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eration Enduring Freedom upon their return from
such deployment.
‘‘(2) ELEMENTS.—The assessment and rec-
ommendations required by paragraph (1) shall in-
clude the following:
‘‘(A) An assessment of the specific needs
with respect to mental health of members of the
National Guard and Reserve who are deployed
in Operation Iraqi Freedom or Operation En-
during Freedom upon their return from such de-
ployment.
‘‘(B) An identification of mental health con-
ditions and disorders (including Post Traumatic
Stress Disorder (PTSD), suicide attempts, and
suicide) occurring among members of the Na-
tional Guard and Reserve who undergo multiple
deployments in Operation Iraqi Freedom or Op-
eration Enduring Freedom upon their return
from such deployment.
‘‘(C) Recommendations on mechanisms for
improving the mental health services available to
members of the National Guard and Reserve who
are deployed in Operation Iraqi Freedom or Op-
eration Enduring Freedom, including such mem-
bers who undergo multiple deployments in such
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operations, upon their return from such deploy-
ment.’’.
(b) REPORT.—Subsection (f) of such section, as redes-
ignated by subsection (a)(1) of this section, is further
amended—
(1) in the subsection heading, by striking ‘‘RE-
PORT’’ and inserting ‘‘REPORTS’’;
(2) by striking paragraph (1) and inserting the
following new paragraph (1):
‘‘(1) IN GENERAL.—The report submitted to the
Secretary under each of subsections (c) and (d) shall
include—
‘‘(A) a description of the activities of the
task force under such subsection;
‘‘(B) the assessment and recommendations
required by such subsection; and
‘‘(C) such other matters relating to the ac-
tivities of the task force under such subsection as
the task force considers appropriate.’’; and
(3) in paragraph (2)—
(A) by striking ‘‘the report under para-
graph (1)’’ and inserting ‘‘a report under para-
graph (1)’’; and
(B) by striking ‘‘the report as’’ and insert-
ing ‘‘such report as’’.
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(c) PLAN MATTERS.—Subsection (g) of such section,
as redesignated by subsection (a)(1) of this section, is fur-
ther amended—
(1) by striking ‘‘the report from the task force
under subsection (e)(1)’’ and inserting ‘‘a report from
the task force under subsection (f)(1)’’; and
(2) by inserting ‘‘contained in such report’’ after
‘‘the task force’’ the second place it appears.
(d) TERMINATION.—Subsection (h) of such section, as
redesignated by subsection (a)(1) of this section, is further
amended—
(1) by inserting ‘‘with respect to the assessment
and recommendations required by subsection (d)’’
after ‘‘the task force’’; and
(2) by striking ‘‘subsection (e)(2)’’ and inserting
‘‘subsection (f)(2)’’.
SEC. 685. GRANTS ON ASSISTANCE IN COMMUNITY-BASED
SETTINGS FOR MEMBERS OF THE NATIONAL
GUARD AND RESERVE AND THEIR FAMILIES
AFTER DEPLOYMENT IN OPERATION IRAQI
FREEDOM AND OPERATION ENDURING FREE-
DOM.
(a) IN GENERAL.—The Secretary of Defense may
award grants to eligible entities to carry out demonstration
projects to assess the feasibility and advisability of utilizing
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community-based settings for the provision of assistance to
members of the National Guard and Reserve who serve in
Operation Iraqi Freedom or Operation Enduring Freedom,
and their families, after the return of such members from
deployment in Operation Iraqi Freedom or Operation En-
during Freedom, as the case may be, including—
(1) services to improve the reuniting of such
members of the National Guard and Reserve and their
families;
(2) education to increase awareness of the phys-
ical and mental health conditions that members of the
National Guard and Reserve can and may experience
on their return from such deployment, including edu-
cation on—
(A) 
Post 
Traumatic 
Stress 
Disorder
(PTSD) and traumatic brain injury (TBI); and
(B) mechanisms for the referral of such
members of the National Guard and Reserve for
medical and mental health screening and care
when necessary; and
(3) education to increase awareness of the phys-
ical and mental health conditions that family mem-
bers of such members of the National Guard and Re-
serve can and may experience on the return of such
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members from such deployment, including education
on—
(A) depression, anxiety, and relationship
problems; and
(B) mechanisms for medical and mental
health screening and care when appropriate.
(b) ELIGIBLE ENTITIES.—An entity eligible for the
award of a grant under this section is any public or private
non-profit organization, such as a community mental
health clinic, family support organization, military sup-
port organization, law enforcement agency, community col-
lege, or public school.
(c) APPLICATION.—An eligible entity seeking a grant
under this section shall submit to the Secretary of Defense
an application therefor in such manner, and containing
such information, as the Secretary may require for purposes
of this section, including a description of how such entity
will work with the Department of Defense, the Department
of Veterans Affairs, State health agencies, other appropriate
Federal, State, and local agencies, family support organiza-
tions, and other community organization in undertaking
activities described in subsection (a).
(d) ANNUAL REPORTS BY GRANT RECIPIENTS.—An
entity awarded a grant under this section shall submit to
the Secretary of Defense on an annual basis a report on
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the activities undertaken by such entity during the pre-
ceding year utilizing amounts under the grant. Each report
shall include such information as the Secretary shall specify
for purposes of this subsection.
(e) ANNUAL REPORTS TO CONGRESS.—
(1) IN GENERAL.—Not later than one year after
the date of the enactment of this Act, and annually
thereafter, the Secretary of Defense shall submit to
Congress a report on activities undertaken under the
grants awarded under this section. The report shall
include 
recommendations 
for 
legislative, 
pro-
grammatic, or administrative action to improve or
enhance activities under the grants awarded under
this section.
(2) AVAILABILITY
TO
PUBLIC.—The Secretary
shall take appropriate actions to make each report
under this subsection available to the public.
SEC. 686. LONGITUDINAL STUDY ON TRAUMATIC BRAIN IN-
JURY 
INCURRED 
BY 
MEMBERS 
OF 
THE
ARMED FORCES IN OPERATION IRAQI FREE-
DOM AND OPERATION ENDURING FREEDOM.
(a) STUDY REQUIRED.—The Secretary of Defense
shall, in consultation with the Secretary of Veterans Affairs,
conduct a longitudinal study on the effects of traumatic
brain injury incurred by members of the Armed Forces in
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Operation Iraqi Freedom or Operation Enduring Freedom.
The duration of the longitudinal study shall be 15 years.
(b) ELEMENTS.—The study required by subsection (a)
shall address the following:
(1) The long-term physical and mental health ef-
fects of traumatic brain injuries incurred by members
of the Armed Forces during service in Operation
Iraqi Freedom or Operation Enduring Freedom.
(2) The health care, mental health care, and re-
habilitation needs of such members for such injuries
after the completion of inpatient treatment through
the Department of Defense, the Department of Vet-
erans Affairs, or both.
(3) The type and availability of long-term care
rehabilitation programs and services within and out-
side the Department of Defense and the Department
of Veterans Affairs for such members for such injuries,
including community-based programs and services
and in-home programs and services.
(c) REPORTS.—
(1) PERIODIC AND FINAL REPORTS.—After the
third, seventh, eleventh, and fifteenth years of the
study required by subsection (a), the Secretary of De-
fense shall, in consultation with the Secretary of Vet-
erans Affairs, submit to Congress a comprehensive re-
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port on the results of the study during the preceding
years. Each report shall include the following:
(A) Current information on the cumulative
outcomes of the study.
(B) Such recommendations as the Secretary
of Defense and the Secretary of Veterans Affairs
jointly consider appropriate based on the out-
comes of the study, including recommendations
for legislative, programmatic, or administrative
action to improve long-term care and rehabilita-
tion programs and services for members of the
Armed Forces with traumatic brain injuries.
