10 U.S.C. § 1073c — Administration of Defense Health Agency

Page 1022 TITLE 10—ARMED FORCES § 1073b ‘‘(D) Focus on preventive care that emphasizes— ‘‘(i) early detection and timely treatment of disease; ‘‘(ii) periodic health screenings; and ‘‘(iii) education regarding healthy lifestyle be- haviors. ‘‘(E) Coordinate and integrate health care across the continuum of care, connecting all aspects of the health care received by the patient, including the patient’s health care team. ‘‘(F) Facilitate access to health care providers, including— ‘‘(i) after-hours care; ‘‘(ii) urgent care; and ‘‘(iii) through telehealth appointments, when appropriate. ‘‘(G) Encourage patients to participate in making health care decisions. ‘‘(H) Use evidence-based treatment protocols that improve the consistency of health care and elimi- nate ineffective, wasteful health care practices.’’ § 1073b. Recurring reports and publication of certain data (a) ANNUAL REPORT ON RECORDING OF HEALTH ASSESSMENT DATA IN MILITARY HEALTH RECORDS.—The Secretary of Defense shall issue each year a report on the compliance by the military departments with applicable law and policies on the recording of health assessment data in military health records, including com- pliance with section 1074f(c) of this title. The re- port shall cover the calendar year preceding the year in which the report is submitted and in- clude a discussion of the extent to which immu- nization status and predeployment and postdeployment health care data are being re- corded in such records. (b) PUBLICATION OF DATA ON PATIENT SAFETY, QUALITY OF CARE, SATISFACTION, AND HEALTH OUTCOME MEASURES.—(1) The Secretary of De- fense shall publish on a publically available Internet website of the Department of Defense data on all measures that the Secretary con- siders appropriate that are used by the Depart- ment to assess patient safety, quality of care, patient satisfaction, and health outcomes for health care provided under the TRICARE pro- gram at each military medical treatment facil- ity. Such data shall include the core quality per- formance metrics adopted by the Secretary under section 728 of the National Defense Au- thorization Act for Fiscal Year 2017. (2) The Secretary shall publish an update to the data published under paragraph (1) not less frequently than once each quarter during each fiscal year. (3) The Secretary may not include data relat- ing to risk management activities of the Depart- ment in any publication under paragraph (1) or update under paragraph (2). (4) The Secretary shall ensure that the data published under paragraph (1) and updated under paragraph (2) is accessible to the public through the primary Internet website of the Department and the primary Internet website of the military medical treatment facility with respect to which such data applies. (Added Pub. L. 108–375, div. A, title VII, § 739(a)(1), Oct. 28, 2004, 118 Stat. 2001; amended Pub. L. 114–92, div. A, title VII, § 712, Nov. 25, 2015, 129 Stat. 864; Pub. L. 114–328, div. A, title VII, § 728(b)(1), Dec. 23, 2016, 130 Stat. 2234; Pub. L. 115–91, div. A, title X, §§ 1051(a)(5), 1081(d)(3), Dec. 12, 2017, 131 Stat. 1560, 1600.) Editorial Notes REFERENCES IN TEXT Section 728 of the National Defense Authorization Act for Fiscal Year 2017, referred to in subsec. (b)(1), is section 728 of Pub. L. 114–328, which amended this sec- tion and enacted provisions set out as notes under sec- tion 1071 of this title. AMENDMENTS 2017—Pub. L. 115–91, § 1081(d)(3), amended directory language of Pub. L. 114–328, § 728(b)(1). See 2016 Amend- ment notes below. Subsecs. (a) to (c). Pub. L. 115–91, § 1051(a)(5), redesig- nated subsecs. (b) and (c) as (a) and (b), respectively, and struck out former subsec. (a) which related to an- nual report on the Force Health Protection Quality As- surance Program. 2016—Pub. L. 114–328, § 728(b)(1)(B), as amended by Pub. L. 115–91, § 1081(d)(3), inserted ‘‘and publication of certain data’’ after ‘‘reports’’ in section catchline. Amendment was executed as the probable intent of Congress, notwithstanding directory language amend- ing the section heading of section ‘‘1073b(c)’’. Subsec. (c)(1). Pub. L. 114–328, § 728(b)(1)(A), as amend- ed by Pub. L. 115–91, § 1081(d)(3), substituted ‘‘The Sec- retary’’ for ‘‘Not later than 180 days after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2016, the Secretary’’ and inserted at end ‘‘Such data shall include the core quality perform- ance metrics adopted by the Secretary under section 728 of the National Defense Authorization Act for Fis- cal Year 2017.’’ 2015—Subsec. (c). Pub. L. 114–92 added subsec. (c). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2017 AMENDMENT Pub. L. 115–91, div. A, title X, § 1081(d), Dec. 12, 2017, 131 Stat. 1599, provided that the amendment made by section 1081(d)(3) is effective as of Dec. 23, 2016, and as if included in Pub. L. 114–328 as enacted. INCLUSION OF DENTAL CARE For purposes of amendment by Pub. L. 108–375 adding this section, references to medical readiness, health status, and health care to be considered to include den- tal readiness, dental status, and dental care, see sec- tion 740 of Pub. L. 108–375, set out as a note under sec- tion 1074 of this title. INITIAL REPORTS Pub. L. 108–375, div. A, title VII, § 739(a)(3), Oct. 28, 2004, 118 Stat. 2002, directed that the first reports under this section be completed not later than 180 days after Oct. 28, 2004. § 1073c. Administration of Defense Health Agency and military medical treatment facilities (a) ADMINISTRATION OF MILITARY MEDICAL TREATMENT FACILITIES.