ESTABLISHMENT OF DEPARTMENT OF DEFENSE 
SYSTEM TO TRACK AND RECORD INFORMA-
TION ON VACCINE ADMINISTRATION. 
(a) ESTABLISHMENT OF SYSTEM.—Section 1110 of 
title 10, United States Code, is amended— 
(1) by redesignating subsections (a) and (b) as 
subsections (b) and (c), respectively; and 
(2) by inserting after the heading the following 
new subsection: 
‘‘(a) SYSTEM TO TRACK AND RECORD VACCINE IN-
FORMATION.—(1) The Secretary of Defense, in coordina-
tion with the Secretaries of the military departments, shall 
establish a system to track and record the following infor-
mation: 
‘‘(A) Each vaccine administered by a health 
care provider of the Department of Defense to a 
member of an armed force under the jurisdiction of 
the Secretary of a military department. 
‘‘(B) Any adverse reaction of the member re-
lated to such vaccine.
710 
‘‘(C) Each refusal of a vaccine by such a mem-
ber on the basis that the vaccine is being adminis-
tered by a health care provider of the Department 
pursuant to an emergency use authorization granted 
by the Commissioner of Food and Drugs under sec-
tion 564 of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 360bbb–3). 
‘‘(2) In carrying out paragraph (1), the Secretary of 
Defense shall ensure that— 
‘‘(A) any electronic health record maintained by 
the Secretary for a member of an armed force under 
the jurisdiction of the Secretary of a military depart-
ment is updated with the information specified in 
such paragraph with respect to the member; and 
‘‘(B) any collection, storage, or use of such in-
formation is conducted through means involving 
such cyber protections as the Secretary determines 
necessary to safeguard the personal information of 
the member.’’. 
(b) CONFORMING AMENDMENTS.—Such section is 
further amended— 
(1) in the heading by striking ‘‘Anthrax vac-
cine immunization program; procedures 
for exemptions and monitoring reac-
tions’’ and inserting ‘‘System for tracking
711 
and recording vaccine information; an-
thrax vaccine immunization program’’; 
and 
(2) in subsection (b), as redesignated by sub-
section (a)(1), by striking ‘‘Secretary of Defense’’ 
and inserting ‘‘Secretary’’. 
(c) CLERICAL AMENDMENT.—The table of sections 
for chapter 55 of title 10, United States Code, is amended 
by striking the item relating to section 1110 and inserting 
the following new item: 
‘‘1110. System for tracking and recording vaccine information; anthrax vaccine 
immunization program.’’. 
(d) DEADLINE FOR ESTABLISHMENT OF SYSTEM.— 
The Secretary of Defense shall establish the system under 
section 1110 of title 10, United States Code. as added by 
subsection (a), by not later than January 1, 2023. 
(e) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Defense 
shall submit to the Committees on Armed Services of the 
House of Representatives and the Senate a report on the 
administration of vaccines to members of the Armed 
Forces under the jurisdiction of the Secretary of a military 
department and on the status of establishing the system 
under section 1110(a) of title 10, United States Code (as 
added by subsection (a)). Such report shall include infor-
mation on the following:
712 
(1) The process by which such members receive 
vaccines, and the process by which the Secretary 
tracks, records, and reports on, vaccines received by 
such members (including with respect to any trans-
fers by a non-Department provider to the Depart-
ment of vaccination records or other medical infor-
mation of the member related to the administration 
of vaccines by the non-Department provider). 
(2) The storage of information related to the 
administration of vaccines in the electronic health 
records of such members, and the cyber protections 
involved in such storage, as required under such sec-
tion 1110(a)(2) of title 10, United States Code. 
(3) The general process by which medical infor-
mation of beneficiaries under the TRICARE pro-
gram is collected, tracked, and recorded, including 
the process by which medical information from pro-
viders contracted by the Department or from a State 
or local department of health is transferred to the 
Department and associated with records maintained 
by the Secretary. 
(4) Any gaps or challenges relating to the vac-
cine administration process of the Department and 
any legislative or budgetary recommendations to ad-
dress such gaps or challenges.
713 
(f) DEFINITIONS.—In this section: 
(1) The term ‘‘military departments’’ has the 
meaning given such term in section 101 of title 10, 
United States Code. 
(2) The term ‘‘TRICARE program’’ has the 
meaning given such term in section 1072 of such 
title. 
SEC. 718. AUTHORIZATION OF PROVISION OF INSTRUCTION 
AT UNIFORMED SERVICES UNIVERSITY OF 
THE HEALTH SCIENCES TO CERTAIN FED-
ERAL EMPLOYEES. 
Section 2114(h) of title 10, United States Code, is 
amended— 
(1) by striking ‘‘The Secretary of Defense’’ and 
inserting ‘‘(1) The Secretary of Defense, in coordi-
nation with the Secretary of Health and Human 
Services and the Secretary of Veterans Affairs,’’; 
and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2)(A) A covered employee whose employment or 
service with the Department of Veterans Affairs, Public 
Health Service, or Coast Guard (as applicable) is in a posi-
tion relevant to national security or health sciences may
715 
ice of, a covered employee permitted to receive in-
struction at the University under subparagraph (A) 
in the relevant position described in such subpara-
graph.’’. 
SEC. 719. MANDATORY TRAINING ON HEALTH EFFECTS OF 
BURN PITS. 
The Secretary of Defense shall provide to each med-
ical provider of the Department of Defense mandatory 
training with respect to the potential health effects of burn 
pits. 
SEC. 720. DEPARTMENT OF DEFENSE PROCEDURES FOR 
EXEMPTIONS FROM MANDATORY COVID–19 
VACCINES. 
(a) EXEMPTIONS.—The Secretary of Defense shall 
establish uniform procedures under which covered mem-
bers may be exempted from receiving an otherwise man-
dated COVID–19 vaccine for administrative, medical, or 
religious reasons, including on the basis of possessing an 
antibody test result demonstrating previous COVID–19 
infection. 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘covered member’’ means a mem-
ber of an Armed Force under the jurisdiction of the 
Secretary of a military department.
716 
(2) The term ‘‘COVID–19 vaccine’’ means any 
vaccine for the coronavirus disease 2019 (COVID– 
19), including any subsequent booster shot for 
COVID–19. 
SEC. 721. MODIFICATIONS AND REPORT RELATED TO RE-
DUCTION OR REALIGNMENT OF MILITARY 
MEDICAL MANNING AND MEDICAL BILLETS. 
(a) MODIFICATIONS TO LIMITATION ON REDUCTION 
OR REALIGNMENT.—Section 719 of the National Defense 
Authorization Act for Fiscal Year 2020 (Public Law 116– 
92; 133 Stat. 1454), as amended by section 717 of the 
William M. (Mac) Thornberry National Defense Author-
ization Act for Fiscal Year 2021 (Public Law 116–283), 
is further amended— 
(1) in subsection (a), by striking ‘‘180 days fol-
lowing the date of the enactment of the William M. 