(2) AVAILABILITY TO PUBLIC.—The Secretary of
Defense and the Secretary of Veterans Affairs shall
jointly take appropriate actions to make each report
under this subsection available to the public.
(d) FUNDING.—
(1) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to the Depart-
ment of Defense to carry out this section amounts as
follows:
(A) For fiscal year 2007, $5,000,000.
(B) For each of fiscal years 2008 through
2021, such sums as may be necessary.
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(2) OFFSET.—The amount authorized to be ap-
propriated by section 102(a)(2) for weapons procure-
ment for the Navy is hereby reduced by $5,000,000,
with the amount of the reduction to be allocated to
amounts for the Trident II conventional modification
program.
SEC. 687. TRAINING CURRICULA FOR FAMILY CAREGIVERS
ON CARE AND ASSISTANCE FOR MEMBERS
AND FORMER MEMBERS OF THE ARMED
FORCES WITH TRAUMATIC BRAIN INJURY IN-
CURRED IN OPERATION IRAQI FREEDOM AND
OPERATION ENDURING FREEDOM.
(a) TRAUMATIC BRAIN INJURY FAMILY CAREGIVER
PANEL.—
(1) ESTABLISHMENT.—The Secretary of Defense
shall, in consultation with the Secretary of Veterans
Affairs, establish within the Department of Defense a
panel to develop coordinated, uniform, and consistent
training curricula to be used in training family
members in the provision of care and assistance to
members and former members of the Armed Forces for
traumatic brain injuries incurred during service in
the Armed Forces in Operation Iraqi Freedom or Op-
eration Enduring Freedom.
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(2) DESIGNATION OF PANEL.—The panel estab-
lished under paragraph (1) shall be known as the
‘‘Traumatic Brain Injury Family Caregiver Panel’’.
(3) MEMBERS.—The Traumatic Brain Injury
Family Caregiver Panel established under paragraph
(1) shall consist of 15 members appointed by the Sec-
retary of Defense, in consultation with the Secretary
of Veterans Affairs, equally represented from among—
(A) physicians, nurses, rehabilitation thera-
pists, and other individuals with an expertise in
caring for and assisting individuals with trau-
matic brain injury, including those who spe-
cialize in caring for and assisting individuals
with traumatic brain injury incurred in war;
(B) representatives of family caregivers or
family caregiver associations;
(C) Department of Defense and Department
of Veterans Affairs health and medical personnel
with expertise in traumatic brain injury, and
Department of Defense personnel and readiness
representatives with expertise in traumatic brain
injury;
(D) psychologists or other individuals with
expertise in the mental health treatment and
care of individuals with traumatic brain injury;
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(E) experts in the development of training
curricula; and
(F) any other individuals the Secretary
considers appropriate.
(b) DEVELOPMENT OF CURRICULA.—
(1) IN GENERAL.—The Traumatic Brain Injury
Family Caregiver Panel shall develop training cur-
ricula to be utilized during the provision of training
to family members of members and former members
of the Armed Forces described in subsection (a) on
techniques, strategies, and skills for care and assist-
ance for such members and former members with the
traumatic brain injuries described in that subsection.
(2) 
SCOPE
OF
CURRICULA.—The 
curricula
shall—
(A) be based on empirical research and
validated techniques; and
(B) shall provide for training that permits
recipients to tailor caregiving to the unique cir-
cumstances of the member or former member of
the Armed Forces receiving care.
(3) PARTICULAR REQUIREMENTS.—In developing
the curricula, the Traumatic Brain Injury Family
Caregiver Panel shall—
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(A) specify appropriate training commensu-
rate with the severity of traumatic brain injury;
and
(B) identify appropriate care and assist-
ance to be provided for the degree of severity of
traumatic brain injury for caregivers of various
levels of skill and capability.
(4) USE
OF
EXISTING
MATERIALS.—In devel-
oping the curricula, the Traumatic Brain Injury
Family Caregiver Panel shall utilize and enhance
any existing training curricula, materials, and re-
sources applicable to such curricula as the Panel con-
siders appropriate.
(5) DEADLINE FOR DEVELOPMENT.—The Trau-
matic Brain Injury Family Caregiver Panel shall de-
velop the curricula not later than one year after the
date of the enactment of this Act.
(c) DISSEMINATION OF CURRICULA.—
(1) IN
GENERAL.—The Secretary of Defense
shall, in consultation with the Traumatic Brain In-
jury Family Caregiver Panel, develop mechanisms for
the dissemination of the curricula developed under
subsection (b) to health care professionals referred to
in paragraph (2) who treat or otherwise work with
members and former members of the Armed Forces
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with traumatic brain injury incurred in Operation
Iraqi Freedom or Operation Enduring Freedom. In
developing such mechanisms, the Secretary may uti-
lize and enhance existing mechanisms, including the
Military Severely Injured Center.
(2) HEALTH CARE PROFESSIONALS.—The health
care professionals referred to in this paragraph are
the following:
(A) Personnel at military medical treat-
ment facilities.
(B) Personnel at the polytrauma centers of
the Department of Veterans Affairs.
(C) Personnel and care managers at the
Military Severely Injured Center.
(D) Such other health care professionals of
the Department of Defense as the Secretary con-
siders appropriate.
(E) Such other health care professionals of
the Department of Veterans Affairs as the Sec-
retary of Defense, in consultation with the Sec-
retary of Veterans Affairs, considers appropriate.
(3) PROVISION OF TRAINING TO FAMILY CARE-
GIVERS.—
(A) IN GENERAL.—Health care professionals
referred to in paragraph (2) who are trained in
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the curricula developed under subsection (b) shall
provide training to family members of members
and former members of the Armed Forces who
incur traumatic brain injuries during service in
the Operation Iraqi Freedom or Operation En-
during Freedom in the care and assistance to be
provided for such injuries.
(B) TIMING OF TRAINING.—Training under
this paragraph shall, to the extent practicable, be
provided to family members while the member or
former member concerned is undergoing treat-
ment at a facility of the Department of Defense
or Department of Veterans Affairs, as applicable,
in order to ensure that such family members re-
ceive practice on the provision of such care and
assistance under the guidance of qualified health
professionals.
(C) PARTICULARIZED TRAINING.—Training
provided under this paragraph to family mem-
bers of a particular member or former member
shall be tailored to the particular care needs of
such member or former member and the par-
ticular caregiving needs of such family members.
(4) QUALITY ASSURANCE.—The Secretary shall
develop mechanisms to ensure quality in the provision
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of training under this section to health care profes-
sionals referred to in paragraph (2) and in the provi-
sion of such training under paragraph (4) by such
health care professionals.
(5) REPORT.—Not later than one year after the
development of the curricula required by subsection
(b), and annually thereafter, the Traumatic Brain
Injury Family Caregiver Training Panel shall submit
to the Secretary of Defense and the Secretary of Vet-
erans Affairs, and to Congress, a report on the fol-
lowing:
(A) The actions undertaken under this sub-
section.
(B) The results of the tracking of outcomes
based on training developed and provided under
this section.
(C) Recommendations for the improvement
of training developed and provided under this
section.
(d) FUNDING.—
(1) AUTHORIZATION
OF
APPROPRIATIONS.—
There is authorized to be appropriated to the Depart-
ment of Defense to carry out this section amounts as
follows:
(A) For fiscal year 2007, $1,000,000.
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(B) For each of fiscal years 2008 through
2011, such sums as may be necessary.
