FY2015 National Defense Authorization Act: Selected Military Personnel Issues

FY2015 National Defense Authorization Act:

Selected Military Personnel Issues

(name redacted), Coordinator

Analyst in Defense Budget and Military Manpower

(name redacted)

Specialist in Military Manpower Policy

(name redacted)

Specialist in Defense Health Care Policy

December 11, 2014

Congressional Research Service

7-....

www.crs.gov

R43647

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Summary

Military personnel issues typically generate significant interest from many Members of Congress

and their staffs. Ongoing operations in Afghanistan, along with the regular use of the reserve

component personnel for operational missions, further heighten interest in a wide range of

military personnel policies and issues.

The Congressional Research Service (CRS) has selected a number of the military personnel

issues considered in deliberations on H.R. 4435, the initial House-passed version of the National

Defense Authorization Act (NDAA) for Fiscal Year 2015; S. 2410, the version of the NDAA

reported by the Senate Committee on Armed Services (S.Rept. 113-176) but not considered by

the full Senate; and H.R. 3979, the proposed final version. This report provides a brief synopsis of

sections in each bill that pertain to selected personnel policy. These include end strengths,

compensation, health care, and sexual assault, as well as less prominent issues that nonetheless

generate significant public interest.

This report focuses exclusively on the annual defense authorization process. It does not include

language concerning appropriations, veterans’ affairs, tax implications of policy choices, or any

discussion of separately introduced legislation, topics which are addressed in other CRS products.

Some issues were addressed in the FY2014 National Defense Authorization Act and discussed in

CRS Report R43184, FY2014 National Defense Authorization Act: Selected Military Personnel

Issues coordinated by (name redacted). Those issues that were considered previously are designated

with a “*” in the relevant section titles of this report.

Congressional Research Service

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Contents

Introduction...................................................................................................................................... 1

*Active Duty End Strengths ............................................................................................................ 2

*Selected Reserves End Strength..................................................................................................... 4

*Military Pay Raise ......................................................................................................................... 5

Basic Allowance for Housing (BAH) .............................................................................................. 7

*Briefing on Sexual Assault Prevention and Response ................................................................... 9

Department of Defense Hair and Grooming Standards ................................................................. 10

*Protection of the Religious Freedom of Military Chaplains to Close a Prayer Outside of

a Religious Service According to the Traditions, Expressions, and Religious Exercises

of the Endorsing Faith Group ..................................................................................................... 11

*Removal of Artificial Barriers to the Service of Women in the Armed Forces, and, Study

on Gender integration in Defense Operation Planning and Execution ....................................... 13

*Protection of Child Custody Arrangements for Parents Who Are Members of the Armed

Forces.......................................................................................................................................... 15

*Required Consideration of Certain Elements of Command Climate in Performance

Appraisals of Commanding Officers .......................................................................................... 17

*Sexual Assault .............................................................................................................................. 18

Medals for Members of the Armed Forces and Civilian Employees of the Department of

Defense Who Were Killed or Wounded in an Attack Inspired or Motivated by a Foreign

Terrorist Organization ................................................................................................................. 21

Retroactive Award of Army Combat Action Badge ....................................................................... 23

Medal of Honor (MoH) Process .................................................................................................... 25

*TRICARE Beneficiary Cost-Sharing........................................................................................... 26

*TRICARE Pharmacy Copayments .............................................................................................. 28

Mental Health Assessments ........................................................................................................... 30

Elimination of Inpatient Mental Health Day Limits ...................................................................... 31

Review of Military Health System Modernization ........................................................................ 32

Authority for Provisional TRICARE Coverage for Emerging Health Care Services and

Supplies ...................................................................................................................................... 34

Availability of Breastfeeding Support, Supplies, and Counseling under the TRICARE

Program ...................................................................................................................................... 37

Contacts

Author Contact Information........................................................................................................... 37

Acknowledgments ......................................................................................................................... 37

Congressional Research Service

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Introduction

Each year, the House and Senate Armed Services Committees take up their respective versions of

the National Defense Authorization Act (NDAA). These bills contain numerous provisions that

affect military personnel, retirees, and their family members. Provisions in one version are often

not included in another; are treated differently; or, in certain cases, are identical. Following

passage of these bills by the respective legislative bodies, a conference committee is usually

convened to resolve the various differences between the House and Senate versions.

In the course of a typical authorization cycle, congressional staffs receive many requests for

information on provisions contained in the annual NDAA. This report highlights those personnelrelated issues that seem likely to generate high levels of congressional and constituent interest,

and tracks their status in the House and Senate versions of the FY2015 NDAA.

The initial House version of the Howard P. “Buck” McKeon National Defense Authorization Act

for Fiscal Year 2015, H.R. 4435 (113th Congress), was introduced in the House on April 9, 2014;

reported by the House Committee on Armed Services on May 13, 2014 (H.Rept. 113-446); and

passed by the House on May 22, 2014. A Senate version, S. 2410 (113th Congress), was

introduced in the Senate on June 2, 2014, and reported by the Senate Committee on Armed

Services (S.Rept. 113-176) on the same day. However, the Senate did not consider this bill.

Instead, members of the House and Senate Armed Services Committees drafted H.R. 3979, a

proposed final version of the FY2015 NDAA. On December 4, 2014, the House approved this

H.R. 3979.

Related CRS products are identified to provide more detailed background information and

analysis of the issues. For each issue, a CRS analyst is identified and contact information is

provided.

Some issues were addressed in the FY2014 National Defense Authorization Act, and discussed in

CRS Report R43184, FY2014 National Defense Authorization Act: Selected Military Personnel

Issues, coordinated by (name redacted), or earlier versions of reports on this act. Those issues that

were considered previously are designated with a “*” in the relevant section titles of this report.

