179 
(7) Section 326(g), relating to incentive bonus 
for conversion to military occupational specialty to 
ease personnel shortage. 
(8) Section 327(h), relating to incentive bonus 
for transfer between Armed Forces. 
(9) Section 330(f), relating to accession bonus for 
officer candidates. 
SEC. 616. INCREASE IN MAXIMUM AMOUNT OF AVIATION 
SPECIAL PAYS FOR FLYING DUTY. 
Section 334(c)(1) of title 37, United States Code, is 
amended by striking subparagraphs (A) and (B) and in-
serting the following new subparagraphs: 
‘‘(A) aviation incentive pay under sub-
section (a) shall be paid at a monthly rate not 
to exceed $1,000 per month; and 
‘‘(B) an aviation bonus under subsection (b) 
may not exceed $60,000 for each 12-month pe-
riod of obligated service agreed to under sub-
section (d).’’. 
SEC. 617. CONFORMING AMENDMENT TO CONSOLIDATION 
OF SPECIAL PAY, INCENTIVE PAY, AND BONUS 
AUTHORITIES. 
Section 332(c)(1)(B) of title 37, United States Code, 
is amended by striking ‘‘$12,000’’ and inserting ‘‘$20,000’’. 
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SEC. 618. TECHNICAL AND CLERICAL AMENDMENTS RELAT-
ING TO 2008 CONSOLIDATION OF CERTAIN 
SPECIAL PAY AUTHORITIES. 
(a) FAMILY CARE PLANS.—Section 586 of the National 
Defense Authorization Act for Fiscal Year 2008 (Public 
Law 110–181; 10 U.S.C. 991 note) is amended by inserting 
‘‘or 351’’ after ‘‘section 310’’. 
(b) 
DEPENDENTS’ 
MEDICAL
CARE.—Section 
1079(g)(1) of title 10, United States Code, is amended by 
inserting ‘‘or 351’’ after ‘‘section 310’’. 
(c) RETENTION ON ACTIVE DUTY DURING DISABILITY 
EVALUATION PROCESS.—Section 1218(d)(1) of title 10, 
United States Code, is amended by inserting ‘‘or 351’’ after 
‘‘section 310’’. 
(d) STORAGE SPACE.—Section 362(1) of the John 
Warner National Defense Authorization Act for Fiscal Year 
2007 (Public Law 109–364; 10 U.S.C. 2825 note) is amend-
ed by inserting ‘‘, or paragraph (1) or (3) of section 
351(a),’’ after ‘‘section 310’’. 
(e) 
STUDENT
ASSISTANCE
PROGRAMS.—Sections 
455(o)(3)(B) and 465(a)(2)(D) of the Higher Education Act 
of 1965 (20 U.S.C. 1087e(o)(3)(B), 1087ee(a)(2)(D)) are 
amended by inserting ‘‘or paragraph (1) or (3) of section 
351(a).’’ after ‘‘section 310’’. 
(f) ARMED FORCES RETIREMENT HOME.—Section 
1512(a)(3)(A) of the Armed Forces Retirement Home Act 
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of 1991 (24 U.S.C. 412(a)(3)(A)) is amended by inserting 
‘‘or 351’’ after ‘‘section 310’’. 
(g) VETERANS OF FOREIGN WARS MEMBERSHIP.— 
Section 230103(3) of title 36, United States Code, is amend-
ed by inserting ‘‘or 351’’ after ‘‘section 310’’. 
(h) MILITARY PAY
AND ALLOWANCES.—Title 37, 
United States Code, is amended— 
(1) in section 212(a), by inserting ‘‘, or para-
graph (1) or (3) of section 351(a),’’ after ‘‘section 
310’’; 
(2) in section 402a(b)(3)(B), by inserting ‘‘or 
351’’ after ‘‘section 310’’; 
(3) in section 481a(a), by inserting ‘‘or 351’’ 
after ‘‘section 310’’; 
(4) in section 907(d)(1)(H), by inserting ‘‘or 
351’’ after ‘‘section 310’’; and 
(5) in section 910(b)(2)(B), by inserting ‘‘, or 
paragraph (1) or (3) of section 351(a),’’ after ‘‘section 
310’’. 
(i) EXCLUSIONS FROM INCOME FOR PURPOSE OF SUP-
PLEMENTAL SECURITY INCOME.—Section 1612(b)(20) of 
the Social Security Act (42 U.S.C. 1382a(b)(20)) is amend-
ed by inserting ‘‘, or paragraph (1) or (3) of section 
351(a),’’ after ‘‘section 310’’. 
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(j) EXCLUSIONS FROM INCOME
FOR PURPOSE
OF 
HEAD START PROGRAM.—Section 645(a)(3)(B)(i) of the 
Head Start Act (42 U.S.C. 9840(a)(3)(B)(i)) is amended 
by inserting ‘‘or 351’’ after ‘‘section 310’’. 
(k) EXCLUSIONS FROM GROSS INCOME FOR FEDERAL 
INCOME TAX PURPOSES.—Section 112(c)(5)(B) of the In-
ternal Revenue Code of 1986 is amended by inserting ‘‘, 
or paragraph (1) or (3) of section 351(a),’’ after ‘‘section 
310’’. 
SEC. 619. COMBAT-RELATED SPECIAL COMPENSATION CO-
ORDINATING AMENDMENT. 
Subparagraph (B) of section 1413a(b)(3) of title 10, 
United States Code, is amended by striking ‘‘the amount 
equal to’’ and all that follows through ‘‘creditable service 
multiplied’’ and inserting the following: ‘‘the amount equal 
to the retired pay multiplier determined for the member 
under section 1409 of this title multiplied’’. 
Subtitle C—Disability, Retired Pay, 
and Survivor Benefits 
SEC. 621. SEPARATION DETERMINATIONS FOR MEMBERS 
PARTICIPATING IN THRIFT SAVINGS PLAN. 
The amendment to be made by section 632(c)(2) of the 
National Defense Authorization Act for Fiscal Year 2016 
(Public Law 114–92; 129 Stat. 847) shall not take effect. 
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SEC. 622. CONTINUATION PAY FOR FULL THRIFT SAVINGS 
PLAN MEMBERS WHO HAVE COMPLETED 8 TO 
12 YEARS OF SERVICE. 
(a) CONTINUATION PAY.—Section 356 of title 37, 
United States Code, which shall take effect on January 1, 
2018, pursuant to section 635 of the National Defense Au-
thorization Act for Fiscal Year 2016 (Public Law 114–92; 
129 Stat. 851), is amended— 
(1) in the heading, by striking ‘‘12 years’’ and 
inserting ‘‘8 to 12 years’’; 
(2) in subsection (a)— 
(A) by striking paragraph (1) and inserting 
the following: 
‘‘(1) has completed not less than 8 and not more 
than 12 years of service in a uniformed service; and’’; 
and 
(B) in paragraph (2), by striking ‘‘an addi-
tional 4 years’’ and inserting ‘‘not less than 3 
additional years’’; 
(3) by amending subsection (b) to read as fol-
lows: 
‘‘(b) PAYMENT AMOUNT.—The Secretary concerned 
shall determine the payment amount under this section as 
a multiple of a full TSP member’s monthly basic pay but 
shall not be less than 2.5 times the member’s monthly basic 
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pay. The maximum amount the Secretary concerned may 
pay the member under this section is— 
‘‘(1) in the case of a member of a regular compo-
nent or in a reserve component if the member is per-
forming active Guard and Reserve duty (as defined in 
section 101(d)(6) of title 10), 13 times the amount of 
the monthly basic pay payable to the member for the 
month during which the agreement under subsection 
(a)(2) is entered into; and 
‘‘(2) in the case of any member not covered by 
paragraph (1), 6 times the amount of monthly basic 
pay to which the member would be entitled for the 
month during which the agreement under subsection 
(a)(2) is entered into if the member were serving on 
active duty at the time the agreement is entered 
into.’’; and 
(4) by amending subsection (d) to read as fol-
lows: 
‘‘(d) TIMING OF PAYMENT.—The Secretary concerned 
shall pay continuation pay under subsection (a) to a full 
TSP member when the member has completed not less than 
8 and not more than 12 years of service in a uniformed 
service.’’. 
(b) CLERICAL AMENDMENT.—The item relating to sec-
tion 356 in the table of sections at the beginning of chapter 
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5 of title 37, United States Code, which shall take effect 
on January 1, 2018, pursuant to section 635 of the Na-
tional Defense Authorization Act for Fiscal Year 2016 (Pub-
lic Law 114–92; 129 Stat. 851), is amended by striking 
‘‘12 years’’ and inserting ‘‘8 to 12 years’’. 
SEC. 623. SPECIAL SURVIVOR INDEMNITY ALLOWANCE. 
(a) PAYMENT AMOUNT PER FISCAL YEAR.—Para-
graph (2)(I) of section 1450(m) of title 10, United States 
Code, is amended by striking ‘‘fiscal year 2017’’ and insert-
ing ‘‘each of fiscal years 2017 and 2018’’. 
(b) DURATION.—Paragraph (6) of such section is 
amended— 
(1) by striking ‘‘September 30, 2017’’ and insert-
ing ‘‘September 30, 2018’’; and 
(2) by striking ‘‘October 1, 2017’’ both places it 
appears and inserting ‘‘October 1, 2018’’. 
SEC. 624. EQUAL BENEFITS UNDER SURVIVOR BENEFIT 
PLAN FOR SURVIVORS OF RESERVE COMPO-
NENT MEMBERS WHO DIE IN THE LINE OF 
DUTY DURING INACTIVE-DUTY TRAINING. 
(a) TREATMENT
OF INACTIVE-DUTY TRAINING
IN 
SAME MANNER AS ACTIVE DUTY.—Section 1451(c)(1)(A) 
of title 10, United States Code, is amended— 
(1) in clause (i)— 
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(A) by inserting ‘‘or 1448(f)’’ after ‘‘section 
1448(d)’’; and 
(B) by inserting ‘‘or (iii)’’ after ‘‘clause 
(ii)’’; and 
(2) in clause (iii)— 
(A) by striking ‘‘section 1448(f) of this 
title’’ and inserting ‘‘section 1448(f)(1)(A) of this 
title by reason of the death of a member or 
former member not in line of duty’’; and 
(B) by striking ‘‘active service’’ and insert-
ing ‘‘service’’. 
(b) CONSISTENT TREATMENT OF DEPENDENT CHIL-
DREN.—Paragraph (2) of section 1448(f) of title 10, United 
States Code, is amended to read as follows: 
‘‘(2) DEPENDENT CHILDREN ANNUITY.— 
‘‘(A) ANNUITY
WHEN
NO
ELIGIBLE
SUR-
VIVING SPOUSE.—In the case of a person de-
scribed in paragraph (1), the Secretary con-
cerned shall pay an annuity under this sub-
chapter to the dependent children of that person 
under section 1450(a)(2) of this title as applica-
ble. 
‘‘(B) OPTIONAL ANNUITY WHEN THERE IS 
AN ELIGIBLE SURVIVING SPOUSE.—The Secretary 
may pay an annuity under this subchapter to 
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the dependent children of a person described in 
paragraph (1) under section 1450(a)(3) of this 
title, if applicable, instead of paying an annuity 
to the surviving spouse under paragraph (1), if 
the Secretary concerned, in consultation with the 
surviving spouse, determines it appropriate to 
provide an annuity for the dependent children 
under this paragraph instead of an annuity for 
the surviving spouse under paragraph (1).’’. 
