Each year, the House and Senate armed services committees take up national defense authorization bills. The House of Representatives passed the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (NDAA; H.R. 5515 ) on May 24, 2018. The Senate passed its version of the NDAA ( H.R. 5515 ) on June 18, 2018. These bills contain numerous provisions that affect military personnel, retirees, and their family members. Provisions in one version are sometimes not included in the other, are treated differently, or are identical in both versions. Following passage of each chamber's bill, a conference committee typically convenes to resolve the differences between the respective chambers' versions of the bill. The FY2019 NDAA conference report was passed by the House on July 26, 2018, and the Senate on August 1, 2018. On August 13, 2018, President Donald J. Trump signed the bill into law ( P.L. 115-232 ). This report highlights selected personnel-related issues that may generate high levels of congressional and constituent interest. CRS will update this report to reflect enacted legislation. Related CRS products are identified in each section to provide more detailed background information and analysis of the issues. For each issue, a CRS analyst is identified. Some issues discussed in this report were previously addressed in the FY18 NDAA ( P.L. 115-91 ) and discussed in CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon, or other reports. Those issues that were considered previously are designated with an asterisk in the relevant section titles of this report. Background: The authorized active duty end-strengths for FY2001, enacted in the year prior to the September 11 terrorist attacks, were as follows: Army (480,000), Navy (372,642), Marine Corps (172,600), and Air Force (357,000). Over the next decade, in response to the demands of wars in Afghanistan and Iraq, Congress substantially increased the authorized personnel strength of the Army and Marine Corps. Congress began reversing those increases in light of the withdrawal of U.S. forces from Iraq in 2011, the drawdown of U.S. forces in Afghanistan beginning in 2012, and budgetary constraints. Congress halted further reductions in Army and Marine Corps end-strength in FY2017, providing slight end-strength increases that year and more substantial increases in FY2018. End-strength for the Air Force generally declined from 2004-2015, but increased from 2016-2018. End-strength for the Navy declined from 2002-2012, increased in 2013, and remained essentially stable through 2017 with a modest increase in 2018. Authorized end-strengths for FY2018 and FY2019 are in Figure 1 . Discussion: In comparison to FY2018 authorized end-strengths, the Administration's FY2019 budget proposed increases for the Army (+4,000), Navy (+7,500), Marine Corps (+100) and Air Force (+4,000). Section 401 of the enacted bill approved end-strengths identical to the Administration request. The enacted bill also adopted Section 402 of the House bill which adjusts the minimum end-strengths required by 10 U.S.C. §619 to a level equal to the authorized end-strengths set in Section 401. References: Previously discussed in CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon, and similar reports from earlier years. CRS Point of Contact: Lawrence Kapp. Background: The overall authorized end-strength of the Selected Reserves has declined by about 6% over the past 16 years (874,664 in FY2001 versus 823,900 in FY2018). Much of this can be attributed to the reductions in Navy Reserve strength during this period. There were also modest shifts in strength for some other components of the Selected Reserve. Authorized end-strengths for FY2018 and FY2019 are in Figure 2 . Discussion: Relative to FY2018 authorized end-strengths, the Administration's FY2019 budget proposed increases for the Navy Reserve (+100), Air Force Reserve (+200), and Air National Guard (+500); and no change for the Army National Guard, Army Reserve, Marine Corps Reserve, and Coast Guard Reserve. Section 411 of the enacted bill specified end-strengths identical to the Administration request. References: Previously discussed in CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon, and similar reports from earlier years. CRS Point of Contact: Lawrence Kapp. Background: DOD operates a health care delivery system that serves approximately 9.4 million beneficiaries. The military health system (MHS) provides care through DOD-operated and staffed medical and dental facilities (collectively referred to as military treatment facilities ) or through care from civilian providers purchased through an insurance-like program known as TRICARE. Currently, military treatment facilities (MTFs) are administered by each respective service surgeon general and provide a wide range of clinical services depending on its size, mission, and level of capabilities. TRICARE is administered by the Defense Health Agency (DHA), a combat support agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to combatant commands in both peacetime and wartime. The DHA also operates six MTFs in the Washington DC metropolitan area. In 2016, Congress found that the organizational structure of the MHS could be streamlined to sustain the "medical readiness of the Armed Forces, improve beneficiaries' access to care and the experience of care, improve health outcomes, and lower the total management cost." Section 702 of the FY2017 NDAA ( P.L. 114-328 ) directed significant reform to the MHS and administration of MTFs by October 1, 2018. This reform includes transfer of administration and management of MTFs from each respective service surgeon to the Director, DHA; reorganization of DHA's internal structure; and redesignation of the Service Surgeons General as principal advisors for their respective military service, and as service chief medical advisor to the DHA. In June 2018, DOD submitted its final implementation plan to Congress. The implementation plan details how DOD will reform the MHS to a "streamlined organizational model that standardizes the delivery of care across the MHS with less overhead, more timely policy-making, and a transparent process for oversight and measurement of performance." DOD also included recommendations on legislative actions to assist with executing its implementation plan, which includes ability to implement 10 U.S.C. §1073c using a three-year phased-in approach; and authority for the Secretary of Defense to waive specific requirements in 10 U.S.C. §1073c if necessary for implementation feasibility or military health readiness. Discussion: Section 711 of the enacted bill incorporates DOD's recommendation for a three-year, phased-in approach to implementing 10 U.S.C. §1073c. The provision requires the DHA Director to assume responsibility for administration and management of each MTF no later than September 30, 2021. However, there are no authorities included in Section 711 to allow the Secretary of Defense to waive requirements in 10 U.S.C. §1073c. Section 711 also requires limitation on MTF closures and downsizing in connection with implementation of 10 U.S.C. §§1073c-1073d; establishment of a DHA subordinate organization for research and development; establishment of a DHA subordinate organization for public health; feasibility study on establishing a DHA subordinate organization for education and training; and feasibility study on establishing a Defense Health Command as a superseding organization to DHA. Section 712 of the enacted bill directs the Director of the DHA, by October 1, 2018, to implement an "organizational framework" that effectively delivers DOD health benefits, maximizes interoperability of military medical capabilities, and integrates those capabilities to support combatant commander requirements. As part of the organizational framework, Section 712 also requires DOD to establish four "defense health regions," two in the continental United States and two outside of the continental United States. Additionally, the service surgeons general are assigned new responsibilities focusing on manning, training, and equipping medical forces to meet MTF or combatant commander requirements. References: CRS In Focus IF10530, Defense Primer: Military Health System , by Bryce H. P. Mendez. CRS Point of Contact: Bryce H. P. Mendez. Background : According to Arlington National Cemetery (ANC) news, in about 25 years, the cemetery will run out of space as an active cemetery that would allow for future burials. Section 2 of Public Law 114-158 called for the Secretary of the Army in consultation with the Secretary of Defense (SECDEF), to submit a report to Congress on the capacity of ANC. The Secretary of the Army's report, The Future of Arlington National Cemetery: Report on the Cemetery's Internment and Inurnment Capacity , February 14, 2017, identified the current status of ANC and provided future options, including restricting eligibility; expanding the geographical footprint of the cemetery; and other hybrid solutions. In July 2017, the cemetery conducted a survey in partnership with several military and veteran service organizations. Among the findings from this preliminary survey: 94% of the respondents want Arlington Cemetery to stay active well into the future; and nearly 50% who favor expansion also recognize the need to modify eligibility. The survey had more than 28,000 respondents who indicated that—if eligibility at ANC is limited—those killed in action, Medal of Honor (MoH) and other high award recipients, former POWs, and those active duty servicemembers who die on operational missions should have a place at Arlington. ANC launched a second survey in April 2018 and encouraged the public and its various stakeholders to continue to share their thoughts on the future of Arlington. ANC shared the results of the second survey that was similar to the first with 96% of the 230,000 respondents wanting Arlington to remain an active cemetery. The Advisory Committee on Arlington National Cemetery (ACANC) is expected to make recommendations on future eligibility criteria, capacity issues, and expansion plans in the committee's annual report to the Secretary of the Army. Discussion : Section 582 of the enacted bill adopts House Section 582 requiring the Secretary of the Army in consultation with the Secretary of Defense (SECDEF), to prescribe revised criteria for interment at ANC that would preserve Arlington Cemetery as an active burial ground ''well into the future.'' The SECDEF is required to establish the revised criteria no later than September 30, 2019. Section 1070 of the enacted bill adopts House Section 1062, with an amendment requiring the Secretary of Defense and the Administrator of the FAA to jointly submit a report on unmanned aircraft in Arlington National Cemetery to preserve the sanctity of the cemetery as a national shrine. This report for Congress will discuss how to prevent the flight of unmanned aircraft over Arlington to preserve the sacred atmosphere of the national cemetery; and restrict all flights of unmanned aircraft during the execution of funeral services, except in emergency situations or if requested by the family as part of the service. The report is due not later than 90 days after the date of the enactment of this Act. Section 2852 of the enacted bill adopts a Senate provision that would commemorate the southern expansion of Arlington Cemetery and grant permanent easement of approximately 0.1 acres of land in Arlington County for the purpose of commemorating Freedman's Village and Gate. In the event ANC subsequently acquires the property used for the commemoration for burial purposes, the Army shall relocate any commemoration of Freedman's Village to an appropriate location. Section 2830B of the House bill had a similar provision. Section 2105 of the Senate bill would have extended an authorization of $30 million for certain FY2016 military construction projects including Arlington National Cemetery Southern Expansion. Section 2105 of the enacted bill increased the authorization to $60 million for Arlington extension projects. Section 4601 of the enacted bill adopts Senate Section 4601, which authorizes $30 million for ANC military construction in FY2019. CRS Point of Contact : Barbara Salazar Torreon. Background: Over the past few years, Congress has been concerned with improving the Defense Commissary Agency (DeCA) system, mandating several studies and reports on the topic. Recent reform proposals have sought to reduce DeCA's reliance on appropriated funds without compromising patrons' commissary benefits or by reducing the revenue generated by DOD's nonappropriated fund (NAF) entities (military exchanges) that fund morale, welfare, and recreation (MWR) facilities on military installations. An option to consolidate commissaries and military exchanges has been the subject of numerous studies in the last several years. In 2015, the Military Compensation and Retirement Modernization Commission (MCRMC) recommended consolidating the commissary and three exchange systems into one entity to be called the Defense Resale Activity (DeRA). Other options discussed include expanding commissary and exchange access to all eligible veterans to increase patronage and sales revenue. However, Congress has stopped short of major changes that would significantly reduce or eliminate the commissary subsidy. In the FY2018 NDAA, Congress authorized $1.4 billion for commissary operations and an additional $40 million for the construction of a new commissary in Stuttgart, Germany. Approximately $800 million of DeCA's annual operating budget is spent on pay and benefits for the commissary workforce. The President's FY2019 budget request for $1.3 billion included funding for DeCA to operate 237 commissaries on military installations worldwide and employ a workforce of over 14,000 civilian full-time equivalent (FTE) employees. Discussion : Section 579 of the enacted bill adopts Senate Section 576, which requires the Secretary of Defense (SECDEF) to submit a report to Congress assessing the feasibility and advisability of permitting small business activities of military spouses on military installations in the United States including partnership with commissaries, exchanges, and other morale, welfare, and recreation (MWR) facilities of the U.S. Armed Forces. Elements of this report would include (1) taking into account the usage by military spouses of installation facilities, utilities, and other resources in the conduct of small business activities on military installations in the United States, and other matters in connection with the business activities by military spouses as the SECDEF considers appropriate; and (2) seeking to identify mechanisms to ensure that costs and fees associated with the usage by military spouses of such facilities, utilities, and other resources in connection with such business activities does not curtail or eliminate the opportunity for military spouses to profit reasonably from such business activities. The report is due to the House and Senate Armed Services Committees no later than March 1, 2019. Section 621 of the enacted bill adopts