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Active Duty End Strengths

Background: The authorized active duty end-strengths1 for FY2001, enacted in the year prior to

the September 11th 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 Iraq and Afghanistan, Congress increased the authorized personnel strength of the Army

and Marine Corps. Some of these increases were quite substantial, particularly after FY2006, but

Congress began reversing these increases in light of the withdrawal of U.S. forces from Iraq in

2011 and a drawdown of U.S. forces in Afghanistan which began in 2012. In FY2014, the

authorized end-strength for the Army was 520,000, while the authorized end-strength for the

Marine Corps was 190,200. Given the budgetary outlook, particularly the future impact of the

Budget Control Act of 2011 (BCA), the Army plans to reduce its active personnel strength to

between 420,000 and 450,000 by FY2017, while the Marine Corps plans to reduce its active

personnel strength to between 175,000 to 182,600. End-strength for the Air Force and Navy has

decreased gradually since 2001. The authorized end-strength for FY2014 was 327,600 for the Air

Force and 323,600 for the Navy.

House-Passed H.R. 4435

Senate Committee-Reported

S. 2410

Proposed Final Version H.R.

3979

Section 401 authorizes a total

FY2015 active duty end strength of

1,308,920 including:

Section 401 authorizes a total FY2015

active duty end strength of 1,308,600

including:

Section 401 authorizes a total

FY2015 active duty end strength of

1,310,680 including:

490,000 for the Army

323,600 for the Navy

184,100 for the Marine Corps

311,220 for the Air Force

490,000 for the Army

323,600 for the Navy

184,100 for the Marine Corps

310,900 for the Air Force

490,000 for the Army

323,600 for the Navy

184,100 for the Marine Corps

312,980 for the Air Force

Discussion: In light of the ongoing drawdown in Afghanistan and the budgetary environment, the

Administration requested major reductions in Army (-30,000), Air Force (-16,700), and Marine

Corps (-6,100) end strengths in comparison to their FY2014 authorized end-strengths. The endstrength request for the Navy remained stable at 323,600 in comparison to FY2014. The figures

in H.R. 3979 are identical to the administration’s end-strength request except for the Air Force;

the proposed final bill recommends an Air Force end-strength slightly higher (+2,080) than the

Administration’s request. Taken together, the proposed final bill stipulates a total active duty endstrength which is 50,720 lower than the FY2014 level. The committee report which accompanied

H.R. 4435 noted that “the services plan for more drastic reductions in end strength and force

structure in fiscal year 2016 absent a change in the Budget Control Act of 2011” and expressed

concerns that “This continued stress on the force, coupled with potential further reductions as a

result of the BCA’s discretionary caps, may have serious implications on the capacity and

capability of the All-Volunteer Force and the ability for the services to meet the National Defense

Strategy.”2

1

The term “end-strength” refers to the authorized strength of a specified branch of the military at the end of a given

fiscal year, while the term authorized strength means “the largest number of members authorized to be in an armed

force, a component, a branch, a grade, or any other category of the armed forces”. 10 USC 101(b)(11). As such, endstrengths are maximum strength levels. Congress also sets minimum strength levels for the active component, which

may be identical to or lower than the end-strength.

2

H.Rept. 113-446, p. 135.

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Reference(s): Previously discussed in CRS Report R43184, FY2014 National Defense

Authorization Act: Selected Military Personnel Issues, and similar reports from earlier years.

CRS Point of Contact: (name redacted), x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Selected Reserves End Strength

Background: Although the Reserves have been used extensively in support of operations since

September 11, 2001, the overall authorized end strength of the Selected Reserves has declined by

about 4% over the past twelve years (874,664 in FY2001 versus 842,700 in FY2014). 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. For

comparative purposes, the authorized end strengths for the Selected Reserves for FY2001 were as

follows: Army National Guard (350,526), Army Reserve (205,300), Navy Reserve (88,900),

Marine Corps Reserve (39,558), Air National Guard (108,022), Air Force Reserve (74,358), and

Coast Guard Reserve (8,000).3 Between FY2001 and FY2014, the largest shifts in authorized end

strength have occurred in the Army and Navy Reserve (-29,800 or -33.5%), Army National Guard

(+3,674 or +1.1%), Air Force Reserve (-3,958 or -5.3%), and Coast Guard Reserve (+1,000 or

+12.5%). A smaller change occurred in the Air National Guard (-2,622 or -2.4%), while the

authorized end strength of the Army Reserve (-300 or -0.15%) and the Marine Corps Reserve

(+42 or +0.11%) have been largely unchanged during this period.

House-Passed H.R. 4435

Senate Committee Reported

S. 2410

Proposed Final Version

H.R. 3979

Section 411 authorizes the following end

strengths for the Selected Reserves:

Section 411 authorizes the following end

strengths for the Selected Reserves:

Army National Guard: 350,200

Army Reserve: 202,000

Navy Reserve: 57,300

Marine Corps Reserve: 39,200

Air National Guard: 105,000

Air Force Reserve: 67,100

Coast Guard Reserve: 7,000

Army National Guard: 350,200

Army Reserve: 202,000

Navy Reserve: 57,300

Marine Corps Reserve: 39,200

Air National Guard: 105,000

Air Force Reserve: 67,100

Coast Guard Reserve: 9,000

Section 411 authorizes the

following end strengths for

the Selected Reserves:

Army National Guard:

350,200

Army Reserve: 202,000

Navy Reserve: 57,300

Marine Corps Reserve:

39,200

Air National Guard:

105,000

Air Force Reserve:

67,100

Coast Guard Reserve:

7,000

Discussion: For FY2015, the Administration requested an authorized Selected Reserve end

strength lower than those for FY2014 for all of the reserve components. The reductions in

comparison to FY2014 are as follows: Army National Guard (-4,000), Army Reserve (-3,000),

Navy Reserve (-1,800), Marine Corps Reserve (-400), Air National Guard (-400), Air Force

Reserve (-3,300) and Coast Guard Reserve (-2,000). The recommendations in the proposed final

bill are identical with the administration’s request.

Reference(s): Previously discussed in CRS Report R43184, FY2014 National Defense

Authorization Act: Selected Military Personnel Issues, and similar reports from earlier years.

CRS Point of Contact: (name redacted), x7-.....