(c) DEEMED ELECTIONS.—Section 1448(f) of title 10, 
United States Code, is further amended by adding at the 
end the following new paragraph: 
‘‘(5) DEEMED ELECTION TO PROVIDE AN ANNU-
ITY FOR DEPENDENT.—Paragraph (6) of subsection 
(d) shall apply in the case of a member described in 
paragraph (1) who dies after November 23, 2003, 
when no other annuity is payable on behalf of the 
member under this subchapter.’’. 
(d) AVAILABILITY OF SPECIAL SURVIVOR INDEMNITY 
ALLOWANCE.—Section 1450(m)(1)(B) of title 10, United 
States Code, is amended by inserting ‘‘or (f)’’ after ‘‘sub-
section (d)’’. 
(e) APPLICATION OF AMENDMENTS.— 
(1) PAYMENT.—No annuity benefit under sub-
chapter II of chapter 73 of title 10, United States 
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Code, shall accrue to any person by reason of the 
amendments made by this section for any period be-
fore the date of the enactment of this Act. 
(2) ELECTIONS.—For any death that occurred 
before the date of the enactment of this Act with re-
spect to which an annuity under such subchapter is 
being paid (or could be paid) to a surviving spouse, 
the Secretary concerned may, within six months of 
that date and in consultation with the surviving 
spouse, determine it appropriate to provide an annu-
ity for the dependent children of the decedent under 
paragraph 1448(f)(2)(B) of title 10, as added by sub-
section (b)(1), instead of an annuity for the surviving 
spouse. Any such determination and resulting change 
in beneficiary shall be effective as of the first day of 
the first month following the date of the determina-
tion. 
SEC. 625. USE OF MEMBER’S CURRENT PAY GRADE AND 
YEARS OF SERVICE, RATHER THAN FINAL RE-
TIREMENT PAY GRADE AND YEARS OF SERV-
ICE, IN A DIVISION OF PROPERTY INVOLVING 
DISPOSABLE RETIRED PAY. 
(a) USE OF CURRENT PAY GRADE REQUIRED.—Sec-
tion 1408(a)(4) of title 10, United States Code, is amended 
in the matter preceding subparagraph (A) by inserting after 
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‘‘member is entitled’’ the following: ‘‘(to be determined using 
the member’s pay grade and years of service at the time 
of the court order, rather than the member’s pay grade and 
years of service at the time of retirement, unless the same)’’. 
(b) APPLICATION OF AMENDMENT.—The amendment 
made by subsection (a) shall apply with respect to any divi-
sion of property as part of a final decree of divorce, dissolu-
tion, annulment, or legal separation involving a member 
of the Armed Forces to which section 1408 of title 10, 
United States Code, applies that becomes final after the date 
of the enactment of this Act. 
Subtitle D—Commissary and Non-
appropriated Fund Instrumen-
tality Benefits and Operations 
SEC. 631. PROTECTION AND ENHANCEMENT OF ACCESS TO 
AND SAVINGS AT COMMISSARIES AND EX-
CHANGES. 
(a) OPTIMIZATION STRATEGY.—Section 2481(c) of 
title 10, United States Code, is amended by adding at the 
end the following paragraph: 
‘‘(3)(A) The Secretary of Defense shall develop and im-
plement a comprehensive strategy to optimize management 
practices across the defense commissary system and the ex-
change system that reduce reliance of those systems on ap-
propriated funding without reducing benefits to the patrons 
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of those systems or the revenue generated by non-
appropriated fund entities or instrumentalities of the De-
partment of Defense for the morale, welfare, and recreation 
of members of the armed forces. 
‘‘(B) The Secretary shall ensure that savings generated 
due to such optimization practices are shared by the defense 
commissary system and the exchange system through con-
tracts or agreements that appropriately reflect the partici-
pation of the systems in the development and implementa-
tion of such practices. 
‘‘(C) If the Secretary determines that the reduced reli-
ance on appropriated funding pursuant to subparagraph 
(A) is insufficient to maintain the benefits to the patrons 
of the defense commissary system, and if the Secretary con-
verts the defense commissary system to a nonappropriated 
fund entity or instrumentality pursuant to paragraph (1) 
of section 2484(j) of this title, the Secretary shall transfer 
appropriated funds pursuant to paragraph (2) of such sec-
tion to ensure the maintenance of such benefits. 
‘‘(4) On not less than a quarterly basis, the Secretary 
shall provide to the congressional defense committees a 
briefing on the defense commissary system, including— 
‘‘(A) an assessment of the savings the system 
provides patrons; 
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‘‘(B) the status of implementing section 2484(i) 
of this title; 
‘‘(C) the status of implementing section 2484(j), 
including whether the system requires any appro-
priated funds pursuant to paragraph (2) of such sec-
tion; 
‘‘(D) the status of carrying out a program for 
such system to sell private label merchandise; and 
‘‘(E) any other matters the Secretary considers 
appropriate.’’. 
(b) AUTHORIZATION
TO SUPPLEMENT APPROPRIA-
TIONS
THROUGH
BUSINESS
OPTIMIZATION.—Section 
2483(c) of such title is amended by adding at the end the 
following new sentence: ‘‘Such appropriated amounts may 
also be supplemented with additional funds derived from 
improved management practices implemented pursuant to 
sections 2481(c)(3) and 2487(c) of this title and the variable 
pricing program implemented pursuant to section 2484(i) 
of this title.’’. 
(c) VARIABLE PRICING PILOT PROGRAM.—Section 
2484 of such title is amended by adding at the end the fol-
lowing new subsections: 
‘‘(i) VARIABLE
PRICING
PROGRAM.—(1) Notwith-
standing subsection (e), and subject to subsection (k), the 
Secretary may establish a variable pricing program pursu-
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ant to which prices may be established in response to mar-
ket conditions and customer demand, in accordance with 
the requirements of this subsection. Notwithstanding the 
amount of the uniform surcharge assessed in subsection (d), 
the Secretary may provide for an alternative surcharge of 
not more than five percent of sales proceeds under such vari-
able pricing program to be made available for the purposes 
specified in subsection (h). 
‘‘(2) Subject to subsection (k), before establishing a 
variable pricing program under this subsection, the Sec-
retary shall establish the following: 
‘‘(A) Specific, measurable benchmarks for success 
in the provision of high quality grocery merchandise, 
discount savings to patrons, and levels of customer 
satisfaction while achieving savings for the Depart-
ment of Defense. 
‘‘(B) A baseline of overall savings to patrons 
achieved by commissary stores prior to the initiation 
of the variable pricing program, based on a compari-
son of prices charged by those stores on a regional 
basis with prices charged by relevant local competi-
tors for a representative market basket of goods. 
‘‘(3) The Secretary shall ensure that the defense com-
missary system implements the variable pricing program 
by conducting price comparisons using the methodology es-
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tablished for paragraph (2)(B) and adjusting pricing as 
necessary to ensure that pricing in the variable pricing pro-
gram achieves overall savings to patrons that are consistent 
with the baseline savings established for the relevant region 
pursuant to such paragraph. 
‘‘(j) CONVERSION TO NONAPPROPRIATED FUND ENTI-
TY OR INSTRUMENTALITY.—(1) Subject to subsection (k), if 
the Secretary determines that the variable pricing program 
has met the benchmarks for success established pursuant to 
paragraph (2)(A) of subsection (i) and the savings require-
ments established pursuant to paragraph (3) of such sub-
section over a period of at least six months, the Secretary 
may convert the defense commissary system to a non-
appropriated fund entity or instrumentality, with oper-
ating expenses financed in whole or in part by receipts from 
the sale of products and the sale of services. Upon such con-
version, appropriated funds shall be transferred to the de-
fense commissary system only in accordance with para-
graph (2) or section 2491 of this title. The requirements 
of section 2483 shall not apply to the defense commissary 
system operating as a nonappropriated fund entity or in-
strumentality. 
‘‘(2) If the Secretary determines that the defense com-
missary system operating as a nonappropriated fund entity 
or instrumentality is likely to incur a loss in any fiscal 
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year as a result of compliance with the savings requirement 
established in subsection (i), the Secretary shall authorize 
a transfer of appropriated funds available for such purpose 
to the commissary system in an amount sufficient to offset 
the anticipated loss. Any funds so transferred shall be con-
sidered to be nonappropriated funds for such purpose. 
‘‘(3)(A) The Secretary of Defense may identify posi-
tions of employees in the defense commissary system who 
are paid with appropriated funds whose status may be con-
verted to the status of an employee of a nonappropriated 
fund entity or instrumentality. 
‘‘(B) The status and conversion of employees in a posi-
tion identified by the Secretary under subparagraph (A) 
shall be addressed as provided in section 2491(c) for em-
ployees in morale, welfare, and recreation programs, in-
cluding with respect to requiring the consent of such em-
ployee to be so converted. 
‘‘(C) No individual who is an employee of the defense 
commissary system as of the date of the enactment of this 
subsection shall suffer any loss of or decrease in pay as a 
result of a conversion made under this paragraph. 
‘‘(k) OVERSIGHT REQUIRED TO ENSURE CONTINUED 
BENEFIT TO PATRONS.—(1) With respect to each action de-
scribed in paragraph (2), the Secretary may not carry out 
such action until— 
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‘‘(A) the Secretary provides to the congressional 
defense committees a briefing on such action, includ-
ing a justification for such action; and 
‘‘(B) a period of 30 days has elapsed following 
such briefing. 
‘‘(2) The actions described in this paragraph are the 
following: 
‘‘(A) Establishing the representative market bas-
ket of goods pursuant to subsection (i)(2)(B). 
‘‘(B) Establishing the variable pricing program 
under subsection (i)(1). 
‘‘(C) Converting the defense commissary system 
to a nonappropriated fund entity or instrumentality 
under subsection (j)(1).’’. 
(d) ESTABLISHMENT OF COMMON BUSINESS PRAC-
TICES.—Section 2487 of such title is amended— 
(1) by redesignating subsection (c) as subsection 
(d); and 
(2) by inserting after subsection (b) the following 
new subsection (c): 
‘‘(c) COMMON BUSINESS PRACTICES.—(1) Notwith-
standing subsections (a) and (b), the Secretary of Defense 
may establish common business processes, practices, and 
systems— 
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‘‘(A) to exploit synergies between the defense 
commissary system and the exchange system; and 
‘‘(B) to optimize the operations of the defense re-
tail systems as a whole and the benefits provided by 
the commissaries and exchanges. 
‘‘(2) The Secretary may authorize the defense com-
missary system and the exchange system to enter into con-
tracts or other agreements— 
‘‘(A) for products and services that are shared by 
the defense commissary system and the exchange sys-
tem; and 
‘‘(B) for the acquisition of supplies, resale goods, 
and services on behalf of both the defense commissary 
system and the exchange system. 
‘‘(3) For the purpose of a contract or agreement au-
thorized under paragraph (2), the Secretary may— 
‘‘(A) use funds appropriated pursuant to section 
2483 of this title to reimburse a nonappropriated 
fund entity or instrumentality for the portion of the 
cost of a contract or agreement entered by the non-
appropriated fund entity or instrumentality that is 
attributable to the defense commissary system; and 
‘‘(B) authorize the defense commissary system to 
accept reimbursement from a nonappropriated fund 
entity or instrumentality for the portion of the cost 
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of a contract or agreement entered by the defense com-
missary system that is attributable to the non-
appropriated fund entity or instrumentality.’’. 
(e) AUTHORITY FOR EXPERT COMMERCIAL ADVICE.— 
Section 2485 of such title is amended by adding at the end 
the following new subsection: 
‘‘(h) EXPERT COMMERCIAL ADVICE.—The Secretary of 
Defense may enter into a contract with an entity to obtain 
expert commercial advice, commercial assistance, or other 
similar services not otherwise carried out by the Defense 
Commissary Agency, to implement section 2481(c), sub-
sections (i) and (j) of section 2484, and section 2487(c) of 
this title.’’. 