(Mac) Thornberry National Defense Authorization 
Act for Fiscal Year 2021’’ and inserting ‘‘the year 
following the date of the enactment of the National 
Defense Authorization Act for Fiscal Year 2022’’; 
and 
(2) in subsection (b)(1), by inserting ‘‘, includ-
ing any billet validation requirements determined 
pursuant to estimates provided in the joint medical 
estimate under section 732 of the John S. McCain
717 
National Defense Authorization Act for Fiscal Year 
2019 (Public Law 115–232),’’ after ‘‘requirements 
of the military department of the Secretary’’. 
(b) GAO REPORT ON REDUCTION OR REALIGNMENT 
OF MILITARY MEDICAL MANNING AND MEDICAL BIL-
LETS.— 
(1) REPORT.—Not later than one year after the 
date of the enactment of this Act, the Comptroller 
General of the United States shall submit to the 
Committees on Armed Services of the House of Rep-
resentatives and the Senate a report on the analyses 
used to support any reduction or realignment of 
military medical manning, including any reduction 
or realignment of medical billets of the military de-
partments. 
(2) ELEMENTS.—The report under paragraph 
(1) shall include the following: 
(A) An analysis of the use of the joint 
medical estimate under section 732 of the John 
S. McCain National Defense Authorization Act 
for Fiscal Year 2019 (Public Law 115–232; 
132 Stat. 1817) and wartime scenarios to de-
termine military medical manpower require-
ments, including with respect to pandemic influ-
enza and homeland defense missions.
718 
(B) An assessment of whether the Secre-
taries of the military departments have used the 
processes under section 719(b) of the National 
Defense Authorization Act for Fiscal Year 2020 
(Public Law 116–92; 133 Stat. 1454) to ensure 
that a sufficient combination of skills, special-
ties, and occupations are validated and filled 
prior to the transfer of any medical billets of a 
military department to fill other military med-
ical manpower needs. 
(C) An assessment of the effect of the re-
duction or realignment of such billets on local 
health care networks and whether the Director 
of the Defense Health Agency has conducted 
such an assessment in coordination with the 
Secretaries of the military departments. 
SEC. 
722. 
CROSS-FUNCTIONAL 
TEAM 
FOR 
EMERGING 
THREAT RELATING TO ANOMALOUS HEALTH 
INCIDENTS. 
(a) ESTABLISHMENT.—Using the authority provided 
under section 911(c) of the National Defense Authoriza-
tion Act for Fiscal Year 2017 (Public Law 114–328; 10 
U.S.C. 111 note), the Secretary of Defense shall establish 
a cross-functional team to address national security chal-
lenges posed by anomalous health incidents (as defined by
719 
the Secretary) and ensure that individuals affected by 
anomalous health incidents receive timely and comprehen-
sive health care and treatment pursuant to title 10, United 
States Code, or other provisions of law administered by 
the Secretary, for symptoms consistent with an anomalous 
health incident. 
(b) DUTIES.—The duties of the cross-functional team 
established under subsection (a) shall be— 
(1) to assist the Secretary of Defense with ad-
dressing the challenges posed by anomalous health 
incidents and any other efforts regarding such inci-
dents that the Secretary determines necessary; and 
(2) to integrate the efforts of the Department 
of Defense regarding anomalous health incidents 
with the efforts of other departments or agency of 
the Federal Government regarding such incidents. 
(c) TEAM LEADER.—The Secretary shall select an 
Under Secretary of Defense to lead the cross-functional 
team and a senior military officer to serve as the deputy 
to the Under Secretary so selected. 
(d) DETERMINATION
OF ORGANIZATIONAL ROLES 
AND RESPONSIBILITIES.—The Secretary, in coordination 
with the Director of National Intelligence and acting 
through the cross-functional team established under sub-
section (a), shall determine the roles and responsibilities
720 
of the organizations and elements of the Department of 
Defense with respect to addressing anomalous health inci-
dents, including the roles and responsibilities of the Office 
of the Secretary of Defense, the intelligence components 
of the Department, Defense agencies, and Department of 
Defense field activities, the military departments, combat-
ant commands, and the Joint Staff. 
(e) BRIEFINGS.— 
(1) INITIAL BRIEFING.—Not later than 30 days 
after the date of the enactment of this Act, the Sec-
retary shall provide to the appropriate congressional 
committees a briefing on— 
(A) the progress of the Secretary in estab-
lishing the cross-functional team; and 
(B) the progress the team has made in— 
(i) determining the roles and respon-
sibilities of the organizations and elements 
of the Department of Defense with respect 
the cross-functional team; and 
(ii) carrying out the duties under sub-
section (b). 
(2) UPDATES.—Not later than 75 days after 
the date of the enactment of this Act, and once 
every 45 days thereafter during the one-year period 
following such date of enactment, the Secretary shall
721 
provide to the appropriate congressional committees 
a briefing containing updates with respect to the ef-
forts of the Department regarding anomalous health 
incidents. 
(f) APPROPRIATE CONGRESSIONAL COMMITTEES DE-
FINED.—In this section, the term ‘‘appropriate congres-
sional committees’’ means— 
(1) the congressional defense committees; and 
(2) the Permanent Select Committee on Intel-
ligence of the House of Representatives and the Se-
lect Committee on Intelligence of the Senate. 
SEC. 723. IMPLEMENTATION OF INTEGRATED PRODUCT 
FOR MANAGEMENT OF POPULATION HEALTH 
ACROSS MILITARY HEALTH SYSTEM. 
(a) INTEGRATED PRODUCT.—The Secretary of De-
fense shall develop and implement an integrated product 
for the management of population health across the mili-
tary health system. Such integrated product shall serve 
as a repository for the health care, demographic, and other 
relevant data of all covered beneficiaries, including with 
respect to data on health care services furnished to such 
beneficiaries through the purchased care and direct care 
components of the TRICARE program, and shall—
722 
(1) be compatible with the electronic health 
record system maintained by the Secretary for mem-
bers of the Armed Forces; 
(2) enable the coordinated case management of 
covered beneficiaries with respect to health care 
services furnished to such beneficiaries at military 
medical treatment facilities and at private sector fa-
cilities through health care providers contracted by 
the Department of Defense; 
(3) enable the collection and stratification of 
data from multiple sources to measure population 
health goals, facilitate disease management pro-
grams of the Department, improve patient edu-
cation, and integrate wellness services across the 
military health system; and 
(4) enable predictive modeling to improve 
health outcomes for patients and to facilitate the 
identification and correction of medical errors in the 
treatment of patients, issues regarding the quality of 
health care services provided, and gaps in health 
care coverage. 
(b) DEFINITIONS.—In this section: 
(1) The terms ‘‘covered beneficiary’’ and 
‘‘TRICARE program’’ have the meanings given such
723 
terms in section 1072 of title 10, United States 
Code. 
(2) The term ‘‘integrated product’’ means an 
electronic system of systems (or solutions or prod-
ucts) that provides for the integration and sharing 
of data to meet the needs of an end user in a timely 
and cost effective manner. 
