H. R. 1815—218
(5) the use of flexible spending accounts and health savings 
accounts for military retirees under the age of 65; 
(6) incentives for eligible beneficiaries of the military health 
care system to retain private employer-provided health care 
insurance; 
(7) means of improving integrated systems of disease 
management, including chronic illness management; 
(8) means of improving the safety and efficiency of phar-
macy benefits management; 
(9) the management of enrollment options for categories 
of eligible beneficiaries in the military health care system; 
(10) reform of the provider payment system, including the 
potential for use of a pay-for-performance system in order to 
reward quality and efficiency in the TRICARE system; 
(11) means of improving efficiency in the administration 
of the TRICARE program, to include the reduction of head-
quarters and redundant management layers, and maximizing 
efficiency in the claims processing system; 
(12) other improvements in the efficiency of the military 
health care system; and 
(13) any other matters the Secretary considers appropriate 
to improve the efficiency and quality of military health care 
benefits. 
SEC. 734. COMPTROLLER GENERAL STUDIES AND REPORT ON DIF-
FERENTIAL PAYMENTS TO CHILDREN’S HOSPITALS FOR 
HEALTH CARE FOR CHILDREN DEPENDENTS AND MAX-
IMUM ALLOWABLE CHARGE FOR OBSTETRICAL CARE 
SERVICES UNDER TRICARE. 
(a) STUDIES REQUIRED.—The Comptroller General of the United 
States shall conduct the following studies: 
(1) A study of the effectiveness of the current system of 
differential payments to children’s hospitals for health care 
services for dependent children of members of the uniformed 
services under the TRICARE program in achieving the objective 
of securing adequate health care services for such dependent 
children under that program. 
(2) A study of the effectiveness of the TRICARE program 
in achieving the objective of adequate access to high quality 
obstetrical care services for family members of members of 
the uniformed services. 
(b) ELEMENTS OF CHILDREN’S HOSPITALS STUDY.—The study 
required by subsection (a)(1) shall include the following: 
(1) A description of the current participation of children’s 
hospitals in the TRICARE program. 
(2) An assessment of the current system of payments to 
children’s hospitals under the TRICARE program, including 
differential payments to such hospitals for health care services 
described in subsection (a)(1), including an assessment of—
(A) the extent to which the calculation of such differen-
tial payments takes into account the complexity and 
extraordinary resources required for the provision of such 
health care services; 
(B) the extent to which TRICARE payment rates, 
including the children’s hospital differential, have kept pace 
with inflation in health care costs for children’s hospitals 
since the establishment of the differential in 1988;
H. R. 1815—219
(C) the extent to which such differential payments 
provide appropriate compensation to such hospitals for the 
provision of such services; and 
(D) any obstacles or challenges to the development 
of future modifications to the system of differential pay-
ments. 
(3) An assessment of the adequacy of, including any barrier 
to, the access of dependent children described in subsection 
(a)(1) to specialized hospital services for their illnesses under 
the TRICARE program. 
(c) ELEMENTS OF OBSTETRICAL CARE SERVICES STUDY.—The 
study required by subsection (a)(2) shall include the following: 
(1) A description of the current participation of civilian 
providers of obstetrical care services in the TRICARE program. 
(2) An assessment of the current system of payments for 
obstetrical care services, including an assessment of—
(A) the extent to which the calculation of such pay-
ments takes into account the complexity and resources 
required; 
(B) the extent to which TRICARE payment rates have 
kept pace with inflation in health care costs; 
(C) the extent to which such payments provide appro-
priate compensation to providers of such services; and 
(D) obstacles or challenges to the development of future 
improvements to access to high quality obstetrical services, 
including referral patterns and inclusion of all necessary 
services within the maximum allowable charge. 
(3) An assessment of the adequacy of the access of military 
family members to needed obstetrical care services. 
(d) REPORT.—Not later than May 1, 2006, the Comptroller 
General shall submit to the Secretary of Defense and the congres-
sional defense committees a report on the studies required by 
subsection (a), together with such recommendations, if any, as 
the Comptroller General considers appropriate for modifications 
of the current system of differential payments to children’s hospitals 
and payments for obstetrical care services in order to achieve the 
objectives described in that subsection. 
(e) TRANSMITTAL TO CONGRESS.—
(1) IN GENERAL.—Not later than November 1, 2006, the 
Secretary of Defense shall transmit to the congressional defense 
committees the report submitted by the Comptroller General 
to the Secretary under subsection (d). 
(2) IMPLEMENTATION
OF
MODIFICATIONS.—If the report 
under paragraph (1) includes recommendations of the Comp-
troller General for modifications of the current system of dif-
ferential payments to children’s hospitals or of payments for 
obstetrical care services, the Secretary shall transmit with the 
report—
(A) a proposal for such legislative or administration 
action as may be required to implement such modifications; 
and 
(B) an assessment and estimate of the costs associated 
with the implementation of such modifications. 
