To provide for improved medical readiness of the members of the Armed Forces, and for other purposes.

May 18, 2004

Mrs. CLINTON (for herself, Mr. TALENT, and Mr. SCHUMER) introduced the following bill; which was read twice and referred to the Committee on Armed Services

To provide for improved medical readiness of the members of the Armed Forces, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medical Readiness and Tracking Act of 2004'.

TITLE I--RESERVE COMPONENT PERSONNEL

SEC. 101. STUDY OF HEALTH OF RESERVES ORDERED TO ACTIVE DUTY FOR OPERATIONS ENDURING FREEDOM AND IRAQI FREEDOM.

(a) REQUIREMENT FOR GAO STUDY- The Comptroller General of the United States shall carry out a study of the health of the members of the reserve components of the Armed Forces who have been called or ordered to active duty for a period of more than 30 days in support of Operation Enduring Freedom and Operation Iraqi Freedom. The Comptroller General shall commence the study not later than 180 days after the date of the enactment of this Act.

(b) PURPOSES- The purposes of the study under this section are as follows:

(1) To review the health status and medical fitness of the activated Reserves when they were called or ordered to active duty.

(2) To review the effects, if any, on logistics planning and the deployment schedules for the operations referred to in subsection (a) that resulted from deficiencies in the health or medical fitness of activated Reserves.

(3) To review compliance of the responsible Department of Defense personnel with Department of Defense policies on routine medical and physical fitness examinations that are applicable to the reserve components of the Armed Forces.

(4) To review in the case of activated Reserves deployed to the theater of an operation referred to in subsection (a), the medical care that was provided to such personnel in the theater during the first six months after arrival in the theater.

(c) REPORT- The Comptroller General shall, not later than 18 months after the date of the enactment of this Act, submit a report on the results of the study under this section to the Committees on Armed Services of the Senate and the House of Representatives. The report shall include the following matters:

(1) With respect to the matters reviewed under paragraph (1) of subsection (b)--

(A) the percentage of activated Reserves who were determined to be medically unfit for deployment, together with an analysis of the medical illnesses or conditions most commonly found among the activated Reserves that were grounds for determinations of medical unfitness for deployment; and

(B) the percentage of the activated Reserves who, before being deployed, needed medical care for health conditions identified when called or ordered to active duty, together with an analysis of the types of care that were provided for such conditions.

(2) With respect to the matters reviewed under paragraph (2) of subsection (b)--

(A) the delays and other disruptions in deployment schedules that resulted from deficiencies in the health status or medical fitness of activated Reserves; and

(B) an analysis of the extent to which it was necessary to merge units or otherwise alter the composition of units, and the extent to which it was necessary to merge or otherwise alter objectives, in order to compensate for limitations on the deployability of activated Reserves resulting from deficiencies in the health status or medical fitness of activated Reserves.

(3) With respect to the matters reviewed under paragraph (3) of subsection (b), an assessment of the extent of the compliance of the responsible Department of Defense personnel with Department of Defense policies on routine medical and physical fitness examinations that are applicable to the reserve components of the Armed Forces.

(4) With respect to the matters reviewed under paragraph (4) of subsection (b), an analysis of the extent to which the medical care provided to activated Reserves in each theater of operations referred to in subsection (a) related to preexisting conditions that were not adequately addressed before the deployment of such personnel to the theater.

(d) DEFINITIONS- In this section:

(1) The term `activated Reserves' means the members of the Armed Forces referred to in subsection (a).

(2) The term `active duty for a period of more than 30 days' has the meaning given such term in section 101(d) of title 10, United States Code.

(3) The term `health condition' includes a dental condition.

(4) The term `reserve components of the Armed Forces' means the reserve components listed in section 10101 of title 10, United States Code.

SEC. 102. PHYSICAL EXAMINATIONS.

(a) REQUIREMENT- Section 10206(a) of title 10, United States Code, is amended by striking `shall--' and all that follows and inserting `shall be examined as to his

physical fitness every 30 months, or more often as the Secretary concerned considers necessary.'.