House Section 629, which extends eligibility of certain MWR and commissary privileges to certain veterans and their caregivers. Eligible veterans include recipients of the Purple Heart and Medal of Honor; veterans with service-connected disabilities; former Prisoners of War (POWs); and the caregivers for eligible veterans. A fee, to be determined by the SECDEF, for purchases by these newly eligible individuals will offset any increase in expenses arising from this provision associated with the use of credit or debit cards for customer purchases, including expenses related to card network use and related transaction processing fees. This provision will take effect on January 1, 2020, after a briefing by the SECDEF to the House and Senate Armed Services Committees not later October 1, 2019. Section 627 of the enacted bill adopts House Section 625, which requires the SECDEF to conduct a study to determine the feasibility of consolidating military commissaries under DeCA and NAF exchange entities (i.e., Army and Air Force Exchange Service, Navy Exchange, and Marine Corps Exchange) into a single defense resale system. The report is to be submitted to the defense congressional committees no later than January 1, 2019. It shall contain the following: (1) details of the internal and external organizational structures of a consolidated defense resale system; (2) recommendations of the Secretaries of each of the military departments regarding the plan to consolidate the military resale entities; (3) the costs and associated plan for the merger of technologies or implementation of new technology from a third-party provider to standardize financial management and accounting processes of a consolidated defense resale system; (4) best practices to maximize reductions in costs associated with back-office retail payment processing for a consolidated defense resale system; (5) a timeline for converting DeCA into a NAF under Section 2484(j) of Title 10, United States Code; (6) a determination whether the business case analysis supports consolidation of the military resale entities; (7) recommendations of the SECDEF for legislation related to consolidation of the military resale entities; and (8) any other elements the SECDEF determines are necessary for a successful evaluation of a consolidation of the military resale entities. Section 4501 of the enacted bill authorizes $1,266,200,000 for commissary operations in FY2019. References: CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon; and similar reports from earlier years. CRS Point of Contact : Barbara Salazar Torreon. Background : The Family Advocacy Program (FAP) is the congressionally-mandated program within DOD devoted to "clinical assessment, supportive services, and treatment in response to domestic abuse and child abuse and neglect in military families." As required by law, the FAP provides an annual report to Congress on child abuse and neglect and domestic abuse in military families. Approximately half of military servicemembers are married and there are approximately 1.6 million dependent children across the active and reserve components. According to DOD statistics, in FY2017, the rate of child abuse or neglect in military homes was 13.7 per 1,000 children. This is a decrease from the previous year's rate of 14.4 per 1,000 children. There were 17 child abuse-related fatalities in the same year, 65% of which were 1 year old or younger. The rate of reported spousal abuse in FY2017 was 24.5 per 1,000 military couples, an increase to the FY2016 rate of 23.4 per 1,000 couples. Since FY2006, DOD has been collecting data on intimate partner abuse. In FY2017, there were 916 incidents of intimate partner abuse involving 756 victims and five fatalities. Discussion: The FY2019 NDAA (Sec. 532) adds a punitive article to the Uniform Code of Military Justice (UCMJ) for domestic violence. Previously, domestic violence could be prosecuted under UCMJ punitive articles for assault (Article 28), cruelty and maltreatment (Article 93), and rape and sexual assault (Article 20) among other articles. While these crimes may be perpetrated against any individual, the new punitive article criminalizes certain acts committed against a spouse, intimate partner, or immediate family member. Two provisions in the Senate bill would have authorized victims of domestic violence to receive the same services that are currently available to victims of sexual assault. These include Special Victims' Counsel (SVC) services (Sec. 545), and expedited transfer eligibility for servicemember victims (Sec. 547). Section 536 of the enacted bill requires the SECDEF to standardize expedited transfer procedures for servicemembers who are victims of sexual assault or physical domestic violence. The Administration objected to Section 545 of the Senate bill which would expand SVC services to victims of other violent crimes, arguing that SVC representation is focused on legal issues specifically related to sexual assault. The enacted bill does not authorize victims of domestic violence to have access to SVC services; however, Section 534 requires DOD to study and report on the feasibility and advisability of expanding services. Section 577 requires service secretaries to establish and maintain multidisciplinary teams to enhance collaboration and cooperation among specialists in the response to domestic violence and child abuse on military installations. Section 578 requires a maximum two-year pilot program on no less than five installations for information on the risk factors for child abuse and training on safe childcare practices for military families. In 2018, an investigative report on juvenile sex offense cases on military installations drew congressional concern about gaps in the response, investigation, tracking, and prosecution of such cases. Section 1089 seeks to improve the response to juvenile-on-juvenile problematic sexual behavior on military installations by requiring DOD to establish a formal policy for such incidents, and to create a confidential database for tracking substantiated and unsubstantiated incidents. Section 1035 of the Senate bill would have removed the military's exclusive jurisdiction over criminal offenses committed by juveniles on military installations. This provision was not adopted in the enacted bill; however, the conferees noted concern "about the lack of State or local criminal jurisdiction over offenses committed on those portions of military installations with exclusive Federal jurisdiction by individuals not subject to the Uniform Code of Military Justice," and directed the service secretaries to seek to relinquish jurisdiction (pursuant to 10 U.S.C. §2683). A report to the armed services committees is required by the service secretaries on the relinquishment of jurisdiction no later than 15 months after the enactment date of this act. References: For information on expedited transfers and Special Victims' Counsel, see CRS Report R44944, Military Sexual Assault: A Framework for Congressional Oversight , by Kristy N. Kamarck and Barbara Salazar Torreon. CRS Point of Contact : Kristy N. Kamarck. Background: In accordance with 10 U.S.C. §502(b), U.S. citizens, noncitizen nationals (individuals born in American Samoa and Swains Island), legal permanent residents, and persons from Micronesia, Marshall Islands, and Palau are eligible to enlist in the U.S. Armed Forces. Subparagraph (b)(2) of this law also allows individuals who do not meet those requirements to enlist if the Service Secretary "determines that such enlistment is vital