(2) OFFSET.—The amount authorized to be ap-
propriated by section 102(a)(2) for weapons procure-
ment for the Navy is hereby reduced by $1,000,000,
with the amount of the reduction to be allocated to
amounts for the Trident II conventional modification
program.
TITLE VII—HEALTH CARE
Subtitle A—Benefits Matters
SEC. 701. IMPROVED PROCEDURES FOR CANCER SCREEN-
ING FOR WOMEN.
(a) PRIMARY AND PREVENTIVE HEALTH CARE SERV-
ICES AUTHORITY.—Section 1074d of title 10, United States
Code, is amended—
(1) in subsection (a)(1), by adding at the end the
following new sentence: ‘‘The services described in
paragraphs (1) and (2) of subsection (b) shall be pro-
vided under such procedures and at such intervals as
the Secretary of Defense shall prescribe.’’; and
(2) in subsection (b), by striking paragraphs (1)
and (2) and inserting the following new paragraphs:
‘‘(1) Cervical cancer screening.
‘‘(2) Breast cancer screening.’’.
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(b) TRICARE PROGRAM.—Section 1079(a)(2) of such
title is amended—
(1) in the matter preceding subparagraph (A),
by striking ‘‘the schedule of pap smears and mammo-
grams’’ and inserting ‘‘the schedule and method of
cervical 
cancer 
screenings 
and 
breast 
cancer
screenings’’; and
(2) in subparagraph (B), by striking ‘‘pap
smears and mammograms’’ and inserting ‘‘cervical
and breast cancer screenings’’.
SEC. 702. NATIONAL MAIL-ORDER PHARMACY PROGRAM.
(a) AVAILABILITY OF REFILLS OF MAINTENANCE-TYPE
MEDICATIONS SOLELY THROUGH PROGRAM.—
(1) IN GENERAL.—Subsection (a)(2) of section
1074g of title 10, United States Code, is amended—
(A) in subparagraph (E), by striking
‘‘Pharmaceutical agents’’ and inserting ‘‘Except
as provided in subparagraph (F), pharma-
ceutical agents’’; and
(B) by adding at the end the following new
subparagraph:
‘‘(F)(i) Effective April 1, 2007, refills of maintenance
medications shall, except as provided under clause (ii), be
available to eligible covered beneficiaries solely through the
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national mail-order pharmacy program referred to in sub-
paragraph (E)(iii).
‘‘(ii) Under such regulations as the Secretary may pre-
scribe under this subparagraph, refills of a maintenance
medication may be available to covered eligible beneficiaries
through means other than the national mail-order phar-
macy program if clinical requirements make it advisable
that such medication be available to such beneficiaries
through such other means.
‘‘(iii) The Secretary shall specify the pharmaceutical
agents constituting maintenance medications for purposes
of this subparagraph.’’.
(2) 
CONFORMING
AMENDMENT.—Subsection
(f)(1) of such section is amended by striking ‘‘sub-
section (a)(2)(E)’’ and inserting ‘‘subparagraphs (E)
and (F) of subsection (a)(2)’’.
(b) PROHIBITION
ON COPAYMENTS
FOR CERTAIN
PHARMACEUTICALS
AVAILABLE
THROUGH
PROGRAM.—
Subsection (a)(6) of such section is amended by adding at
the end the following new subparagraph:
‘‘(C) In establishing the cost-sharing requirements, the
Secretary may not impose any copayment or cost-sharing
requirement with respect to the following:
‘‘(i) Refills of generic medications.
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‘‘(ii) Brand name medications determined by a
physician to be medically necessary.’’.
SEC. 703. AVAILABILITY UNDER TRICARE OF ANESTHESIA
FOR CHILDREN IN CONNECTION WITH DEN-
TAL PROCEDURES FOR WHICH DENTAL ANES-
THESIA IS INAPPROPRIATE.
Section 1079(a)(1) of title 10, United States Code, is
amended by inserting before the period at the end the fol-
lowing: ‘‘, except that, pursuant to such regulations as the
Secretary of Defense may prescribe, hospitalization and
professional services may be provided in connection with
the anesthesia of a child under the age of six years for a
dental procedure which, as determined by a qualified dental
specialist, is necessary’’.
SEC. 704. TRICARE COVERAGE FOR FORENSIC EXAMINA-
TIONS FOLLOWING SEXUAL ASSAULTS AND
DOMESTIC VIOLENCE.
Section 1079(a) of title 10, United States Code, is
amended by adding at the end the following new paragraph:
‘‘(17) Forensic examinations following a sexual
assault or domestic violence may be provided.’’.
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SEC. 705. PROHIBITION ON INCREASE IN FISCAL YEAR 2007
IN 
ENROLLMENT 
FEES 
FOR 
COVERAGE
UNDER TRICARE PRIME.
(a) PROHIBITION.—Fees charged for enrollment in
TRICARE Prime may not be increased during fiscal year
2007.
(b) TRICARE PRIME DEFINED.—In this section, the
term ‘‘TRICARE Prime’’ means the managed care option
of the TRICARE program.
SEC. 706. LIMITATION ON FISCAL YEAR 2007 INCREASE IN
PREMIUMS FOR COVERAGE UNDER TRICARE
OF MEMBERS OF RESERVE COMPONENTS
WHO COMMIT TO CONTINUED SERVICE IN SE-
LECTED RESERVE AFTER RELEASE FROM AC-
TIVE DUTY.
Any premium charged under subsection (d) of section
1076d of title 10, United States Code, for coverage under
TRICARE of members of reserve components who commit
to continued service in the Selected Reserve after release
from active duty, as authorized by subsection (a) of such
section, may not be increased during fiscal year 2007 by
an amount which exceeds 2.2 percent of such premium as
of September 30, 2006.
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SEC. 707. TEMPORARY PROHIBITION ON INCREASE IN CO-
PAYMENTS UNDER RETAIL PHARMACY SYS-
TEM OF PHARMACY BENEFITS PROGRAM.
Subsection (a)(6) of section 1074g of title 10, United
States Code, as amended by section 702(b) of this Act, is
further amended by adding at the end the following new
subparagraph:
‘‘(D) During the period beginning on October 1, 2006,
and ending on September 31, 2007, the cost sharing require-
ments established under this paragraph for pharmaceutical
agents available through retail pharmacies covered by para-
graph (2)(E)(ii) may not exceed amounts as follows:
‘‘(i) In the case of generic agents, $3.
‘‘(ii) In the case of formulary agents, $9.
‘‘(iii) In the case of nonformulary agents, $22.’’.
SEC. 708. EXPANSION OF ELIGIBILITY OF MEMBERS OF THE
SELECTED RESERVE FOR COVERAGE UNDER
TRICARE.
(a) IN GENERAL.—Subsection (a) of section 1076b of
title 10, United States Code, is amended—
(1) in paragraph (2), by striking ‘‘or’’ at the
end;
(2) in paragraph (3), by striking the period at
the end and inserting ‘‘; or’’; and
(3) by adding at the end the following new para-
graph:
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‘‘(4) is an employee of a business with 20 or
fewer employees.’’.
(b) PREMIUMS.—Subsection (e)(2) of such section is
amended by adding at the end the following new subpara-
graph:
‘‘(C) For members eligible under paragraph (4)
of subsection (a), the amount equal to 75 percent of
the total amount determined by the Secretary on an
appropriate actuarial basis as being reasonable for
the coverage.’’.
(c) EFFECTIVE DATE.—The amendments made by this
section shall take effect on October 1, 2006.
Subtitle B—Planning,
Programming, and Management
SEC. 721. TREATMENT OF TRICARE RETAIL PHARMACY NET-
WORK UNDER FEDERAL PROCUREMENT OF
PHARMACEUTICALS.