SEC. 724. DIGITAL HEALTH STRATEGY OF DEPARTMENT OF 
DEFENSE. 
(a) DIGITAL HEALTH STRATEGY.— 
(1) STRATEGY.—Not later than April 1, 2022, 
the Secretary of Defense shall develop a digital 
health strategy of the Department of Defense to in-
corporate new and emerging technologies and meth-
ods (including three-dimensional printing, virtual re-
ality, wearable devices, big data and predictive ana-
lytics, distributed ledger technologies, and other in-
novative methods that leverage new or emerging 
technologies) in the provision of clinical care within 
the military health system. 
(2) ELEMENTS.—The strategy under paragraph 
(1) shall address, with respect to future use within 
the military health system, the following: 
(A) Emerging technology to improve the 
delivery of clinical care and health services.
724 
(B) Design thinking to improve the deliv-
ery of clinical care and health services. 
(C) Advanced clinical decision support sys-
tems. 
(D) Simulation technologies for clinical 
training 
(including 
through 
simulation 
immersive training) and clinical education, and 
for the training of health care personnel in the 
adoption of emerging technologies for clinical 
care delivery. 
(E) Wearable devices. 
(F) Three-dimensional printing and related 
technologies. 
(G) Data-driven decision making, including 
through the use of big data and predictive ana-
lytics, in the delivery of clinical care and health 
services. 
(b) REPORT.—Not later than July 1, 2022, the Sec-
retary shall submit to the Committees on Armed Services 
of the House of Representatives and the Senate a report 
setting forth— 
(1) the strategy under subsection (a); and 
(2) a plan to implement such strategy, includ-
ing the estimated timeline and cost for such imple-
mentation.
725 
SEC. 725. DEVELOPMENT AND UPDATE OF CERTAIN POLI-
CIES RELATING TO MILITARY HEALTH SYS-
TEM 
AND 
INTEGRATED 
MEDICAL 
OPER-
ATIONS. 
(a) IN GENERAL.—By not later than October 1, 
2022, the Secretary of Defense, in coordination with the 
Secretaries of the military departments and the Chairman 
of the Joint Chiefs of Staff, shall develop and update cer-
tain policies relating to the military health system and in-
tegrated medical operations of the Department of Defense 
as follows: 
(1) UPDATED PLAN ON INTEGRATED MEDICAL 
OPERATIONS
IN
CONTINENTAL
UNITED
STATES.— 
The Secretary of Defense shall develop an updated 
plan on integrated medical operations in the conti-
nental United States and update the Department of 
Defense Instruction 6010.22, titled ‘‘National Dis-
aster Medical System (NDMS)’’ (or such successor 
instruction) accordingly. Such updated plan shall— 
(A) be informed by the operational plans of 
the combatant commands and by the joint med-
ical estimate under section 732 of the John S. 
McCain National Defense Authorization Act for 
Fiscal Year 2019 (Public Law 115–232; 132 
Stat. 1817);
726 
(B) include a determination as to whether 
combat casualties should receive medical care 
under the direct care or purchased care compo-
nent of the military health system and a risk 
analysis in support of such determination; 
(C) identify the manning levels required to 
furnish medical care under the updated plan, 
including with respect to the levels of military 
personnel, civilian employees of the Depart-
ment, and contractors of the Department; and 
(D) include a cost estimate for the 
furnishment of such medical care. 
(2) UPDATED
PLAN
ON
GLOBAL
PATIENT 
MOVEMENT.—The Secretary of Defense shall develop 
an updated plan on global patient movement and up-
date 
the 
Department 
of 
Defense 
Instruction 
5154.06, relating to medical military treatment fa-
cilities and patient movement (or such successor in-
struction) accordingly. Such updated plan shall— 
(A) be informed by the operational plans of 
the combatant commands and by the joint med-
ical estimate under section 732 of the John S. 
McCain National Defense Authorization Act for 
Fiscal Year 2019 (Public Law 115–232; 132 
Stat. 1817);
727 
(B) include a risk assessment with respect 
to patient movement compared against overall 
operational plans; 
(C) include a description of any capabili-
ties-based assessment of the Department that 
informed the updated plan or that was in 
progress during the time period in which the 
updated plan was developed; and 
(D) identify the manning levels, equipment 
and consumables, and funding levels, required 
to carry out the updated plan. 
(3) ASSESSMENT
OF
BIOSURVEILLANCE
AND 
MEDICAL RESEARCH CAPABILITIES.—The Secretary 
of Defense shall conduct an assessment of biosurveil-
lance and medical research capabilities of the De-
partment of Defense. Such assessment shall include 
the following: 
(A) An identification of the location and 
strategic value of the overseas medical labora-
tories and overseas medical research programs 
of the Department. 
(B) An assessment of the current capabili-
ties of such laboratories and programs with re-
spect to force health protection and evidence- 
based medical research.
730 
essary to support missions as specified in sub-
paragraph (F). 
(4) ANALYSIS OF MILITARY HEALTH SYSTEM 
ORGANIZATION.—The Secretary of Defense shall 
conduct an analysis to determine whether the cur-
rent organizational structure of the military health 
system allows for the implementation of the updated 
plans under paragraphs (1) and (2) and of any rec-
ommendations made by the Secretary as a result of 
the assessment under paragraph (3). Such analysis 
shall include— 
(A) an assessment of how the Secretary 
may leverage TRICARE Regional Offices, 
TRICARE managed care support contractors, 
and local or regional health care systems, to ad-
dress any potential gaps in the provision of 
medical care under the military health system 
that may limit the progress of such implemen-
tation or may arise as the result of such imple-
mentation; and 
(B) recommendations on any organiza-
tional changes to the military health system 
that would be necessary for such implementa-
tion.
731 
(b) INTERIM BRIEFING.—Not later than April 1, 
2022, the Secretary of Defense, in coordination with the 
Secretaries of the military departments and the Chairman 
of the Joint Chiefs of Staff, shall provide to the Commit-
tees on Armed Services of the House of Representatives 
and the Senate an interim briefing on the progress of im-
plementation of the plans, assessment, and analysis re-
quired under subsection (a). 
(c) REPORT.—Not later than December 1, 2022, the 
Secretary of Defense shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate a report describing each updated plan, assessment, 
and analysis required under subsection (a). 
SEC. 726. STANDARDIZATION OF DEFINITIONS USED BY 
THE DEPARTMENT OF DEFENSE FOR TERMS 
RELATED TO SUICIDE. 
(a) STANDARDIZATION OF DEFINITIONS.—Not later 
than 90 days after the date of the enactment of this Act, 
the Secretary of Defense, in coordination with the Secre-
taries of the military departments, shall develop standard-
ized definitions for the following terms: 
(1) ‘‘Suicide’’. 
(2) ‘‘Suicide attempt’’. 
(3) ‘‘Suicidal ideation’’.
