Sec. 741. LIMITATION ON REDUCTION OF MILITARY MEDICAL MANNING END STRENGTH: CERTIFICATION REQUIREMENT AND OTHER REFORMS

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## SEC. 741 LIMITATION ON REDUCTION OF MILITARY MEDICAL MANNING END STRENGTH: CERTIFICATION REQUIREMENT AND OTHER REFORMS ###

(a)Limitation **[**[10 U.S.C. 129c note](/us/usc/t10/s129c)**]** ####

(1)In general Except as provided in paragraph (2), and in addition to the limitation under section 719 of the National Defense Authorization Act for Fiscal Year 2020 (Public Law 116-92; 133 Stat. 1454), as most recently amended by section 731 of the National Defense Authorization Act for Fiscal Year 2022 (Public Law 117-81; 135 Stat. 1795), during the 10-year period beginning on the date of the enactment of this Act, neither the Secretary of Defense nor a Secretary concerned may reduce military medical end strength authorizations, and following such period, neither may reduce such authorizations unless the Secretary of Defense issues a waiver pursuant to paragraph (6). ####

(2)Exception The limitation under paragraph

(1)shall not apply with respect to the following: #####

(A)Administrative billets of a military department that have remained unfilled since at least October 1, 2018. #####

(B)Billets identified as non-clinical in the budget of the President for fiscal year 2020 submitted to Congress pursuant to section 1105(a) of title 31, United States Code, except that the number of such billets may not exceed 1,700. #####

(C)Medical headquarters billets of the military departments not assigned to, or providing direct support to, operational commands. ####

(3)Report on composition of military medical workforce requirements The Secretary of Defense, in coordination with the Secretaries of the military departments, shall conduct an assessment of current military medical manning requirements (taking into consideration factors including future operational planning, training, and beneficiary healthcare) and submit to the Committees on Armed Services of the House of Representatives and the Senate a report containing the findings of such assessment. Such assessment shall be informed by the following: #####

(A)The National Defense Strategy submitted under section 113(g) of title 10, United States Code. #####

(B)The National Military Strategy prepared under section 153(b) of such title. #####

(C)The campaign plans of the combatant commands. #####

(D)Theater strategies. #####

(E)The joint medical estimate under section 732 of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Public Law 115-232; 132 Stat. 1817). #####

(F)The plan of the Department of Defense on integrated medical operations, as updated pursuant to paragraph

(1)of section 724(a) of the National Defense Authorization Act for Fiscal Year 2022 (Public Law 117-81; 135 Stat. 1793; 10 U.S.C. 1096 note). #####

(G)The plan of the Department of Defense on global patient movement, as updated pursuant to paragraph

(2)of such section 724(a). #####

(H)The biosurveillance program of the Department of Defense established pursuant to Department of Defense Directive 6420.02 (relating to biosurveillance). #####

(I)Requirements for graduate medical education. #####

(J)The report of the COVID-19 Military Health System Review Panel under section 731 of the William M.

(Mac)Thornberry National Defense Authorization Act for Fiscal Year 2021 (Public Law 116-283; 134 Stat. 3698). #####

(K)The report of the Inspector General of the Department of Defense titled “Evaluation of Department of Defense Military Medical Treatment Facility Challenges During the Coronavirus Disease-2019 (COVID-19) Pandemic in Fiscal Year 2021 (DODIG-2022-081)” and published on April 5, 2022. #####

(L)Reports of the Comptroller General of the United States relating to military health system reforms undertaken on or after January, 1, 2017, including any such reports relating to military medical manning and force composition mix. #####

(M)Such other reports as may be determined appropriate by the Secretary of Defense. ####

(4)Certification The Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a certification containing the following: #####

(A)A certification of the completion of a comprehensive review of military medical manning, including with respect to the medical corps (or other health- or medical-related component of a military department), designator, profession, occupation, and rating of medical personnel. #####

(B)A justification for any proposed increase, realignment, reduction, or other change to the specialty or occupational composition of military medical end strength authorizations, which may include compliance with a requirement or recommendation set forth in a strategy, plan, or other matter specified in paragraph (3). #####