(f) CLARIFICATION OF REFERENCES TO ‘‘THE EX-
CHANGE SYSTEM’’.—Section 2481(a) of title 10, United 
States Code, is amended by adding at the end the following 
new sentence: ‘‘Any reference in this chapter to ‘the ex-
change system’ shall be treated as referring to each separate 
administrative entity within the Department of Defense 
through which the Secretary of Defense has implemented the 
requirement under this subsection for a world-wide system 
of exchange stores.’’. 
(g) OPERATION OF DEFENSE COMMISSARY SYSTEM AS 
A NONAPPROPRIATED FUND ENTITY.—In the event that the 
defense commissary system is converted to a non-
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appropriated fund entity or instrumentality as authorized 
by section 2484(j)(1) of title 10, United States Code, as 
added by subsection (c) of this section, the Secretary may— 
(1) provide for the transfer of commissary assets, 
including inventory and available funds, to the non-
appropriated fund entity or instrumentality; and 
(2) ensure that revenues accruing to the defense 
commissary system are appropriately credited to the 
nonappropriated fund entity or instrumentality. 
(h) CONFORMING CHANGE.—Section 2643(b) of such 
title is amended by adding at the end the following new 
sentence: ‘‘Such appropriated funds may be supplemented 
with additional funds derived from improved management 
practices implemented pursuant to sections 2481(c)(3) and 
2487(c) of this title.’’. 
Subtitle E—Travel and Transpor-
tation Allowances and Other 
Matters 
SEC. 641. MAXIMUM REIMBURSEMENT AMOUNT FOR TRAV-
EL EXPENSES OF MEMBERS OF THE RE-
SERVES ATTENDING INACTIVE DUTY TRAIN-
ING OUTSIDE OF NORMAL COMMUTING DIS-
TANCES. 
Section 478a(c) of title 37, United States Code, is 
amended— 
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(1) by striking ‘‘The amount’’ and inserting the 
following: ‘‘(1) Except as provided by paragraph (2), 
the amount’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(2) The Secretary concerned may authorize, on a 
case-by-case basis, a higher reimbursement amount for a 
member under subsection (a) when the member— 
‘‘(A) resides— 
‘‘(i) in the same State as the training loca-
tion; and 
‘‘(ii) outside of an urbanized area with a 
population of 50,000 or more, as determined by 
the Bureau of the Census; and 
‘‘(B) is required to commute to a training loca-
tion— 
‘‘(i) using an aircraft or boat on account of 
limited or nonexistent vehicular routes to the 
training location or other geographical chal-
lenges; or 
‘‘(ii) from a permanent residence located 
more than 75 miles from the training location.’’. 
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SEC. 642. STATUTE OF LIMITATIONS ON DEPARTMENT OF 
DEFENSE RECOVERY OF AMOUNTS OWED TO 
THE UNITED STATES BY MEMBERS OF THE 
UNIFORMED SERVICES, INCLUDING RETIRED 
AND FORMER MEMBERS. 
Section 1007(c)(3) of title 37, United States Code, is 
amended by adding at the end the following new subpara-
graphs: 
‘‘(C)(i) In accordance with clause (ii), if the indebted-
ness of a member of the uniformed services to the United 
States occurs, through no fault of the member, as a result 
of the overpayment of pay or allowances to the member or 
upon the settlement of the member’s accounts, the Secretary 
concerned may not recover the indebtedness from the mem-
ber, including a retired or former member, using deductions 
from the pay of the member, deductions from retired or sep-
aration pay, or any other collection method unless recovery 
of the indebtedness commences before the end of the 10-year 
period beginning on the date on which the indebtedness was 
incurred. 
‘‘(ii) Clause (i) applies with respect to cases of indebt-
edness that incur on or after October 1, 2027. 
‘‘(D)(i) Not later than January 1 of each of years 2017 
through 2027, the Director of the Defense Finance and Ac-
counting Service shall review all cases occurring during the 
10-year period prior to the date of the review of indebted-
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ness of a member of the uniformed services, including a re-
tired or former member, to the United States in which— 
‘‘(I) the recovery of the indebtedness commenced 
after the end of the 10-year period beginning on the 
date on which the indebtedness was incurred; or 
‘‘(II) the Director did not otherwise notify the 
member of such indebtedness during such 10-year pe-
riod. 
‘‘(ii) The Director shall submit to the congressional de-
fense committees and the Committees on Veterans’ Affairs 
of the House of Representatives and the Senate each review 
conducted under clause (i), including the amounts owed to 
the United States by the members included in such review.’’. 
TITLE VII—HEALTH CARE 
PROVISIONS 
Subtitle A—Reform of TRICARE 
and Military Health System 
SEC. 701. TRICARE PREFERRED AND OTHER TRICARE RE-
FORM. 
(a) ESTABLISHMENT.— 
(1) TRICARE PREFERRED.—Chapter 55 of title 
10, United States Code, is amended by inserting after 
section 1074n the following new section: 
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‘‘§ 1075. TRICARE Preferred 
‘‘(a) ESTABLISHMENT.—(1) Not later than January 1, 
2018, the Secretary of Defense shall establish a self-man-
aged, 
preferred-provider 
network 
option 
under 
the 
TRICARE program. Such option shall be known as 
‘TRICARE Preferred’. 
‘‘(2) The Secretary shall establish TRICARE Preferred 
in all areas. Under TRICARE Preferred, eligible bene-
ficiaries will not have restrictions on the freedom of choice 
of the beneficiary with respect to health care providers. 
‘‘(b) ENROLLMENT ELIGIBILITY.—(1) The beneficiary 
categories for purposes of eligibility to enroll in TRICARE 
Preferred and cost sharing requirements applicable to such 
category are as follows: 
‘‘(A) An ‘active-duty family member’ category 
that consists of beneficiaries who are covered by sec-
tion 1079 of this title (as dependents of active duty 
members). 
‘‘(B) A ‘retired’ category that consists of bene-
ficiaries covered by subsection (c) of section 1086 of 
this title, other than Medicare-eligible beneficiaries de-
scribed in subsection (d)(2) of such section. 
‘‘(C) A ‘reserve and young adult’ category that 
consists of beneficiaries who are covered by— 
‘‘(i) section 1076d of this title; 
‘‘(ii) section 1076e; or 
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‘‘(iii) section 1110b. 
‘‘(2) A covered beneficiary who elects to participate in 
TRICARE Preferred shall enroll in such option under sec-
tion 1099 of this title. 
‘‘(c) COST-SHARING REQUIREMENTS.—The cost shar-
ing requirements under TRICARE Preferred are as follows: 
‘‘(1) With respect to beneficiaries in the active- 
duty family member category or the retired category 
by reason of being a member or former member of the 
uniformed services who originally enlists or is ap-
pointed in the uniformed services on or after January 
1, 2018, or by reason of being a dependent of such a 
member, the cost sharing requirements shall be cal-
culated pursuant to subsection (d)(1). 
‘‘(2)(A) Except as provided by subsection (e), 
with respect to beneficiaries described in subpara-
graph (B) in the active-duty family member category 
or the retired category, the cost sharing requirements 
shall be calculated as if the beneficiary were enrolled 
in TRICARE Extra or TRICARE Standard as if 
TRICARE Extra or TRICARE Standard, as the case 
may be, were still being carried out by the Secretary. 
‘‘(B) Beneficiaries described in this subpara-
graph are beneficiaries who are eligible to enroll in 
the TRICARE program by reason of being a member 
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or former member of the uniformed services who origi-
nally enlists or is appointed in the uniformed services 
before January 1, 2018, or by reason of being a de-
pendent of such a member. 
‘‘(3) With respect to beneficiaries in the reserve 
and young adult category, the cost sharing require-
ments shall be calculated pursuant to subsection 
(d)(1) as if the beneficiary were in the active-duty 
family member category or the retired category, as 
applicable, except that the premiums calculated pur-
suant to sections 1076d, 1076e, or 1110b of this title, 
as the case may be, shall apply instead of any enroll-
ment fee required under this section. 
‘‘(d) COST-SHARING AMOUNTS FOR CERTAIN BENE-
FICIARIES.—(1) Beneficiaries described in subsection (c)(1) 
enrolled in TRICARE Preferred shall be subject to cost- 
sharing requirements in accordance with the amounts and 
percentages under the following table during calendar year 
2018 and as such amounts are adjusted under paragraph 
(2) for subsequent years: 
‘‘TRICARE Pre-
ferred 
Active-Duty Family 
Member 
(Individual/Family) 
Retired 
(Individual/Family) 
Annual Enroll-
ment 
$300 / $600 
$425 / $850 
Annual deduct-
ible 
$0 
$0 
Annual cata-
strophic cap 
$1,000 
$3,000 
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‘‘TRICARE Pre-
ferred 
Active-Duty Family 
Member 
(Individual/Family) 
Retired 
(Individual/Family) 
Outpatient visit 
civilian network 
$15 primary care 
$25 primary care 
$25 specialty care 
$40 specialty care 
Out of network: 20% 
25% of out of network 
ER visit civilian 
network 
$40 network 
$60 network 
20% out of network 
Urgent care civil-
ian network 
$20 network 
$40 network 
20% out of network 
25% out of network 
Ambulatory sur-
gery civilian net-
work 
$40 network 
$80 network 
20% out of network 
25% out of network 
Ambulance civil-
ian network 
$15 
$25 
Durable medical 
equipment civil-
ian network 
10% 
20% 
Inpatient visit ci-
vilian network 
$60 per network admis-
sion 
$125 per admission net-
work 
20% out of network 
25% out of net work 
Inpatient skilled 
nursing/rehab ci-
vilian 
$20 per day network 
$50 per day network 
$50 per day out of net-
work 
$300 per day or 20% of 
billed charges out of 
network 
‘‘(2) Each dollar amount expressed as a fixed dollar 
amount in the table set forth in paragraph (1), and the 
amounts determined under subsection (e), shall be annually 
indexed to the amount by which retired pay is increased 
under section 1401a of this title, rounded to the next lower 
multiple of $1. The remaining amount above such multiple 
of $1 shall be carried over to, and accumulated with, the 
amount of the increase for the subsequent year or years and 
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made when the aggregate amount of increases carried over 
under this clause for a year is $1 or more. 
‘‘(3) Enrollment fees, deductible amounts, and cata-
strophic caps under this section are on a calendar-year 
basis. 
‘‘(e) 
EXCEPTIONS
TO
CERTAIN
COST-SHARING 
AMOUNTS FOR CERTAIN BENEFICIARIES ELIGIBLE PRIOR 
TO 2018.—(1) Subject to paragraph (3), and in accordance 
with subsection (d)(2), the Secretary shall establish an an-
nual enrollment fee for beneficiaries described in subsection 
(c)(2)(B) in the retired category who enroll in TRICARE 
Preferred (other than such beneficiaries covered by para-
graph (2)). Such enrollment fee shall be $100 for an indi-
vidual and $200 for a family. 
‘‘(2) The enrollment fee established pursuant to para-
graph (1) for beneficiaries described in subsection (c)(2)(B) 
in the retired category shall not apply with respect to the 
following beneficiaries: 
‘‘(A) Retired members and the family members 
of such members covered by paragraph (1) of section 
1086(c) of this title by reason of being retired under 
chapter 61 of this title or being a dependent of such 
a member. 
‘‘(B) Survivors covered by paragraph (2) of such 
section 1086(c). 
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‘‘(3) The Secretary may not establish an annual en-
rollment fee under paragraph (1) until 90 days has elapsed 
following the date on which the Comptroller General of the 
United States is required to submit the review under para-
graph (4). 