(b) EFFECTIVE DATE- This section and the amendment made by subsection (a) shall take effect on October 1, 2004.

SEC. 103. RETRAINING OR SEPARATION OF MEDICALLY UNFIT MEMBERS.

(a) REQUIREMENT- Chapter 1007 of title 10, United States Code, is amended by inserting after section 10206 the following new section:

`Sec. 10206a. Required actions for members not medically fit

`(a) IN GENERAL- The Secretary of a military department shall take action under subsection (b) in the case of each member of a reserve component under the Secretary's jurisdiction who--

`(1) as a result of an examination under section 10206 of this title or any other physical or medical examination performed under regulations prescribed by the Secretary, is determined not medically qualified for the performance of the duties of such member's position; and

`(2) either--

`(A) as of the date that is 180 days after the date of that determination, is not making progress to become medically qualified in accordance with a plan approved under regulations prescribed by the Secretary; or

`(B) does not become medically qualified for the position within the period covered by such a plan.

`(b) REQUIRED ACTIONS- A member of a reserve component described in subsection (a)--

`(1) shall be reassigned to a position in such reserve component for which the member is medically and otherwise qualified; or

`(2) if there is no position in such reserve component for which the member is medically and otherwise qualified, shall be separated from such reserve component.'.

(b) CLERICAL AMENDMENT- The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 10206 the following new item:

`10206a. Required actions for members not medically fit.'.

SEC. 104. POLICY ON DEFERRAL OF MEDICAL TREATMENT PENDING DEPLOYMENT TO THEATERS OF OPERATION.

(a) REQUIREMENT FOR POLICY- (1) Chapter 1007 of title 10, United States Code, as amended by section 103, is further amended by inserting after section 10206a the following new section:

`Sec. 10206b. Members ordered to active duty: treatment of medical conditions

`(a) POLICY REQUIRED- The Secretary of Defense shall prescribe a policy that specifies for members of the reserve components called or ordered to active duty for a period of more than 30 days under a provision of law referred to in section 101(a)(13)(B) of this title--

(1) the circumstances under which treatment for medical conditions may be deferred to be provided within a theater of operations in order to prevent delay or other disruption of a deployment to that theater; and

(2) the circumstances under which medical conditions are to be treated before deployment to that theater.

`(b) FACTORS TO BE CONSIDERED- The policy under subsection (a) shall specify the factors to be considered in a determination of deferral or initiation of treatment of a medical condition of a member to be deployed to a theater of operations, including the following factors:

`(1) Severity of the condition, including the extent of risk of significant aggravation of the condition if treatment is delayed or inadequate.

`(2) Medical treatment capabilities available to the member for such condition in the theater of operations.

`(3) The cost of treatment of the condition in such theater as compared to the cost of treatment of the condition under chapter 55 of this title at or in the vicinity of the facility or installation from which the member is to be deployed.'.

(2) The table of sections at the beginning of such chapter, as amended by section 103(b), is further amended by inserting after the item relating to section 10206a the following new item:

`10206b. Members ordered to active duty: treatment of medical conditions.'.

(b) TIME FOR ISSUANCE OF POLICY- The Secretary of Defense shall issue the policy required by section 10206b of title 10, United States Code (as added by subsection (a)), not later than 180 days after the date of the enactment of this Act.

TITLE II--ALL ARMED FORCES PERSONNEL

Subtitle A--Health Screening

SEC. 201. RECRUIT ASSESSMENT PROGRAM.

(a) BASELINE HEALTH DATA- (1) Chapter 55 of title 10, United States Code, is amended by inserting after section 1092 the following new section:

`Sec. 1092a. Persons entering the armed forces: baseline health data

`(a) PROGRAM REQUIRED- The Secretary of Defense shall, for the purposes set forth in subsection (b), carry out a program for--

`(1) the routine collection of baseline health data from all persons entering the armed forces;

`(2) computerized compilation and maintenance of the baseline health data; and

`(3) analysis of the data.