732 
(b) REQUIRED USE
OF STANDARDIZED DEFINI-
TIONS.—Not later than 180 days after the date of the en-
actment of this Act, the Secretary shall issue policy guid-
ance requiring the exclusive and uniform use across the 
Department of Defense and within each military depart-
ment of the standardized definitions developed under sub-
section (a) for the terms specified in such subsection. 
(c) REPORT.—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 House of 
Representatives and the Senate a report that sets forth 
the standardized definitions developed under subsection 
(a) and includes— 
(1) a description of the process that was used 
to develop such definitions; 
(2) a description of the methods by which data 
shall be collected on suicide, suicide attempts, and 
suicidal ideations (as those terms are defined pursu-
ant to such definitions) in a standardized format 
across the Department and within each military de-
partment; and 
(3) an implementation plan to ensure the use of 
such definitions as required pursuant to subsection 
(b).
733 
SEC. 727. EXEMPTION FROM REQUIRED PHYSICAL EXAM-
INATION AND MENTAL HEALTH ASSESSMENT 
FOR CERTAIN MEMBERS OF THE RESERVE 
COMPONENTS. 
Section 1145(a)(5) of title 10, United States Code 
is amended— 
(1) in subparagraph (A), by striking ‘‘The Sec-
retary’’ and inserting ‘‘Except as provided in sub-
paragraph (D), the Secretary’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) The requirement for a physical examina-
tion and mental health assessment under subpara-
graph (A) shall not apply with respect to a member 
of a reserve component described in paragraph 
(2)(B) unless the member is retiring, or being dis-
charged or dismissed, from the armed forces.’’. 
Subtitle C—Reports and Other 
Matters 
SEC. 731. GRANT PROGRAM FOR INCREASED COOPERA-
TION 
ON 
POST-TRAUMATIC 
STRESS 
DIS-
ORDER RESEARCH BETWEEN UNITED STATES 
AND ISRAEL. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that the Secretary of Defense, acting through the 
Psychological Health and Traumatic Brain Injury Re-
734 
search Program, should seek to explore scientific collabo-
ration between American academic institutions and non-
profit research entities, and Israeli institutions with exper-
tise in researching, diagnosing, and treating post-trau-
matic stress disorder. 
(b) GRANT PROGRAM.—The Secretary of Defense, in 
coordination with the Secretary of State, shall award 
grants to eligible entities to carry out collaborative re-
search between the United States and Israel with respect 
to post-traumatic stress disorders. The Secretary of De-
fense shall carry out the grant program under this section 
in accordance with the agreement titled ‘‘Agreement Be-
tween the Government of the United States of America 
and the Government of Israel on the United States-Israel 
Binational Science Foundation’’, dated September 27, 
1972. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall be an academic 
institution or a nonprofit entity located in the United 
States. 
(d) AWARD.—The Secretary shall award grants 
under this section to eligible entities that— 
(1) carry out a research project that— 
(A) addresses a requirement in the area of 
post-traumatic stress disorders that the Sec-
735 
retary determines appropriate to research using 
such grant; and 
(B) is conducted by the eligible entity and 
an entity in Israel under a joint research agree-
ment; and 
(2) meet such other criteria that the Secretary 
may establish. 
(e) APPLICATION.—To be eligible to receive a grant 
under this section, an eligible entity shall submit an appli-
cation to the Secretary at such time, in such manner, and 
containing such commitments and information as the Sec-
retary may require. 
(f) GIFT AUTHORITY.—The Secretary may accept, 
hold, and administer, any gift of money made on the con-
dition that the gift be used for the purpose of the grant 
program under this section. Such gifts of money accepted 
under this subsection shall be deposited in the Treasury 
in the Department of Defense General Gift Fund and shall 
be available, subject to appropriation, without fiscal year 
limitation. 
(g) REPORTS.—Not later than 180 days after the 
date on which an eligible entity completes a research 
project using a grant under this section, the Secretary 
shall submit to Congress a report that contains—
736 
(1) a description of how the eligible entity used 
the grant; and 
(2) an evaluation of the level of success of the 
research project. 
(h) TERMINATION.—The authority to award grants 
under this section shall terminate on the date that is seven 
years after the date on which the first such grant is 
awarded. 
SEC. 732. PILOT PROGRAM ON CARDIAC SCREENING AT 
CERTAIN MILITARY SERVICE ACADEMIES. 
(a) PILOT PROGRAM.—The Secretary of Defense 
shall establish a pilot program to furnish mandatory elec-
trocardiograms to candidates who are seeking admission 
to a covered military service academy in connection with 
the military accession screening process, at no cost to such 
candidates. 
(b) SCOPE.—The scope of the pilot program under 
subsection (a) shall include at least 25 percent of the in-
coming class of candidates who are seeking admission to 
a covered military service academy during the first fall se-
mester that follows the date of the enactment of this Act, 
and the pilot program shall terminate on the date on 
which the Secretary determines the military accession 
screening process for such class has concluded.
738 
sult of an electrocardiogram furnished under the 
pilot program. 
(e) COVERED MILITARY SERVICE ACADEMY DE-
FINED.—In this section, the term ‘‘covered military serv-
ice academy’’ does not include the Untied States Coast 
Guard Academy or the United States Merchant Marine 
Academy. 
SEC. 733. PILOT PROGRAM ON CRYOPRESERVATION AND 
STORAGE. 
(a) PILOT PROGRAM.—The Secretary of Defense 
shall establish a pilot program to provide not more than 
1,000 members of the Armed Forces serving on active 
duty with the opportunity to cryopreserve and store their 
gametes prior to deployment to a combat zone. 
(b) PERIOD.— 
(1) IN GENERAL.—The Secretary shall provide 
for the cryopreservation and storage of gametes of 
a participating member of the Armed Forces under 
subsection (a), at no cost to the member, in a facil-
ity of the Department of Defense or at a private en-
tity pursuant to a contract under subsection (d) 
until the date that is one year after the retirement, 
separation, or release of the member from the 
Armed Forces.
739 
(2) 
CONTINUED
CRYOPRESERVATION
AND 
STORAGE.—At the end of the one-year period speci-
fied in paragraph (1), the Secretary shall authorize 
an individual whose gametes were cryopreserved and 
stored in a facility of the Department as described 
in that paragraph to select, including pursuant to an 
advance medical directive or military testamentary 
instrument completed under subsection (c), one of 
the following options: 
(A) To continue such cryopreservation and 
storage in such facility with the cost of such 
cryopreservation and storage borne by the indi-
vidual. 
(B) To transfer the gametes to a private 
cryopreservation and storage facility selected by 
the individual. 
(C) To authorize the Secretary to dispose 
of the gametes of the individual not earlier than 
the date that is 90 days after the end of the 
one-year period specified in paragraph (1) with 
respect to the individual. 