‘‘(4) Not later than February 1, 2020, the Comptroller 
General of the United States shall submit to the Committees 
on Armed Services of the House of Representatives and the 
Senate a review of the following: 
‘‘(A) Whether health care coverage for covered 
beneficiaries has changed since the enactment of this 
section. 
‘‘(B) Whether covered beneficiaries are able to ob-
tain appointments for health care according to the ac-
cess standards established by the Secretary of Defense. 
‘‘(C) The percent of network providers that ac-
cept new patients under the TRICARE program. 
‘‘(D) The satisfaction of beneficiaries under 
TRICARE Preferred. 
‘‘(f) PUBLICATION OF MEASURES.—As part of the ad-
ministration of TRICARE Prime and TRICARE Preferred, 
the Secretary shall publish on a publically available Inter-
net website of the Department of Defense data on all meas-
ures required by section 711 of the National Defense Author-
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ization Act for Fiscal Year 2017. The published measures 
shall be updated not less frequently than quarterly. 
‘‘(g) CONSTRUCTION.—Nothing in this section may be 
construed as affecting the availability of TRICARE Prime 
and TRICARE for Life. 
‘‘(h) DEFINITIONS.—In this section, terms ‘active-duty 
family member category’, ‘retired category’, and ‘reserve 
and young adult category’ mean the respective categories 
of TRICARE Preferred enrollment described in subsection 
(b).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 55 of title 10, 
United States Code, is amended by inserting after the 
item relating to section 1074n, the following new 
item: 
‘‘1075. TRICARE Preferred.’’. 
(b) TRICARE PRIME COST SHARING.— 
(1) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 
1075, as added by subsection (a), the following new 
section: 
‘‘§ 1075a. TRICARE Prime: cost sharing 
‘‘(a) COST-SHARING REQUIREMENTS.—The cost shar-
ing requirements under TRICARE Prime are as follows: 
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‘‘(1) There are no cost-sharing requirements for 
beneficiaries who are covered by section 1074(a) of 
this title. 
‘‘(2) With respect to beneficiaries in the active- 
duty family member category or the retired category 
(as described in section 1075(b)(1) of this title) by 
reason of being a member or former member of the 
uniformed services who originally enlists or is ap-
pointed in the uniformed services on or after January 
1, 2018, or by reason of being a dependent of such a 
member, the cost-sharing requirements shall be cal-
culated pursuant to subsection (b)(1). 
‘‘(3)(A) With respect to beneficiaries described in 
subparagraph (B) in the active-duty family member 
category or the retired category (as described in sec-
tion 1075(b)(1) of this title), the cost-sharing require-
ments shall be calculated in accordance with the other 
provisions of this chapter without regard to subsection 
(b). 
‘‘(B) Beneficiaries described in this subpara-
graph are beneficiaries who are eligible to enroll in 
the TRICARE program by reason of being a member 
or former member of the uniformed services who origi-
nally enlists or is appointed in the uniformed services 
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before January 1, 2018, or by reason of being a de-
pendent of such a member. 
‘‘(b) COST-SHARING AMOUNTS.—(1) Beneficiaries de-
scribed in subsection (a)(2) enrolled in TRICARE Prime 
shall be subject to cost-sharing requirements in accordance 
with the amounts and percentages under the following table 
during calendar year 2018 and as such amounts are ad-
justed under paragraph (2) for subsequent years: 
‘‘TRICARE Prime 
Active-Duty Family 
Member 
(Individual/Family) 
Retired 
(Individual/Family) 
Annual Enrollment 
$180 / $360 
$325 / $650 
Annual deductible 
No1 
No1 
Annual catastrophic 
cap 
$1,000 
$3,000 per family 
Outpatient visit civil-
ian network 
$0 with authorization 
$20 primary care 
$30 specialty care 
ER visit civilian net-
work 
$0 
$50 network 
Urgent care civilian 
network 
$0 
$30 network 
Ambulatory surgery ci-
vilian network 
$0 with authorization 
$60 network with author-
ization 
Ambulance civilian 
network 
$0 
$20 
Durable medical equip-
ment civilian net-
work 
$0 with authorization 
20% 
Inpatient visit civilian 
network 
$0 with authorization 
$100 network per admis-
sion with authoriza-
tion 
Inpatient skilled nurs-
ing/rehab civilian 
$0 with authorization 
$30 per day network 
with authorization 
1: Deductibles and cost-sharing does apply to TRICARE Prime beneficiaries 
that seek care in the civilian network care through the point-of-service option 
(without a referral). Annual deductible is $300 individual and $600 family. Cost- 
sharing for covered inpatient and outpatient services are 50% of the TRICARE 
allowable charges. 
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‘‘(2) Each dollar amount expressed as a fixed dollar 
amount in the table set forth in paragraph (1) shall be an-
nually indexed to the amount by which retired pay is in-
creased under section 1401a of this title, rounded to the next 
lower multiple of $1. The remaining amount above such 
multiple of $1 shall be carried over to, and accumulated 
with, the amount of the increase for the subsequent year 
or years and made when the aggregate amount of increases 
carried over under this clause for a year is $1 or more. 
‘‘(3) Enrollment fees, deductible amounts, and cata-
strophic caps under this section are on a calendar-year 
basis.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 55 of title 10, 
United States Code, is amended by inserting after the 
item relating to section 1075, as added by subsection 
(a), the following new item: 
‘‘1075a. TRICARE Prime: cost sharing.’’. 
(c) PORTABILITY.—Section 1073 of title 10, United 
States Code, is amended by adding at the end the following 
new subsection: 
‘‘(c) PORTABILITY IN PROGRAM.—The Secretary of De-
fense shall ensure that the enrollment status of covered bene-
ficiaries is portable between or among TRICARE program 
regions of the United States and that effective procedures 
are in place for automatic electronic transfer of information 
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between or among contractors responsible for administra-
tion in such regions and prompt communication with such 
beneficiaries. 
Each 
covered 
beneficiary 
enrolled 
in 
TRICARE Prime who has relocated the beneficiary’s pri-
mary residence to a new area in which enrollment in 
TRICARE Prime is available shall be able to obtain a new 
primary health care manager or provider within 10 days 
of the relocation and associated request for such manager 
or provider.’’. 
(d) TERMINATION
OF TRICARE STANDARD
AND 
TRICARE EXTRA.—Beginning on January 1, 2018, the 
Secretary of Defense may not carry out TRICARE Stand-
ard and TRICARE Extra under the TRICARE program. 
The Secretary shall ensure that any individual who is cov-
ered under TRICARE Standard or TRICARE Extra as of 
December 31, 2017, enrolls in TRICARE Prime, TRICARE 
Preferred, or TRICARE for Life, as the case may be, as 
of January 1, 2018, for the individual to continue coverage 
under the TRICARE program. 
(e) IMPLEMENTATION PLAN.— 
(1) IN GENERAL.—Not later than June 1, 2017, 
the Secretary of Defense shall submit to the Commit-
tees on Armed Services of the House of Representa-
tives and the Senate an implementation plan to im-
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prove access to health care for TRICARE beneficiaries 
pursuant to the amendments made by this section. 
(2) ELEMENTS.—The plan under paragraph (1) 
shall— 
(A) ensure that at least 85 percent of the 
beneficiary population under TRICARE Pre-
ferred is covered by the network by January 1, 
2018; 
(B) establish access standards for appoint-
ments for health care; 
(C) establish mechanisms for monitoring 
compliance with access standards; 
(D) establish health care provider-to-bene-
ficiary ratios; 
(E) monitor on a monthly basis complaints 
by beneficiaries with respect to network adequacy 
and the availability of health care providers; 
(F) establish requirements for mechanisms 
to monitor the responses to complaints by bene-
ficiaries; 
(G) mechanisms to evaluate the quality 
metrics of the network providers established 
under section 711; 
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(H) any recommendations for legislative ac-
tion the Secretary determines necessary to carry 
out the plan; and 
(I) any other elements the Secretary deter-
mines appropriate. 
(f) GAO REVIEWS.— 
(1) IMPLEMENTATION PLAN.—Not later than De-
cember 1, 2017, the Comptroller General of the United 
States shall submit to the Committees on Armed Serv-
ices of the House of Representatives and the Senate a 
review of the implementation plan of the Secretary 
under paragraph (1) of subsection (e), including an 
assessment of the adequacy of the plan in meeting the 
elements specified in paragraph (2) of such sub-
section. 
(2) NETWORK.—Not later than September 1, 
2017, the Comptroller General shall submit to the 
Committees on Armed Services of the House of Rep-
resentatives and the Senate a review of the network 
established under TRICARE Extra, including the fol-
lowing: 
(A) An identification of the percent of bene-
ficiaries who are covered by the network. 
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(B) An assessment of the extent to which 
beneficiaries are able to obtain appointments 
under TRICARE extra. 
(C) The percent of network providers under 
TRICARE Extra that accept new patients under 
the TRICARE program. 
(D) An assessment of the satisfaction of 
beneficiaries under TRICARE Extra. 
(g) DEFINITIONS.—In this section: 
(1) The terms ‘‘uniformed services’’, ‘‘covered 
beneficiary’’, ‘‘TRICARE Extra’’, ‘‘TRICARE for 
Life’’, ‘‘TRICARE Prime’’, and ‘‘TRICARE Stand-
ard’’ have the meaning given those terms in section 
1072 of title 10, United States Code, as amended by 
subsection (h). 
(2) The term ‘‘TRICARE Preferred’’ means the 
self-managed, 
preferred-provider 
network 
option 
under the TRICARE program established by section 
1075 of such title, as added by subsection (a). 
(h) CONFORMING AMENDMENTS.— 
(1) IN GENERAL.—Title 10, United States Code, 
is amended as follows: 
(A) Section 1072 is amended— 
(i) by striking paragraph (7) and in-
serting the following: 
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‘‘(7) The term ‘TRICARE program’ means the 
various programs carried out by the Secretary of De-
fense under this chapter and any other provision of 
law providing for the furnishing of medical and den-
tal care and health benefits to members and former 
members of the uniformed services and their depend-
ents, including the following health plan options: 
‘‘(A) TRICARE Prime. 
‘‘(B) TRICARE Preferred. 
‘‘(C) TRICARE for Life.’’; and 
(ii) by adding at the end the following 
new paragraphs: 
‘‘(11) The term ‘TRICARE Extra’ means the 
preferred provider option of the TRICARE program 
made available prior to January 1, 2018, under 
which TRICARE Standard beneficiaries may obtain 
discounts on cost-sharing as a result of using 
TRICARE network providers. 
‘‘(12) The term ‘TRICARE Preferred’ the self- 
managed, preferred-provider network option under the 
TRICARE program established by section 1075 of 
this title. 
‘‘(13) The term ‘TRICARE for Life’ means the 
Medicare 
wraparound 
coverage 
option 
of 
the 
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TRICARE program made available to the beneficiary 
by reason of section 1086(d) of this title. 
‘‘(14) The term ‘TRICARE Prime’ means the 
managed care option of the TRICARE program. 
‘‘(15) The term ‘TRICARE Standard’ means the 
TRICARE program made available prior to January 
1, 2018, covering— 
‘‘(A) medical care to which a dependent de-
scribed in section 1076(a)(2) of this title is enti-
tled; and 
‘‘(B) health benefits contracted for under the 
authority of section 1079(a) of this title and sub-
ject to the same rates and conditions as apply to 
persons covered under that section.’’. 