to the national interest." This is the statutory basis for the Military Accessions Vital to the National Interest (MAVNI) program. As implemented by DOD, the MAVNI program allowed the military services to recruit certain legally present aliens whose skills were deemed vital to the national interest. Those skills included medical specialties and expertise in certain languages. Applicants at the time of enlistment had to be either asylees, refugees, holders of Temporary Protected Status (TPS), beneficiaries of the Deferred Action for Childhood Arrivals (DACA) policy, or in any one of a range of nonimmigrant categories. DOD established new security screening requirements for MAVNI personnel in a memorandum published on September 30, 2016. Among other things, it prohibited certain personnel enlisted under MAVNI from commencing with basic training until the military service certified in writing that the individuals could meet the administrative, security, and suitability protocols mandated in the memo. Subsequently, the military services stopped accepting new applicants to the MAVNI program. It is not known if or when DOD will reactivate the program. Discussion: The provision in the enacted bill tightens requirements on the skills required for an enlistee's admission under the MAVNI program and mandates that those skills be used in the individual's primary daily duties as a member of the Armed Forces. It codifies DOD's prohibition on MAVNI enlistees attending initial military training until they complete required background checks and security and screening requirements. It also places a cap on MAVNI accessions for each military department that may be exceeded if the Secretary of Defense notifies Congress and a period of 30 days elapses ( notify and wait ). The Joint Explanatory Statement noted "The conferees believe the Military Accessions Vital to National Interest, or MAVNI, program continues to be an important option for the acquisition of certain critical skills for military service." References: CRS In Focus IF10884, Expedited Citizenship through Military Service , by William A. Kandel and Lawrence Kapp. CRS Point of Contact: Lawrence Kapp. Background: Over the past decade, the issues of sexual assault and sexual harassment in the military have generated sustained congressional and media attention. In 2005, DOD issued its first department-wide sexual assault policies and procedures. These policy documents were built on recommendations from the Joint Task Force for Sexual Assault Prevention and Response (SAPR) and on congressional requirements specified in the FY2005 NDAA ( P.L. 108-375 ). In the same year, DOD established the Sexual Assault Prevention and Response Office (SAPRO), its primary oversight body for all service-level programs. Sexual harassment policy and oversight is separately handled by DOD's Office of Diversity and Military Equal Opportunity. Between 2012 and 2018, DOD took a number of steps to implement its own strategic initiatives as well as dozens of congressionally mandated actions related to sexual assault prevention and response, victim services, reporting and accountability, and military justice. In FY2016, estimated sexual assault prevalence rates across the DOD's active duty population were 4.3% for women and 0.6% for men. These estimated prevalence rates were slightly lower than the reported prevalence rates in 2014 (4.9% and 0.9%, respectively). Discussion: Section 546 of the FY2015 NDAA ( P.L. 113-291 ) called for the establishment of a 20-member Defense Advisory Committee on Investigation, Prosecution, and Defense of Sexual Assault in the Armed Forces (DAC-IPAD) to "review, on an ongoing basis, cases involving allegations of rape, forcible sodomy, sexual assault, and other sexual misconduct involving members of the Armed Forces." Section 533 in the enacted bill gives the committee additional authority to require DOD and other Federal agencies to provide information relevant to the committee's scope as requested. One of the DAC-IPAD's findings in its March 2018 annual report was that DOD policies and standards for expedited transfer apply "only to active duty victims whose sexual assault reports are handled by the SAPR program and expressly excludes victims covered under FAP from the expedited transfer policy." Expedited transfer policies have been in place since 2011 and allow victims to request transfer to a new unit or installation in order to separate themselves from an alleged perpetrator. Section 536 of the enacted bill requires DOD to modify policies related to expedited transfers in order to standardize processes for all sexual assault victims and extend the transfer policy to a servicemember's dependent when the dependent is a victim. Section 542 of the House bill would have allowed cadets and midshipmen from the military service academies who are victims of sexual assault to apply for a transfer to one of the other service academies. This was not adopted; however, the conference report noted, "The Conferees believe that providing an option for a cadet or midshipman, who was sexually assaulted, to request a transfer to another academy should be explored," and directs DOD to study the feasibility of establishing such a process. The Administration objected to Section 544 of the Senate bill which would have authorized military judges to issue and enforce domestic protective orders, stating that this would, "strain the military judiciary's limited resources and greatly expand the authority of military judges into an area that has been reserved to civil courts." This provision was not adopted. Military protective orders (MPOs) may currently be issued by commanding officers having full force and effect on military installations, but are not enforceable by civilian law authorities. DOD is required to produce an annual report for Congress on sex-related offenses. Section 547 of the enacted bill requires DOD to also report information on collateral misconduct of victims of sexual assault. Collateral misconduct by the victim is considered to be one barrier to reporting assault due to the victim's fear of punishment for offenses such as underage drinking or fraternization. Psychological trauma following a sexual assault incident has been associated with negative behavioral changes in the victim such as increased drug or alcohol use, poor work performance, or other disciplinary issues. The Department of Veterans Affairs defines psychological trauma related to sexual assault or harassment as military sexual trauma (MST). DOD's policies recognize psychological trauma related to sexual assault and defines it as trauma-informed care. Section 547 of the House bill would have required DOD and VA to develop a joint definition of military sexual trauma. This section was not adopted. Section 702 of the enacted bill requires DOD to carry out a pilot program to treat servicemembers suffering from post-traumatic stress disorder (PTSD) resulting from military sexual trauma. Behaviors associated with sexual trauma may affect the nature of a victim's discharge from the Armed Forces. Discharges that are not under "honorable" conditions affect servicemember eligibility for certain veterans' benefits. Under certain circumstances, servicemembers may appeal these decisions through Discharge Review Boards or Boards of Correction for Military Records. Senate Section 536 was not adopted, but would have amended 10 U.S.C. §1552 and §1553 with respect to the correction of military records to ensure that the claimants receive "liberal consideration" that the sexual trauma