Section 1074g of title 10, United States Code, is
amended—
(1) by redesignating subsections (f) and (g) as
subsections (g) and (h), respectively; and
(2) by inserting after subsection (e) the following
new subsection (f):
‘‘(f) TRICARE RETAIL PHARMACY NETWORK.—The
TRICARE Retail Pharmacy Network under the TRICARE
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program shall be treated as an element of the Department
of Defense for purposes of the procurement of drugs by Fed-
eral agencies under section 8126 of title 38 in connection
with the provision by pharmacies in the Network of phar-
maceutical services to eligible covered beneficiaries under
this section.’’.
SEC. 722. RELATIONSHIP BETWEEN THE TRICARE PROGRAM
AND EMPLOYER-SPONSORED GROUP HEALTH
CARE PLANS.
(a) IN GENERAL.—Chapter 55 of title 10, United
States Code, is amended by inserting after section 1097b
the following new section:
‘‘§ 1097c. TRICARE program: relationship with em-
ployer-sponsored group health plans
‘‘(a) IN GENERAL.—(1) The TRICARE program is the
secondary payer for any health care services provided by
an employer to a TRICARE eligible employee of such em-
ployer, and the spouse of such employee, through any group
health plan offered by such employer.
‘‘(2) An employer shall provide that a TRICARE eligi-
ble employee of such employer, and the spouse of such em-
ployee, is entitled to benefits and services under the group
health plan offered by such employer in the same manner
and to the same extent as similarly situated employees of
such employer who are not TRICARE eligible employees.
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‘‘(3) An employer of a TRICARE eligible employee
may not establish any condition applicable to the partici-
pation of the employee in a group health plan offered by
such employer in connection with the entitlement of the em-
ployee for health care services under the TRICARE pro-
gram, including any condition on—
‘‘(A) the eligibility of the employee for participa-
tion in the plan; or
‘‘(B) benefits or services available to the em-
ployee under the plan.
‘‘(b) PROHIBITION ON INCENTIVES FOR TRICARE EL-
IGIBLE EMPLOYEES NOT TO ENROLL OR TO DISENROLL
IN GROUP HEALTH PLANS.—(1) An employer may not offer
a TRICARE eligible employee any financial or other benefit
(including health services coverage that is supplemental to
health services coverage under the TRICARE program) not
to enroll, or to disenroll, in the group health plan offered
by the employer in order to ensure that the TRICARE pro-
gram, rather than the plan, is the primary payer for health
care services received by the employee.
‘‘(2)(A) An employer who violates the prohibition in
paragraph (1) shall be liable to the United States for a civil
penalty in an amount not to exceed $5,000 for each viola-
tion.
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‘‘(B) Any amounts collected under this paragraph
shall be credited to the appropriation available for the
TRICARE program for the fiscal year in which such
amounts are collected.
‘‘(3)(A) Except as provided in subparagraph (B), the
provisions of section 1128A of the Social Security Act (42
U.S.C. 1320a–7a), other than subsections (a) and (b) of
such section 1128A, which provisions relate to procedures
for the imposition of civil money penalties for certain viola-
tions of the Social Security Act, shall apply to the imposi-
tion of penalties under paragraph (2).
‘‘(B) The Secretary of Defense may provide in the reg-
ulations prescribed under this section for the application
to the imposition of penalties under paragraph (2) of proce-
dural requirements specified in such regulations rather
than the procedural requirements referred to in subpara-
graph (A). Any procedural requirements under such regula-
tions shall be comparable to the procedural requirements
referred to in subparagraph (A).
‘‘(c) ELECTION OF TRICARE ELIGIBLE EMPLOYEES
TO PARTICIPATE IN GROUP HEALTH PLAN.—A TRICARE
eligible employee shall have the opportunity to elect to par-
ticipate in the group health plan offered by the employer
of the employee and receive primary coverage for health care
services under the plan in the same manner and to the same
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extent as similarly situated employees of such employer who
are not TRICARE eligible employees.
‘‘(d) INAPPLICABILITY TO CERTAIN EMPLOYERS.—The
provisions of this section do not apply to any employer who
has fewer than 20 employees.
‘‘(e) RETENTION
OF ELIGIBILITY
FOR COVERAGE
UNDER TRICARE.—Nothing in this section, including an
election made by a TRICARE eligible employee under sub-
section (c), shall be construed to effect, modify, or terminate
the eligibility of a TRICARE eligible employee or spouse
of such employee for health care or dental services under
this chapter in accordance with the other provisions of this
chapter.
‘‘(f) COLLECTION OF INFORMATION.—(1) To improve
the administration of this section, the Secretary of Defense
may utilize the authorities on collection of information set
forth in paragraphs (1) and (2) of section 1095(k) of this
title, including the authority in the second sentence of para-
graph (2) of such section.
‘‘(2) Information obtained pursuant to the use of the
authorities in paragraph (1) may not be disclosed for any
purpose of than to carry out the purpose of this section.
‘‘(g) OUTREACH.—The Secretary of Defense shall, in
coordination with the other administering Secretaries, con-
duct outreach to inform covered beneficiaries who are enti-
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tled to health care benefits under the TRICARE program
of the rights and responsibilities of such beneficiaries and
employers under this section.
‘‘(h) REGULATIONS.—The Secretary of Defense shall
prescribe regulations relating to the administration and en-
forcement of this section. The regulations shall be prescribed
in consultation with the other administering Secretaries
and the Attorney General, as appropriate.
‘‘(i) DEFINITIONS.—In this section:
‘‘(1) The term ‘employer’ includes a State or
unit of local government.
‘‘(2) The term ‘group health plan’ means a group
health plan (as that term is defined in section
5000(b)(1) of the Internal Revenue Code of 1986 with-
out regard to section 5000(d) of the Internal Revenue
Code of 1986).
‘‘(3) The term ‘primary payer’ means a group
health plan that provides a benefit that would be pri-
mary under section 1079(j)(1) or 1086(g) of this title.
‘‘(4) The term ‘secondary payer’ means a plan or
program whose medical benefits are payable only
after a primary payer has provided medical benefits
in accordance with applicable law and the plan of the
primary payer.
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‘‘(5) The term ‘TRICARE eligible employee’
means a covered beneficiary under section 1086 of
this title entitled to health care benefits under the
TRICARE program.
‘‘(j) EFFECTIVE DATE.—This section shall take effect
on January 1, 2008.’’.
(b) CLERICAL AMENDMENT.—The table of sections at
the beginning of chapter 55 of such title is amended by in-
serting after the item relating to section 1097b the following
new item:
‘‘1097c. TRICARE program: relationship with employer-sponsored group health
plans.’’.
SEC. 723. ENROLLMENT IN THE TRICARE PROGRAM.
(a) SYSTEM OF ENROLLMENT REQUIRED.—Chapter
55 of title 10, United States Code, is amended by inserting
after section 1097c, as added by section 722(a) of this Act,
the following new section:
‘‘§ 1097d. TRICARE program: system of enrollment
‘‘(a) ESTABLISHMENT OF SYSTEM.—Not later than
October 1, 2007, the Secretary of Defense shall establish a
universal system for enrollment of all beneficiaries who ob-
tain health care services from military medical treatment
facilities or civilian health care providers under the
TRICARE program (in this section referred to as ‘partici-
pating beneficiaries’).
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‘‘(b) PURPOSES OF SYSTEM.—The purposes of the sys-
tem required by subsection (a) shall be as follows:
‘‘(1) To ensure the efficient administration of
benefits under the TRICARE program, including the
Standard option of TRICARE.