—(1) In accordance with paragraph (5), by not later than September 30, 2021, the Director of the Defense Health Agency shall be responsible for the administration of each military medical treatment facility, in- cluding with respect to— (A) provision and delivery of health care within each such facility; (B) management of privileging, scope of practice, and quality of health care provided within each such facility; (C) budgetary matters; Page 1023 TITLE 10—ARMED FORCES § 1073c (D) information technology; (E) health care administration and manage- ment; (F) supply and equipment; (G) administrative policy and procedure; (H) military medical construction; and (I) any other matters the Secretary of De- fense determines appropriate. (2) In addition to the responsibilities set forth in paragraph (1), the Director of the Defense Health Agency shall, commencing when the Di- rector begins to exercise responsibilities under that paragraph, have the authority— (A) to direct, control, and serve as the pri- mary rater of the performance of commanders or directors of military medical treatment fa- cilities; (B) to direct and control any intermediary organizations between the Defense Health Agency and military medical treatment facili- ties; (C) to determine the scope of medical care provided at each military medical treatment facility to meet the military personnel readi- ness requirements of the senior military oper- ational commander of the military installa- tion; (D) to identify the capacity of each military medical treatment facility to support clinical readiness standards of health care providers established by the Secretary of a military de- partment or the Assistant Secretary of De- fense for Health Affairs; (E) to determine total workforce require- ments at each military medical treatment fa- cility; (F) to determine, in coordination with each Secretary of a military department, manning, including joint manning, assigned to military medical treatment facilities and intermediary organizations; (G) to select, after considering nominations from the Secretaries of the military depart- ments, commanders or directors of military medical treatment facilities; (H) to address personnel staffing shortages at military medical treatment facilities; and (I) to select among service nominations for commanders or directors of military medical treatment facilities. (3) The military commander or director of each military medical treatment facility shall be responsible for— (A) on behalf of the military departments, ensuring the readiness of the members of the armed forces at such facility; and (B) on behalf of the Defense Health Agency, furnishing the health care and medical treat- ment provided at such facility. (4) If the Secretary of Defense determines it appropriate, a military director (or any other senior military officer or officers) of a military medical treatment facility may be a com- manding officer for purposes of chapter 47 of this title (the Uniform Code of Military Justice) with respect to military personnel assigned to the military medical treatment facility. (5) The Secretary of Defense shall establish a timeline to ensure that each Secretary of a mili- tary department transitions the administration of military medical treatment facilities from such Secretary to the Director of the Defense Health Agency pursuant to paragraph (1) by the date specified in such paragraph. (6) The Secretary of Defense shall establish within the Defense Health Agency a professional staff to provide policy, oversight, and direction to carry out paragraphs (1) and (2). The Sec- retary shall carry out this paragraph by ap- pointing the positions specified in subsections (b) and (c). (b) DHA ASSISTANT DIRECTOR.—(1) There is in the Defense Health Agency an Assistant Direc- tor for Health Care Administration. The Assist- ant Director shall— (A) be a career appointee within the Depart- ment; and (B) report directly to the Director of the De- fense Health Agency. (2) The Assistant Director shall be appointed from among individuals who have the education and experience to perform the responsibilities of the position. (3) The Assistant Director shall be responsible for the following: (A) Establishing priorities for health care administration and management. (B) Establishing policies, procedures, and di- rection for the provision of direct care at mili- tary medical treatment facilities. (C) Establishing priorities for budgeting matters with respect to the provision of direct care at military medical treatment facilities. (D) Establishing policies, procedures, and di- rection for clinic management and operations at military medical treatment facilities. (E) Establishing priorities for information technology at and between the military med- ical treatment facilities. (c) DHA DEPUTY ASSISTANT DIRECTORS.—(1)(A) There is in the Defense Health Agency a Deputy Assistant Director for Information Operations. (B) The Deputy Assistant Director for Infor- mation Operations shall be responsible for poli- cies, management, and execution of information technology operations at and between the mili- tary medical treatment facilities. (2)(A) There is in the Defense Health Agency a Deputy Assistant Director for Financial Oper- ations. (B) The Deputy Assistant Director for Finan- cial Operations shall be responsible for the pol- icy, procedures, and direction of budgeting mat- ters and financial management with respect to the provision of direct care at military medical treatment facilities. (3)(A) There is in the Defense Health Agency a Deputy Assistant Director for Health Care Oper- ations. (B) The Deputy Assistant Director for Health Care Operations shall be responsible for the pol- icy, procedures, and direction of health care ad- ministration in the military medical treatment facilities. (4)(A) There is in the Defense Health Agency a Deputy Assistant Director for Medical Affairs. (B) The Deputy Assistant Director for Medical Affairs shall be responsible for policy, proce- dures, and direction of clinical quality and proc- ess improvement, patient safety, infection con- Page 1024 TITLE 10—ARMED FORCES § 1073c trol, graduate medical education, clinical inte- gration, utilization review, risk management, patient experience, and civilian physician re- cruiting at military medical treatment facili- ties. (5) Each Deputy Assistant Director appointed under paragraph (3) or (4) shall report directly to the Assistant Director for Health Care Ad- ministration. (d) CERTAIN RESPONSIBILITIES OF DHA DIREC- TOR.