(B) Section 1076d is amended— 
(i) in subsection (d)(1), by inserting 
after ‘‘coverage.’’ the following: ‘‘Such pre-
mium shall apply instead of any enrollment 
fees required under section 1075 of this sec-
tion.’’; and 
(ii) in subsection (f), by striking para-
graph (2) and inserting the following new 
paragraph: 
‘‘(2) The term ‘TRICARE Reserve Select’ means 
the TRICARE Preferred self-managed, preferred-pro-
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vider network option under section 1075 made avail-
able to beneficiaries by reason of this section and in 
accordance with subsection (d)(1).’’; and 
(iii) by striking ‘‘TRICARE Stand-
ard’’ each place it appears (including in the 
heading of such section) and inserting 
‘‘TRICARE Reserve Select’’. 
(C) Section 1076e is amended— 
(i) in subsection (d)(1), by inserting 
after ‘‘coverage.’’ the following: ‘‘Such pre-
mium shall apply instead of any enrollment 
fees required under section 1075 of this sec-
tion.’’; and 
(ii) in subsection (f), by striking para-
graph (2) and inserting the following new 
paragraph: 
‘‘(2) The term ‘TRICARE Retired Reserve’ 
means the TRICARE Preferred self-managed, pre-
ferred-provider network option under section 1075 
made available to beneficiaries by reason of this sec-
tion and in accordance with subsection (d)(1).’’; 
(iii) in subsection (b), by striking 
‘‘TRICARE Standard coverage at’’ and in-
serting ‘‘TRICARE coverage at’’; and 
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(iv) by striking ‘‘TRICARE Standard’’ 
each place it appears (including in the 
heading of such section) and inserting 
‘‘TRICARE Retired Reserve’’. 
(D) Section 1079a is amended— 
(i) in the section heading, by striking 
‘‘CHAMPUS’’ 
and 
inserting 
‘‘TRICARE program’’; and 
(ii) by striking ‘‘the Civilian Health 
and Medical Program of the Uniformed 
Services’’ and inserting ‘‘the TRICARE 
program’’. 
(E) Section 1099(c) is amended by striking 
paragraph (2) and inserting the following new 
paragraph: 
‘‘(2) A plan under the TRICARE program.’’. 
(F) Section 1110b(c)(1) is amended by in-
serting after ‘‘(b).’’ the following: ‘‘Such pre-
mium shall apply instead of any enrollment fees 
required under section 1075 of this section.’’. 
(2) CLERICAL AMENDMENTS.—The table of sec-
tions at the beginning of chapter 55 of title 10, 
United States Code, is further amended— 
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(A) in the item relating to section 1076d, by 
striking ‘‘TRICARE Standard’’ and inserting 
‘‘TRICARE Reserve Select’’; 
(B) in the item relating to section 1076e, by 
striking ‘‘TRICARE Standard’’ and inserting 
‘‘TRICARE Retired Reserve’’; and 
(C) in the item relating to section 1079a, by 
striking 
‘‘CHAMPUS’’ 
and 
inserting 
‘‘TRICARE program’’. 
(3) CONFORMING STYLE.—Any new language in-
serted or added to title 10, United States Code, by an 
amendment made by this subsection shall conform to 
the typeface and typestyle of the matter in which the 
language is so inserted or added. 
(i) APPLICATION.—The amendments made by this sec-
tion shall apply with respect to the provision of health care 
under the TRICARE program beginning on January 1, 
2018. 
SEC. 702. REFORM OF ADMINISTRATION OF THE DEFENSE 
HEALTH AGENCY AND MILITARY MEDICAL 
TREATMENT FACILITIES. 
(a) ADMINISTRATION.— 
(1) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 
1073b the following new section: 
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‘‘§ 1073c. Administration of Defense Health Agency 
and military medical treatment facilities 
‘‘(a) ADMINISTRATION OF MILITARY MEDICAL TREAT-
MENT FACILITIES.—(1) Beginning October 1, 2018, the Di-
rector of the Defense Health Agency shall be responsible for 
the administration of each military medical treatment fa-
cility, including with respect to— 
‘‘(A) budgetary matters; 
‘‘(B) information technology; 
‘‘(C) health care administration and manage-
ment; 
‘‘(D) administrative policy and procedure; and 
‘‘(E) any other matters the Secretary of Defense 
determines appropriate. 
‘‘(2) The commander of each military medical treat-
ment facility shall be responsible for— 
‘‘(A) ensuring the readiness of the members of the 
armed forces and civilian employees at such facility; 
and 
‘‘(B) furnishing the health care and medical 
treatment provided at such facility. 
‘‘(3) The Secretary of Defense shall establish within the 
Defense Health Agency a professional staff serving in senior 
executive service positions to carry out this subsection. The 
Secretary may carry out this paragraph by appointing the 
positions specified in subsections (b) and (c). 
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‘‘(b) DHA ASSISTANT DIRECTOR.—(1) The Secretary 
of Defense may establish in the Defense Health Agency an 
Assistant Director for Health Care Administration. If so 
established, the Assistant Director shall— 
‘‘(A) be a career appointee within the senior ex-
ecutive service of the Department; and 
‘‘(B) report directly to the Director of the De-
fense Health Agency. 
‘‘(2) If established under paragraph (1), the Assistant 
Director shall be appointed from among individuals who 
have equivalent education and experience as a chief execu-
tive officer leading a large, civilian health care system. 
‘‘(3) If established under paragraph (1), the Assistant 
Director shall be responsible for the following: 
‘‘(A) Establishing priorities for health care ad-
ministration and management. 
‘‘(B) Establishing policies and procedures for the 
provision of direct care at military medical treatment 
facilities. 
‘‘(C) Establishing priorities for budgeting mat-
ters with respect to the provision of direct care at 
military medical treatment facilities. 
‘‘(D) Establishing policies and procedures for 
clinic management and operations at military med-
ical treatment facilities. 
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‘‘(E) Establishing priorities for information 
technology at and between the military medical treat-
ment facilities. 
‘‘(c) DHA DEPUTY ASSISTANT DIRECTORS.—(1)(A) 
The Secretary of Defense may establish in the Defense 
Health Agency a Deputy Assistant Director for Information 
Operations. 
‘‘(B) If established under subparagraph (A), the Dep-
uty Assistant Director for Information Operations shall be 
responsible for management and execution of information 
technology operations at and between the military medical 
treatment facilities. 
‘‘(2)(A) The Secretary of Defense may establish in the 
Defense Health Agency a Deputy Assistant Director for Fi-
nancial Operations. 
‘‘(B) If established under subparagraph (A), the Dep-
uty Assistant Director for Financial Operations shall be re-
sponsible for the management and execution of budgeting 
matters and financial management with respect to the pro-
vision of direct care at military medical treatment facili-
ties. 
‘‘(3)(A) The Secretary of Defense may establish in the 
Defense Health Agency a Deputy Assistant Director for 
Health Care Operations. 
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‘‘(B) If established under subparagraph (A), the Dep-
uty Assistant Director for Health Care Operations shall be 
responsible for the execution of health care administration 
and management in the military medical treatment facili-
ties. 
‘‘(4)(A) The Secretary of Defense may establish in the 
Defense Health Agency a Deputy Assistant Director for 
Medical Affairs. 
‘‘(B) If established under subparagraph (A), the Dep-
uty Assistant Director for Medical Affairs shall be respon-
sible for the management and leadership of clinical quality 
and process improvement, patient safety, infection control, 
graduate medical education, clinical integration, utiliza-
tion review, risk management, patient experience, and civil-
ian physician recruiting. 
‘‘(5) Each Deputy Assistant Director appointed under 
paragraphs (1) through (4) shall— 
‘‘(A) be a career appointee within the senior ex-
ecutive service of the Department; and 
‘‘(B) report directly to the Assistant Director for 
Health Care Administration. 
‘‘(d) DHA DEPUTY DIRECTOR.—(1) In addition to the 
other duties of the Joint Staff Surgeon, the Joint Staff Sur-
geon shall serve as the Deputy Director for Combat Support 
of the Defense Health Agency. 
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‘‘(2) The responsibilities of the Deputy Director shall 
include the following: 
‘‘(A) Ensuring that the Defense Health Agency 
meets the operational needs of the commanders of the 
combatant commands. 
‘‘(B) Coordinating with the military depart-
ments to ensure that the staffing at the military med-
ical treatment facilities support readiness require-
ments for members of the armed forces and health 
care personnel. 
‘‘(C) Serving as the link between the commanders 
of the combatant commands and the Defense Health 
Agency. 
‘‘(e) APPOINTMENTS.—In carrying out subsection 
(a)(3), including with respect to establishing positions 
under subsections (b) and (c), the Secretary shall make ap-
pointments under such subsections— 
‘‘(1) by not later than October 1, 2018; and 
‘‘(2) by not increasing the number of full-time 
equivalent employees of the Defense Health Agency. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The term ‘career appointee’ has the mean-
ing given that term in section 3132(a)(4) of title 5. 
‘‘(2) The term ‘Defense Health Agency’ means 
the Defense Agency established pursuant to Depart-
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ment of Defense Directive 5136.13, or such successor 
Defense Agency. 
‘‘(3) The term ‘senior executive service’ has the 
meaning given that term in section 2101a of title 5.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended by 
inserting after the item relating to section 1073b the 
following new item: 
‘‘1073c. Administration of Defense Health Agency and military medical treatment 
facilities.’’. 
(b) IMPLEMENTATION PLAN.— 
(1) IN GENERAL.—The Secretary of Defense shall 
develop a plan to implement section 1073c of title 10, 
United States Code, as added by subsection (a). 
(2) ELEMENTS.—The plan developed under 
paragraph (1) shall include the following: 
(A) How the Secretary will carry out sub-
section (a) of such section 1073c. 
(B) Efforts to minimize potentially duplica-
tive activities carried out by the elements of the 
Defense Health Agency. 
(C) Efforts to maximize efficiencies in the 
activities carried out by the Defense Health 
Agency. 
(D) How the Secretary will implement such 
section 1073 in a manner that does not increase 
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the number of full-time equivalent employees of 
the headquarters activities of the military health 
system as of the date of the enactment of this 
Act. 
(c) REPORTS.— 
(1) INTERIM REPORT.—Not later than March 1, 
2017, the Secretary shall submit to the congressional 
defense committees a report containing— 
(A) a preliminary draft of the plan devel-
oped under subsection (b)(1); and 
(B) any recommendations for legislative ac-
tions the Secretary determines necessary to carry 
out the plan. 
(2) FINAL REPORT.—Not later than March 1, 
2018, the Secretary shall submit to the congressional 
defense committees a report containing the final 
version of the plan developed under subsection (b)(1). 
(3) COMPTROLLER GENERAL REVIEWS.— 
(A) The Comptroller General of the United 
States shall submit to the congressional defense 
committees— 
(i) a review of the preliminary draft of 
the plan submitted under paragraph (1) by 
not later than September 1, 2017; and 
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(ii) a review of the final version of the 
plan submitted under paragraph (2) by not 
later than September 1, 2018. 
(B) Each review of the plan conducted 
under paragraph (A) shall determine whether the 
Secretary has addressed the required elements for 
the plan under subsection (b)(2). 
SEC. 703. MILITARY MEDICAL TREATMENT FACILITIES. 
(a) ADMINISTRATION.— 
(1) IN GENERAL.—Chapter 55 of title 10, United 
States Code, as amended by section 702, is further 
amended by inserting after section 1073c the fol-
lowing new section: 
‘‘§ 1073d. Military medical treatment facilities 
‘‘(a) IN GENERAL.—To support the medical readiness 
of the armed forces and the readiness of medical personnel, 
the Secretary of Defense, in consultation with the Secre-
taries of the military departments, shall maintain the mili-
tary medical treatment facilities described in subsections 
(b), (c), and (d). 
‘‘(b) MEDICAL CENTERS.—(1) The Secretary of De-
fense shall maintain medical centers in areas with a large 
population of members of the armed forces and covered 
beneficiaries. 