‘‘(2) To ensure that the geographic distribution
of healthcare providers under the TRICARE program
meets the needs of participating beneficiaries for
ready access to health care services under the pro-
gram.
‘‘(3) To promote the implementation of disease
management and chronic care management programs
authorized by the National Defense Authorization Act
for Fiscal Year 2007 and other provisions of law.
‘‘(c) ELEMENTS.—The system required by subsection
(a) shall be subject to the following:
‘‘(1) Enrollment is required for all benefits op-
tions under the TRICARE program.
‘‘(2) A one-time enrollment fee (in the amount of
$25, in the case of an individual enrolling in self only
coverage, or $40, in the case of an individual enroll-
ing in self and family coverage) may be collected for
all participating beneficiaries who utilize the Stand-
ard option of TRICARE, except that such enrollment
fee may not be collected from the following:
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‘‘(A) Dependents of members of the armed
forces on active duty.
‘‘(B) Dependents of Reserves on extended ac-
tive duty pursuant to a call or order to active
duty of 30 days or more.
‘‘(C) Participating beneficiaries who are
also eligible for benefits under the Medicare pro-
gram under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).
‘‘(D) Participating beneficiaries enrolled in
TRICARE Reserve Select under section 1076d of
this title.
‘‘(3) Enrollment in the system may occur at any
time.
‘‘(4) Enrollment in the system shall be by a vari-
ety of means utilizing a standard format.
‘‘(d) ADMINISTRATION.—The Secretary shall provide
for the administration of the system in each region of the
TRICARE program by the TRICARE Regional Director
for such region.
‘‘(e) HEALTH RISK ASSESSMENT.—(1) The Secretary
of Defense shall provide to each participating beneficiary
who enrolls in the system required by subsection (a) a health
risk assessment not later than 120 days after the date of
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the enrollment of such participating beneficiary in the sys-
tem.
‘‘(2) The Secretary shall provide health risk assess-
ments under paragraph (1) by any means that the Sec-
retary considers appropriate for purposes of this section.
‘‘(f) CONSEQUENCES OF LACK OF PAYMENT OF EN-
ROLLMENT FEE.—(1) In the case of any participating bene-
ficiary who is subject to the payment of an enrollment fee
under the authority in subsection (c)(2), payment of the en-
rollment fee shall, except as provided in paragraph (2), be
a condition for receipt of benefits under the TRICARE pro-
gram.
‘‘(2) The Secretary of Defense may waive the applica-
bility of paragraph (1) to any participating beneficiary or
class of participating beneficiaries if the Secretary deter-
mines that the waiver is in the best interests of the United
States.
‘‘(g) COMMUNICATIONS
AND OUTREACH WITH EN-
ROLLEES.—(1) The Secretary of Defense shall, on a periodic
basis but not less often than annually, provide to partici-
pating beneficiaries who are enrolled in the system required
by subsection (a) information on current matters relating
to the TRICARE program, including information on bene-
fits available under the TRICARE program and informa-
tion on preventive health care services and other practices
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intended to promote health and wellness among such par-
ticipating beneficiaries.
‘‘(2) The Secretary shall, on a periodic basis, conduct
surveys or otherwise collect information on participating
beneficiaries enrolled in the system with respect to the fol-
lowing:
‘‘(A) The satisfaction of such beneficiaries who
are participants in the option of the TRICARE pro-
gram known as TRICARE Standard with the nature
and scope of, and access to, health care services under
that option.
‘‘(B) Other health care insurance, if any, that is
available to such beneficiaries.
‘‘(C) Any other matters that the Secretary con-
siders appropriate to improve health care benefits and
access to health care services under the TRICARE
program.
‘‘(h) CONSULTATION.—The Secretary of Defense shall
carry out this section in consultation with the other admin-
istering Secretaries.’’.
(b) COMPTROLLER GENERAL REPORT ON SYSTEM.—
Not later than September 15, 2007, the Comptroller General
of the United States shall submit to the congressional de-
fense committees a report on the system of enrollment re-
quired by section 1097d of title 10, United States Code (as
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added by subsection (a)). The report shall include the fol-
lowing:
(1) An assessment of the progress made toward
implementation of the system.
(2) A description and assessment of the integra-
tion of the system with the regional business plan of
the TRICARE Regional Offices.
(3) An assessment of the readiness of the Depart-
ment to implement the system by October 1, 2007.
(c) REPEAL OF SUPERSEDED AUTHORITY.—Section
1099 of title 10, United States Code, is repealed.
(d) CLERICAL AMENDMENTS.—The table of sections at
the beginning of chapter 55 of such title is amended—
(1) by inserting after the item relating to section
1097c, as added by section 722(b) of this Act, the fol-
lowing new item:
‘‘1097d. TRICARE program: system of enrollment.’’;
and
(2) by striking the item relating to section 1099.
SEC. 724. INCENTIVE PAYMENTS FOR THE PROVISION OF
SERVICES UNDER THE TRICARE PROGRAM IN
MEDICALLY UNDERSERVED AREAS.
(a) IN GENERAL.—Chapter 55 of title 10, United
States Code, is amended by inserting after section 1097d,
as added by section 723(a) of this Act, the following new
section:
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‘‘§ 1097e. TRICARE program: incentive payments for
provision of services in medically under-
served areas
‘‘(a) INCENTIVE PAYMENTS AUTHORIZED.—(1) Com-
mencing with the calendar quarter beginning on January
1, 2008, the Secretary of Defense, after consultation with
the other administering Secretaries, shall make incentive
payments under this section to physicians participating in
the TRICARE program in a medically underserved area.
‘‘(2) Incentive payments payable under this section
shall be paid with respect to physician professional services
furnished in medically underserved areas.
‘‘(3) The incentive payment payable under this section
with respect to a physician professional service is in addi-
tion to any other amounts payable for such service under
the TRICARE program.
‘‘(b) MEDICALLY UNDERSERVED AREA.—For purposes
of this section, a medically underserved area is either of
the following:
‘‘(1) A primary care scarcity county (with re-
spect to a primary care physician) or specialist care
scarcity county (with respect to any other physician)
identified by the Secretary of Health and Human
Services under section 1833(u)(4) of the Social Secu-
rity Act (42 U.S.C. 1395l(u)(4)).
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‘‘(2) A health professional shortage area identi-
fied by the Secretary of Health and Human Services
under section 1833(m)(1) of the Social Security Act
(42 U.S.C. 1395l(m)(1)).
‘‘(c) AMOUNT OF INCENTIVE PAYMENT.—The amount
of the incentive payment payable under subsection (a) with
respect to a physician professional service is as follows:
‘‘(1) In the case of a service furnished by a pri-
mary care physician in a primary care scarcity
county or a service furnished by any other physician
in a specialist care scarcity county covered by sub-
section (b)(1), an amount equal to 5 percent of the
amount payable for the service under the TRICARE
program.
‘‘(2) In the case of a service furnished in an area
covered by subsection (b)(2), an amount equal to 10
percent of the amount payable for the service under
the TRICARE program.
‘‘(3) In the case of a service provided in a loca-
tion that is covered by both paragraphs (1) and (2)
of subsection (b), an amount equal to 15 percent of
the amount payable for the service under the
TRICARE program.
‘‘(d) LOCATION OF PROVISION OF SERVICE.—(1) For
purposes of identifying the location in which a physician
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professional service is furnished for purposes of this section,
the Secretary of Defense shall use the 5-digit postal ZIP
code system.
‘‘(2) If the 5-digit postal ZIP code for an area covers
more than one county, the dominant county (as determined
by the United States Postal Service or otherwise) shall be
used to determine whether the postal ZIP code is in a scar-
city county covered by subsection (b)(1).