(C)A certification that, in the case that any change to such specialty or occupational composition is required, a vacancy resulting from such change may not be filled with a position other than a health- or medical-related position until such time as there are no military medical billets remaining to fill the vacancy. #####

(D)A risk analysis associated with the potential realignment or reduction of any military medical end strength authorizations. #####

(E)An identification of any plans of the Department to backfill military medical personnel positions with civilian personnel. #####

(F)A plan to address persistent vacancies for civilian personnel in health- or medical-related positions, and a risk analysis associated with the hiring, onboarding, and retention of such civilian personnel, taking into account provider shortfalls across the United States. #####

(G)A comprehensive plan to mitigate any risk identified pursuant to subparagraph

(D)or (F), including with respect to funding necessary for such mitigation across fiscal years. ####

(5)Process required The Secretaries of the military departments, in coordination with the Secretary of Defense and the Chairman of the Joint Chiefs of Staff, shall develop and submit to the Committees on Armed Services of the House of Representatives and the Senate a process for the authorization of proposed modifications to the composition of the medical manning force mix across the military departments while maintaining compliance with the limitation under paragraph (1). Such process shall— #####

(A)take into consideration the funding required for any such proposed modification; and #####

(B)include distinct processes for proposed increases and proposed decreases, respectively, to the medical manning force mix of each military department. ####

(6)Waiver #####

(A)In general Following the conclusion of the 10-year period specified in paragraph (1), the Secretary of Defense may waive the prohibition under such subsection if— ######

(i)the report requirement under paragraph (3), the certification requirement under paragraph (4), and the process requirement under paragraph

(5)have been completed; ######

(ii)the Secretary determines that the waiver is necessary and in the interests of the national security of the United States; and ######

(iii)the waiver is issued in writing. #####

(B)Notification to congress Not later than five days after issuing a waiver under subparagraph (A), the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a notification of the waiver (including the text of the waiver and a justification for the waiver) and provide to such committees a briefing on the components of the waiver. ###

(b)Temporary Suspension of Implementation of Plan for Restructure or Realignment of Military Medical Treatment Facilities The Secretary of Defense may not implement the plan under section 703(d)(1) of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114-328; 130 Stat. 2199) until the later of the following: ####

(1)The date that is one year after the date of the enactment of this Act. ####

(2)The date on which the Secretary of Defense completes the following: #####

(A)A risk analysis for each military medical treatment facility to be realigned, restructured, or otherwise affected under the implementation plan under such section 703(d)(1), including an assessment of the capacity of the TRICARE network of providers in the area of such military medical treatment facility to provide care to the TRICARE Prime beneficiaries that would otherwise be assigned to such military medical treatment facility. #####

(B)An identification of the process by which the assessment conducted under subsection (a)(3) and the certification required under subsection (a)(4) shall be linked to any restructuring or realignment of military medical treatment facilities. ###

(c)Briefings; Final Report ####

(1)Initial briefing Not later than April 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— #####

(A)the method by which the Secretary plans to meet the report requirement under subsection (a)(3), the certification requirement under subsection (a)(4), and the process requirement under subsection (a)(5); and #####

(B)the matters specified in subparagraphs

(A)and

(B)of subsection (b)(2). ####

(2)Briefing on progress During each of 2024 and 2029, the Secretary of Defense shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the progress made towards completion of the requirements specified in paragraph (1)(A). ####

(3)Final briefing Not later than December 31, 2030, the Secretary of Defense shall provide to the Committees on Armed Services of the House of Representatives and the Senate a final briefing on the completion of such requirements. ####

(4)Final report Not later than December 31, 2030, the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a final report on the completion of such requirements. Such final report shall be in addition to the report, certification, and process submitted under paragraphs (3), (4), and

(5)of subsection (a), respectively. ###

(d)Definitions **[**[10 U.S.C. 129c note](/us/usc/t10/s129c)**]** In this section: ####

(1)The term “medical personnel” has the meaning given such term in section 115a(e) of title 10, United States Code. ####

(2)The term “Secretary concerned” has the meaning given that term in section 101(a) of such title. ####

(3)The term “theater strategy” means an overarching construct outlining the vision of a combatant commander for the integration and synchronization of military activities and operations with other national power instruments to achieve the strategic objectives of the United States.

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