(f) DEFINITIONS.—In this section: 
(1) DIFFERENTIAL PAYMENTS TO CHILDREN’S HOSPITALS.—
The term ‘‘differential payments to children’s hospitals’’ means 
the additional amounts paid to children’s hospitals under the
H. R. 1815—220
TRICARE program for health care procedures for severely ill 
children in order to take into account the additional costs 
associated with such procedures for such children when com-
pared with the costs associated with such procedures for adults 
and other children. 
(2) PAYMENTS
FOR
OBSTETRICAL
CARE.—The term ‘‘pay-
ments for obstetrical care services’’ means the maximum allow-
able payment rates established by the Department of Defense 
under the TRICARE program for routine obstetrical care, 
including prenatal care, laboratory tests in accordance with 
accepted obstetrical practices standards, specialty care if 
needed, delivery, and post-partum maternal care. 
(3) TRICARE PROGRAM.—The term ‘‘TRICARE program’’ has 
the meaning given that term in section 1072(7) of title 10, 
United States Code. 
SEC. 735. REPORT ON THE DEPARTMENT OF DEFENSE AHLTA GLOBAL 
ELECTRONIC HEALTH RECORD SYSTEM. 
(a) REPORT REQUIRED.—Not later than six months after the 
date of the enactment of this Act, the Secretary of Defense shall 
submit to the appropriate committees of Congress a report on 
the Department of Defense AHLTA global electronic health record 
system. 
(b) REPORT ELEMENTS.—The report under subsection (a) shall 
include the following: 
(1) A chronology and description of previous efforts under-
taken to develop an electronic medical records system capable 
of maintaining a two-way exchange of data between the Depart-
ment of Defense and the Department of Veterans Affairs. 
(2) The plans as of the date of the report, including any 
projected commencement dates, for the implementation of the 
AHLTA global electronic health record system. 
(3) A description of the software and hardware being consid-
ered as of the date of the report for use in the AHLTA global 
electronic health record system. 
(4) A description of the management structure used in 
the development of the AHLTA global electronic health record 
system. 
(5) A description of the accountability measures utilized 
during the development of the AHLTA global electronic health 
record system in order to evaluate progress made in the 
development of that system. 
(6) The schedule for the remaining development of the 
AHLTA global electronic health record system. 
(c) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—In this 
section, the term ‘‘appropriate committees of Congress’’ means—
(1) the Committees on Armed Services, Appropriations, 
Veterans’ Affairs, and Health, Education, Labor, and Pensions 
of the Senate; and 
(2) the Committees on Armed Services, Appropriations, 
Veterans’ Affairs, and Energy and Commerce of the House 
of Representatives.
H. R. 1815—221
SEC. 736. COMPTROLLER GENERAL STUDY AND REPORT ON VACCINE 
HEALTHCARE CENTERS. 
(a) STUDY REQUIRED.—The Comptroller General shall conduct 
a study of the Vaccine Healthcare Centers operated by the Depart-
ment of Defense in support of medical needs arising from mandatory 
military vaccinations. 
(b) ELEMENTS.—In conducting the study under subsection (a), 
the Comptroller General shall examine the following: 
(1) The mission of each Center. 
(2) The adequacy of resources available to support the 
mission of each Center and the source of those resources from 
within the Department of Defense. 
(3) The extent of participation and support of the Centers 
by each of the Armed Forces. 
(4) The effectiveness of the Centers in supporting the med-
ical needs of members of the Armed Forces arising from manda-
tory military vaccinations. 
(5) The effectiveness of the Centers in providing assistance 
to military and civilian healthcare providers based on outreach 
to and response to inquiries from providers. 
(6) The extent to which the Centers are conducting evalua-
tions to identify and treat potential and actual health effects 
from vaccines. 
(7) The extent to which the Centers take advantage of 
and are linked to vaccine health resources outside the Depart-
ment of Defense. 
(8) The extent to which the Centers are involved in out-
reach to military and civilian healthcare providers relating 
to vaccine safety, efficiency, and acceptability. 
(9) The extent to which similar activities conducted by 
the Centers are conducted in governmental or nongovernmental 
agencies outside the Department of Defense. 
(c) RECOMMENDATIONS.—The Comptroller General shall submit 
to Congress a report containing findings and recommendations not 
later than May 30, 2006, including recommendations on ways to 
improve the ability of the Department of Defense to understand 
and support medical needs arising from mandatory military vaccina-
tions and the extent to which the Department of Defense requires 
the Vaccine Healthcare Centers to continue in their current configu-
ration. 
SEC. 737. REPORT ON ADVERSE HEALTH EVENTS ASSOCIATED WITH 
USE OF ANTI-MALARIAL DRUGS. 
(a) STUDY REQUIRED.—The Secretary of Defense shall conduct 
a study of adverse health events that may be associated with 
use of anti-malarial drugs, including mefloquine. 
(b) MATTERS COVERED.—The study required by subsection (a) 
shall include a comparison of adverse health (including mental 
health) events that may be associated with different anti-malarial 
drugs, including mefloquine. 
(c) REPORT.—Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the congres-
sional defense committees a report on the study required by sub-
section (a).