‘‘(e) FREQUENCY OF PAYMENT.—Incentive payments
payable under this section shall be paid on a quarterly basis
for incentive payments accrued during the previous cal-
endar quarter.
‘‘(f) REGULATIONS.—The Secretary of Defense, in con-
sultation with the other administering Secretaries, shall
prescribe regulations for the administration of this sec-
tion.’’.
(b) CLERICAL AMENDMENT.—The table of sections at
the beginning of chapter 55 of such title, as amended by
section 723(d)(1) of this Act, is further amended by insert-
ing after the item relating to section 1097d the following
new item:
‘‘1097e. TRICARE program: incentive payments for provision of services in medi-
cally underserved areas.’’.
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SEC. 725. STANDARDIZATION OF CLAIMS PROCESSING
UNDER TRICARE PROGRAM AND MEDICARE
PROGRAM.
(a) IN GENERAL.—Effective October 1, 2007, the
claims processing requirements under the TRICARE pro-
gram on the matters described in subsection (b) shall be
identical to the claims processing requirements under the
Medicare program on such matters.
(b) COVERED MATTERS.—The matters described in
this subsection are as follows:
(1) The utilization of single or multiple provider
identification numbers for purposes of the payment of
health care claims by Department of Defense contrac-
tors.
(2) The documentation required to substantiate
medical necessity for items and services that are cov-
ered under both the TRICARE program and the
Medicare program.
(c) IMMEDIATE
COLLECTION
FROM
THIRD-PARTY
PAYERS.—
(1) POLICY REQUIRED.—The Secretary of De-
fense, in consultation with the other administering
Secretaries, shall prescribe in regulations a policy for
the collection of amounts from third-party payers as
authorized by section 1095 of title 10, United States
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Code, immediately upon the presentation of claims for
health care services to the Department of Defense.
(2) OVERPAYMENT.—The policy required by sub-
section 
(a) 
shall 
include 
mechanisms 
for 
the
recoupment by third-party payers of amounts over-
paid to the United States under the policy.
(d) ANNUAL
REPORTS
ON
CLAIMS
PROCESSING
STANDARDIZATION.—
(1) IN
GENERAL.—Not later than October 1,
2007, and annually thereafter, the Secretary of De-
fense shall submit to the congressional defense com-
mittees a report setting forth a complete list of the
claims processing requirements under the TRICARE
program that differ from claims processing require-
ments under the Medicare program.
(2) ELEMENTS.—Each report under paragraph
(1) shall include, for each claims processing require-
ment listed in such report, a business case that justi-
fies 
maintaining 
such 
requirement 
under 
the
TRICARE program as a different claims processing
requirement than that required under the Medicare
program.
(e) DEFINITIONS.—In this section:
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(1) The term ‘‘administering Secretaries’’ has the
meaning given that term in section 1072(3) of title
10, United States Code.
(2) The term ‘‘Medicare program’’ means the
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(3) The term ‘‘TRICARE program’’ has the
meaning given that term in section 1072(7) of title
10, United States Code.
SEC. 726. REQUIREMENTS FOR SUPPORT OF MILITARY
TREATMENT FACILITIES BY CIVILIAN CON-
TRACTORS UNDER TRICARE.
(a) ANNUAL INTEGRATED REGIONAL REQUIREMENTS
ON SUPPORT.—The Regional Director of each region under
the TRICARE program shall develop each year integrated,
comprehensive requirements for the support of military
treatment facilities in such region that is provided by con-
tract civilian health care and administrative personnel
under the TRICARE program.
(b) PURPOSES.—The purposes of the requirements es-
tablished under subsection (a) shall be as follows:
(1) To ensure consistent standards of quality in
the support of military treatment facilities by con-
tract civilian health care personnel under the
TRICARE program.
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(2) To identify targeted, actionable opportunities
throughout each region of the TRICARE program for
the most efficient delivery of health care and support
of military treatment facilities.
(3) To ensure the most effective use of various
available contracting methods in securing support of
military treatment facilities by civilian personnel
under the TRICARE program, including resource-
sharing and clinical support agreements, direct con-
tracting, and venture capital investments.
(4) To achieve savings targets for each region
under the TRICARE program.
(c) FACILITATION
AND
ENHANCEMENT
OF
CON-
TRACTOR SUPPORT.—
(1) IN GENERAL.—The Secretary of Defense shall
take appropriate actions to facilitate and enhance the
support of military treatment facilities under the
TRICARE program in order to assure maximum
quality and productivity.
(2) ACTIONS.—In taking actions under para-
graph (1), the Secretary shall—
(A) ensure approval by a Regional Director
of all proposals for the support of military treat-
ment facilities in the region concerned in accord-
ance with the most current requirements estab-
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lished by such Regional Director under sub-
section (a);
(B) ensure the availability of adequate and
sustainable funding support for projects which
produce a return on investment to the military
treatment facilities;
(C) ensure that a portion of any return on
investment is returned to the military treatment
facility to which such savings are attributable;
(D) require consistent standards of quality
for contract civilian health care personnel pro-
viding support of military treatment facilities
under the TRICARE program, including—
(i) consistent credentialing require-
ments among military treatment facilities;
and
(ii) accreditation of health care staff-
ing firms by the Joint Commission on the
Accreditation of Health Care Organization
Health Care Staffing Standards;
(E) remove financial disincentives for mili-
tary treatment facilities and civilian contractors
to initiate and sustain agreements for the sup-
port of military treatment facilities by such con-
tractors under the TRICARE program;
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(F) provide for a consistent process across
all regions of the TRICARE program for devel-
oping cost benefit analyses of agreements for the
support of military treatment facilities by civil-
ian contractors under the TRICARE program
based on actual cost and utilization data within
each region of the TRICARE program; and
(G) provide for a system for tracking the
performance of each project for support of mili-
tary treatment facilities by a civilian contractor
under the TRICARE program.
(d) REPORTS TO CONGRESS.—
(1) ANNUAL
REPORTS
REQUIRED.—Not later
than February 1 each year, the Secretary shall submit
to the congressional defense committees a report on
the support of military treatment facilities by civilian
contractors under the TRICARE program during the
preceding fiscal year.
(2) ELEMENTS.—Each report shall set forth, for
the fiscal year covered by such report, the following:
(A) The status of the support of military
health treatment facilities that is provided by
contract civilian health care personnel under the
TRICARE program in each region of the
TRICARE program.
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(B) An assessment of the compliance of such
support with regional requirements under sub-
section (a).
(C) The number and type of agreements for
the support of military treatment facilities by
contract civilian health care personnel.
(D) The standards of quality in effect under
the requirements under subsection (a).
(E) The savings anticipated, and any sav-
ings achieved, as a result of the implementation
of the requirements under subsection (a).
SEC. 727. UNIFORM STANDARDS FOR ACCESS TO HEALTH
CARE SERVICES FOR WOUNDED OR INJURED
SERVICEMEMBERS.
(a) UNIFORM STANDARDS REQUIRED.—The Secretary
of Defense shall prescribe in regulations uniform standards
for the access of wounded or injured members of the Armed
Forces to health care services through the military health
care system.
(b) MATTERS COVERED BY STANDARDS.—The stand-
ards required by subsection (a) shall establish uniform pol-
icy with respect to the following:
(1) The access of wounded or injured members of
the Armed Forces to emergency care.
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(2) The access of such members to surgical serv-
ices.
(3) Waiting times for referrals and consultations
of such members by medical personnel, dental per-
sonnel, mental health specialists, and rehabilitative
service specialists, including personnel and specialists
with expertise in prosthetics and the in treatment of
head, vision, and spinal cord injuries.