—(1) In addition to the other duties of the Director of the Defense Health Agency, the Di- rector shall coordinate with the Joint Staff Sur- geon to ensure that the Director most effec- tively carries out the responsibilities of the De- fense Health Agency as a combat support agency under section 193 of this title. (2) The responsibilities of the Director shall include the following: (A) Ensuring that the Defense Health Agen- cy meets the operational needs of the com- manders of the combatant commands. (B) Coordinating with the military depart- ments to ensure that the staffing at the mili- tary medical treatment facilities supports readiness requirements for members of the armed forces and health care personnel. (C) Ensuring that the Defense Health Agency meets the military medical readiness require- ments of the senior military operational com- manders of the military installations. (e) ADDITIONAL DHA ORGANIZATIONS.—Not later than September 30, 2024, and subject to subsection (f), the Secretary of Defense shall, acting though the Director of the Defense Health Agency, establish within the Defense Health Agency the following: (1) A subordinate organization, to be called the Defense Health Agency Research and De- velopment— (A) led, at the election of the Director, by a director or commander (to be called the Director or Commander of Defense Health Agency Research and Development); (B) comprised of the Army Medical Re- search and Materiel Command and such other medical research organizations and ac- tivities of the armed forces as the Secretary considers appropriate; and (C) responsible for coordinating funding for Defense Health Program Research, De- velopment, Test, and Evaluation, the Con- gressionally Directed Medical Research Pro- gram, and related Department of Defense medical research. (2) A subordinate organization, to be called the Defense Health Agency Public Health— (A) led, at the election of the Director, by a director or commander (to be called the Director or Commander of Defense Health Agency Public Health); and (B) comprised of the Army Public Health Center, the Navy–Marine Corps Public Health Center, Air Force public health pro- grams, and any other related defense health activities that the Secretary considers ap- propriate, including overseas laboratories fo- cused on preventive medicine, environ- mental health, and similar matters. (f) EXCEPTION TO ESTABLISHMENT OF ADDI- TIONAL DHA ORGANIZATIONS.—At the discretion of the Secretary of Defense, a military depart- ment may retain a function that would other- wise be transferred to the Defense Health Agen- cy under subsection (e) if the Secretary of De- fense determines the function— (1) addresses a need that is unique to the military department; and (2) is in direct support of operating forces and necessary to execute strategies relating to national security and defense. (g) CONSULTATIONS ON MEDICAL RESEARCH OF MILITARY DEPARTMENTS.—In establishing the Defense Health Agency Research and Develop- ment pursuant to subsection (e)(1), and on a basis that is not less frequent than semiannu- ally thereafter, the Secretary of Defense shall carry out recurring consultations with each military department regarding the plans and re- quirements for military medical research orga- nizations and activities of the military depart- ment. (h) TREATMENT OF DEPARTMENT OF DEFENSE FOR PURPOSES OF PERSONNEL ASSIGNMENT.—In implementing this section— (1) the Department of Defense shall be con- sidered a single agency for purposes of civilian personnel assignment under title 5; and (2) the Secretary of Defense may reassign any employee of a component of the Depart- ment of Defense or a military department in a position in the civil service (as defined in sec- tion 2101 of title 5) to any other component of the Department of Defense or military depart- ment. (i) RULE OF CONSTRUCTION REGARDING SECRE- TARIES CONCERNED AND MEDICAL EVALUATION BOARDS.—Nothing in this section shall be con- strued as transferring to the Director of the De- fense Health Agency, or otherwise revoking, any authority or responsibility of the Secretary con- cerned under chapter 61 of this title with respect to a member of the armed forces (including with respect to the administration of morale and wel- fare and the determination of fitness for duty for the member) while the member is being con- sidered by a medical evaluation board. (j) DEFINITIONS.