contributed to the circumstances surrounding discharge or dismissal. Following a sexual assault investigation in the military, the investigator will provide recommendations for legal or other actions to a disposition authority – typically a military commander in the accused's chain of command. Section 535 of the enacted bill adopts Senate Section 548, requiring the SECDEF to establish a uniform command action form for reporting the final disposition of certain sexual assault cases. Section 544 of the enacted bill seeks to improve compliance with sex offender reporting requirements by establishing a single entity within DOD for the oversight of the registered sex offender management program. Finally, Section 542 of the enacted bill requires security clearance reinvestigations under expedited procedures for flag officers and DOD Senior Executive Service personnel who are convicted of certain offenses, including sexual assault and sexual harassment. Not adopted was House Section 531, which would have imposed mandatory penalties for those convicted of sex-related offenses. References: See also CRS Report R44944, Military Sexual Assault: A Framework for Congressional Oversight , by Kristy N. Kamarck and Barbara Salazar Torreon, CRS Report R43168, Military Sexual Assault: Chronology of Activity in Congress and Related Resources , by Barbara Salazar Torreon, CRS Report R43928, Veterans' Benefits: The Impact of Military Discharges on Basic Eligibility , by Umar Moulta-Ali and Sidath Viranga Panangala. Previously discussed in CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon, and similar reports from earlier years. CRS Point of Contact : Kristy N. Kamarck. Background: There is long-standing congressional interest on the military pay raise in relation to the overall cost of military personnel and recruitment and retention of high-quality personnel to serve in the all-volunteer military. Section 1009 of Title 37 of the U.S. Code provides a permanent formula for an automatic annual increase in basic pay that is indexed to the annual increase in the Employment Cost Index (ECI). The statutory formula stipulates that the increase in basic pay for 2019 will be 2.6% unless either (1) Congress passes a law to provide otherwise; or (2) the President specifies an alternative pay adjustment under subsection (e) of 37 U.S.C. §1009. Increases in basic pay are typically effective at the start of the calendar year, rather than the fiscal year. The FY2019 President's Budget requested a 2.6% military pay raise, equal to the statutory formula. Discussion: The enacted bill contained no provision relating to a general increase in basic pay, thereby leaving the automatic adjustment of 37 U.S.C. §1009 in place. According to the Joint Explanatory Statement, "The conferees note that current law authorizes automatic military pay raises consistent with the Economic Cost Index, which for calendar year 2019 amounts to a 2.6 percent raise in basic pay for all members of the uniformed services." Reference(s): For an explanation of the pay raise process and historical increases, see CRS In Focus IF10260, Defense Primer: Military Pay Raise , by Lawrence Kapp. Previously discussed in CRS Report R44577, FY2017 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck et al., and similar reports from earlier years. CRS Point of Contact: Lawrence Kapp. Background: Since 1998, DOD and the Department of Veterans Affairs (VA) have pursued numerous efforts to increase interoperability between each department's electronic health records (EHR). The lack of EHR interoperability, or bi-directional communication, has been a historical barrier to access and continuity of care for both DOD and VA beneficiaries. Congress has expressed significant interest in DOD and VA efforts to develop an interoperable or joint EHR. Section 1635 of the FY2008 National Defense Authorization Act directed DOD and VA to develop an interoperable EHR, accelerate the exchange of health care information between the two departments by September 30, 2009, and create an interagency program office to facilitate these efforts. As directed by law, the DOD/VA Interagency Program Office was established in 2011 to jointly develop an integrated EHR that would replace each department's legacy systems. As an interim solution, the Joint Legacy Viewer (JLV) was developed to facilitate health care data sharing between each department's legacy systems. While the JLV provides read-only access, it continues to be the primary platform for DOD and VA clinicians to review a patient's medical history and care delivered in both health systems. In 2012, DOD and VA committed to developing a new integrated EHR that would be fully operational by 2017. In 2013, DOD and VA announced that they would no longer pursue the development of an integrated EHR; rather, they would invest in separate systems that could meet interoperability requirements. DOD opted to pursue a commercial alternative, while VA decided to modernize VistA. On August 25, 2014, DOD issued a request for proposals for a new EHR to replace its legacy systems. In July 2015, DOD awarded a $4.3 billion EHR contract, also known as MHS Genesis , to the Leidos Partnership for Defense Health (LPDH), comprised of the following vendors: Leidos (prime vendor), Cerner, Accenture Federal Services, and Henry Schein, Inc. On June 5, 2017, VA announced its decision to adopt the same EHR platform as MHS Genesis as its replacement to VistA and awarded a $10 billion contract to Cerner. On April 9, 2018, the Coast Guard announced its intent to partner with DOD and adopt MHS Genesis. Adding the Coast Guard to DOD's contract with LPDH increased the award ceiling to $5.5 billion. DOD intends to deploy MHS Genesis at all military treatment facilities (MTFs) by 2022. The VA intends to start with three operational sites by 2020. Discussion: While there are no provisions in the enacted bill relating to DOD's new electronic health record, House Section 718 was incorporated into the conference report. DOD is directed to "submit a letter report to the Committees on Armed Services of the Senate and the House of Representatives describing the corrective actions taken, as a result of the findings in the initial operational and test evaluation report, prior to fielding MHS Genesis to additional military medical treatment facilities." Currently, there are six congressional committees that may exercise jurisdiction in oversight of this program. As DOD, VA, and the Coast Guard implement a new, common EHR over the next four years, Congress may consider additional or streamlined oversight activities to ensure successful deployment of MHS Genesis. CRS Point of Contact: Bryce H. P. Mendez. Background: In 2017, four incidents involving Navy ships in the Western Pacific resulted in serious damage and the deaths of 17 sailors. These incidents prompted Congressional inquiry into possible root causes of such accidents. Experts and investigators have pointed to various issues in the Surface Warfare community, including fleet and unit readiness, the seamanship training and qualification processes, ship-board workloads, and operational/personnel tempo. In response to these concerns, the FY2019 NDAA includes several provisions related to Navy training and personnel management issues. Discussion: In 2018, a 3-year internal Navy review of junior surface warfare officer (SWO) competency uncovered gaps in basic seamanship and navigation skills. The enacted bill includes provisions that seek to improve training, as well as qualification standards and processes