(4) Waiting times of such members for acute care
and for routine follow-up care.
(c) REFERRAL
TO PROVIDERS OUTSIDE MILITARY
HEALTH CARE SYSTEM.—To the extent practicable, the
Secretary shall require in the standards under subsection
(a) that the standards be met through whatever means or
mechanisms possible, including through the referral of mem-
bers described in that subsection to health care providers
outside the military health care system.
(d) TRACKING OF PERFORMANCE.—The standards re-
quired by subsection (a) shall require each Secretary con-
cerned to establish mechanisms for tracking the performance
of the military health care system under the jurisdiction
of such Secretary in meeting the requirements for access of
wounded or injured members of the Armed Forces to health
care services set forth in such standards.
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(e) SECRETARY CONCERNED DEFINED.—In this sec-
tion, the term ‘‘Secretary concerned’’ has the meaning given
that term in section 101(a) of title 10, United States Code.
SEC. 728. DISEASE AND CHRONIC CARE MANAGEMENT.
(a) PROGRAM REQUIRED.—Not later than October 1,
2007, the Secretary of Defense shall establish and imple-
ment throughout the military health care system a fully-
integrated program on disease and chronic care manage-
ment that provides, to the extent practicable, uniform poli-
cies and practices, and regional execution of such policies
and practices, on disease management and chronic care
management throughout that system, including both mili-
tary hospitals and clinics and civilian healthcare providers.
(b) PURPOSES OF PROGRAM.—The purposes of the pro-
gram required by subsection (a) are as follows:
(1) To facilitate the improvement of the health
status of individuals under care in the military
health care system.
(2) To ensure the availability of effective health
care services in that system for individuals with dis-
eases and other chronic conditions.
(3) To ensure the proper allocation of health care
resources for individuals who need care for disease or
other chronic conditions.
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(c) ELEMENTS.—The program required by subsection
(a) shall meet the following requirements:
(1) Based on uniform policies prescribed by the
Secretary under subsection (a), the program shall, at
a minimum, address the following chronic diseases
and conditions:
(A) Diabetes.
(B) Cancer.
(C) Heart disease.
(D) Asthma.
(E) Chronic obstructive pulmonary dis-
order.
(F) Depression and anxiety disorders.
(2) The program shall meet nationally-recog-
nized accreditation standards for disease and chronic
care management.
(3) The program shall include specific outcome
measures and objectives on disease and chronic care
management.
(4) The program shall include strategies for dis-
ease and chronic care management for all bene-
ficiaries, including beneficiaries eligible for benefits
under the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), for
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whom the TRICARE program is not the primary
payer for health care benefits.
(5) Activities under the program shall conform
to applicable laws and regulations relating to the con-
fidentiality of health care information.
(d) DESIGN OF CERTAIN PORTIONS OF PROGRAM.—
As part of the program required under subsection (a), the
Secretary may contract for the design of a disease and
chronic care management program for the military health
care system.
(e) ACTIONS TO FACILITATE PROGRAM.—In order to
facilitate the carrying out of the program required by sub-
section (a), the Secretary shall—
(1) require a comprehensive analysis of the dis-
ease and chronic care management opportunities
within each region of the TRICARE program, includ-
ing within military treatment facilities and through
contractors under the TRICARE program;
(2) ensure continuous, adequate funding of dis-
ease and chronic care management activities through-
out the military health care system in order to
achieve maximum health outcomes and cost avoid-
ance;
(3) eliminate, to the extent practicable, any fi-
nancial disincentives to sustained investment by mili-
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tary hospitals and health care services contractors of
the Department of Defense in the disease and chronic
care management activities of the Department;
(4) ensure that appropriate clinical and claims
data, including pharmacy utilization data, is avail-
able for use in implementing the program;
(5) ensure outreach to eligible beneficiaries, who,
on the basis of their clinical conditions, are can-
didates for the program utilizing print and electronic
media, telephone, and personal interaction; and
(6) provide a system for monitoring improve-
ments in health status and clinical outcomes under
the program and savings associated with the pro-
gram.
(f) COMPTROLLER GENERAL REPORT.—Not later than
September 15, 2007, the Comptroller General of the United
States shall submit to the congressional defense committees
a report on the program required by subsection (a). The
report shall include the following:
(1) An assessment of the progress made toward
implementation of the program.
(2) A description and assessment of the integra-
tion of disease and chronic care management strate-
gies in the regional business plan of the TRICARE
Regional Offices.
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(3) An assessment of the readiness of the Depart-
ment to implement the program by October 1, 2007.
(g) SECRETARY OF DEFENSE REPORTS.—
(1) IN GENERAL.—Not later than January 1,
2008, and every year thereafter, the Secretary shall
submit to the congressional defense committees a re-
port on the program required by subsection (a).
(2) REPORT ELEMENTS.—Each report required
by this subsection shall include the following:
(A) An assessment of the program during
the one-year period ending on the date of such
report.
(B) A description and assessment of im-
provements in health status and clinical out-
comes.
(C) A description of the savings and return
on investment associated with the program.
(D) A description of an investment strategy
to assure the sustainment of the disease and
chronic care management programs of the De-
partment of Defense.
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SEC. 729. POST-DEPLOYMENT HEALTH ASSESSMENTS FOR
MEMBERS OF THE ARMED FORCES RETURN-
ING FROM DEPLOYMENT IN SUPPORT OF A
CONTINGENCY OPERATION.
(a) IN GENERAL.—Not later than 60 days after the
date of the enactment of this Act, the Secretary of Defense
shall prescribe in regulations requirements applicable to the
conduct of post-deployment health assessments for members
of the Armed Forces returning from deployment in support
of a contingency operation.
(b) GENERAL REQUIREMENTS.—The regulations pre-
scribed under subsection (a) shall require the following:
(1) That a health assessment be conducted on
each member of the Armed Forces returning from de-
ployment in support of a contingency operation with-
in such time after the return of such member from de-
ployment as the Secretary shall specify in the regula-
tions.
(2) That each health assessment be conducted by
a healthcare provider having such qualifications as
the Secretary shall specify in the regulations.
(3) That each health assessment assess such
health-related matters as the Secretary shall specify
in the regulations, including an assessment of mental
health (including Traumatic Brain Injury (TBI)) for
referral of a member for further evaluation relating to
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mental health (including evaluation of the effects of
combat or operational stress).
(4) That the results of each health assessment be
stored in a centralized data base maintained by the
Secretary under this section.
(c) ASSESSMENTS OF MENTAL HEALTH.—
(1) CRITERIA
FOR
REFERRAL
FOR
FURTHER
EVALUATIONS.—The regulations prescribed under sub-
section (a) shall include—
(A) criteria to be utilized by healthcare pro-
viders in determining whether to refer a member
of the Armed Forces for further evaluation relat-
ing to mental health (including Traumatic
Brain Injury);
(B) mechanisms to ensure that healthcare
providers are trained in the application of such
criteria in making such determinations; and
(C) mechanisms for oversight to ensure that
healthcare providers apply such criteria consist-
ently.
(2) AVAILABILITY
OF
REFERRAL.—Under the
regulations, a copy of a referral of a member for fur-
ther evaluation relating to mental health shall be—
(A) provided to the member;
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(B) placed in the healthcare record of the
member that is maintained by the Department of
Defense; and
(C) provided to the healthcare manager of
the member.
(3) TRACKING
MECHANISMS.—The regulations
shall include mechanisms to ensure that a member
who receives a referral for further evaluation relating
to mental health receives such evaluation and obtains
such care and services as are warranted.