—In this section: (1) The term ‘‘career appointee’’ has the meaning given that term in section 3132(a)(4) of title 5. (2) The term ‘‘Defense Health Agency’’ means the Defense Agency established pursu- ant to Department of Defense Directive 5136.13, or such successor Defense Agency. (3) The term ‘‘military medical treatment facility’’ means— (A) any fixed facility of the Department of Defense that is outside of a deployed envi- ronment and used primarily for health care; and (B) any other location used for purposes of providing health care services as designated by the Secretary of Defense. (Added Pub. L. 114–328, div. A, title VII, § 702(a)(1), Dec. 23, 2016, 130 Stat. 2193; amended Pub. L. 115–91, div. A, title VII, § 713, title X, § 1081(a)(23), Dec. 12, 2017, 131 Stat. 1437, 1595; Pub. L. 115–232, div. A, title VII, § 711(a)(1), (2), (b)(1), Aug. 13, 2018, 132 Stat. 1806, 1807; Pub. L. 116–92, div. A, title VII, § 711, title XVII, Page 1025 TITLE 10—ARMED FORCES § 1073c § 1731(a)(22), Dec. 20, 2019, 133 Stat. 1441, 1813; Pub. L. 116–283, div. A, title X, § 1081(a)(24), Jan. 1, 2021, 134 Stat. 3872; Pub. L. 117–81, div. A, title VII, §§ 711, 712(a), Dec. 27, 2021, 135 Stat. 1783; Pub. L. 117–263, div. A, title VII, §§ 711(b), 720(c), Dec. 23, 2022, 136 Stat. 2656, 2663; Pub. L. 118–31, div. A, title VII, § 711(a), Dec. 22, 2023, 137 Stat. 301; Pub. L. 118–159, div. A, title XVII, § 1701(a)(18), Dec. 23, 2024, 138 Stat. 2204.) Editorial Notes AMENDMENTS 2024—Subsecs. (h) to (j). Pub. L. 118–159 redesignated subsec. (h) relating to rule of construction regarding Secretaries concerned and medical evaluation boards as (i) and former subsec. (i) as (j). 2023—Subsec. (e). Pub. L. 118–31, § 711(a)(1), sub- stituted ‘‘Not later than September 30, 2024, and subject to subsection (f),’’ for ‘‘Not later than September 30, 2022,’’ in introductory provisions. Subsecs. (f) to (h). Pub. L. 118–31, § 711(a)(2), (3), added subsec. (f) and redesignated former subsec. (f) as (g) and former subsec. (g) as (h) relating to treatment of De- partment of Defense for purposes of personnel assign- ment. 2022—Subsec. (e)(2)(B). Pub. L. 117–263, § 720(c), sub- stituted ‘‘Army Public Health Center, the Navy–Marine Corps Public Health Center’’ for ‘‘Army Public Health Command, the Navy–Marine Corps Public Health Com- mand’’. Subsecs. (h), (i). Pub. L. 117–263, § 711(b), added subsec. (h) and redesignated former subsec. (h) as (i). 2021—Subsec. (a)(4), (6). Pub. L. 116–283 redesignated par. (6) relating to authorization of military director or other senior military officer to serve as a commanding officer as (4) and moved it to appear before par. (5). Subsec. (c)(5). Pub. L. 117–81, § 711, substituted ‘‘para- graph (3) or (4)’’ for ‘‘paragraphs (1) through (4)’’. Subsecs. (f) to (h). Pub. L. 117–81, § 712(a), added sub- sec. (f) and redesignated former subsecs. (f) and (g) as (g) and (h), respectively. 2019—Subsec. (a)(1). Pub. L. 116–92, § 711(f)(1), sub- stituted ‘‘paragraph (5)’’ for ‘‘paragraph (4)’’ in intro- ductory provisions. Pub. L. 116–92, § 711(a)(1), added subpars. (A), (B), and (F) and redesignated former subpars. (A), (B), (C), (D), (E), and (F) as (C), (D), (E), (G), (H), and (I), respec- tively. Subsec. (a)(2)(D) to (I). Pub. L. 116–92, § 711(a)(2), added subpars. (D), (F), and (G), redesignated former subpars. (D), (E), (F), and (G) as (E), (F), (H), and (I), re- spectively, and struck out subpar. (F) as so redesig- nated. Prior to repeal, the redesignated subpar. (F) read as follows: ‘‘to direct joint manning at military med- ical treatment facilities and intermediary organiza- tions;’’. Subsec. (a)(3)(A). Pub. L. 116–92, § 711(a)(3)(A), inserted ‘‘on behalf of the military departments,’’ before ‘‘ensur- ing’’ and struck out ‘‘and civilian employees’’ after ‘‘armed forces’’. Subsec. (a)(3)(B). Pub. L. 116–92, § 711(a)(3)(B), inserted ‘‘on behalf of the Defense Health Agency,’’ before ‘‘fur- nishing’’. Subsec. (a)(4). Pub. L. 116–92, § 711(f)(4), which directed moving the second par. (4) so as to appear before par. (5), could not be executed because of the intervening amendment by Pub. L. 116–92, § 1731(a)(22). See below. Pub. L. 116–92, § 711(f)(3), redesignated par. (4) relating to timeline for transition of administration of military medical treatment facilities as (5). Pub. L. 116–92, § 1731(a)(22), redesignated par. (4) relat- ing to authorization of military director or other sen- ior military officer to serve as a commanding officer as (6). Amendment executed before amendment by section 711(f)(4) of Pub. L. 116–92, see above, pursuant to section 1731(f) of Pub. L. 116–92, set out as a Coordination of Certain Sections of an Act With Other Provisions of That Act note under section 101 of this title. Subsec. (a)(5). Pub. L. 116–92, § 711(f)(3), redesignated par. (4) relating to timeline for transition of adminis- tration of military medical treatment facilities as (5). Former par. (5) redesignated (6) relating to establish- ment of professional staff. Subsec. (a)(6). Pub. L. 116–92, § 711(f)(2), redesignated par. (5) as (6) relating to establishment of professional staff. Pub. L. 116–92, § 1731(a)(22), redesignated par. (4) relat- ing to authorization of military director or other sen- ior military officer to serve as a commanding officer as (6). Subsec. (b)(2). Pub. L. 116–92, § 711(b), substituted ‘‘the education and experience to perform the responsibil- ities of the position.’’ for ‘‘equivalent education and ex- perience as a chief executive officer leading a large, ci- vilian health care system.’’ Subsec. (c)(2)(B). Pub. L. 116–92, § 711(c)(1), substituted ‘‘at military medical treatment facilities’’ for ‘‘across the military health system’’. Subsec. (c)(4)(B). Pub. L. 116–92, § 711(c)(2), inserted ‘‘at military medical treatment facilities’’ before pe- riod at end. Subsecs. (f), (g). Pub. L. 116–92, § 711(d), added subsec. (f) and redesignated former subsec. (f) as (g). Subsec. (g)(3). Pub. L. 116–92, § 711(e), added par. (3). 