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‘‘(2) Medical centers shall serve as referral facilities for 
members and covered beneficiaries who require comprehen-
sive health care services that support medical readiness. 
‘‘(3) Medical centers shall consist of the following: 
‘‘(4) Inpatient and outpatient tertiary care fa-
cilities that incorporate specialty and subspecialty 
care. 
‘‘(5) Graduate medical education programs. 
‘‘(6) Residency training programs. 
‘‘(7) Level one or level two trauma care capabili-
ties. 
‘‘(c) HOSPITALS.—(1) The Secretary of Defense shall 
maintain hospitals in areas where civilian health care fa-
cilities are unable to support the health care needs of mem-
bers of the armed forces and covered beneficiaries. 
‘‘(2) Hospitals shall provide— 
‘‘(A) inpatient and outpatient health services to 
maintain medical readiness; and 
‘‘(B) such other programs and functions as the 
Secretary determines appropriate. 
‘‘(3) Hospitals shall consist of inpatient and out-
patient care facilities with limited specialty care that the 
Secretary determines— 
‘‘(A) is cost effective; or 
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‘‘(B) is not available at civilian health care fa-
cilities in the area of the hospital. 
‘‘(d) AMBULATORY CARE CENTERS.—(1) The Sec-
retary of Defense shall maintain ambulatory care centers 
in areas where civilian health care facilities are able to sup-
port the health care needs of members of the armed forces 
and covered beneficiaries. 
‘‘(2) Ambulatory care centers shall provide the out-
patient health services required to maintain medical readi-
ness, including with respect to partnerships established pur-
suant to section 707 of the National Defense Authorization 
Act for Fiscal Year 2017. 
‘‘(3) Ambulatory care centers shall consist of out-
patient care facilities with limited specialty care that the 
Secretary determines— 
‘‘(A) is cost effective; or 
‘‘(B) is not available at civilian health care fa-
cilities in the area of the ambulatory care center.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter, as amended by 
section 702, is further amended by inserting after the 
item relating to section 1073c the following new item: 
‘‘1073d. Military medical treatment facilities.’’. 
(b) UPDATE OF STUDY.— 
(1) IN GENERAL.—The Secretary of Defense, in 
collaboration with the Secretaries of the military de-
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partments, shall update the report described in para-
graph (2) to address the restructuring or realignment 
of military medical treatment facilities pursuant to 
section 1073d of title 10, United States Code, as 
added by subsection (a), including with respect to any 
expansions or consolidations of such facilities. 
(2) REPORT DESCRIBED.—The report described 
in this paragraph is the Military Health System 
Modernization Study dated May 29th, 2015, required 
by section 713(a)(2) of the Carl Levin and Howard 
P. ‘‘Buck’’ McKeon National Defense Authorization 
Act for Fiscal Year 2015 (Public Law 113–291; 128 
Stat. 3414). 
(3) SUBMISSION.—Not later than 270 days after 
the date of the enactment of this Act, the Secretary of 
Defense shall submit to the congressional defense com-
mittees the updated report under paragraph (1). 
(c) IMPLEMENTATION PLAN.— 
(1) IN GENERAL.—Not later than two years after 
the date of the enactment of this Act, the Secretary of 
Defense shall submit to the congressional defense com-
mittees an implementation plan to restructure or re-
align the military medical treatment facilities pursu-
ant to section 1073d of title 10, United States Code, 
as added by subsection (a). 
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(2) 
ELEMENTS.—The 
implementation 
plan 
under paragraph (1) shall include the following: 
(A) With respect to each military medical 
treatment facility— 
(i) whether the facility will be re-
aligned or restructured under the plan; 
(ii) whether the functions of such facil-
ity will be expanded or consolidated; 
(iii) the costs of such realignment or 
restructuring; 
(iv) a description of any changes to the 
military and civilian personnel assigned to 
such facility as of the date of the plan; 
(v) a timeline for such realignment or 
restructuring; and 
(vi) the justifications for such realign-
ment or restructuring, including an assess-
ment of the capacity of the civilian health 
care facilities located near such facility. 
(B) A description of the relocation of the 
graduate medical education programs and the 
residency programs. 
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SEC. 704. ACCESS TO URGENT CARE UNDER TRICARE PRO-
GRAM. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1077 the 
following new section: 
‘‘§ 1077a. Access to military medical treatment facili-
ties and other facilities 
‘‘(a) URGENT CARE.—(1) Beginning not later than 
one year after the date of the enactment of this section, the 
Secretary of Defense shall ensure that military medical 
treatment facilities, at locations the Secretary determines 
appropriate, provide urgent care services for members of the 
armed forces and covered beneficiaries until 11:00 p.m each 
day. 
‘‘(2) With respect to areas in which a military medical 
treatment facility covered by paragraph (1) is not located, 
the Secretary shall ensure that members of the armed forces 
and covered beneficiaries may access urgent care clinics 
that are open during the hours specified in such paragraph 
through the health care provider network under the 
TRICARE program. 
‘‘(3) A covered beneficiary may access urgent care serv-
ices without the need for preauthorization for such services. 
‘‘(4) The Secretary shall— 
‘‘(A) publish information about changes in access 
to urgent care under the TRICARE program— 
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‘‘(i) on the primary publicly available 
Internet website of the Department; and 
‘‘(ii) on the primary publicly available 
website of each military treatment facility; and 
‘‘(B) ensure that such information is made 
available on the publically available Internet website 
of each current managed care contractor that has es-
tablished a health care provider network under the 
TRICARE program. 
‘‘(b) NURSE ADVICE LINE.—The Secretary shall en-
sure that the nurse advice line of the Department directs 
covered beneficiaries seeking access to care to the source of 
the most appropriate level of health care required to treat 
the medical conditions of the beneficiaries, including urgent 
care services described in subsection (a).’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of such chapter is amended by inserting after 
the item relating to section 1077 the following new item: 
‘‘1077a. Access to military medical treatment facilities and other facilities’’. 
SEC. 705. ACCESS TO PRIMARY CARE CLINICS AT MILITARY 
MEDICAL TREATMENT FACILITIES. 
(a) IN GENERAL.—Section 1077a of title 10, United 
States Code, as added by section 704, is amended by adding 
at the end the following new subsection: 
‘‘(c) PRIMARY CARE CLINICS.—(1) The Secretary shall 
ensure that primary care clinics at military medical treat-
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ment facilities are available for members of the armed forces 
and covered beneficiaries between the hours determined ap-
propriate under paragraph (2), including with respect to 
expanded hours described in subparagraph (B) of such 
paragraph. 
‘‘(2)(A) The Secretary shall determine the hours that 
each primary care clinic at a military medical treatment 
facility is available for members of the armed forces and 
covered beneficiaries based on— 
‘‘(i) the needs of the military treatment facility 
to meet the access standards under the TRICARE 
Prime program; and 
‘‘(ii) the primary care usage patterns of members 
and covered beneficiaries at such military medical 
treatment facility. 
‘‘(B) The primary care clinic hours at a military med-
ical treatment facility determined under subparagraph (A) 
shall include expanded hours beyond regular business hours 
during weekdays and the weekend if the Secretary deter-
mines under such subparagraph that sufficient demand ex-
ists at the military medical treatment facility for such ex-
panded primary care clinic hours.’’. 
(b) IMPLEMENTATION.—The Secretary of Defense shall 
implement subsection (c) of section 1077a of title 10, United 
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States Code, as added by subsection (a), by not later than 
180 days after the date of the enactment of this Act. 
SEC. 706. INCENTIVES FOR VALUE-BASED HEALTH UNDER 
TRICARE PROGRAM. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1095g 
the following new section: 
‘‘§ 1095h. TRICARE program: value-based health care 
‘‘(a) IN GENERAL.—The Secretary of Defense may de-
velop and implement value-based incentive programs as 
part of any contract awarded under this chapter for the 
provision of health care services to covered beneficiaries to 
encourage health care providers under the TRICARE pro-
gram (including physicians, hospitals, and other persons 
and facilities involved in providing such health care serv-
ices) to improve the following: 
‘‘(1) The quality of health care provided to cov-
ered beneficiaries under the TRICARE program. 
‘‘(2) The experience of covered beneficiaries in re-
ceiving health care under the TRICARE program. 
‘‘(3) The health of covered beneficiaries. 
‘‘(b) VALUE-BASED INCENTIVE PROGRAMS.—(1) In de-
veloping value-based incentive programs under subsection 
(a), the Secretary shall— 
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‘‘(A) link payments to health care providers 
under the TRICARE program to improved perform-
ance with respect to quality, cost, and reducing the 
provision of inappropriate care; 
‘‘(B) consider the characteristics of the popu-
lation of covered beneficiaries affected by the value- 
based incentive program; 
‘‘(C) consider how the value-based incentive pro-
gram would affect the receipt of health care under the 
TRICARE program by such covered beneficiaries; 
‘‘(D) establish or maintain an assurance that 
such covered beneficiaries will have timely access to 
health care during the operation of the value-based in-
centive program; 
‘‘(E) ensure that such covered beneficiaries do 
not incur any additional costs by reason of the value- 
based incentive program; and 
‘‘(F) consider such other factors as the Secretary 
considers appropriate. 
‘‘(2) With respect to a value-based incentive program 
developed and implemented under subsection (a), the Sec-
retary shall ensure that— 
‘‘(A) the size, scope, and duration of the value- 
based incentive program is reasonable in relation to 
the purpose of the value-based incentive program; and 
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‘‘(B) the value-based incentive program relies on 
the core quality performance metrics pursuant to sec-
tion 711 of the National Defense Authorization Act 
for Fiscal Year 2017. 
‘‘(c) USE OF EXISTING MODELS.—In developing a 
value-based incentive program under subsection (a), the 
Secretary may adapt a value-based incentive program con-
ducted by a TRICARE managed care support contractor, 
the Centers for Medicare & Medicaid Services, or any other 
governmental or commercial health care program.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of such chapter is amended by inserting after 
the item relating to section 1095g the following new item: 
‘‘1095h. TRICARE program: value-based health care.’’. 
(c) BRIEFINGS.— 
(1) PRIOR
TO
CERTAIN
CONTRACT
MODIFICA-
TIONS.—Not later than 60 days before the date on 
which the Secretary of Defense modifies a contract 
awarded under chapter 55 of title 10, United States 
Code, to implement a value-based incentive program 
under section 1095h of such title, as added by sub-
section (a), the Secretary shall provide to the Com-
mittees on Armed Services of the House of Represent-
atives and the Senate (and any other appropriate 
congressional committee upon request) a briefing on 
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any implementation plan of the Secretary with re-
spect to such a value-based incentive program. 
(2) ANNUAL BRIEFING.—Not later than one year 
after the date of the enactment of this Act, and annu-
ally thereafter through 2022, the Secretary shall pro-
vide to the Committees on Armed Services of the 
House of Representatives and the Senate (and any 
other appropriate congressional committee upon re-
quest) a briefing on the quality performance metrics 
and expenditures relating to a value-based incentive 
program developed and implemented under section 
1095h of title 10, United States Code, as added by 
subsection (a). 
(3) 
APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES.—In this subsection, the term ‘‘appropriate con-
gressional committees’’ means— 
(A) the congressional defense committees; 
and 
(B) the Committee on Transportation and 
Infrastructure of the House of Representatives 
and the Committee on Commerce, Science, and 
Transportation of the Senate. 
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SEC. 707. IMPROVEMENTS TO MILITARY-CIVILIAN PARTNER-
SHIPS TO INCREASE ACCESS TO HEALTH 
CARE AND READINESS. 