(c) ADVANCE MEDICAL DIRECTIVE AND MILITARY 
TESTAMENTARY INSTRUMENT.—A member of the Armed 
Forces who elects to cryopreserve and store their gametes 
under this section shall complete an advance medical di-
740 
rective described in section 1044c(b) of title 10, United 
States Code, and a military testamentary instrument de-
scribed in section 1044d(b) of such title, that explicitly 
specifies the use of their cryopreserved and stored gametes 
if such member dies or otherwise loses the capacity to con-
sent to the use of their cryopreserved and stored gametes. 
(d) AGREEMENTS.—To carry out this section, the 
Secretary may enter into agreements with private entities 
that provide cryopreservation and storage services for 
gametes. 
SEC. 734. PILOT PROGRAM ON ASSISTANCE FOR MENTAL 
HEALTH 
APPOINTMENT 
SCHEDULING 
AT 
MILITARY MEDICAL TREATMENT FACILITIES. 
(a) PILOT PROGRAM.—The Secretary of Defense 
shall carry out a pilot program to provide direct assistance 
for mental health appointment scheduling at military med-
ical treatment facilities and clinics selected by the Sec-
retary for participation in the pilot program in a number 
determined by the Secretary. 
(b) REPORT.—Not later than 90 days after the date 
on which the pilot program terminates, the Secretary shall 
submit to the Committees on Armed Services of the House 
of Representatives and the Senate a report on the pilot 
program. Such report shall include an assessment of—
741 
(1) the effectiveness of the pilot program with 
respect to improved access to mental health appoint-
ments; and 
(2) any barriers to scheduling mental health ap-
pointments under the pilot program observed by 
health care professionals or other individuals in-
volved in scheduling such appointments. 
(c) TERMINATION.—The authority to carry out the 
pilot program under subsection (a) shall terminate on the 
date that is one year after the commencement of the pilot 
program. 
SEC. 735. PILOT PROGRAM ON ORAL REHYDRATION SOLU-
TIONS. 
(a) PILOT PROGRAM.—The Secretary of Defense may 
carry out a pilot program under which the Secretary shall 
furnish medically approved oral rehydration solutions to 
members of the Armed Forces. 
(b) DISTRIBUTION.—Oral rehydration solutions fur-
nished under the pilot program carried out pursuant to 
subsection (a) shall be distributed to members of the 
Armed Forces at the brigade level, through the Airborne 
and Ranger Training Brigade, the Maneuver Center of 
Excellence of the Army, and the United States Army 
Training and Doctrine Command. Such distribution shall
742 
be carried out during a period of summer months, as de-
termined by the Secretary. 
(c) REPORT.—Not later than 60 after the date of the 
conclusion of the pilot program carried out pursuant to 
subsection (a), the Secretary shall submit to the Commit-
tees on Armed Services of the House of Representatives 
and the Senate a report on the effectiveness of the oral 
rehydration solutions furnished under the pilot program. 
Such report shall include— 
(1) all data tracking the prevention of heat cas-
ualties and hyponatremia among participants under 
the pilot program; and 
(2) any other benefits realized under the pilot 
program, including benefits related to cost savings, 
readiness, or wellness of members of the Armed 
Forces. 
SEC. 736. AUTHORIZATION OF PILOT PROGRAM TO SURVEY 
ACCESS TO MENTAL HEALTH CARE UNDER 
MILITARY HEALTH SYSTEM. 
(a) FINDINGS; SENSE OF CONGRESS.— 
(1) FINDINGS.—Congress finds that— 
(A) there is a connection between stigma, 
mental health care access, and death by suicide; 
and
743 
(B) current command climate surveys lack 
sufficient questions regarding mental health 
stigma. 
(2) SENSE OF CONGRESS.—It is the sense of 
Congress that— 
(A) military research and research of the 
Department of Veterans Affairs significantly 
contribute to overall health care research useful 
for all individuals; and 
(B) command climate surveys provide an 
important function for ensuring safe command 
environments. 
(b) AUTHORIZATION OF PILOT PROGRAM TO SURVEY 
ACCESS TO MENTAL HEALTH CARE UNDER MILITARY 
HEALTH SYSTEM.— 
(1) PILOT PROGRAM AUTHORIZED.—The Sec-
retary of Defense may carry out a pilot program to 
survey access to mental health care under the mili-
tary health system. 
(2) ELEMENTS.—In carrying out a pilot pro-
gram pursuant to paragraph (1), the Secretary shall 
ensure that an adequate number of command cli-
mate surveys that include questions on access to 
mental health care under the military health system 
are administered to a representative sample of active
744 
duty members of the Armed Forces across each mili-
tary department. Such questions shall be developed 
by the survey administrator of the Defense Organi-
zational Climate Survey and shall address, at a min-
imum, the following matters: 
(A) The perceived ability of the respondent 
to access mental health care under the military 
health system. 
(B) Whether the respondent has previously 
been prohibited from, or advised against, ac-
cessing such care. 
(C) Any overall stigma perceived by the re-
spondent with respect to such care. 
(D) The belief of the respondent that re-
ceiving care from a mental health care provider 
may harm the career, or the ability to obtain a 
security clearance, of the respondent. 
(E) The belief of the respondent that re-
ceiving a mental health diagnosis may harm the 
career, or the ability to obtain a security clear-
ance, of the respondent. 
(3) TERMINATION.—The authority to carry out 
a pilot program under paragraph (1) shall terminate 
on September 1, 2023.
745 
(4) REPORT.—Not later than 90 days after the 
date on which a pilot program carried out pursuant 
to paragraph (1) terminates, the Secretary shall sub-
mit to the Committees on Armed Services of the 
House of Representatives and the Senate a report on 
the results of the updated surveys administered pur-
suant to the pilot program. 
(c) DEFINITIONS.—In this section, the terms ‘‘active 
duty’’, ‘‘Armed Forces’’, and ‘‘military departments’’ have 
the meanings given those terms in section 101 of title 10, 
United States Code. 
SEC. 737. PROHIBITION ON AVAILABILITY OF FUNDS FOR 
RESEARCH CONNECTED TO CHINA. 
(a) PROHIBITION.—None of the funds authorized to 
be appropriated by this Act or otherwise made available 
for fiscal year 2022 for the Department of Defense may 
be obligated or expended— 
(1) to conduct research in China, including bio-
medical, infectious disease, gene editing, genetics, 
virus, or military medical research, whether directly 
or through a third-party entity; or 
(2) to provide funds for research, including bio-
medical, infectious disease, gene editing, genetics, 
virus, or military medical research, to any entity de-
746 
termined by the Secretary of Defense to be owned 
or controlled, directly or indirectly, by China. 
(b) WAIVER.—The Secretary of Defense may waive 
a prohibition under subsection (a) if the Secretary— 
(1) determines that the waiver is in the national 
security interests of United States; and 
(2) not later than 14 days after granting the 
waiver, submits to the congressional defense commit-
tees a detailed justification for the waiver, includ-
ing— 
(A) an identification of the Department of 
Defense entity obligating or expending the 
funds; 
(B) an identification of the amount of such 
funds; 
(C) an identification of the intended pur-
pose of such funds; 
(D) an identification of the recipient or 
prospective recipient of such funds (including 
any third-party entity recipient, as applicable); 
(E) an explanation for how the waiver is in 
the national security interests of the United 
States; and 
(F) any other information the Secretary 
determines appropriate.