3

P.L. 106-398, Section 411.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Military Pay Raise

Background: Increasing concern with the overall cost of military personnel, combined with

longstanding congressional interest in recruiting and retaining high quality personnel to serve in

the all-volunteer military, have continued to focus interest on the military pay raise. Section 1009

of Title 37 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 increase in basic pay for

2015 under this statutory formula would be 1.8% 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. 1009.4

The FY2015 President’s Budget requested a 1.0% military pay raise, lower than the statutory

formula of 1.8%. This is in keeping with Department of Defense (DOD) plans to limit increases

in basic pay through FY2017:

As part of the FY 2014 President’s Budget, the Department had already planned on limiting

basic pay raises through FY 2017 to levels likely below those called for under the formula in

current law, which calls for a raise to equal the annual increase in the wages and salaries of

private industry employees as measured by the ECI. This FY 2014 plan called for pay raises

of 1.0 percent in FY 2015 and FY 2016, 1.5 percent in FY 2017, and then returned to more

likely ECI levels of 2.8 percent in FY 2018 and beyond.

Similar to FY 2014, the FY 2015 President’s Budget again seeks a 1.0 percent basic pay

raise for military members in FY 2015, which is less generous than the 1.8 percent increase

in ECI as of September 30, 2013.5

House-passed H.R. 4435

No provision relating to a general

increase in basic pay.

Section 602 caps the pay of officers in

paygrades O-7 through O-10 (one-star

through four-star generals and admirals)

at the Executive Schedule Level II rate of

pay in effect during 2014.

Senate Committee-reported

S. 2410

Proposed Final Version

H.R. 3979

Sec. 601 (a) waives the statutory

formula of 37 USC 1009 and

601(b) specifies a 1.0% increase in

basic pay for servicemembers

below the O-7 paygrade.

No provision relating to a general

increase in basic pay.

Sec. 601(c) caps the pay of officers

in paygrades O-7 through O-10 at

the Executive Schedule Level II rate

of pay in effect during 2014.

Sec. 601caps the pay of officers in

paygrades O-7 through O-10 at

the Executive Schedule Level II

rate of pay in effect during 2014,

and specifies that the basic pay of

such officers shall not increase

during 2015.

4

Last year, Congress did not include a provision specifying an increase in basic pay; typically, that would have meant

the automatic formula would have provided an increase equal to the ECI (1.8%). However, the President sent a letter to

Congress stating “I have determined it is appropriate to exercise my authority under Section 1009(e) of title 37, United

States Code, to set the 2014 monthly basic pay increase at 1.0 percent ... The adjustments described above shall take

effect on the first applicable pay period beginning on or after January 1, 2014.” Letter available at

http://www.whitehouse.gov/the-press-office/2013/08/30/letter-president-regarding-alternate-pay-plan-membersuniformed-services

5

Department of Defense, Fiscal Year 2015 Defense Budget Overview, March 2014, page 5-5, available here:

http://comptroller.defense.gov/Portals/45/Documents/defbudget/fy2015/fy2015_Budget_Request_Overview_Book.pdf

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Discussion: The House bill contained no provision to specify the rate of increase in basic pay,

although the report accompanying it (H.Rept. 113-446) contained the following statement:

The committee continues to believe that robust and flexible compensation programs are

central to maintaining a high-quality, all-volunteer, combat-ready force. Accordingly, the

committee supports a 1.8 percent military pay raise for fiscal year 2015, in accordance with

current law, in order for military pay raises to keep pace with the pay increases in the private

sector, as measured by the Employment Cost Index.

The Senate committee-reported version contained a provision waiving the automatic adjustment

of 37 U.S.C. 1009 and setting the pay increase at 1.0% for servicemembers below the O-7

paygrade. On August 29, President Obama sent a letter to Congress invoking 37 U.S.C. 1009(e)

to set the pay raise for 2015 at 1.0%.6 The proposed final version contains no general pay raise

provision, thereby leaving in place the 1.0% increase specified by President Obama under 37

U.S.C. 1009(e), but section 601 freezes the basic pay of generals and admirals at 2014 levels.

Reference(s): Previously discussed in CRS Report R43184, FY2014 National Defense

Authorization Act: Selected Military Personnel Issues, and similar reports from earlier years.

CRS Point of Contact: (name redacted), x7-.....

6

Letter available here: http://www.whitehouse.gov/the-press-office/2014/08/29/letter-president-alternative-pay-planuniformed-services

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Basic Allowance for Housing (BAH)

Background: The armed services provide funds to assist members of the military to pay for

housing when government quarters adequate for themselves and their dependents are not

available. Originally known as Basic Allowance for Quarters (BAQ), such compensation was

based on rank and whether or not dependents were involved. During the 1970s housing costs

began to vary more by location. In 1980, Congress added a Variable Housing Allowance (VHA)

as a means to defray high housing costs in certain areas. BAQ/VHA was not intended to defray

the entire cost of housing. It was expected that service members would pay approximately 15% of

these costs out-of-pocket. By 1997, the increase in housing costs increased this out-of-pocket

amount to about 20%. In 1998, Congress combined BAQ and VHA and renamed it BAH. In

2001, Congress enacted language that would increase BAH over successive years to remove the

out-of-pocket costs to the service member. Out-of-pocket costs were eliminated by 2005.7 The

President’s 2015 budget submission called for a slowing of BAH growth such that service

members would pay 5% out-of-pocket by 2019.

House-Passed H.R. 4435

No provision.

The committee report which

accompanied the bill expressed concern

about the effects of this change on

servicemembers. It also noted that the

Military Compensation and Retirement

Modernization Commission is scheduled

to release its report in February, 2015,

and suggested that DOD share its analysis

of the impact of such a change with the

Commission.

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

Section 603 would allow the

Secretary of Defense to reduce

monthly BAH payments by up to 5%

of the “national average monthly cost

of adequate housing in the United

States.”

Section 604 would allow the

Secretary of Defense to

reduce monthly BAH

payments by up to 1% of the

“national average monthly cost

of adequate housing in the

United States.” It also

specifies that this change “shall

not apply with respect to

benefits paid by the Secretary

of Veterans Affairs under the

laws administered by the

Secretary, including pursuant

to sections 3108 and 3313 of

title 38, United States Code.”