2018—Subsec. (a)(1). Pub. L. 115–232, § 711(a)(1)(A), sub- stituted ‘‘In accordance with paragraph (4), by not later than September 30, 2021,’’ for ‘‘Beginning October 1, 2018,’’ in introductory provisions. Subsec. (a)(2), (3). Pub. L. 115–232, § 711(a)(1)(B), (C), added par. (2) and redesignated former par. (2) as (3). Former par. (3) redesignated (5). Subsec. (a)(4). Pub. L. 115–232, § 711(a)(1)(D), added par. (4) relating to timeline for transition of administration of military medical treatment facilities. Subsec. (a)(5). Pub. L. 115–232, § 711(a)(1)(B), (E), redes- ignated par. (3) as (5) and substituted ‘‘paragraphs (1) and (2)’’ for ‘‘subsection (a)’’. Subsec. (d)(2)(C). Pub. L. 115–232, § 711(a)(2), added sub- par. (C). Subsecs. (e), (f). Pub. L. 115–232, § 711(b)(1), added sub- sec. (e) and redesginated former subsec. (e) as (f). 2017—Subsec. (a)(1)(E). Pub. L. 115–91, §§ 713(1), 1081(a)(23), amended subpar. (E) identically, sub- stituting ‘‘military’’ for ‘‘miliary’’. Subsec. (a)(2). Pub. L. 115–91, § 713(2), substituted ‘‘military commander or director’’ for ‘‘commander’’ in introductory provisions. Subsec. (a)(4). Pub. L. 115–91, § 713(3), added par. (4) re- lating to authorization of military director or other senior military officer to serve as a commanding offi- cer. Statutory Notes and Related Subsidiaries EXPANSION OF RECOGNITION BY THE DEFENSE HEALTH AGENCY OF CERTIFYING BODIES FOR PHYSICIANS Pub. L. 118–159, div. A, title VII, § 715, Dec. 23, 2024, 138 Stat. 1948, provided that: ‘‘(a) EXPANSION.—Not later than 180 days after the date of the enactment of this Act [Dec. 23, 2024], the Di- rector of the Defense Health Agency shall revise the policy of the Defense Health Agency regarding the credentialing and privileging under the military health system to expand the recognition of certifying bodies for physicians under such policy to a wide range of ad- ditional board certifications in medical specialties and subspecialties. Subject to subsection (b), the following certifying bodies shall be so recognized: ‘‘(1) The member boards of the American Board of Medical Specialties. ‘‘(2) The Bureau of Osteopathic Specialists of the American Osteopathic Association. ‘‘(3) The American Board of Foot and Ankle Sur- gery. ‘‘(4) The American Board of Podiatric Medicine. ‘‘(5) The American Board of Oral and Maxillofacial Surgery. Page 1026 TITLE 10—ARMED FORCES § 1073c ‘‘(b) STANDARDS FOR RECOGNITION OF OTHER CERTI- FYING BODIES.—To be recognized under subsection (a), a certifying body shall— ‘‘(1) be an organization described in section 501(c) of the Internal Revenue Code of 1986 [26 U.S.C. 501(c)] and exempt from taxation under section 501(a) of that Code; ‘‘(2) maintain a process to define, periodically re- view, enforce, and update specific standards regard- ing knowledge and skills of the specialty or sub- specialty; ‘‘(3) administer a psychometrically valid assess- ment to determine whether a physician meets stand- ards for initial certification, recertification, or con- tinuing certification; ‘‘(4) establish and enforce a code of professional conduct; ‘‘(5) require that, in order to be considered a board certified specialty physician, a physician must sat- isfy— ‘‘(A) the certifying body’s applicable require- ments for initial certification; and ‘‘(B) any applicable recertification or continuing certification requirements of the certifying body that granted the initial certification; and ‘‘(6) meets such other requirements as the Sec- retary of Defense may establish for purposes of com- pliance with appropriate requirements of applicable State laws and the promotion of consistency in credentialing and privileging health care providers throughout military medical treatment facilities of the Defense Health Agency.’’ WAIVER WITH RESPECT TO EXPERIENCED NURSES AT MILITARY MEDICAL TREATMENT FACILITIES Pub. L. 118–159, div. A, title VII, § 716, Dec. 23, 2024, 138 Stat. 1949, provided that: ‘‘(a) IN GENERAL.—The hiring manager of a military medical treatment facility or other health care facility of the Department of Defense may waive any General Schedule qualification standard related to work experi- ence established by the Director of the Office of Per- sonnel Management in the case of any applicant for a nursing or practical nurse position in a military med- ical treatment facility or other health care facility of the Department of Defense who— ‘‘(1)(A) is a nurse or practical nurse in the Depart- ment of Defense; or ‘‘(B) was a nurse or practical nurse in the Depart- ment of Defense for at least one year; and ‘‘(2) after commencing work as a nurse or practical nurse in the Department of Defense, obtained a bach- elor’s degree or graduate degree from an accredited professional nursing educational program. ‘‘(b) CERTIFICATION.—If, in the case of any applicant described in subsection (a), a hiring manager waives a qualification standard in accordance with such sub- section, such hiring manager shall submit to the Direc- tor of the Office of Personnel Management a certifi- cation that such applicant meets all remaining General Schedule qualification standards established by the Di- rector of the Office of Personnel Management for the applicable position.’’ MODIFICATION OF REQUIREMENT TO TRANSFER RE- SEARCH AND DEVELOPMENT AND PUBLIC HEALTH FUNCTIONS TO DEFENSE HEALTH AGENCY Pub. L. 117–263, div. A, title VII, § 720, Dec. 23, 2022, 136 Stat. 2662, provided that: ‘‘(a) TEMPORARY RETENTION.—Notwithstanding sec- tion 1073c(e) of title 10, United States Code, at the dis- cretion of the Secretary of Defense, a military depart- ment may retain, until not later than February 1, 2024, a covered function if the Secretary of Defense deter- mines the covered function— ‘‘(1) addresses a need that is unique to the military department; and ‘‘(2) is in direct support of operating forces and nec- essary to execute strategies relating to national secu- rity and defense. ‘‘(b) BRIEFING.— ‘‘(1) IN GENERAL.