(a) PARTNERSHIP AGREEMENTS.—Subsection (a) of 
section 1096 of title 10, United States Code, is amended 
to read as follows: 
‘‘(a) PARTNERSHIP AGREEMENTS.—The Secretary of 
Defense may enter into a partnership agreement between 
facilities of the uniformed services and local or regional 
health care systems if the Secretary determines that such 
an agreement would— 
‘‘(1) result in the delivery of health care to which 
covered beneficiaries are entitled under this chapter 
in a more effective, efficient, or economical manner; 
or 
‘‘(2) provide members of the armed forces with 
additional training opportunities to maintain readi-
ness requirements.’’. 
(b) IN
GENERAL.—Such section 1096 is further 
amended— 
(1) by redesignating subsections (c) and (d) as 
subsections (f) and (g), respectively; and 
(2) by inserting after subsection (b) the following 
new subsections: 
‘‘(c) CRITERIA.—In entering into an agreement under 
subsection (a) between a facility of the uniformed services 
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and a local or regional health care system, the Secretary 
shall— 
‘‘(1) identify and analyze— 
‘‘(A) the health care delivery options pro-
vided by the local or regional health care system; 
and 
‘‘(B) the health care services provided by the 
facility; 
‘‘(2) assess— 
‘‘(A) how such agreement affects the delivery 
of health care at the facility and the readiness of 
the members of the uniformed services; 
‘‘(B) the viability of the agreement with re-
spect to succeeding on a long-term basis in the 
local community of the facility; and 
‘‘(C) the cost efficiency and effectiveness of 
the agreement; and 
‘‘(3) consult with— 
‘‘(A) the Secretary concerned; 
‘‘(B) representatives from such facility, in-
cluding the leadership of the installation at 
which the facility is located, the leadership of the 
facility, and covered beneficiaries at such instal-
lation; 
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‘‘(C) the TRICARE managed care support 
contractor with responsibility for such facility; 
‘‘(D) officials of the Federal, State, and 
local governments, as appropriate; and 
‘‘(E) representatives from the local or re-
gional health care system. 
‘‘(d) LOCAL CONSORTIUM.—The Secretary shall ensure 
that an agreement entered into under subsection (a) between 
a facility of the uniformed services and a local or regional 
health care system is developed by a consortium rep-
resenting the community of the facility and such health care 
system. 
‘‘(e) BIENNIAL EVALUATION.—The Secretary of De-
fense shall evaluate each agreement entered into under sub-
section (a) on a biennial basis to— 
‘‘(1) assess whether the agreement provides in-
creased access to health care for covered beneficiaries; 
‘‘(2) assess the training opportunities to main-
tain readiness requirements provided pursuant to 
such agreement; and 
‘‘(3) determine whether such agreement should 
continue.’’. 
(c) REMOVAL OF REIMBURSEMENT LIMIT FOR LICENS-
ING FEES.—Subsection (g) of such section 1096, as redesig-
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nated by subsection (a), is amended by striking ‘‘up to $500 
of’’. 
SEC. 708. JOINT TRAUMA SYSTEM. 
(a) PLAN.— 
(1) IN GENERAL.—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 Sen-
ate an implementation plan to establish a Joint 
Trauma System within the Defense Health Agency 
that promotes improved trauma care to members of 
the Armed Forces and other individuals who are eligi-
ble to be treated for trauma at a military medical 
treatment facility. 
(2) IMPLEMENTATION.—The Secretary shall im-
plement the plan under paragraph (1) after a 90-day 
period has elapsed following the date on which the 
Comptroller General of the United States is required 
to submit to the Committees on Armed Services of the 
House of Representatives and the Senate the review 
under subsection (c). In implementing such plan, the 
Secretary shall take into account any recommenda-
tion made by the Comptroller General under such re-
view. 
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(b) ELEMENTS.—The Joint Trauma System described 
in subsection (a)(1) shall include the following elements: 
(1) Serve as the reference body for all trauma 
care provided across the military health system. 
(2) Establish standards of care for trauma serv-
ices provided at military medical treatment facilities. 
(3) Coordinate the translation of research from 
the centers of excellence of the Department of Defense 
into standards of clinical trauma care. 
(4) Coordinate the incorporation of lessons 
learned from the trauma education and training 
partnerships pursuant to section 709 into clinical 
practice. 
(c) REVIEW.—Not later than 120 days after the date 
on which the Secretary submits to the Committees on Armed 
Services of the House of Representatives and the Senate the 
implementation plan under subsection (a)(1), the Comp-
troller General of the United States shall submit to such 
committees a review of such plan to determine if each ele-
ment under subsection (b) is included in such plan. 
(d) REVIEW OF MILITARY TRAUMA SYSTEM.—In es-
tablishing a Joint Trauma System, the Secretary of Defense 
may seek to enter into an agreement with a non-govern-
mental entity with subject matter experts to— 
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(1) conduct a system-wide review of the military 
trauma system; and 
(2) make publicly available a report containing 
such review and recommendations to establish a com-
prehensive trauma system for the Armed Forces. 
SEC. 709. JOINT TRAUMA EDUCATION AND TRAINING DI-
RECTORATE. 
(a) ESTABLISHMENT.—The Secretary of Defense shall 
establish a Joint Trauma Education and Training Direc-
torate (in this section referred to as the ‘‘Directorate’’) to 
ensure that the traumatologists of the Armed Forces main-
tain readiness and are able to be rapidly deployed for future 
armed conflicts. The Secretary shall carry out this section 
in collaboration with the Secretaries of the military depart-
ments. 
(b) DUTIES.—The duties of the Directorate are as fol-
lows: 
(1) To enter into and coordinate the partner-
ships under subsection (c). 
(2) To establish the goals of such partnerships 
necessary for trauma combat casualty care teams led 
by traumatologists to maintain professional com-
petency in trauma care. 
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(3) To establish metrics for measuring the per-
formance of such partnerships in achieving such 
goals. 
(4) To develop methods of data collection and 
analysis for carrying out paragraph (3). 
(5) To communicate and coordinate lessons 
learned from such partnerships with the Joint Trau-
ma System established under section 708. 
(c) PARTNERSHIPS.— 
(1) IN GENERAL.—The Secretary shall enter into 
partnerships with civilian academic medical centers 
and large metropolitan teaching hospitals that have 
level I civilian trauma centers. 
(2) TRAUMA COMBAT CASUALTY CARE TEAMS.— 
Under the partnerships entered into with civilian 
academic medical centers and large metropolitan 
teaching hospitals under paragraph (1), trauma com-
bat casualty care teams of the Armed Forces led by 
traumatologists of the Armed Forces shall embed 
within the trauma centers of the medical centers and 
hospitals on an enduring basis. 
(3) SELECTION.—The Secretary shall select civil-
ian academic medical centers and large metropolitan 
teaching hospitals to enter into partnerships under 
paragraph (1) based on patient volume, acuity, and 
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other factors the Secretary determines necessary to en-
sure that the traumatologists of the Armed Forces and 
the associated clinical support teams have adequate 
and continuous exposure to critically injured pa-
tients. 
(4) CONSIDERATION.—In entering into partner-
ships under paragraph (1), the Secretary may con-
sider the experiences and lessons learned by the mili-
tary departments that have entered into memoranda 
of understanding with civilian medical centers for 
trauma care. 
(d) ANALYSIS.—The Secretary of Defense shall conduct 
an analysis to determine the number of traumatologists of 
the Armed Forces, by specialty, that must be maintained 
within the Department of Defense to meet the requirements 
of the combatant commands. 
(e) IMPLEMENTATION PLAN.—Not later than July 1, 
2017, the Secretary shall submit to the Committees on 
Armed Services of the House of Representatives and the 
Senate an implementation plan for establishing the Joint 
Trauma Education and Training Directorate under sub-
section (a) and entering into partnerships under subsection 
(c). 
(f) LEVEL I CIVILIAN TRAUMA CENTER DEFINED.— 
In this section, the term ‘‘level I civilian trauma center’’ 
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means a comprehensive regional resource that is a tertiary 
care facility central to the trauma system and is capable 
of providing total care for every aspect of injury from pre-
vention through rehabilitation. 
SEC. 710. IMPROVEMENTS TO ACCESS TO HEALTH CARE IN 
MILITARY MEDICAL TREATMENT FACILITIES. 
(a) FIRST CALL RESOLUTION.— 
(1) IN GENERAL.—The Secretary of Defense shall 
implement standard processes to ensure that, in the 
case of a beneficiary contacting a military medical 
treatment facility over the telephone for, at a min-
imum, scheduling an appointment, requesting a pre-
scription drug refill, and other matters determined 
appropriate by the Secretary, the needs of the bene-
ficiary are met during the first such telephone call. 
(2) METRICS.—The Secretary shall— 
(A) develop metrics, collect data, and evalu-
ate the performance of the processes implemented 
under paragraph (1); and 
(B) carry out satisfaction surveys to mon-
itor the satisfaction of beneficiaries with such 
processes, including with respect to the satisfac-
tion regarding access to appointments and pa-
tient care. 
(b) APPOINTMENT SCHEDULING.— 
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(1) IN
GENERAL.—The Secretary shall imple-
ment standard processes to schedule beneficiaries for 
appointments at military medical treatment facili-
ties. 
(2) ELEMENTS.—The standard processes imple-
mented under paragraph (1) shall include the fol-
lowing: 
(A) Requiring clinics at military medical 
treatment facilities to allow a beneficiary to 
schedule an appointment for wellness visits or 
follow-up appointments during the six-month or 
longer period beginning on the date of the request 
for the appointment. 
(B) A process to remind a beneficiary of fu-
ture appointments in a manner that the bene-
ficiary prefers, which may include sending post-
cards to the beneficiary prior to appointments 
and making reminder telephone calls, emails, or 
cellular text messages to the beneficiary at speci-
fied intervals prior to appointments. 
(c) APPOINTMENT SUPPLY AND DEMAND.— 
(1) PRODUCTIVITY.—The Secretary shall imple-
ment standards for the productivity of health care 
providers at military medical treatment facilities. In 
developing such standards, the Secretary shall con-
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sider civilian benchmarks for measuring the produc-
tivity of health care providers, the optimal number of 
appointments (patient contact hours) required to 
maintain access according to the standards developed 
by the Secretary, and readiness requirements. 
(2) MANAGING USE OF FACE-TO-FACE APPOINT-
MENTS.—The Secretary shall implement strategies for 
managing the use of face-to-face appointments at 
military medical treatment facilities. Such strategies 
may include— 
(A) maximizing the use of telehealth and 
virtual appointments for beneficiaries at the dis-
cretion of the health care provider and the bene-
ficiary; 
(B) the implementation of remote patient 
monitoring of chronic conditions to improve out-
comes and reduce the number of follow-up ap-
pointments for beneficiaries; and 
(C) maximizing the use of secure messaging 
between health care providers and beneficiaries 
to improve the access of beneficiaries to health 
care and reduce the number of visits for health 
care needs. 
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(d) IMPLEMENTATION.—The Secretary shall imple-
ment subsections (a), (b), and (c) by not later than Feb-
ruary 1, 2017. 
(e) BRIEFING.—Not later than March 1, 2017, the Sec-
retary shall provide the Committees on Armed Services of 
the House of Representatives and the Senate a briefing on 
the implementation of subsections (a), (b), and (c). 
(f) BENEFICIARIES DEFINED.—In this section, the 
term ‘‘beneficiaries’’ means members of the Armed Forces 
and covered beneficiaries (as defined in section 1072(5) of 
title 10, United States Code). 
SEC. 711. ADOPTION OF CORE QUALITY PERFORMANCE 
METRICS. 