`(b) PURPOSES- The program under this section shall be designed to achieve the following purposes:

`(1) To facilitate understanding of how exposures related to service in the armed forces affect health.

`(2) To facilitate development of early intervention and prevention programs to protect health and readiness.

`(c) BASELINE HEALTH DATA DEFINED- In this section, the term `baseline health data', with respect to a person entering any of the armed forces, means comprehensive information on the health of that person upon entry.

`(d) APPLICABILITY TO COAST GUARD- (1) The program under this section shall apply to members of the

Coast Guard to the extent approved by the Secretary of Homeland Security.

`(2) Nothing in paragraph (1) shall be construed to limit the application of the program under this section to a member of the Coast Guard in that member's capacity as a person entering a reserve component of the Army, Navy, Air Force, or Marine Corps.'.

(2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1092 the following new item:

`1092a. Persons entering the armed forces: baseline health data.'.

(b) TIME FOR IMPLEMENTATION- The Secretary of Defense shall implement the program required under section 1092a of title 10, United States Code (as added by paragraph (1)), not later than two years after the date of the enactment of this Act.

SEC. 202. FURTHER REFINEMENT OF MEDICAL TRACKING SYSTEM FOR MEMBERS DEPLOYED OVERSEAS.

(a) ESTABLISHMENT OF ADVISORY WORKING GROUP- (1) Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall convene a working group to improve the medical tracking system for members deployed overseas established under section 1074f of title 10, United States Code.

(2) The working group under paragraph (1) shall be composed of any number of members, not less than 12 and not more than 20, that the Secretary of Defense determines appropriate for the working group to carry out its duties effectively, including members appointed by the Secretary as follows:

(A) One or more representatives of the Assistant Secretary of Defense for Health Affairs.

(B) One or more representatives of the Secretary of Veterans Affairs, with the consent of the Secretary.

(C) One or more civilian health professionals who have expertise in public health and epidemiology.

(D) Three or more civilian health professionals who have been involved in military health research or treatment.

(E) Three or more civilian health professionals who have been involved in environmental health research or treatment.

(F) Three or more civilians who are representative of veterans and military health advocacy organizations.

(3) The working group shall--

(A) analyze the strengths and weaknesses of the medical tracking system administered under section 1074f of title 10, United States Code, as a means for detecting--

(i) any health problems (including mental health conditions) of members of the Armed Forces contemporaneous with the performance of the assessment under the system; and

(ii) exposures of the assessed members to environmental hazards that potentially lead to future health problems;

(B) analyze the strengths and weaknesses of such medical tracking system as a means for supporting future research on health issues presenting in the years following the deployment of the members of the Armed Forces assessed under the system; and

(C) identify and develop recommended changes to such medical tracking system that strengthen the system as a means for--

(i) detecting health problems and exposures to environmental hazards as described in subparagraph (A); and

(ii) supporting future research as described in subparagraph (B).

(4) Not later than 180 days after convening, the working group shall submit to the Secretary a report setting forth the analyses and recommendations of the working group.

(b) ACTIONS BY SECRETARY OF DEFENSE- Not later than 180 days after receipt of the report under subsection (a)(4), the Secretary of Defense shall prescribe regulations to implement the recommendations of the working group to the extent that the Secretary considers appropriate. The regulations shall include policies and standards for drawing blood samples for effective assessment and tracking of the medical conditions of personnel before deployment, upon the end of a deployment, and for a follow-up period of appropriate length.

(c) INTERIM STANDARDS FOR BLOOD SAMPLING- (1) The Secretary of Defense shall require that, under the medical tracking system administered under section 1074f of title 10, United States Code--

(A) the blood samples necessary for the predeployment medical examination of a member of the Armed Forces required under subsection (b) of such section be drawn not earlier than 30 days before the date of the deployment;

(B) the blood samples necessary for the postdeployment medical examination of a member of the Armed Forces required under such subsection be drawn not later than 30 days after the date on which the deployment ends; and

(C) annually, for the first three years after the deployment of a member ends, blood samples be drawn from that person for the purpose of assessing the medical condition of such person under such system.