—Not later than March 1, 2023, the Secretary of Defense shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on any covered function that the Secretary has determined should be retained by a military department pursuant to subsection (a). ‘‘(2) ELEMENTS.—The briefing required by paragraph (1) shall address the following: ‘‘(A) A description of each covered function that the Secretary has determined should be retained by a military department pursuant to subsection (a). ‘‘(B) The rationale for each such determination. ‘‘(C) Recommendations for amendments to sec- tion 1073c of title 10, United States Code, to author- ize the ongoing retention of covered functions by military departments. ‘‘(c) MODIFICATION TO NAMES OF PUBLIC HEALTH COM- MANDS.—[Amended this section.] ‘‘(d) COVERED FUNCTION DEFINED.—In this section, the term ‘covered function’ means— ‘‘(1) a function relating to research and develop- ment that would otherwise be transferred to the De- fense Health Agency Research and Development pur- suant to section 1073c(e)(1) of title 10, United States Code; or ‘‘(2) a function relating to public health that would otherwise be transferred to the Defense Health Agen- cy Public Health pursuant to section 1073c(e)(2) of such title.’’ REQUIREMENTS FOR CONSULTATIONS RELATING TO MILI- TARY MEDICAL RESEARCH AND DEFENSE HEALTH AGENCY RESEARCH AND DEVELOPMENT Pub. L. 117–81, div. A, title VII, § 712(b), (c), Dec. 27, 2021, 135 Stat. 1783, 1784, provided that: ‘‘(b) REQUIREMENTS FOR CONSULTATIONS.—The Sec- retary of Defense shall ensure that consultations are carried out under section 1073c(f) of title 10, United States Code (as added by subsection (a)), to include the plans of each military department to ensure a com- prehensive transition of any military medical research organizations of the military department with respect to the establishment of the Defense Health Agency Re- search and Development. ‘‘(c) DEADLINE FOR INITIAL CONSULTATIONS.—Initial consultations shall be carried out under section 1073c(f) of title 10, United States Code (as added by subsection (a)), with each military department by not later than March 1, 2022.’’ LIMITATION ON CLOSURES AND DOWNSIZINGS IN CONNECTION WITH TRANSITION OF ADMINISTRATION Pub. L. 115–232, div. A, title VII, § 711(a)(3), Aug. 13, 2018, 132 Stat. 1807, provided that: ‘‘In carrying out the transition of responsibility for the administration of military medical treatment facilities pursuant to sub- section (a) of section 1073c of title 10, United States Code (as amended by paragraph (1)), and in addition to any other applicable requirements under section 1073d of that title, the Secretary of Defense may not close any military medical treatment facility, or downsize any medical center, hospital, or ambulatory care cen- ter (as specified in section 1073d of that title), that ad- dresses the medical needs of beneficiaries and the com- munity in the vicinity of such facility, center, hospital, or care center until the Secretary submits to the con- gressional defense committees [Committees on Armed Services and Appropriations of the Senate and the House of Representatives] a report setting forth the fol- lowing: ‘‘(A) A description of the methodology and criteria to be used by the Secretary to make decisions to close any military medical treatment facility, or to downsize any medical center, hospital, or ambulatory care center, in connection with the transition, in- cluding input from the military department con- cerned. ‘‘(B) A requirement that no closure of a military medical treatment facility, or downsizing of a med- Page 1027 TITLE 10—ARMED FORCES § 1073c ical center, hospital, or ambulatory care center, in connection with the transition will occur until 90 days after the date on which Secretary submits to the Committees on Armed Services of the Senate and the House of Representatives a report on the closure or downsizing.’’ SUPPORT BY MILITARY HEALTHCARE SYSTEM OF MEDICAL REQUIREMENTS OF COMBATANT COMMANDS Pub. L. 117–81, div. A, title VII, § 731(b)(1), Dec. 27, 2021, 135 Stat. 1796, provided that: ‘‘The Secretaries of the military departments shall ensure that the Sur- geons General of the Armed Forces carry out fully the requirements of section 712(b)(3) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Public Law 115–232; 10 U.S.C. 1073c note) [set out below] by not later than September 30, 2022.’’ Pub. L. 115–232, div. A, title VII, § 712, Aug. 13, 2018, 132 Stat. 1809, as amended by Pub. L. 116–92, div. A, title VII, § 712(a), (b)(1), Dec. 20, 2019, 133 Stat. 1443–1445; Pub. L. 118–31, div. A, title VII, § 714(c), Dec. 22, 2023, 137 Stat. 303, provided that: ‘‘(a) ORGANIZATIONAL FRAMEWORK REQUIRED.— ‘‘(1) IN GENERAL.—The Secretary of Defense shall, acting through the Secretaries of the military de- partments, the Defense Health Agency, and the Joint Staff, implement an organizational framework of the military health system that effectively and effi- ciently implements chapter 55 of title 10, United States Code, to maximize the readiness of the med- ical force, promote interoperability, and integrate medical capabilities of the Armed Forces in order to enhance joint military medical operations in support of requirements of the combatant commands. ‘‘(2) COMPLIANCE WITH CERTAIN REQUIREMENTS.—The organizational framework, as implemented, shall comply with all requirements of section 1073c of title 10, United States Code, except for the implementa- tion date specified in subsection (a) of such section. ‘‘(b) ADDITIONAL DUTIES OF SURGEONS GENERAL OF THE ARMED FORCES.