(4) QUALITY ASSURANCE.—The regulations shall
include a requirement that the Department address,
as part of the deployment health assessment quality
assurance program of the Department, the following:
(A) The types of healthcare providers con-
ducting post-deployment health assessments.
(B) The training received by such providers
applicable to the conduct of such assessments, in-
cluding training on assessments and referrals re-
lating to mental health.
(C) The guidance available to such pro-
viders on how to apply the criteria prescribed
under paragraph (1)(A) in determining whether
to make a referral for further evaluation of a
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member of the Armed Forces relating to mental
health.
(D) The effectiveness of the tracking mecha-
nisms required under paragraph (3) in ensuring
that members who receive referrals for further
evaluations relating to mental health receive such
evaluations and obtain such care and services as
are warranted.
(d) COMPTROLLER GENERAL REPORTS ON IMPLEMEN-
TATION OF REQUIREMENTS.—
(1) STUDY
ON
IMPLEMENTATION.—The Comp-
troller General of the United States shall carry out a
study of the implementation of the requirements pre-
scribed under this section.
(2) PERIODIC EVALUATION OF MENTAL HEALTH
ASSESSMENT PROCESSES.—The Comptroller General
shall, on a periodic basis, evaluate the following:
(A) The compliance of the Department of
Defense and healthcare providers with the re-
quirements under this section applicable to the
assessment and referral of members of the Armed
Forces relating to mental health.
(B) The effectiveness of the processes under
such requirements in addressing the mental
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health care needs of members returning from de-
ployments overseas.
(3) REPORTS.—(A) Not later than March 1,
2007, the Comptroller General shall submit to the
Committees on Armed Services of the Senate and the
House of Representatives a report on the study car-
ried out under paragraph (1).
(B) Upon completion of an evaluation under
paragraph (2), the Comptroller General shall submit
to the committees of Congress referred to in subpara-
graph (A) a report on such evaluation.
(e) CONTINGENCY OPERATION DEFINED.—In this sec-
tion, the term ‘‘contingency operation’’ has the meaning
given that term in section 101(a)(13) of title 10, United
States Code.
SEC. 730. MENTAL HEALTH SELF-ASSESSMENT PROGRAM.
(a) FINDING.—Congress finds that the Mental Health
Self-Assessment Program (MHSAP) of the Department of
Defense is vital to the overall health and well-being of de-
ploying members of the Armed Forces and their families
because that program provides—
(1) a non-threatening, voluntary, anonymous
self-assessment of mental health that is effective in
helping to detect mental health and substance abuse
conditions;
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(2) awareness regarding warning signs of such
conditions; and
(3) information and outreach to members of the
Armed Forces (including members of the National
Guard and Reserves) and their families on specific
services available for such conditions.
(b) EXPANSION OF PROGRAM.—The Secretary of De-
fense shall, acting through the Office of Health Affairs of
the Department of Defense, take appropriate actions to ex-
pand the Mental Health Self-Assessment Program in order
to achieve the following:
(1) The continuous availability of the assessment
under the program to members and former members
of the Armed Forces in order to ensure the long-term
availability of the diagnostic mechanisms of the as-
sessment to detect mental health conditions that may
emerge over time.
(2) The availability of programs and services
under the program to address the mental health of de-
pendent children of members of the Armed Forces who
have been deployed or mobilized.
(c) OUTREACH.—The Secretary shall develop and im-
plement a plan to conduct outreach and other appropriate
activities to expand and enhance awareness of the Mental
Health Self-Assessment Program, and the programs and
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services available under that program, among members of
the Armed Forces (including members of the National
Guard and Reserves) and their families.
(d) REPORTS.—Not later than one year after the date
of the enactment of this Act, the Secretary shall submit to
Congress a report on the actions undertaken under this sec-
tion during the one-year period ending on the date of such
report.
SEC. 731. ADDITIONAL AUTHORIZED OPTION PERIODS FOR
EXTENSION OF CURRENT CONTRACTS UNDER
TRICARE.
(a) ADDITIONAL NUMBER
OF AUTHORIZED PERI-
ODS.—
(1) IN
GENERAL.—The Secretary of Defense,
after consulting with the other administering Secre-
taries, may extend any contract for the delivery of
health care entered into under section 1097 of title 10,
United States Code, that is in force on the date of the
enactment of this Act by one year, and upon expira-
tion of such extension by one additional year, if the
Secretary determines that such extension—
(A) is in the best interests of the United
States; and
(B) will—
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(i) facilitate the effective administra-
tion of the TRICARE program; or
(ii) ensure continuity in the delivery of
health care under the TRICARE program.
(2) LIMITATION ON NUMBER OF EXTENSIONS.—
The total number of one-year extensions of a contract
that may be granted under paragraph (1) may not
exceed 2 extensions.
(3) NOTICE AND WAIT.—The Secretary may not
commence the exercise of the authority in paragraph
(1) until 30 days after the date on which the Sec-
retary submits to the congressional defense committees
a report setting forth the minimum level of perform-
ance by an incumbent contractor under a contract
covered by such paragraph that will be required by
the Secretary in order to be eligible for an extension
authorized by such paragraph.
(4) DEFINITIONS.—In this subsection, the terms
‘‘administering Secretaries’’ and ‘‘TRICARE pro-
gram’’ have the meaning given such terms in section
1072 of title 10, United States Code.
(b) REPORT
ON CONTRACTING MECHANISMS
FOR
HEALTH CARE SERVICE SUPPORT CONTRACTS.—Not later
than 180 days after the date of the enactment of this Act,
the Secretary shall submit to the congressional defense com-
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mittees a report on contracting mechanisms under consider-
ation for future contracts for health care service support
under section 1097 of title 10, United States Code. The re-
port shall include an assessment of the advantages and dis-
advantages for the Department of Defense (including the po-
tential for stimulating competition and the effect on health
care beneficiaries of the Department) of providing in such
contracts for a single term of 5 years, with a single optional
period of extension of an additional 5 years if performance
under such contract is rated as ‘‘excellent’’.
SEC. 732. MILITARY VACCINATION MATTERS.
(a) ADDITIONAL ELEMENT FOR COMPTROLLER GEN-
ERAL STUDY AND REPORT ON VACCINE HEALTHCARE CEN-
TERS.—Section 736(b) of the National Defense Authoriza-
tion Act for Fiscal Year 2006 (Public Law 109–163; 119
Stat. 3356) is amended by adding at the end the following
new paragraph:
‘‘(10) The feasibility and advisability of trans-
ferring direct responsibility for the Centers from the
Army Medical Command to the Under Secretary of
Defense for Personnel and Readiness and the Assist-
ant Secretary of Defense for Force Protection and
Readiness.’’.
(b) RESPONSE TO MEDICAL NEEDS ARISING FROM
MANDATORY MILITARY VACCINATIONS.—
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(1) IN GENERAL.—The Secretary of Defense shall
maintain a joint military medical center of excellence
focusing on the medical needs arising from manda-
tory military vaccinations.
(2) ELEMENTS.—The joint military medical cen-
ter of excellence under paragraph (1) shall consist of
the following:
(A) The Vaccine Healthcare Centers of the
Department of Defense, which shall be the prin-
cipal elements of the center.
(B) Any other elements that the Secretary
considers appropriate.
(3) AUTHORIZED ACTIVITIES.—In acting as the
principal elements of the joint military medical cen-
ter under paragraph (1), the Vaccine Healthcare Cen-
ters referred to in paragraph (2)(A) may carry out
the following:
(A) Medical assistance and care to individ-
uals receiving mandatory military vaccines and
their dependents, including long-term case man-
agement for adverse events where necessary.
(B) Evaluations to identify and treat poten-
tial and actual health effects from vaccines before
and after their use in the field.