Thus, VA benefits that are tied

to BAH rates, such as the

Post-9/11 GI Bill, would

continue to use the full BAH

rate, not the reduced BAH

rate.

Discussion: The language in the proposed final version allows the Secretary of Defense to reduce

monthly BAH payments by up to 1% of the “national average monthly cost of adequate housing

in the United States.” The Joint Explanatory Statement which accompanied the bill also stated

the following:

We note that while the Department of Defense (DOD) legislative proposal included proposed

changes to BAH that would have been implemented over the next 3 years, this agreement

includes those changes to BAH that the committees understand would have been

implemented by DOD in 2015. By adopting changes to BAH beginning in the first year of

7

See page 170-173 of this document for more information: http://www.loc.gov/rr/frd/pdf-files/Military_Comp2011.pdf

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

the proposal, the agreement preserves the option for Congress to achieve the full savings

requested by DOD. This approach does not constitute a rejection of the administration

proposal, which was endorsed by the Joint Chiefs of Staff. Rather, consideration of further

changes to BAH in fiscal years 2016, 2017, and beyond is deferred until after the committees

receive the report of the Military Compensation and Retirement Modernization Commission,

which is due in February 2015. The two committees commit to consider proposed changes to

BAH that are included in the fiscal year 2016 budget request as part of the consideration of

the National Defense Authorization Act for Fiscal Year 2016.8

References: None.

CRS Point of Contact: (name redacted), x7-.....

8

Joint Explanatory Statement to Accompany the National Defense Authorization Act for Fiscal Year 2015, p.86.

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Briefing on Sexual Assault Prevention

and Response

Background: Over the past few years, the issue of sexual assault in the military has received a

good deal of congressional and media attention. Congress has enacted numerous changes, still

problems persist.

House-Passed H.R. 4435

Page 140 of House Report 113-446

directs the Secretary of Defense to

brief the House Armed Services

Committee not later than March 1,

2015 on the status of the

implementation of sexual assault

provision in the NDAA12 through

NDAA14, as well as the initiatives

announced by the Secretary of

Defense on August 14, 2013.

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

Pages 118-119 of Senate Report

113-176 direct the Secretary of

Defense to report to the

Committees on Armed Services of

the Senate and the House of

Representatives not later than July

31, 2014, on the status of DOD’s

response to section 579 of the

National Defense Authorization Act

for Fiscal Year 2013 (Public Law

112–239) that required the

Secretary of Defense to submit a

report, no later than January 2, 2013,

setting forth a comprehensive policy

to prevent and respond to sexual

harassment in the Armed Forces and

also a plan to collect information and

data regarding substantiated

incidents of sexual harassment

involving servicemembers, including

the need to identify cases in which a

servicemember is accused of

multiple incidents of sexual

harassment that was due not later

than June 1, 2013.

No similar provision.

Discussion: Congress continues to maintain its oversight responsibilities concerning the matter of

sexual assault and the military, as well as its desire to see positive changes in this matter.

References: Sexual Assaults Under the Uniform Code of Military Justice (UCMJ): Selected

Legislative Proposals, by (name redacted).

CRS Point of Contact: (name redacted), x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Department of Defense Hair and

Grooming Standards

Background: Military hair and grooming standards as well as the issue of religious

accommodations are designed to achieve uniformity. However, changes in styles, religious

accommodations, etc., can be at variance with these standards. In at least one case, the issue had

reached the Supreme Court.9 As the military has become more diverse, regulations have been

revised and/or updated. In March 2014, the Army released its updated regulation (A.R. 670-1).

The update was criticized as “racially biased.”10 On April 29, 2014, on Secretary Hagel’s

directive, the services had 30 days to “revise any offensive language” in the new regulations and

another 90 days to make whatever appropriate adjustments to their policy as necessary, according

Rear Adm. John Kirby, the Pentagon's chief spokesman.11 As a result, A.R. 670-1 was revised on

September 15, 2014, to update guidance for authorized and unauthorized hairstyles for females.

House-Passed H.R. 4435

The House stated that the Secretary

of Defense “shall not enforce and

shall evaluate the changes to hair

standard and grooming policies for

female service members ... and

report to the congressional defense

committees the results of the

evaluation. The evaluation shall

include the opinions of those who

may have religious accommodation

requirements and minorities serving

in the Armed Forces.”

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

The Senate committee-reported bill

contained no similar provision.

No similar provision.

Discussion: Congress and the Army have addressed similar issues. Any policy change regarding

attire or grooming standards that appear to affect one group, particularly minorities, or people of

religious faith, is viewed as suspect and there has been pressure on the service concerned, in this

case the Army, to be more accommodating.

References: Army Regulation (A.R. 670-1), Wear and Appearance of Army Uniforms and

Insignia, revised September 15, 2014, at http://www.apd.army.mil/pdffiles/r670_1.pdf (See para.

3-2 for authorized and unauthorized hairstyles for females)

CRS Point of Contact: (name redacted), x7-.....

9

Goldman v. Weinberger, 475 U.S. 503 (1986); the case was concerned with the question as to whether the Air Force

could forbid a service member from wearing a yarmulke while in uniform. The Court ruled against the service member

leading Congress to add language in the National Defense Authorization Act for Fiscal Years 1988 and 1989 (section

508) allowing for the wearing of religious apparel that was “neat and conservative,” with other restrictions.

10

Tan, Michelle, “Black female soldiers say new grooming reg is ‘racially biased,’” Army Times, March 31, 2014

11

DoD News Transcript, “Department of Defense Press Briefing by Rear Admiral Kirby in the Pentagon Briefing

Room,” April 29, 2014, at http://www.defense.gov/Transcripts/Transcript.aspx?TranscriptID=5421

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Protection of the Religious Freedom of Military

Chaplains to Close a Prayer Outside of a Religious

Service According to the Traditions, Expressions,

and Religious Exercises of the Endorsing Faith

Group

Background: The free exercise clause in the Bill of Rights is meant to protect individual

religious exercise and requires a heightened standard of review for government actions that may

interfere with a person’s free exercise of religion. The Establishment Clause in the Bill of Rights

is meant to stop the government from endorsing a national religion, or favoring one religion over

another. Actions taken must be carefully balanced to avoid being in violation of one of these

clauses. Sections in Title 10 under the Army, Navy, and Air Force already address chaplains’

duties with regard to holding religious services. A provision in the House-passed bill would

amend these sections (§§3547, 6031, and 8547). Section 533 of the National Defense

Authorization Act for Fiscal Year 2013 (P.L. 112-239) required the Armed Forces to

accommodate the moral principles and religious beliefs of service members concerning

appropriate and inappropriate expression of human sexuality and that such beliefs may not be

used as a basis for any adverse personnel actions.