—The Surgeons General of the Armed Forces shall have the following duties: ‘‘(1) To ensure the readiness for operational deploy- ment of medical and dental personnel and deployable medical or dental teams or units of the Armed Force or Armed Forces concerned. ‘‘(2) To meet medical readiness standards, subject to standards and metrics established by the Assistant Secretary of Defense for Health Affairs. ‘‘(3) With respect to uniformed medical and dental personnel of the military department concerned— ‘‘(A) to assign such personnel— ‘‘(i) primarily to military medical treatment fa- cilities, under the operational control of the com- mander or director of the facility; or ‘‘(ii) secondarily to partnerships with civilian or other medical facilities for training activities specific to such military department; and ‘‘(B) to maintain readiness of such personnel for operational deployment. ‘‘(4) To provide logistical support for operational deployment of medical and dental personnel and deployable medical or dental teams or units of the Armed Force or Armed Forces concerned. ‘‘(5) To oversee mobilization and demobilization in connection with the operational deployment of med- ical and dental personnel of the Armed Force or Armed Forces concerned. ‘‘(6) To develop operational medical capabilities re- quired to support the warfighter, and to develop pol- icy relating to such capabilities. ‘‘(7) To provide health professionals to serve in leadership positions across the military healthcare system. ‘‘(8) To deliver operational clinical services under the operational control of the combatant com- mands— ‘‘(A) on ships and planes; and ‘‘(B) on installations outside of military medical treatment facilities. ‘‘(9) To manage privileging, scope of practice, and quality of health care in the settings described in paragraph (8). ‘‘(c) DEFENSE HEALTH AGENCY REGIONS IN CONUS.— The organizational framework required by subsection (a) shall meet the requirements as follows: ‘‘(1) DEFENSE HEALTH AGENCY REGIONS.—There shall be not more than two Defense Health Agency regions in the continental United States. ‘‘(2) LEADERS.—Each region under paragraph (1) shall be led by a commander or director who is a member of the Armed Forces serving in a grade not higher than major general or rear admiral, and who— ‘‘(A) shall be selected by the Director of the De- fense Health Agency from among members of the Armed Forces recommended by the Secretaries of the departments for service in such position; and ‘‘(B) shall be under the authority, direction, and control of the Director while serving in such posi- tion. ‘‘(d) DEFENSE HEALTH AGENCY REGIONS OCONUS.— The organizational framework required by subsection (a) shall provide for the establishment of not more than two Defense Health Agency regions outside the conti- nental United States in order— ‘‘(1) to enhance joint military medical operations in support of the requirements of the combatant com- mands in such region or regions, with a specific focus on current and future contingency and operational plans; ‘‘(2) to ensure the provision of high-quality healthcare services to beneficiaries; and ‘‘(3) to improve the interoperability of healthcare delivery systems in the Defense Health Agency re- gions (whether under this subsection, subsection (c), or both). ‘‘(e) PLANNING AND COORDINATION.— ‘‘(1) SUSTAINMENT OF CLINICAL COMPETENCIES AND STAFFING.—The Director of the Defense Health Agen- cy shall— ‘‘(A) provide in each Defense Health Agency re- gion under this section healthcare delivery venues for uniformed medical and dental personnel to ob- tain operational clinical competencies; and ‘‘(B) coordinate with the military departments to ensure that staffing at military medical treatment facilities in each region supports readiness require- ments for members of the Armed Forces and mili- tary medical personnel. ‘‘(2) OVERSIGHT AND ALLOCATION OF RESOURCES.— ‘‘(A) IN GENERAL.—The Secretaries of the military departments shall coordinate with the Chairman of the Joint Chiefs of Staff to direct resources allo- cated to the military departments to support re- quirements related to readiness and operational medicine support that are established by the com- batant commands and validated by the Joint Staff. ‘‘(B) SUPPLY AND DEMAND FOR MEDICAL SERVICES.— The Director of the Defense Health Agency, in co- ordination with the Assistant Secretary of Defense for Health Affairs, shall— ‘‘(i) validate supply and demand requirements for medical and dental services at each military medical treatment facility; ‘‘(ii) in coordination with the Surgeons General of the Armed Forces, provide currency workload for uniformed medical and dental personnel at each such facility to maintain skills proficiency; and ‘‘(iii) if workload is insufficient to meet re- quirements, identify alternative training and clinical practice sites for uniformed medical and dental personnel, and establish military-civilian training partnerships, to provide such workload. ‘‘(3) MEDICAL FORCE REQUIREMENTS OF THE COMBAT- ANT COMMANDS.—The Surgeon General of each Armed Force shall, on behalf of the Secretary concerned, en- sure that the uniformed medical and dental personnel serving in such Armed Force receive training and clinical practice opportunities necessary to ensure Page 1028 TITLE 10—ARMED FORCES § 1073d that such personnel are capable of meeting the oper- ational medical force requirements of the combatant commands applicable to such personnel. Such train- ing and practice opportunities shall be provided pri- marily through programs and activities of the De- fense Health Agency, in coordination with the Secre- taries of the military departments, and by such other mechanisms as the Secretary of Defense shall des- ignate for purposes of this paragraph. ‘‘(4) CONSTRUCTION OF DUTIES.—The duties of a Sur- geon General of the Armed Forces under this sub- section are in addition to the duties of such Surgeon General under section 3036, 5137, or 8036 of title 10, United States Code, as applicable. ‘‘(5) MANPOWER.