(2) In the case of a person who is no longer a member of the Armed Forces when a blood sample is to be drawn from such person under paragraph (1)(C), the blood may be drawn at any medical facility of the uniformed services designated by the Secretary of Defense. The Secretary shall attempt to accommodate the convenience of that person in selecting a facility for the drawing of that person's blood sample.

(3) The requirements of paragraph (1) shall cease to be effective on the date on which the regulations prescribed under subsection (b) take effect.

Subtitle B--Medical Care in Theater of Operations

SEC. 211. MEDICAL SERVICES PROVIDED IN ALLIED HEALTH FACILITIES.

Not later than one year after the date of the enactment of this Act, the Assistant Secretary of Defense for

Health Affairs shall submit to the Secretary of Defense and the Committees on Armed Services of the Senate and the House of Representatives a report on the extent and types of medical services that were provided to members of the Armed Forces in facilities of allies of the United States during previous and current deployments of the Armed Forces, including Operations Desert Shield, Desert Storm, Joint Endeavor, Joint Forge, Joint Guardian, Enduring Freedom, and Iraqi Freedom.

SEC. 212. DEVELOPMENT OF POLICY ON PERSONNEL LOCATION DATA.

(a) REQUIREMENT FOR POLICY- The Secretary of Defense shall prescribe a Department of Defense policy on the collection and dissemination of in-theater individual personnel location data for the following purposes:

(1) To facilitate health care research and informed health care policy making for the Armed Forces.

(2) To enhance the capabilities of the Armed Forces to recognize and meet the health care needs of members of the Armed Forces returning to home stations from deployment to a theater of operations.

(b) ADVISORY WORKING GROUP- (1) The Secretary shall establish a working group to advise the Secretary on the development of the policy under subsection (a). The working group shall include the following:

(A) One or more representatives of the Assistant Secretary of Defense for Health Affairs.

(B) One or more representatives of the Secretary of Veterans Affairs, with the consent of the Secretary.

(C) One or more representatives of the program manager for the Global Combat Support System.

(D) One or more representatives of the defense manpower data center.

(E) One or more representatives of the program manager for the Land Warrior System.

(F) One or more civilian health professionals who have been involved in research and treatment of Gulf War Syndrome.

(G) One or more representatives of the Joint Staff.

(2) In developing the policy recommendations, the working group shall take into consideration--

(A) traditional medical requirements for complete and open access to specific, individual personnel location data to provide for--

(i) adequate and independent peer review by all interested parties; and

(ii) an open and transparent process for setting scientifically rigorous health policy and formulating clinical guidelines for care;

(B) traditional operational requirements for securing personnel location data so as to prevent--

(i) compromise of mission objectives; or

(ii) unauthorized disclosure of tactical and logistical planning; and

(C) existing practical limitations on the collection of such data, together with solutions for eliminating such limitations.

SEC. 213. REPORT ON TRAINING OF FIELD MEDICAL PERSONNEL.

(a) REQUIREMENT FOR REPORT- Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the training on environmental hazards that is provided by the Armed Forces to medical personnel of the Armed Forces who are deployable to the field in direct support of combat personnel.

(b) CONTENT- The report under subsection (a) shall include the following:

(1) An assessment of the adequacy of the training regarding--

(A) the identification of--

(i) common environmental hazards; and

(ii) exposures to such hazards; and

(B) the prevention and treatment of adverse health effects of such exposures.

(2) A discussion of the actions taken and to be taken to improve such training.

Subtitle C--Medical Care After Return From Deployment

SEC. 221. FINDINGS.

Congress makes the following findings:

(1) One out of every nine members of the Armed Forces returning to home station from a deployment overseas listed on the member's post-deployment self-reported health assessment under the Health Evaluation Assessment Review program of the United States Army Center for Health Promotion and Preventive Medicine a concern about possibly having been exposed to environmental hazards deleterious to the member's health during the deployment, according to an article in the edition of the Medical Surveillance Monthly Report published for July and August 2003 by the Army Medical Surveillance Activity of the Directorate of Epidemiology and Disease Surveillance of the United States Army Center for Health Promotion and Prevention of Disease.