House-Passed H.R. 4435

Sec. 525, if called upon to lead a prayer

outside of a religious service, a military

chaplain may close the prayer according

to the traditions, expressions and

religious exercises of the endorsing faith

group.

Senate CommitteeReported

S. 2410

The Senate committee-reported

bill contained no similar

provision.

Proposed Final Version

H.R. 3979

No similar provision.

Discussion: DOD Instruction 1300.17 acts to accommodate religious practices in the military

services. This instruction indicates that DOD places a high value on the rights of military

personnel to practice their respective religions. There have been instances where military

personnel have become upset because the chaplain closed the prayer at a mandatory ceremony,

such as a deployment ceremony, with a specific religious remark, such as “praise be Jesus.” In

February 2014, an atheist soldier at Fort Sam Houston in San Antonio, TX, threatened the U.S.

Army with a lawsuit because a chaplain allegedly prayed to the Heavenly Father during a secular

event. However, no personnel are required to recognize the prayer, or participate in it (for

example, they do not have to respond). Religious proselytizing is considered by some to be a

prominent issue in the Armed Forces. Some believe it could destroy the bonds that keep soldiers

together, which could be viewed as a national security threat. The ability for a chaplain to be able

to close a prayer outside of a religious service may heighten the tension between soldiers and may

worsen the problem. Others disagree and argue that it is inappropriate to curtail a chaplain’s

activities.

Reference(s): Previously discussed in CRS Report R42651, FY2013 National Defense

Authorization Act: Selected Military Personnel Policy Issues, coordinated by Catherine A.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Theohary. See also CRS Report R41171, Military Personnel and Freedom of Religion: Selected

Legal Issues, by (name redacted) and (name redacted).

CRS Point of Contact: (name redacted), x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Removal of Artificial Barriers to the Service of

Women in the Armed Forces, and, Study on Gender

integration in Defense Operation Planning and

Execution

Background: Section 535 of P.L. 111-383 (enacted Jan. 7, 2011) required the Secretary of

Defense to submit a report to Congress to determine if changes in laws, policies, and regulations

are needed to ensure that women have an “equitable opportunity” to serve in the Armed Forces.

The report, “Review of Laws, policies, and regulations restricting service of female members of

the Armed Forces,” was submitted on June 1, 2011. In early 2013, then-Secretary of Defense

Panetta rescinded the rule that restricted women from serving in combat units. Since Secretary

Panetta’s decision to rescind the restriction rule, the Army and Marine Corps have taken various

steps to further integrate women.

House-Passed H.R. 4435

Sec. 527 requires the

Secretary of Defense to

direct the Secretary of each

military service, in

collaboration with an

independent research entity,

to validate the gender-neutral

standards used by the Armed

Forces. This section would

require that properly fitted

and design combat

equipment is available. It calls

on the Comptroller General

to conduct a review of

outreach to women by the

Services.

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

Sec. 523. Sense of Senate that the Secretaries of the military

departments should eliminate gender bias and validate

gender-neutral occupational standards for all military

occupations. This section calls for the Secretaries to

validate gender-neutral occupational standards for every

military occupation by no later than September 1, 2015. This

section would require that all combat equipment for female

members meets required standards for wear and

survivability. It also states that “by no later than January 1,

2016, open all military occupations to service by women

who can meet such validated gender-neutral occupational

standards for the military occupations to which they will be

assigned.”

No similar provision.

Sec. 584 requires the

Chairman of the Joint Chiefs

of Staff to conduct a study

concerning the integration of

gender into the planning and

execution of foreign

operations at all levels.

Discussion: In many ways, the report mandated by Section 535 of P.L. 111-383 has been

overtaken by events. Nevertheless, some in Congress are concerned that DOD is not taking

seriously the review of policies affecting female service members. Some are concerned that the

use of the term “equitable,” used above, does not mean the same as “equal.” The service

leadership has already begun assessing the occupational requirements. Section 584 of H.R. 4355

mandates a study of gender integration. There is no study mandate in Sec. 523 of S. 2410 and the

focus is on gender-neutral occupational standards.

Reference(s): CRS Report R42075, Women in Combat: Issues for Congress, by (name redacted).

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

CRS Point of Contact: (name redacted), x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Protection of Child Custody Arrangements for

Parents Who Are Members of the Armed Forces

Background: Military members who are single parents are subjected to the same assignment and

deployment requirements as other service members. Deployments to areas that do not allow

dependents (such as aboard ships or in hostile fire zones) require the service member to have

contingency plans to provide for their dependents, usually a temporary custody arrangement.

Difficulties with child custody could in some cases potentially affect the welfare of military

children as well as service members’ ability to effectively serve their country.12 Concerns have

been raised that the possibility or actuality of military deployments may encourage courts to deny

custodial rights of a service member in favor of a former spouse or others. Also, concerns have

been raised that custody changes may occur while the military member is deployed and unable to

attend court proceedings.

House-Passed H.R. 4435

Section 547 amends the Servicemembers

Civil Relief Act (SCRA) to require courts

to render temporary custody orders

based on deployments and to reinstate

the custody order in effect prior to the

deployment, unless the court determines

that reinstatement is not in the child’s

best interest. This language prohibits

courts from using the absence of a

servicemember due to deployment, or

the possibility of a deployment, as the

sole factor in determining the child’s

best interest. In cases where a state

provides a higher standard of protection

of the rights of the service member, then

the state standards apply.

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

No similar provision.