for Navy watchstanders. Section 334 encourages the Secretary of the Navy to establish a comprehensive proficiency assessment process for SWOs and to more closely align watchstander qualification standards with the International Convention on Standards of Training, Certification and Watchkeeping (STCW). This section would also require a report to Congress on the training curriculum and assessment process for surface warfare watchstanders by March 1, 2019. Section 527 requires reporting on Navy training and qualification standards. The Senate Armed Services Committee (SASC) report also includes language with respect to surface warfare officer initial training, stating, The committee believes SWO candidates lack sufficient at-sea training before reporting to their first ships. The committee is concerned that the lack of practical at-sea experience before reporting to their first ships may result in SWOs having gaps in their foundational safety, seamanship, and navigation knowledge, skills, and experience. The SASC report further directs the Secretary of the Navy to conduct a review of the adequacy and appropriate balance of training methods, to include the feasibility of expanding use of yard patrol craft as training vessels, and to report to Congress by October 1, 2018. The Comptroller General is directed to provide a review of the Secretary's report within 120 days of the Navy report. Finally, Section 526 of the enacted bill requires the Navy to maintain a career record of watchstanding hours. It is current practice for military pilots to log flight hours; however, this has not been a common practice for surface warfare watchstanders. Section 502 of the House bill sought to increase specialization for SWOs by establishing two career paths: (1) ship engineering systems; and (2) ship operations and combat systems. While some foreign navies use this approach for SWO career management (e.g., the British Royal Navy), there is ongoing debate within the U.S. surface warfare community about whether specialization would improve performance and resolve existing problems. The Administration objected to this section, stating that "Separating SWOs into two career paths would limit mastery of core skillsets that are fundamental in developing a warfighter to lead, fight, and operate complex U.S. Navy warships." The enacted bill does not require the Navy to establish separate career paths, but instead requires GAO to conduct a review of SWO career paths and to brief congressional committees by March 1, 2019. Another area of concern is that high shipboard workload and personnel tempo could lead to higher risk of human error due to fatigue. A 2017 GAO report found that, The Navy's process to determine manpower requirements—the number and skill mix of sailors needed for its ships—does not fully account for all ship workload. The Navy continues to use an outdated standard workweek that may overstate the amount of sailor time available for productive work. Although the Navy has updated some of its manpower factors, its instruction does not require reassessing factors to ensure they remain valid or require measuring workload while ships are in port. Current and analytically based manpower requirements are essential to ensuring that crews can maintain readiness and prevent overwork that can affect safety, morale, and retention. Section 525 of the enacted bill requires the Navy to ensure that manning levels on forward deployed ships are consistent with requirements for the ship class and to notify Congress in writing when manning fill for a covered ship falls below 90% and manning fit falls below 87%. CRS Point of Contact : Kristy N. Kamarck. Background: Congress has taken an interest in understanding federal efforts and identifying options to address overall substance abuse issues, particularly in the context of the opioid crisis . According to DOD's 2011 Health Related Behaviors Survey of Active Duty Military Personnel, servicemembers reported using or misusing the following substances within the 12 months prior to the study at the following rates: illicit drugs (1.4%), prescription drugs (0.8%), and heavy alcohol amounts (8.4%). Other than heavy alcohol use, the prevalence of substance abuse is lower than in the general U.S. population. Since 2009, the number of new alcohol or substance abuse diagnoses per year has been on a declining trend for active duty servicemembers. However, opioid medications are prescribed at a higher rate for servicemembers than the general U.S. population. This higher prescription rate may be attributable to deployment-related effects such as combat exposure and injuries. However, the incidence rate for dependence or abuse among servicemembers declined by 38% between 2012 and 2016. When adjusted for demographics, the opioid death rate among servicemembers is significantly lower than the U.S. population at 2.7 per 100,000 and 10.4 per 100,000, respectively. DOD attributes these trends to its extensive education, prevention, and treatment programs developed over the past decade. Discussion: DOD currently operates a prescription drug monitoring program that identifies at-risk beneficiaries and restricts patients from receiving multiple prescriptions for opioids outside of their primary care manager. However, the data exchange that occurs between various TRICARE contractors and military treatment facilities is not shared with state prescription drug monitoring programs. Section 715 of the enacted bill directs DOD to establish a Military Health System Prescription Drug Monitoring Program. The program would allow for bi-directional sharing of patient-specific information regarding prescriptions for controlled substances with state prescription drug monitoring programs. Section 715 also clarifies that the patient-specific information is an authorized disclosure under the Health Insurance Portability and Accountability Act of 1996 ( P.L. 104-191 ). Section 716 of the enacted bill adopts House Section 736 and Senate Section 704, directing DOD to implement an opioid safety pilot program for a period of no more than three years. The pilot program must address: opioid safety for patients, physicians, dentists, and pharmacists; identify potential misuse or abuse of opioid medications within military, retail, or home delivery pharmacies; beneficiary education on opioid misuse or abuse; and use of predictive analytics to identify at-risk beneficiaries. Not adopted were provisions to require DOD to distribute in-home prescription drug disposal kits to beneficiaries and a report on historical prescribing practices that were inconsistent with the DOD-VA clinical practice guidelines for post-traumatic stress disorder. Congress is also considering at least 20 separate legislative proposals to address the opioid crisis , primarily through authorities, programs, and services directed by the Department of Health and Human Services, Department of Homeland Security, and the Drug Enforcement Agency. These proposals do not explicitly address opioid abuse, prevention, treatment, or research within DOD. References: CRS In Focus IF10951, Substance Abuse Prevention, Treatment, and Research Efforts in the Military , by Bryce H. P. Mendez, CRS In Focus IF10219, Opioid Treatment Programs and Related Federal Regulations , by Johnathan H. Duff, and CRS Report R42593, Prescription Drug Monitoring Programs , by Lisa N. Sacco, Johnathan H. Duff, and Amanda K. Sarata. CRS Point of Contact: Bryce H. P. Mendez. Background: Approximately 200,000 servicemembers are discharged from the Armed Forces every year. This