(2) This constitutes a high proportion of members who might have suffered exposure to environmental hazards that potentially lead to immediate or future health problems.

SEC. 222. REPORT ON RESPONSES TO HEALTH CONCERNS OF MEMBERS.

(a) REQUIREMENT FOR REPORT- Not later than 180 days after the date of the enactment of this Act, the Assistant Secretary of Defense for Health Affairs shall submit to the Secretary of Defense and the Committees on Armed Services of the Senate and the House of Representatives a report on Department of Defense responses to expressions of concerns made as described in section 221(1).

(b) CONTENT- The report regarding health concerns submitted under subsection (a) shall include the following:

(1) A discussion of the actions taken by Department of Defense officials to investigate the circumstances underlying such concerns in order to determine the validity of the concerns.

(2) A discussion of the actions taken by Department of Defense officials to evaluate or treat

members and former members of the Armed Forces who are confirmed to have been exposed to environmental hazards deleterious to their health during deployments of the Armed Forces.

SEC. 223. RESPONSIBILITIES OF INSTALLATION COMMANDERS.

(a) PREPARATIONS TO MEET HEALTH CARE NEEDS- Chapter 55 of title 10, United States Code, is amended by inserting after section 1074k the following new section:

`Sec. 1074l. Care of members redeploying from overseas deployment

`(a) NEEDS ASSESSMENT- The Secretary of Defense shall require the commander of each military installation at which members of the armed forces are to be processed upon redeployment from an overseas deployment--

`(1) to identify and analyze the anticipated health care needs of such members before the arrival of such members at that installation; and

`(2) to report such needs to the Secretary.

`(b) DATA SOURCES- To carry out the duties imposed under subsection (a), the commander of an installation shall obtain the necessary information from the sources available to the commander, including the following information:

`(1) Information on schedules and locations from transportation and logistics personnel.

`(2) Information on disease and nonbattle injuries from the Surgeon General of the armed force concerned.

`(3) Information collected from environmental surveillance of the theater of military operations from which members are redeploying.

`(4) Information on the prevalence of combat and noncombat injuries, to the extent relevant.

`(c) HEALTH CARE TO MEET NEEDS- The Secretary of Defense shall prescribe in regulations procedures for the commander of each military installation described in subsection (a) to meet the anticipated health care needs that are identified by the commander in the performance of duties under this section. The procedures shall include the following:

`(1) Arrangements for health care provided by the Secretary of Veterans Affairs.

`(2) Procurement of services from local health care providers.

`(3) Temporary employment of health care personnel to provide services at such installation.'.

(b) CLERICAL AMENDMENT- The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1074k the following new item:

`1074l. Care of members redeploying from overseas deployment.'.

TITLE III--POLICY COMPLIANCE ASSURANCE

SEC. 301. SERUM REPOSITORY AUDITS.

(a) REQUIREMENT FOR BIENNIAL AUDIT- (1) Chapter 55 of title 10, United States Code, is amended by inserting after section 1073a the following new section:

`Sec. 1073b. Serum repository audits

`(a) PERIODIC AUDITS- The Secretary of Defense shall require the director of the serum repository of the Department of Defense to audit at least twice every two years the records of blood samples stored in such repository to determine the percentage of members of the armed forces who are in compliance with the applicable Department of Defense and military department policies on the collection of blood samples from members of the armed forces. The Secretary may impose any higher minimum number of periodic audits under this section that the Secretary considers appropriate.

`(b) REPORT- (1) Upon completion of an audit under subsection (a), the director of the serum repository shall submit a report on the audit to the Secretary of Defense. The report shall include the following information:

`(A) The compliance percentage determined under such subsection.

`(B) A discussion of the most common compliance problems identified.

`(C) Any recommendations for actions to improve compliance.

`(2) The Secretary shall transmit the report received under paragraph (1) to the Committees on Armed Services of the Senate and the House of Representatives. The Secretary may include any comments and recommendations that the Secretary considers appropriate.'.