Section 566, similar to the

House provision, amends the

SCRA to require courts which

issue temporary custody

orders based solely on

deployments to require that

such orders expire not later

than the period justified by the

deployment of the

servicemember. The language

prohibits courts from using the

absence of a servicemember

due to a deployment, or the

possibility of a deployment, as

the sole factor in determining

the child’s best interest. In

cases where a state provides a

higher standard of protection

of the rights of the service

member, then the state

standards would apply.

Discussion: The proposed final version seeks to protect the custodial arrangements of parents

who are members of the armed forces by limiting the duration of a temporary custody order,

based solely on the deployment of a servicemember parent, to the period justified by the

deployment of the servicemember. It also restricts courts from using the absence of a service

member due to deployment, or potential deployment, as the sole factor in determining a child’s

best interests, and directs deference to state law in these matters when the state law is more

beneficial to the service member.

Reference(s): Previously discussed in CRS Report R42651, FY2013 National Defense

Authorization Act: Selected Military Personnel Policy Issues, coordinated by Catherine A.

12

See U.S. Department of Defense, Instruction No. 1342.19, “Family Care Plans,” May 7, 2010.

Congressional Research Service

15

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Theohary. See also CRS Report R43091, Military Parents and Child Custody: State and Federal

Issues, by (name redacted) and (name redacted).

CRS Point of Contact: (name redacted), x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Required Consideration of Certain Elements of

Command Climate in Performance Appraisals of

Commanding Officers

Background: In recent years, the military services, particularly the Army, have reviewed and

broadened what should be considered in evaluating the performance of commanders, including

assessing the “command climate” of their unit. This appraisal includes evaluating how the unit is

functioning and its “health.” Such an appraisal could look at complaints in the unit, as well as

issues concerning turnover, morale, leadership, discipline, etc.

House-Passed H.R. 4435

Sec. 506 requires that in assessing the

command climate, allegations of sexual

assault and the response to the victim of

sexual assault should be taken into

account.

Senate CommitteeReported

S. 2410

Sec. 545 (d) modifies a

reporting requirement

associated with unrestricted

reports of sexual assault,

requiring that they include a

review of command climate

assessments for the units of the

suspect and victim, and an

assessment of whether another

such climate assessment should

be conducted.

Proposed Final Version

H.R. 3979

Sec. 508. Requires consideration of

certain elements of command

climate in performance appraisals of

commanding officers. Under this

section, “The Secretary of a military

department shall ensure that the

performance appraisal of a

commanding officer in an Armed

Force under the jurisdiction of that

Secretary indicates the extent to

which the commanding officer has

or has not established a command

climate in which (1) allegations of

sexual assault are properly managed

and fairly evaluated; and (2) a victim

of criminal activity, including sexual

assault, can report the criminal

activity without fear of retaliation,

including ostracism and group

pressure from other members of the

command.”

Discussion: The language in the proposed final bill would require that performance appraisals of

unit commanders indicate the extent to which he or she has established a “command climate” in

which sexual assault allegations are properly managed and the person making the allegations is

protected from retaliation.

References: CRS Report R43184, FY2014 National Defense Authorization Act: Selected Military

Personnel Issues coordinated by (name redacted).

CRS Point of Contact: (name redacted), x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*Sexual Assault

Background: Sexual assault continues to be an issue in the military. The number of cases

reported in FY2014 was 5,983, exceeding the 5,518 cases reported in FY2013. DOD attributes

this increase to a greater willingness of alleged victims to come forward and report incidents.

House-Passed H.R. 4435

Senate CommitteeReported

S. 2410

Includes the sections listed below

concerning sexual assault in Subtitle D of

Title V.

Includes the sections listed below

concerning sexual assault in

Subtitle E of Title V.

Sec. 533, this section requires the

Secretary of Defense to extend the

sexual assault provisions and preventions

in the FY14 NDAA to the Service

Academies.

Sec. 543, (similar to House Sec.

534) would require that the

Manual for Courts-Martial be

modified to provide that when a

victim of an alleged sex-related

offense has a right to be heard in

connection with the prosecution

of such offense, the victim may

exercise that right through

counsel, including through a

Special Victims’ Counsel, and

requires service secretaries to

establish policies and procedures

to ensure that counsel for the

victim of an alleged sex-related

offense, including a Special

Victims’ Counsel, is provided

prompt and adequate notice of

the scheduling of any hearing,

trial, or other proceeding in

connection with the prosecution

of the offense to permit such

counsel the opportunity to

prepare for the proceeding.

Sec. 534, “This section would require

the Secretary concerned to establish a

procedure to ensure a victim of an

alleged sexual-related offense is

consulted regarding the victim’s

preference for prosecution authority by

court-martial or a civilian court with

jurisdiction over the offense.”

Sec. 535, this section would allow a

victim to seek relief from the Military

Court of Appeals if he/she believes that

a court-martial ruling violated the

victim’s rights concerning the victim’s

previous sexual behavior or

psychological counseling issues.

Sec. 536, “This section would require at

a minimum, dismissal or dishonorable

discharge and confinement for 2 years

for sex-related offenses under the

Uniform Code of Military Justice.”

Sec. 537, “This section would require

the Secretary of Defense to modify the

Military Rules of Evidence to make clear

that the general military character of an

accused is not admissible for the

purpose of showing the probability of

innocence except when the trait of the

military character of an accused is

relevant to an element for which the

accused has been charged and may only

be used for specified military-specific

offenses.”

Sec. 538, “This section would require

the Secretaries of military departments

to establish a confidential process for

victims of a sex-related offense to

appeal, through boards for the

Congressional Research Service

Sec. 544 would amend section

1044e of Title 10, United States

Code to authorize the assistance

of Special Victim’s Counsel for a

member of a reserve component

who is the victim of an alleged

sex-related offense. (No similar

House provision).

Sec. 546 would require that in

any case where a convening

authority decides not to refer a

charge of a sex-related offense to

trial by court martial and the

chief prosecutor of the service

concerned requests review of

the decision, the service

secretary must review the

decision as a superior authority

authorized to exercise general

court-martial convening

Proposed Final Version

H.R. 3979

Includes sections listed below in

Subtitle D of Title V.