747 
SEC. 738. INDEPENDENT ANALYSIS OF DEPARTMENT OF 
DEFENSE COMPREHENSIVE AUTISM CARE 
DEMONSTRATION PROGRAM. 
(a) AGREEMENT.— 
(1) IN
GENERAL.—The Secretary of Defense 
shall seek to enter into an agreement with the Na-
tional Academies of Sciences, Engineering, and Med-
icine (in this section referred to as the ‘‘National 
Academies’’) for the National Academies to carry 
out the activities described in subsections (b) and 
(c). 
(2) TIMING.—The Secretary shall seek to enter 
into the agreement described in paragraph (1) not 
later than 60 days after the date of the enactment 
of this Act. 
(b) ANALYSIS BY THE NATIONAL ACADEMIES.— 
(1) ANALYSIS.—Under an agreement between 
the Secretary and the National Academies entered 
into pursuant to subsection (a), the National Acad-
emies shall conduct an analysis of the effectiveness 
of the Department of Defense Comprehensive Au-
tism Care Demonstration program (in this section 
referred to as the ‘‘demonstration program’’) and 
develop recommendations for the Secretary based on 
such analysis.
748 
(2) ELEMENTS.—The analysis conducted and 
recommendations developed under paragraph (1) 
shall include the following: 
(A) An assessment of the Pervasive Devel-
opmental Disabilities Behavior Inventory as a 
measure to assist in the assessment of domains 
related to autism spectrum disorder, and a de-
termination as to whether the Secretary is ap-
plying such inventory appropriately under the 
demonstration project. 
(B) An assessment of the methods used 
under the demonstration project to measure the 
effectiveness of applied behavior analysis in the 
treatment of autism spectrum disorder. 
(C) A review of any guidelines or industry 
standards of care adhered to in the provision of 
applied behavior analysis services under the 
demonstration program, including a review of 
the effects of such adherence with respect to 
dose-response or expected health outcomes for 
an individual who has received such services. 
(D) A review of the expected health out-
comes for an individual who has received ap-
plied behavior analysis treatments over time.
749 
(E) An analysis of the increased utilization 
of the demonstration program by beneficiaries 
under the TRICARE program, to improve un-
derstanding of such utilization. 
(F) Such other analyses to measure the ef-
fectiveness of the demonstration program as 
may be determined appropriate by the National 
Academies. 
(G) An analysis on whether the incidence 
of autism is higher among the children of mili-
tary families. 
(H) The development of a list of findings 
and recommendations related to the measure-
ment, 
effectiveness, 
and 
increased 
under-
standing of the demonstration program and its 
effect on beneficiaries under the TRICARE pro-
gram. 
(c) REPORT.—Under an agreement entered into be-
tween the Secretary and the National Academies under 
subsection (a), the National Academies, not later than 
nine months after the date of the execution of the agree-
ment, shall— 
(1) submit to the congressional defense commit-
tees a report on the findings of the National Acad-
emies with respect to the analysis conducted and
750 
recommendations developed under subsection (b); 
and 
(2) make such report available on a public 
website in unclassified form. 
SEC. 739. INDEPENDENT REVIEW OF SUICIDE PREVENTION 
AND 
RESPONSE 
AT 
MILITARY 
INSTALLA-
TIONS. 
(a) ESTABLISHMENT
OF COMMITTEE.—Not later 
than 90 days after the date of the enactment of this Act, 
the Secretary of Defense shall establish an independent 
suicide prevention and response review committee. 
(b) MEMBERSHIP.—The committee established under 
subsection (a) shall be composed of not fewer than five 
individuals— 
(1) designated by the Secretary; 
(2) with expertise determined to be relevant by 
the Secretary, including at least one individual who 
is an experienced provider of mental health services 
and at least one individual who is an experienced 
criminal investigator; 
(3) none of whom may be a member of an 
Armed Force or a civilian employee of the Depart-
ment of Defense. 
(c) SELECTION OF MILITARY INSTALLATIONS.—The 
Secretary shall select, for review by the committee estab-
751 
lished under subsection (a), not fewer than three military 
installations that have a higher-than-average incidence of 
suicide by members of the Armed Forces serving at the 
installation. The Secretary shall ensure that at least one 
of the installations selected under this subsection is a re-
mote installation of the Department of Defense located 
outside the contiguous United States. 
(d) DUTIES.—The committee established under sub-
section (a) shall review the suicide prevention and re-
sponse programs and other factors that may contribute 
to the incidence or prevention of suicide at the military 
installations selected for review pursuant to subsection (c). 
Such review shall be conducted through means includ-
ing— 
(1) a confidential survey; 
(2) focus groups; and 
(3) individual interviews. 
(e) COORDINATION.—In carrying out this section, the 
Secretary shall ensure that the Director of the Office of 
People Analytics of the Department of Defense and the 
Director of the Office of Force Resiliency of the Depart-
ment of Defense coordinate and cooperate with the com-
mittee established under subsection (a). 
(f) REPORTS.—
752 
(1) INITIAL REPORT.—Not later than 270 days 
after the establishment of the committee under sub-
section (a), the committee shall submit to the Sec-
retary a report containing the results of the reviews 
conducted by the committee and recommendations of 
the committee to reduce the incidence of suicide at 
the military installations reviewed. 
(2) REPORT
TO
CONGRESS.—Not later than 
330 days after the establishment of the committee 
under subsection (a), the committee shall submit to 
the Committees on Armed Services of the House of 
Representatives and the Senate the report under 
paragraph (1). 
SEC. 740. FEASIBILITY AND ADVISABILITY STUDY ON ES-
TABLISHMENT OF AEROMEDICAL SQUADRON 
AT JOINT BASE PEARL HARBOR-HICKAM. 
(a) STUDY.—Not later than April 1, 2022, the Sec-
retary of Defense, in consultation with the Chief of the 
National Guard Bureau and the Director of the Air Na-
tional Guard, shall complete a study on the feasibility and 
advisability of establishing at Joint Base Pearl Harbor- 
Hickam an aeromedical squadron of the Air National 
Guard in Hawaii to support the aeromedical mission needs 
of the State of Hawaii and the United States Indo-Pacific 
Command.
753 
(b) ELEMENTS.—The study under subsection (a) 
shall assess the following: 
(1) The manpower required for the establish-
ment of an aeromedical squadron of the Air Na-
tional Guard in Hawaii as specified in subsection 
(a). 
(2) The overall cost of such establishment. 
(3) The length of time required for such estab-
lishment. 
(4) The mission requirements for such estab-
lishment. 
(5) Such other matters as may be determined 
relevant by the Secretary. 