(a) ADOPTION.— 
(1) IN GENERAL.—Not later than 180 days after 
the date of the enactment of this Act, the Secretary of 
Defense shall adopt the core quality performance 
metrics agreed upon by the Core Quality Measures 
Collaborative for use by the military health system 
and in contracts awarded to carry out the TRICARE 
program. 
(2) CORE MEASURES.—The core quality perform-
ance metrics described in paragraph (1) shall include 
the following sets: 
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(A) Accountable care organizations, patient 
centered medical homes and primary care. 
(B) Cardiology. 
(C) Gastroenterology. 
(D) HIV and hepatitis C. 
(E) Medical oncology. 
(F) Obstetrics and gynecology. 
(G) Orthopedics. 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘Core Quality Measures Collabo-
rative’’ means the collaboration between the Centers 
for Medicare & Medicaid Services, major health in-
surance companies, national physician organizations, 
and other entities to reach consensus on core perform-
ance measures reported by health care providers. 
(2) The term ‘‘TRICARE program’’ has the 
meaning given that term in section 1072 of title 10, 
United States Code. 
SEC. 712. STUDY ON IMPROVING CONTINUITY OF HEALTH 
CARE 
COVERAGE 
FOR 
RESERVE 
COMPO-
NENTS. 
(a) STUDY.—The Secretary of Defense shall conduct a 
study of options for providing health care coverage that im-
proves the continuity of health care provided to current and 
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former members of the Selected Reserve of the Ready Reserve 
who are not— 
(1) serving on active duty; 
(2) eligible for the Transitional Assistance Man-
agement Program under section 1145 of title 10, 
United States Code; or 
(3) eligible for the Federal Employees Health 
Benefit Program under chapter 89 of title 5. 
(b) ELEMENTS.—The study under subsection (a) shall 
address the following: 
(1) Whether to allow current and former mem-
bers of the Selected Reserve to participate in the Fed-
eral Employees Health Benefit Program under chap-
ter 89 of title 5. 
(2) Whether to pay a stipend to current and 
former members to continue coverage in a health plan 
obtained by the member. 
(3) Whether to allow current and former mem-
bers to participate in the TRICARE program under 
section 1076d of title 10, United States Code. 
(4) Whether to allow members of the National 
Guard assigned to Homeland Response Force Units 
mobilized for a State emergency pursuant to chapter 
9 of title 32, United States Code, to remain eligible 
for the TRICARE program. 
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(5) Any other options for providing health care 
coverage to current and former members of the Se-
lected Reserve the Secretary considers appropriate. 
(c) CONSULTATION.—In carrying out the study under 
subsection (a), the Secretary shall consult with, and obtain 
the opinions of, current and former members of the Selected 
Reserve, including the leadership of the Selected Reserve. 
(d) SUBMISSION.— 
(1) REPORT.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary shall 
submit to the congressional defense committees a re-
port on the study under subsection (a). 
(2) MATTERS
INCLUDED.—The report under 
paragraph (1) shall include the following: 
(A) A description of the health care coverage 
options addressed by the Secretary under sub-
section (b). 
(B) Identification of such health care cov-
erage option that the Secretary recommends as 
the best option. 
(C) The justifications for such recommended 
best option. 
(D) The number and proportion of the cur-
rent and former members of the Selected Reserve 
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projected to participate in such recommended 
best option. 
(E) A determination of the appropriate cost 
sharing for such recommended best option with 
respect to the percentage contribution as a 
monthly premium for current members of the Se-
lected Reserve. 
(F) An estimate of the cost of implementing 
such recommended best option. 
(G) Any legislative language required to 
implement such recommended best option. 
Subtitle B—Other Health Care 
Benefits 
SEC. 721. PROVISION OF HEARING AIDS TO DEPENDENTS 
OF RETIRED MEMBERS. 
Section 1077 of title 10, United States Code, is amend-
ed— 
(1) in subsection (a)(16), by striking ‘‘A hearing 
aid’’ and inserting ‘‘Except as provided by subsection 
(g), a hearing aid’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(g) In addition to the authority to provide a hearing 
aid under subsection (a)(16), hearing aids may be sold 
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under this section to dependents of former members of the 
uniformed services at cost to the United States.’’. 
SEC. 722. EXTENDED TRICARE PROGRAM COVERAGE FOR 
CERTAIN 
MEMBERS 
OF 
THE 
NATIONAL 
GUARD AND DEPENDENTS DURING CERTAIN 
DISASTER RESPONSE DUTY. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by inserting after section 1076e 
the following new section: 
‘‘§ 1076f. TRICARE program: extension of coverage for 
certain members of the National Guard 
and dependents during certain disaster 
response duty 
‘‘(a) EXTENDED COVERAGE.—During a period in 
which a member of the National Guard is performing dis-
aster response duty, the member shall be treated as being 
on active duty for a period of more than 30 days for pur-
poses of the eligibility of the member and dependents of the 
member for health care benefits under the TRICARE pro-
gram if such period immediately follows a period in which 
the member served on full-time National Guard duty under 
section 502(f) of title 32, including pursuant to chapter 9 
of such title, unless the Governor of the State (or, with re-
spect to the District of Columbia, the mayor of the District 
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of Columbia) determines that such extended eligibility is not 
in the best interest of the member or the State. 
‘‘(b) CONTRIBUTION BY STATE.—(1) The Secretary 
may charge a State for the costs of providing coverage under 
the TRICARE program to members of the National Guard 
of the State and the dependents of the members pursuant 
to subsection (a). Such charges shall be paid from the funds 
of the State or from any other non-Federal funds. 
‘‘(2) Any amounts received by the Secretary under 
paragraph (1) shall be credited to the appropriation avail-
able for the Defense Health Program Account under section 
1100 of this title, shall be merged with sums in such Ac-
count that are available for the fiscal year in which col-
lected, and shall be available under subsection (b) of such 
section, including to carry out subsection (a) of this section. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘disaster response duty’ means 
duty performed by a member of the National Guard 
in State status pursuant to an emergency declaration 
by the Governor of the State (or, with respect to the 
District of Columbia, the mayor of the District of Co-
lumbia) in response to a disaster or in preparation 
for an imminent disaster. 
‘‘(2) The term ‘State’ means each of the several 
States, the District of Columbia, the Commonwealth 
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of Puerto Rico, and any territory or possession of the 
United States.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of such chapter is amended by inserting after 
the item relating to section 1076e the following new item: 
‘‘1076f. TRICARE program: extension of coverage for certain members of the Na-
tional Guard and dependents during certain disaster response 
duty.’’. 
Subtitle C—Health Care 
Administration 
SEC. 731. PROSPECTIVE PAYMENT OF FUNDS NECESSARY 
TO PROVIDE MEDICAL CARE FOR THE COAST 
GUARD. 
(a) IN GENERAL.—Chapter 13 of title 14, United 
States Code, is amended by adding at the end the following: 
‘‘§ 519. Prospective payment of funds necessary to pro-
vide medical care 
‘‘(a) PROSPECTIVE PAYMENT REQUIRED.—In lieu of 
the reimbursement required under section 1085 of title 10, 
the Secretary of Homeland Security shall make a prospec-
tive payment to the Secretary of Defense of an amount that 
represents the actuarial valuation of treatment or care— 
‘‘(1) that the Department of Defense shall pro-
vide to members of the Coast Guard, former members 
of the Coast Guard, and dependents of such members 
and former members (other than former members and 
dependents of former members who are a Medicare-eli-
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gible beneficiary or for whom the payment for treat-
ment or care is made from the Medicare-Eligible Re-
tiree Health Care Fund) at facilities under the juris-
diction of the Department of Defense or a military 
department; and 
‘‘(2) for which a reimbursement would otherwise 
be made under section 1085. 
‘‘(b) AMOUNT.—The amount of the prospective pay-
ment under subsection (a) shall be— 
‘‘(1) in the case of treatment or care to be pro-
vided to members of the Coast Guard and their de-
pendents, derived from amounts appropriated for the 
operating expenses of the Coast Guard; 
‘‘(2) in the case of treatment or care to be pro-
vided former members of the Coast Guard and their 
dependents, derived from amounts appropriated for 
retired pay; 
‘‘(3) determined under procedures established by 
the Secretary of Defense; 
‘‘(4) paid during the fiscal year in which treat-
ment or care is provided; and 
‘‘(5) subject to adjustment or reconciliation as 
the Secretaries determine appropriate during or 
promptly after such fiscal year in cases in which the 
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prospective payment is determined excessive or insuf-
ficient based on the services actually provided. 
‘‘(c) NO PROSPECTIVE PAYMENT WHEN SERVICE IN 
NAVY.—No prospective payment shall be made under this 
section for any period during which the Coast Guard oper-
ates as a service in the Navy. 
‘‘(d) RELATIONSHIP TO TRICARE.—This section shall 
not be construed to require a payment for, or the prospective 
payment of an amount that represents the value of, treat-
ment or care provided under any TRICARE program.’’. 
(b) CLERICAL AMENDMENT.—The analysis for chapter 
13 of title 14, United States Code, is amended by adding 
at the end the following: 
‘‘519. Prospective payment of funds necessary to provide medical care.’’. 
(c) REPEAL.—Section 217 of the Coast Guard Author-
ization Act of 2016 (Public Law 114–120), as amended by 
section 3504, and the item relating to that section in the 
table of contents in section 2 of such Act, are repealed. 
Subtitle D—Reports and Other 
Matters 
SEC. 741. MENTAL HEALTH RESOURCES FOR MEMBERS OF 
THE MILITARY SERVICES AT HIGH RISK OF 
SUICIDE. 
(a) IN GENERAL.—The Secretary of Defense shall de-
velop a methodology that identifies which members of the 
military services are at high risk of suicide. 
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(b) MENTAL HEALTH RESOURCES.— 
(1) HIGH
RISK
MEMBERS
OF
THE
MILITARY 
SERVICES.—The Secretary of Defense shall use the re-
sults under subsection (c) to— 
(A) identify which units have a dispropor-
tionately high rate of suicide and suicide at-
tempts; and 
(B) provide additional preventative and 
treatment resources for mental health for mem-
bers of the military services who were deployed 
with the units identified under subparagraph 
(A). 
(2) PREVENTATIVE MENTAL HEALTH CARE.—The 
Secretary of Defense shall use the results under sub-
section (c) to— 
(A) identify the circumstances of deploy-
ments associated with increased vulnerability to 
suicide, including the length of deployment, the 
region and area of deployment, and the nature 
and extent to which there was contact with 
enemy forces; and 
(B) provide additional preventative mental 
health care to units who currently are, or will be, 
deployed under circumstances similar to those of 
subparagraph (A). 
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(c) METHODOLOGY.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Defense 
shall develop a methodology to assess the rate of suicide and 
suicide attempts of members of the military services of units 
that have been deployed in support of a contingency oper-
ation after September 11, 2001. 
(d) REPORTS.—Not later than September 30, 2017, the 
Secretary of Defense shall submit to the Committee on 
Armed Services of the House of Representatives and the 
Committee on Armed Services of the Senate a report on the 
activities carried out under this section and the effectiveness 
of such activities. 
(e) RESTRICTION ON USE OF INFORMATION.—Infor-
mation disclosed or obtained pursuant to the provisions of 
this section may be used by officers, employees, and contrac-
tors of the Department of Defense only for the purposes of, 
and to the extent necessary in, carrying out this section. 
(f) MILITARY SERVICES DEFINED.—In this section, the 
term ‘‘military services’’ means the Army, Navy, Air Force, 
and the Marine Corps, including the reserve components 
thereof. 
SEC. 
742. 
RESEARCH 
OF 
CHRONIC 
TRAUMATIC 
ENCEPHALOPATHY. 
Of the funds authorized to be appropriated by this Act 
or otherwise made available for fiscal year 2017 for ad-
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