Sec. 543 (similar to Senate Sec. 543

and House Sec. 534) would (1)

require the Secretary of Defense to

establish a process to ensure

consultation with the victim of an

alleged sex-related offense that

occurs in the United States to solicit

the victim’s preference regarding

whether the offense should be

prosecuted by court-martial or in a

civilian court with jurisdiction over

the offense; (2) require the

convening authority to consider the

victim’s preference; (3) require the

convening authority to ensure that

the civilian authority with jurisdiction

over the offense is notified of a

victim’s preference for civilian

prosecution; and (4) require the

convening authority to ensure that

the victim is informed if the

convening authority learns of any

decision by the civilian authority to

prosecute or not prosecute the

offense in civilian court.

Sec. 533. (similar to Senate Sec.

544) would amend section 1044e of

Title 10, United States Code, to

authorize the assistance of Special

Victims’ Counsel for a member of a

reserve component who is the

victim of an alleged sex-related

offense and who is not otherwise

eligible for military legal assistance

under Section 1044 of Title 10.

Sec. 541, (similar to Senate Sec.

546), would require that in any case

where a convening authority decides

not to refer a charge of a sex-related

offense to trial by court martial and

the chief prosecutor of the service

concerned requests review of the

decision, the service secretary must

review the decision as a superior

authority authorized to exercise

18

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

House-Passed H.R. 4435

correction of military records, the

characterization of discharge or

separation of the individual from the

Armed Forces.”

Sec. 540 would authorize the return to

the rightful owner of personal property

retained as evidence in connection with

an incident of sexual assault involving a

servicemember after the conclusion of

all legal, adverse action, and

administrative proceedings related to the

sexual assault.

Senate CommitteeReported

S. 2410

Proposed Final Version

H.R. 3979

authority. (No similar House

provision.)

general court-martial convening

authority.

Sec. 547,(similar to House Sec.

540, would authorize the return

to the rightful owner of personal

property retained as evidence in

connection with an incident of

sexual assault involving a

servicemember after the

conclusion of all legal, adverse

action, and administrative

proceedings related to the sexual

assault.

Sec. 538, similar to Senate section

547, similar to House section 540,

would authorize the return to the

rightful owner of personal property

retained as evidence in connection

with an incident of sexual assault

involving a servicemember after the

conclusion of all legal, adverse

action, and administrative

proceedings related to the sexual

assault.

Sec. 548, would require the

Secretary of Defense to issue

policies and procedures for the

inclusion of certain information in

the Defense Sexual Assault

Incident Database obtained from

restricted and unrestricted

reports of sexual assault,

including the following: (1) The

name of the alleged assailant, if

known; (2) Identifying features of

the alleged assailant; (3) The date

of the assault; (4) The location of

the assault; (5) Information on

the means or method used by

the alleged assailant to commit

the assault. (No similar House

provision.)

Sec. 543 includes the language in

Senate Section 548 that would

require the Secretary of Defense to

issue policies and procedures for the

inclusion of certain information

obtained from restricted and

unrestricted reports of sexual

assault in the Defense Sexual Assault

Incident Database. Further, it would

require the Secretary of Defense,

not later than 1 year after the date

of enactment, to submit to the

Armed Services committees a plan

that will allow an individual who files

a restricted report on an incident of

sexual assault to elect to permit a

military criminal investigative

organization, on a confidential basis

and without affecting the restricted

nature of the report, to access

certain information of the alleged

perpetrator if available, for the

purpose of identifying individuals

who are suspected of perpetrating

multiple sexual assaults.

Sec. 550, (similar to House Sec.

533), would require the

Secretary of Defense to extend

the sexual assault provisions and

preventions in the FY14 NDAA

to the Service Academies.

Sec. 551 would require that the

Department of Defense Annual

Report on Sexual Assault in the

Military include an analysis and

assessment of the disposition of

the most serious offenses

identified in unrestricted reports

of sexual assault. (No similar

House provision.)

Sec. 552, would require the

Secretary of Defense to establish

and maintain a Defense Advisory

Committee on Investigation,

Prosecution, and Defense of

Sexual Assault in the Armed

Forces to advise the Secretary on

Congressional Research Service

Sec. 552, (similar to Senate Sec. 550

and House Sec. 533), would require

the Secretary of Defense to extend

the sexual assault provisions and

preventions in the FY14 NDAA to

the Academies.

Sec. 542,(similar to Senate Sec. 551),

would require that the Department

of Defense Annual Report on Sexual

Assault in the Military include an

analysis and assessment of the

disposition of the most serious

offenses identified in unrestricted

reports of sexual assault.

Sec. 546, (similar to Senate Sec. 552)

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

House-Passed H.R. 4435

Senate CommitteeReported

S. 2410

the investigation, prosecution,

and defense of rape, forcible

sodomy, sexual assault, and other

sexual misconduct in the Armed

Forces and to submit a report on

an annual basis to the Secretary

and to the Armed Services

committees. (No similar House

provision.)

Sec. 553 would require the

Secretary of Defense and the

Attorney General to jointly

develop a strategic framework

for ongoing collaboration

between the Department of

Defense and the Department of

Justice in their efforts to prevent

and respond to sexual assault.

(No similar House provision.)

Proposed Final Version

H.R. 3979

would require the Secretary of

Defense to establish and maintain a

Defense Advisory Committee on

Investigation, Prosecution, and

Defense of Sexual Assault in the

Armed Forces to advise the

Secretary on the investigation,

prosecution, and defense of rape,

forcible sodomy, sexual assault, and

other sexual misconduct in the

Armed Forces not later than 30 days

before the termination date of the

independent panel established under

section 576(a)(2) of the FY2013

NDAA and to submit a report on

an annual basis to the Secretary and

to the Armed Services committees.

Discussion: Many believe that more can and should be done to address the issue of sexual assault

in the military. These provisions require additional efforts by the military related to preventing

and reporting sexual assault, providing assistance to victims, and modifying judicial proceedings.