is a diverse group including, for example, enlistees completing their first-term (typically 4-6 years), mid-career members, retirees (>20 years), and those with medical disabilities. A majority of these members pursue a post-service career; veterans account for about 6% of the civilian labor force. In the past few decades, Congress has enacted legislation and appropriated funds in support of programs that help servicemembers prepare for transition to civilian life by providing them with counseling, resources, and tools for accessing veteran benefits and leveraging their skills, education, and training gained in the service for post-service education and employment opportunities. Some DOD programs are the Transition Assistance Program (TAP); Credentialing Opportunities Online (COOL); and the DOD Skillbridge program, which is also known as the Job Training, Employment Skills Training, Apprenticeships, and Internships (JTEST-AI) program. There are also DOD programs to help servicemembers in pursuit of post-secondary degrees, for example, tuition assistance (TA) for off-duty education and the Defense Activity for Non-Traditional Education Support (DANTES). Discussion: Congressional concerns about the transition of servicemembers to civilian employment are evident in the number of provisions seeking to enhance or expand transition services, education support, and other transition-related programs. Section 558 of the enacted bill extends the availability of Military OneSource services to members and their families for a minimum period of one year following separation from the military. A broad range of information resources and training programs are available online in an open source format on Military OneSource; however, previously, some counseling and support services were only available to veterans for a period of 180 days following separation. Other House provisions seeking to improve outreach to recently separated veterans through the addition of email addresses to discharge paperwork (Section 525), allowing for discharge information to be transmitted to country veteran service officers (Section 560B), and follow-up phone calls to check on status (Section 560D) were not adopted. A Government Accountability Office (GAO) report released in November 2017 found that fewer than half of all eligible servicemembers completed TAP before the statutory deadline of 90 days prior to separation. In addition, the report found that relatively few members were participating in DOD's optional two-day classes on (1) Accessing Higher Education, (2) Career Technical Training, and (3) Entrepreneurship. The SASC raised concerns in its committee report that, "requiring transitioning servicemembers to opt into a two-day workshop signals to both servicemembers and their commanders that the workshops may be superfluous, thereby discouraging participation," and encourages DOD to mandate member participation in one of the workshops. Section 552 of the enacted bill requires that TAP counseling begin no later than 365 days before transition. This provision requires the development of tailored transition pathways depending on the characteristics or needs of different member groups (e.g., rank, term of service, or gender), and would mandate certain elements of the TAP curriculum. Another requirement in this section is that transitioning members and the Secretary of Veterans Affairs are provided with a copy of their Joint Service Transcript upon separation. Congress also requires GAO and DOD reports on the implementation of this law. Section 556 of the enacted bill removes the requirement that credentials earned under the authority in 10 U.S.C. §2015 be "related to military training." This will potentially expand a member's ability to use COOL funds to pursue nonmilitary-related credentials. Section 560A of the House bill would have required DOD to report on TAP participants who met with academic or technical training advisors and would also request specific information on equivalent college credit and technical certifications for members of the armed forces. This provision was not adopted. The American Council on Education (ACE), as funded by DOD, provides a military guide with credit recommendations for formal military courses and occupations. This information may be provided to servicemembers and veterans as part of a Joint Service Transcript (JST) or Verification of Military Experience and Training (VMET). The COOL program provides an online resource that translates military service occupations and experience to civilian credentials. Currently servicemembers' spouses are authorized to participate in certain elements of TAP under 10 U.S.C. §§1142 and 1144. Section 575 of the Senate bill would have required a pilot program for spouse participation in TAP regardless of whether the member is also participating in TAP at the same time. This provision was not adopted. Finally, Section 559 of the House bill would have required that DOD provide members with information about apprenticeship programs as part of pre-separation counseling. While this provision was not adopted, the conferees noted that, "apprenticeships provide a valuable career option for separating servicemembers and encourage the Department of Defense to ensure information on apprenticeship programs, and appropriate funding options, is easily accessible to those servicemembers who may be interested in pursuing an apprenticeship upon separating from the military." References: CRS In Focus IF10347, Military Transition Assistance Program (TAP): An Overview , by Kristy N. Kamarck, CRS In Focus IF10850, DOD's Troops to Teachers Program (TTT) , by Kristy N. Kamarck and Eva G. McKinsey, CRS In Focus IF10490, Veterans' Employment , coordinated by Benjamin Collins, and CRS Report R42790, Employment for Veterans: Trends and Programs , coordinated by Benjamin Collins. CRS Video WVB00223, Service Member-to-Veteran Transitions: Education and Employment , by Kristy N. Kamarck, Benjamin Collins, and Cassandria Dortch. CRS Point of Contact : Kristy N. Kamarck. Background : Under the Survivor Benefit Plan (SBP), a military retiree may have a portion of his or her monthly retired pay withheld in order to provide, after his or her death, a monthly benefit to a surviving spouse or other eligible recipients. When an active duty servicemember dies, his or her survivor's payment through the SBP is usually 55% of the retired base pay that the member would otherwise have been eligible to receive. By law, surviving spouses who receive both an annuity from DOD as a beneficiary of the SBP and from the Department of Veterans Affairs' Dependency and Indemnity Compensation (DIC) must have their SBP payments reduced by the amount of DIC they receive. This offset has sometimes been referred to as a widows' tax . Congress first authorized a payment to such surviving spouses to offset that reduction in the FY2008 NDAA. This benefit is called the Special Survivor Indemnity Allowance (SSIA). Monthly SSIA payments are currently capped at $310 and are taxable. Section 621 of the FY2018 NDAA ( P.L. 115-91 ) amended 10 U.S.C. §1450 to permanently extend the authority to pay the SSIA and requires inflation adjustments to that allowance by the amount of the military retired pay COLA for each calendar year beginning in 2019. Section 622 of the FY2018 NDAA modified 10 U.S.C. §§1447 and 1452 to ensure equitable treatment under the SBP of members of the uniformed services covered by the modernized retirement system who elect to receive a lump sum of retired pay, as authorized under 