— ‘‘(A) ADMINISTRATIVE CONTROL OF MILITARY PER- SONNEL.—Each Secretary of a military department shall exercise administrative control of members of the Armed Forces assigned to military medical treatment facilities, including personnel assign- ment and issuance of military orders. ‘‘(B) OVERSIGHT OF CERTAIN PERSONNEL BY THE DI- RECTOR OF THE DEFENSE HEALTH AGENCY.—In situa- tions in which members of the Armed Forces pro- vide health care services at a military medical treatment facility, the Director of the Defense Health Agency shall maintain operational control over such members and oversight for the provision of care delivered by such members through policies, procedures, and privileging responsibilities of the military medical treatment facility. ‘‘(f) REPORT.—Not later than 270 days after the date of the enactment of this Act [Aug. 13, 2018], the Sec- retary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Rep- resentatives a report that sets forth the following: ‘‘(1) A description of the organizational structure of the office of each Surgeon General of the Armed Forces, and of any subordinate organizations of the Armed Forces that will support the functions and re- sponsibilities of a Surgeon General of the Armed Forces. ‘‘(2) The manning documents for staffing in support of the organizational structures described pursuant to paragraph (1), including manning levels before and after such organizational structures are imple- mented. ‘‘(3) Such recommendations for legislative or ad- ministrative action as the Secretary considers appro- priate in connection with the implementation of such organizational structures and, in particular, to avoid duplication of functions and tasks between the orga- nizations in such organizational structures and the Defense Health Agency.’’ SELECTION OF MILITARY COMMANDERS AND DIRECTORS OF MILITARY MEDICAL TREATMENT FACILITIES Pub. L. 115–91, div. A, title VII, § 722, Dec. 12, 2017, 131 Stat. 1441, provided that: ‘‘(a) IN GENERAL.—Not later than January 1, 2019, the Secretary of Defense, in consultation with the Secre- taries of the military departments, shall establish the common qualifications and core competencies required for an individual to serve as a military commander or director of a military medical treatment facility. ‘‘(b) OBJECTIVE.—The objective of the Secretary under this section shall be to ensure that each indi- vidual selected to serve as a military commander or di- rector of a military medical treatment facility is high- ly qualified to serve as health system executive. ‘‘(c) STANDARDS.—In establishing common qualifica- tions and core competencies under subsection (a), the Secretary shall include standards with respect to the following: ‘‘(1) Professional competence. ‘‘(2) Moral and ethical integrity and character. ‘‘(3) Formal education in health care executive leadership and in health care management. ‘‘(4) Such other matters the Secretary determines to be appropriate.’’ APPOINTMENTS Pub. L. 114–328, div. A, title VII, § 702(c), Dec. 23, 2016, 130 Stat. 2196, provided that: ‘‘The Secretary of Defense shall make appointments of the positions under section 1073c of title 10, United States Code, as added by sub- section (a)— ‘‘(1) by not later than October 1, 2018; and ‘‘(2) by not increasing the number of full-time equivalent employees of the Defense Health Agency.’’ § 1073d. Military medical treatment facilities (a) IN GENERAL.—To support the medical read- iness of the armed forces and the readiness of medical personnel, the Secretary of Defense, in consultation with the Secretaries of the mili- tary departments, shall maintain the military medical treatment facilities described in sub- sections (b), (c), and (d). (b) MEDICAL CENTERS.—(1) The Secretary of Defense shall maintain medical centers in areas with a large population of members of the armed forces and covered beneficiaries. (2) Medical centers shall serve as referral fa- cilities for members and covered beneficiaries who require comprehensive health care services that support medical readiness. (3) Medical centers shall consist of the fol- lowing: (A) Inpatient and outpatient tertiary care facilities that incorporate specialty and sub- specialty care. (B) Graduate medical education programs. (C) Residency training programs. (D) Level one, level two, or level three trau- ma care capabilities. (4)(A) The Secretary shall designate certain major medical centers as regional centers of ex- cellence for the provision of specialty care serv- ices in the areas of specialty care described in subparagraph (D). A major medical center may be designated as a center of excellence under this subparagraph for more than one such area of specialty care. (B) The Secretary may designate certain med- ical centers as satellite centers of excellence for the provision of specialty care services for spe- cific conditions, such as the following: (i) Post-traumatic stress. (ii) Traumatic brain injury. (iii) Such other conditions as the Secretary determines appropriate. (C) Centers of excellence designated under this paragraph shall serve the purposes of— (i) ensuring the military medical force readi- ness of the Department of Defense and the medical readiness of the armed forces; (ii) improving the quality of health care fur- nished by the Secretary to eligible bene- ficiaries; and (iii) improving health outcomes for eligible beneficiaries. (D) The areas of specialty care described in this subparagraph are as follows: (i) Oncology. (ii) Burn injuries and wound care. (iii) Rehabilitation medicine. (iv) Psychological health and traumatic brain injury. (v) Amputations and prosthetics. (vi) Neurosurgery.