(c) SUBMISSION TO CONGRESS.—Not later than April 
1, 2022, the Secretary shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate a report containing the findings of the feasibility 
and advisability study under subsection (a), including with 
respect to each element specified in subsection (b). 
SEC. 741. PLAN TO ADDRESS FINDINGS RELATED TO AC-
CESS TO CONTRACEPTION FOR MEMBERS OF 
THE ARMED FORCES. 
(a) PLAN REQUIRED.—The Secretary of Defense (in 
coordination with the Secretaries of the military depart-
ments) shall develop and implement a plan to address the
754 
findings of the report of the Department of Defense on 
the status of implementation of guidance for ensuring ac-
cess to contraception published in response to pages 155 
through 156 of the report of the Committee on Armed 
Services of the House of Representatives accompanying 
H.R. 6395 of the 116th Congress (H. Rept. 116-617). 
(b) ELEMENTS.—The plan under subsection (a) shall 
address— 
(1) the barriers and challenges to implementa-
tion identified in the report of the Department speci-
fied in such subsection; and 
(2) the inability of certain members of the 
Armed Forces to access their preferred method of 
contraception and have ongoing access during de-
ployment. 
(c) REPORT.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary shall submit 
to the appropriate congressional committees a report on 
the plan under subsection (a) and any progress made pur-
suant to such plan. 
(d) APPROPRIATE
CONGRESSIONAL
COMMITTEES 
DEFINED.—In this section, the term ‘‘appropriate con-
gressional committees’’ means—
755 
(1) the Committee on Armed Services and the 
Committee on Transportation and Infrastructure of 
the House of Representatives; and 
(2) the Committee on Armed Services and the 
Committee on Commerce, Science, and Transpor-
tation of the Senate. 
SEC. 742. GAO BIENNIAL STUDY ON INDIVIDUAL LONGITU-
DINAL EXPOSURE RECORD PROGRAM. 
(a) STUDIES AND REPORTS REQUIRED.—Not later 
than December 31, 2022, and once every two years there-
after until December 31, 2030, the Comptroller General 
of the United States shall— 
(1) conduct a study on the implementation and 
effectiveness of the Individual Longitudinal Expo-
sure Record program of the Department of Defense 
and the Department of Veterans Affairs; and 
(2) submit to the appropriate congressional 
committees a report containing the findings of the 
most recently conducted study. 
(b) ELEMENTS.—The biennial studies under sub-
section (a) shall include an assessment of elements as fol-
lows: 
(1) INITIAL
STUDY.—The initial study con-
ducted under subsection (a) shall assess, at a min-
imum, the following:
756 
(A) Statistics relating to use of the Indi-
vidual Longitudinal Exposure Record program, 
including the total number of individuals the 
records of whom are contained therein and the 
total number of records accessible under the 
program. 
(B) Costs associated with the program, in-
cluding any cost overruns associated with the 
program. 
(C) The capacity to expand the program to 
include the medical records of veterans who 
served prior to the establishment of the pro-
gram. 
(D) Any illness recently identified as relat-
ing to a toxic exposure (or any guidance relat-
ing to such an illness recently issued) by either 
the Secretary of Defense or the Secretary of 
Veterans Affairs, including any such illness or 
guidance that relates to open burn pit exposure. 
(E) How the program has enabled (or 
failed to enable) the discovery, notification, and 
medical care of individuals affected by an illness 
described in subparagraph (D).
757 
(F) Physician and patient feedback on the 
program, particularly feedback that relates to 
ease of use. 
(G) Cybersecurity and privacy protections 
of patient data stored under the program, in-
cluding whether any classified or restricted data 
has been stored under the program (such as 
data relating to deployment locations or duty 
stations). 
(H) Any technical or logistical impedi-
ments to the implementation or expansion of 
the program, including any impediments to the 
inclusion in the program of databases or mate-
rials originally intended to be included. 
(I) Any issues relating to read-only access 
to data under the program by veterans. 
(J) Any issues relating to the interoper-
ability of the program between the Department 
of Defense and the Department of Veterans Af-
fairs. 
(2) SUBSEQUENT
STUDIES.—Except as pro-
vided in paragraph (3), each study conducted under 
subsection (a) following the initial study specified in 
paragraph (1) shall assess—
758 
(A) statistics relating to use of the Indi-
vidual Longitudinal Exposure Record program, 
including the total number of individuals the 
records of whom are contained therein and the 
total number of records accessible under the 
program; and 
(B) such other elements as the Comptroller 
General determines appropriate, which may in-
clude any other element specified in paragraph 
(1). 
(3) FINAL STUDY.—The final study conducted 
under subsection (a) shall assess— 
(A) the elements specified in subpara-
graphs (A), (B), (D), (E), (F), and (H) of 
paragraph (1); and 
(B) such other elements as the Comptroller 
General determines appropriate, which may in-
clude any other element specified in paragraph 
(1). 
(c) ACCESS BY COMPTROLLER GENERAL.— 
(1) INFORMATION AND MATERIALS.—Upon re-
quest of the Comptroller General, the Secretary of 
Defense and the Secretary of Veterans Affairs shall 
make available to the Comptroller General any infor-
759 
mation or other materials necessary for the conduct 
of each biennial study under subsection (a). 
(2) INTERVIEWS.—In addition to such other au-
thorities as are available, the Comptroller General 
shall have the right to interview officials and em-
ployees of the Department of Defense and the De-
partment of Veterans Affairs (including clinicians, 
claims adjudicators, and researchers) as necessary 
for the conduct of each biennial study under sub-
section (a). 
(3) 
INFORMATION
FROM
PATIENTS
AND 
FORMER PATIENTS.— 
(A) DEVELOPMENT OF QUESTIONNAIRE.— 
In carrying out each biennial study under sub-
section (a), the Comptroller General may de-
velop a questionnaire for individuals the records 
of whom are contained in the Individual Longi-
tudinal Exposure Record, to obtain the infor-
mation necessary for the conduct of the study. 
(B) DISTRIBUTION.—The Secretary con-
cerned shall ensure that any questionnaire de-
veloped pursuant to subparagraph (A) is dis-
tributed to individuals the records of whom are 
contained in the Individual Longitudinal Expo-
sure Record.
760 
(d) DEFINITIONS.—In this Act: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committee on Armed Services and 
the Committee on Veterans’ Affairs of the 
House of Representatives; and 
(B) the Committee on Armed Services and 
the Committee on Veterans’ Affairs of the Sen-
ate. 
(2) The term ‘‘Secretary concerned’’ means— 
(A) the Secretary of Defense, with respect 
to matters concerning the Department of De-
fense; and 
(B) the Secretary of Veterans Affairs, with 
respect to matters concerning the Department 
of Veterans Affairs. 
SEC. 743. GAO STUDY ON EXCLUSION OF CERTAIN REMAR-
RIED INDIVIDUALS FROM MEDICAL AND DEN-
TAL COVERAGE UNDER TRICARE PROGRAM. 