10 U.S.C. §1415. Discussion: Section 621 of the Senate bill would make technical corrections in calculation and publication of special survivor indemnity allowance (SSIA) cost of living adjustments. This provision was adopted in Section 622 of the enacted bill. A provision not included in the enacted bill was House Section 607, which expressed a sense of Congress that the widows' tax be eliminated. While the SSIA alleviates the gap in benefits, Section 607 states "the whole Congress must work together to find a way to eliminate the widows' tax entirely. There was no similar provision in the Senate bill. Another House provision that was not adopted was Section 626, which would amend 10 U.S.C. §1448(b)(1), by allowing designation of a new beneficiary by a terminally ill participant. Any such beneficiary must be a natural person with an insurable interest in the participant. Such an election would be effective the first day of the first month following the month in which the election is received by the Secretary concerned. There was no similar provision in the Senate bill. References: Previously discussed in CRS Report R44923, FY2018 National Defense Authorization Act: Selected Military Personnel Issues , by Kristy N. Kamarck, Lawrence Kapp, and Barbara Salazar Torreon; CRS Report R40757, Veterans' Benefits: Dependency and Indemnity Compensation (DIC) for Survivors , by Scott D. Szymendera; CRS Report RL34751, Military Retirement: Background and Recent Developments , by Kristy N. Kamarck; and CRS Report R40589, Concurrent Receipt: Background and Issues for Congress , by Kristy N. Kamarck. CRS Point of Contact : Barbara Salazar Torreon. Background: TRICARE is a DOD-administered health insurance-like program for uniformed servicemembers, uniformed service retirees, their family members, and survivors. With the exception of active duty servicemembers (who are assigned to the TRICARE Prime option and pay no out-of-pocket costs for TRICARE coverage), DOD beneficiaries may have a choice of TRICARE plan options depending on their status (e.g., active duty family members, retiree, reservist, child under age 26 ineligible for family coverage, Medicare-eligible, etc.) and geographic location. Each of the three major plan options has different beneficiary cost-sharing features: TRICARE Prime, TRICARE Select, and TRICARE for Life. Since 1966, Congress has enacted legislation to deliver a robust health care benefit to eligible beneficiaries. TRICARE now accounts for approximately 52% (or $15.3 billion) of the total cost of care delivered through the military health system. In FY2017 and FY2018, Congress directed numerous TRICARE reforms including replacing TRICARE options with new plans featuring an annual enrollment period and a new benefit structure with enrollment fees, annual deductibles, co-payments, and annual catastrophic caps; changes to the delivery of the TRICARE dental benefit for uniformed services retirees and their family members; and increased pharmacy co-pays for retirees and military family members. The Administration's FY2019 Budget request did not include any cost-share reforms or programmatic changes to TRICARE. Discussion: The enacted bill does not include any changes to TRICARE's cost-sharing requirements. It focuses on administration and delivery of certain health benefits. Section 737 of the enacted bill directs the Comptroller General to assess, report, and brief Congress on the Defense Health Agency's guidance and oversight provided to outgoing and incoming managed care support contractors during the recent TRICARE contract transition. This reporting requirement will also be in effect for future TRICARE contract transitions. Section 713 adopts Senate Section 702 directing DOD to administer the TRICARE dental benefit for uniformed services dependents and reserve component members through the Office of Personnel Management's Federal Employee Dental and Vision Insurance Program (FEDVIP) no earlier than January 1, 2022. Section 734 adopts House Section 739 directing a study on how beneficiaries desiring to remain in the workforce are affected by the current requirement to participate in Medicare Part B, as a condition to participate in TRICARE for Life. References: CRS In Focus IF10530, Defense Primer: Military Health System , by Bryce H. P. Mendez; CRS Insight IN10922, TRICARE Modernization: Eligibility for the Federal Employee Dental and Vision Insurance Program , by Bryce H. P. Mendez. CRS Point of Contact: Bryce H. P. Mendez.

Summary: Each year, the National Defense Authorization Act (NDAA) provides authorization of appropriations for a range of Department of Defense (DOD) and national security programs and related activities. New or clarified defense policies, organizational reform, and directed reports to Congress are often included. For FY2019, the John S. McCain NDAA (H.R. 5515) contains several high-profile military personnel issues. Some are required annual authorizations, such as end-strengths; some are updates or modifications to existing programs; and some changes in response to problems identified in certain military personnel programs. In this year's NDAA, Congress authorized end-strengths identical to the Administration's FY2019 budget proposal, which are slightly higher than in FY2018. The authorized active duty end-strength increased by 1% to 1,338,100. The authorized Selected Reserves end-strength increased by <1% to 824,700. With regards to military pay, a 2.6% increase will take effect in calendar year 2019. Congress considered the increase as requested by the Administration; however, an authorization was not required since 37 U.S.C. §1009 provides for automatic annual increases in basic pay that is indexed to increases in the Employment Cost Index. Congress also directed modifications to several existing programs, including development of criteria for internment at Arlington National Cemetery, as well as a $30 million authorization to expand the cemetery; clarified military health system reform requirements outlined in 10 U.S.C. §1073c and revised the implementation date from October 1, 2018 to September 30, 2021; expanded eligibility for TRICARE beneficiaries to access the Federal Dental and Vision Insurance Program (FEDVIP); extended eligibility for commissary and morale, welfare, and recreation (MWR) privileges to certain veterans and veterans' caregivers, as well as a $1.26 billion authorization for commissary operations; expanded availability of Military OneSource services, enhanced Transition Assistance Program (TAP) counseling requirements, and broadened educational opportunities for servicemembers desiring professional credentials; and corrected technical calculations for automatic annual adjustments to the Special Survivor Indemnity Allowance. As part of the oversight process, additional provisions were incorporated to address selected congressional items of interest, such as added punitive articles on domestic violence in the Uniform Code of Military Justice and directed clarifying policy, support programs, and further study on services for victims of domestic violence and child abuse; stricter eligibility requirements for enlistees of the Military Accessions Vital to the National Interest (MAVNI) program; standardized processes for reporting and accountability, military justice and investigations, and victim services relating to military sexual assault and sexual harassment; increased transparency in Navy watchstander training programs and standards; and enhanced data-sharing between DOD and states to prevent opioid abuse or misuse.