(2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1073a the following new item:

`1073b. Serum repository audits.'.

(b) INITIAL AUDIT- The first audit under section 1073b of title 10, United States Code (as added by subsection (a)), shall be completed not later than 180 days after the date of the enactment of this Act.

SEC. 302. DEPLOYMENT-RELATED HEALTH ASSESSMENT AUDITS.

(a) REQUIREMENT FOR BIENNIAL AUDIT- Section 1074f(d) of title 10, United States Code, is amended--

(1) by inserting `(1)' after `(d) QUALITY ASSURANCE- '; and

(2) by adding at the end the following:

`(2)(A) The Secretary of Defense shall require the director of the Defense Medical Surveillance System to audit, every two years, the predeployment and postdeployment health assessment database maintained by the director in order to determine the percentage of members of the armed forces who are in compliance with the applicable Department of Defense and military department policies on the collection of predeployment and postdeployment health assessment data.

`(B) Upon completion of the biennial audit under subparagraph (A), the director of the Defense Medical Surveillance System shall submit a report on the audit to the Secretary of Defense. The report shall include the following information:

`(i) The compliance percentage determined under such audit.

`(ii) A discussion of the most common compliance problems identified.

`(iii) Any recommendations for actions to improve compliance.

`(C) The Secretary shall transmit the report received under subparagraph (B) to the Committees on Armed Services of the Senate and the House of Representatives. The Secretary may include any comments and recommendations that the Secretary considers appropriate.'.

(b) INITIAL AUDIT- The first audit under section 1074f(d)(2) of title 10, United States Code (as added by subsection (a)), shall be completed not later than 180 days after the date of the enactment of this Act.

SEC. 303. DECLASSIFICATION OF INFORMATION ON EXPOSURES TO ENVIRONMENTAL HAZARDS.

(a) REQUIREMENT FOR REVIEW- The Secretary of Defense shall review and, as determined appropriate, revise the classification policies of the Armed Forces Medical Intelligence Center with a view to facilitating the declassification of data that is potentially useful for the monitoring and assessment of the health of members of the Armed Forces who have been exposed to environmental hazards during deployments overseas, including the following data:

(1) In-theater injury rates.

(2) Data derived from environmental surveillance.

(3) Health tracking data.

(b) PARTICIPATION OF DIRECTOR OF ARMED FORCES MEDICAL INTELLIGENCE CENTER- The Secretary may act through or consult with the Director of the Armed Forces Medical Intelligence Center in carrying out the review and revising policies under subsection (b).

(c) REPORT- Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on any changes to policies described in subsection (a) that have been made as a result of the review under such subsection.

SEC. 304. ACCESSIBILITY OF HEALTH ASSESSMENT INFORMATION TO ARMY MEMBERS ON THE INTERNET.

Not later than one year after the date of the enactment of this Act, the Chief Information Officer of the Department of the Army shall ensure that the Army Knowledge Online portal website includes the following health-assessment related information:

(1) Information on the Department of Defense policies regarding predeployment and postdeployment health assessments, including policies on the following matters:

(A) Health surveys.

(B) Physical examinations.

(C) Collection of blood samples and other tissue samples.

(2) Procedural information on compliance with such policies, including the following information:

(A) Information for determining whether a member is in compliance.

(B) Information on how to comply.

(3) Health assessment surveys that are either--

(A) web-based; or

(B) accessible (with instructions) in printer-ready form by download.

SEC. 305. FULL IMPLEMENTATION OF FORCE HEALTH PROTECTION AND READINESS PROGRAM.

(a) IMPLEMENTATION AT ALL LEVELS- The Secretary of Defense, in conjunction with the Secretaries of the military departments, shall take such actions as are necessary to ensure that each of the Armed Forces fully implements at all levels the Force Health Protection and Readiness Program of the Department of Defense (relating to the prevention of injury and illness and the reduction of disease and noncombat injury threats).

(b) ACTION OFFICIAL- The Secretary of Defense may act through the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness in carrying out subsection (a).

END