(a) GAO STUDY.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the purpose 
and effects of limiting medical and dental coverage 
under the TRICARE program to exclude remarried
761 
widows, widowers, and former spouses of members 
or former members of the uniformed services. 
(2) ELEMENTS.—The study under paragraph 
(1) shall include the following: 
(A) A census of the widows and widowers 
who currently qualify as a dependent under the 
TRICARE program pursuant to subparagraph 
(B) or (C) of section 1072(2) of title 10, 
United States Code. 
(B) A census of the former spouses who 
currently qualify as a dependent under the 
TRICARE program pursuant to subparagraph 
(F), (G), or (H) of such section. 
(C) An identification of the number of 
such widows, widowers, and former spouses who 
intend to remarry, and an assessment of wheth-
er potential loss of coverage under the 
TRICARE program has affected the decisions 
of such individuals to remarry or remain 
unremarried. 
(D) An assessment of the effect, if any, on 
the military and local communities of an indi-
vidual who formerly qualified as a dependent 
under the TRICARE program by reason of 
being an unremarried widow, widower, or
762 
former spouse, as specified in section 1072(2) 
of title 10, United States Code, when the indi-
vidual remarries and loses such coverage. 
(E) A cost analysis of the expansion of 
medical 
and 
dental 
coverage 
under 
the 
TRICARE program to include remarried indi-
viduals who, but for their remarried status, 
would otherwise qualify as a dependent under 
such program. 
(b) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Comptroller General shall 
submit to the Committees on Armed Services of the House 
of Representatives and the Senate a report containing— 
(1) the findings and conclusions of the study 
under subsection (a); and 
(2) recommendations based on such findings 
and conclusions to improve the dependent categories 
specified in section 1072(2) of title 10, United 
States Code, including with respect to whether re-
married widows, widowers, and former spouses of 
members or former members of the uniformed serv-
ices should remain excluded from coverage under the 
TRICARE program pursuant to such section. 
(c) DEFINITIONS.—In this section, the terms ‘‘de-
pendent’’ and ‘‘TRICARE program’’ have the meanings
763 
given such terms in section 1072 of title 10, United States 
Code. 
SEC. 744. STUDY ON JOINT FUND OF THE DEPARTMENT OF 
DEFENSE AND THE DEPARTMENT OF VET-
ERANS AFFAIRS FOR FEDERAL ELECTRONIC 
HEALTH RECORD MODERNIZATION OFFICE. 
(a) STUDY.—The Secretary of Defense, in coordina-
tion with the Secretary of Veterans Affairs, shall conduct 
a study on— 
(1) the development of a joint fund of the De-
partment of Defense and the Department of Vet-
erans Affairs for the Federal Electronic Health 
Record Modernization Office; and 
(2) the operations of the Federal Electronic 
Health Record Modernization Office since its estab-
lishment, including how the Office has supported the 
implementation of the Individual Longitudinal Expo-
sure Record program of the Department of Defense 
and the Department of Veterans Affairs. 
(b) ELEMENTS.—The study under subsection (a) 
shall assess the following: 
(1) Justifications for the development of the 
joint fund. 
(2) Options for the governance structure of the 
joint fund, including how accountability would be di-
764 
vided between the Department of Defense and the 
Department of Veterans Affairs. 
(3) An estimated timeline for implementation of 
the joint fund. 
(4) The anticipated contents of the joint fund, 
including the anticipated process for annual trans-
fers to the joint fund from the Department of De-
fense and the Department of Veterans Affairs, re-
spectively. 
(5) The progress and accomplishments of the 
Federal Electronic Health Record Modernization Of-
fice during fiscal year 2021 in fulfilling the purposes 
specified in subparagraphs (C) through (R) of sec-
tion 1635(b)(2) of the Wounded Warrior Act (title 
XVI of Public Law 110–181; 10 U.S.C. 1071 note). 
(6) The role and contributions of the Federal 
Electronic Health Record Modernization Office with 
respect to— 
(A) the current implementation of the 
Electronic Health Record Modernization Pro-
gram at the Mann-Grandstaff Department of 
Veterans Affairs Medical Center located in Spo-
kane, Washington; and
765 
(B) the strategic review of the Electronic 
Health Record Modernization Program con-
ducted by the Department of Veterans Affairs. 
(7) How dedicated funding for the Federal 
Electronic Health Record Modernization Office 
would have affected or altered the role and contribu-
tions specified in paragraph (6). 
(8) An estimated timeline for the completion of 
the implementation milestones under section 1635(e) 
of the Wounded Warrior Act (title XVI of Public 
Law 110–181; 10 U.S.C. 1071 note), taking into ac-
count delays in the implementation of the Electronic 
Health Record Modernization Program. 
(c) REPORT.—Not later than April 1, 2022, the Sec-
retary of Defense, in coordination with the Secretary of 
Veterans Affairs, shall submit to the appropriate congres-
sional committees a report on the findings of the study 
under subsection (a), including recommendations on the 
development of the joint fund specified in such subsection. 
Such recommendations shall address— 
(1) the purpose of the joint fund; and 
(2) requirements related to the joint fund. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means—
766 
(A) the Committees on Armed Services of 
the House of Representatives and the Senate; 
and 
(B) the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate. 
(2) The term ‘‘Electronic Health Record Mod-
ernization Program’’ has the meaning given such 
term in section 503(e) of the Veterans Benefits and 
Transition Act of 2018 (Public Law 115–407; 132 
Stat. 5376). 
(3) The term ‘‘Federal Electronic Health 
Record Modernization Office’’ means the Office es-
tablished under section 1635(b) of the Wounded 
Warrior Act (title XVI of Public Law 110–181; 10 
U.S.C. 1071 note). 
SEC. 745. BRIEFING ON DOMESTIC PRODUCTION OF CRIT-
ICAL ACTIVE PHARMACEUTICAL INGREDI-
ENTS. 
Not later than April 1, 2022, the Secretary of De-
fense shall provide to the Committees on Armed Services 
of the House of Representatives and the Senate a briefing 
on the development of a domestic production capability for 
critical active pharmaceutical ingredients and drug prod-
ucts in finished dosage form. Such briefing shall include 
a description of the following:
767 
(1) The anticipated cost over the period covered 
by the most recent future-years defense program 
submitted under section 221 of title 10, United 
States Code (as of the date of the briefing), to de-
velop a domestic production capability for critical ac-
tive pharmaceutical ingredients. 
(2) The cost of producing critical active phar-
maceutical ingredients through such a domestic pro-
duction capability, as compared with the cost of 
standard manufacturing processes used by the phar-
maceutical industry. 
(3) The average time to produce critical active 
pharmaceutical ingredients through such a domestic 
production capability, as compared with the average 
time to produce such ingredients through standard 
manufacturing processes used by the pharmaceutical 
industry. 
(4) Any intersections between the development 
of such a domestic production capability, the mili-
tary health system, and defense-related medical re-
search or operational medical requirements. 
(5) Lessons learned from the progress made in 
developing such a domestic production capability as 
of the date of the briefing, including from any con-