References: CRS Report R43184, FY2014 National Defense Authorization Act: Selected Military

Personnel Issues, coordinated by (name redacted); CRS Report R42651,

FY2013 National Defense

Authorization Act: Selected Military Personnel Policy Issues, coordinated by (name redacte

d); and CRS Report R41874,

FY2012 National Defense Authorization Act: Selected

Military Personnel Policy Issues, coordinated by (name redacted). See also, U.S., Department of

Defense, Annual Report on Sexual Assault in the Military, FY2013: http://www.sapr.mil/public/

docs/reports/FY13_DoD_SAPRO_Annual_Report_on_Sexual_Assault.pdf

CRS Point of Contact: (name redacted), x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Medals for Members of the Armed Forces and

Civilian Employees of the Department of Defense

Who Were Killed or Wounded in an Attack Inspired

or Motivated by a Foreign Terrorist Organization

Background: The Purple Heart is awarded to any member of the Armed Forces who has been (1)

wounded or killed in action against an enemy while serving with friendly forces against a

belligerent party as the result of a hostile foreign force while serving as a member of a

peacekeeping force while outside the United States; or (2) killed or wounded by friendly fire

under certain circumstances. On June 9, 2009, a civilian who was angry over the killing of

Muslims in Iraq and Afghanistan opened fire on two U.S. Army soldiers near a recruiting station

in Little Rock, AK. On November 5, 2009, an Army major, Nidal Hasan, opened fire at Ft. Hood,

TX, killing 13 and wounding 29. Both the civilian and Army major were charged with murder

and other crimes. In 2013, Hasan was convicted and sentenced to death. The shooter in the Little

Rock case confessed and was sentence to life in prison.

House-Passed

H.R. 4435

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

Sec. 571 “would amend the Purple

Heart award to include members

killed or wounded in attacks

inspired or motivated by foreign

terrorist organizations since

September 11, 2001. Additionally,

this section would require a

review of the November 5, 2009,

attack at Fort Hood, Texas, to

determine as to whether the

death or wounding of any civilian

employee of the Department of

Defense or civilian contractor

meets the eligibility criteria for

the award of the Secretary of

Defense Medal for the Defense of

Freedom.” It prohibits the award

being presented to a member

whose wound was the result of

willful misconduct (e.g., the

alleged shooter at Ft. Hood, who

was wounded by police).

Sec. 561. “The committee recommends a

provision that would add a new section 1129a

to title 10, United States Code, to require that

the Secretary concerned treat attacks by a

foreign terrorist organization as an attack by an

international terrorist organization for the

purposes of awarding the Purple Heart in

certain circumstances.”

Sec. 571 has similar language

to Sec. 561to add a new

section 1129a to title 10,

United States Code, “for the

purposes of awarding the

Purple Heart and the

Defense Medal for the

Defense of Freedom... an

attack by an individual or

entity shall be considered to

be an attack by a foreign

terrorist organization if—

‘‘(A) the individual or entity

was in communication with

the foreign terrorist

organization before the

attack; and (B) the attack was

inspired or motivated by the

foreign terrorist

organization.”

Discussion: Authorities had considered, and treated, the shootings at Little Rock and Ft. Hood to

be crimes and not acts perpetrated by an enemy or hostile force. Because these acts involved

Muslim perpetrators angered over U.S. actions in Iraq and Afghanistan, some believe they should

be viewed as acts of war. Still others are concerned that awarding the Purple Heart in these

situations could have anti-Muslim overtones. The decision to award medals and other military

decorations traditionally rests with the executive branch, so enacting this language would

represent a rare legislative initiative in this area.

References: CRS Report R42704, The Purple Heart: Background and Issues for Congress, by

(name redacted).

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

CRS Point of Contact: (name redacted), x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Retroactive Award of Army Combat Action Badge

Background: The Combat Action Badge (CAB) is awarded to any soldier who has actively

engaged or been engaged by the enemy in a combat zone or imminent danger area. The CAB was

established through Department of the Army Letter 600-05-1, dated June 3, 2005, and was

authorized for soldiers who met the requirements after September 18, 2001. As with the coveted

Combat Infantryman Badge (CIB) and Combat Medical Badge (CMB), the CAB recognizes

soldiers who were actively engaged in combat with the enemy, but its award is not restricted by

military occupational specialty.

House-Passed

H.R. 4435

Senate CommitteeReported S. 2410

Proposed Final Version

H.R. 3979

Sec. 572. states that “The Secretary of the

Army may award the Army Combat Action

Badge … to a person who, while a member

of the Army, participated in combat during

which the person personally engaged, or was

personally engaged by, the enemy at any

time during the period beginning on

December 7, 1941, and ending on

September 18, 2001.” In order to minimize

administrative costs, the Secretary may

make arrangements for the newly eligible

individuals to procure the CAB directly from

the suppliers.

No similar provision.

No similar provision. However,

the Joint Explanatory Statement

requests that the Secretary of

Defense review this proposal as

part of DOD’s review of its

military decorations and awards

program.

Discussion: Section 572 of the House bill would give the Secretary of the Army permission to

retroactively award the CAB to certain individuals. If enacted and utilized by the Secretary of the

Army, Section 572 would align the dates of eligibility with those for the CIB and CMB, and

effectively allow eligible Army veterans retroactively to be awarded the CAB. Locating records

that would justify awarding the CAB might, in some cases, be difficult. Additionally, the

language of Section 572 says that the CAB would be awarded to “a person who, while a member

of the Army, participated in combat during which the person personally engaged, or was

personally engaged by, the enemy.” Therefore, survivors of deceased service members seemingly

could not acquire the CAB on behalf of the service member.

The Joint Explanatory Statement accompanying the proposed final bill included the following

statement:

On March 20, 2014, the Secretary of Defense directed a comprehensive review of the

Department of Defense’s military decorations and awards program to ensure that it provides

avenues to appropriately recognize the service, sacrifices, and actions of military personnel.

We request that this comprehensive review include a review of the proposal for the

retroactive award of the Army Combat Action Badge.13

References: None.

CRS Point of Contact: (name redacted), x7-.... and (name redacted), x7-.....

13

Joint Explanatory Statement to Accompany the National Defense Authorization Act for Fiscal Year 2015, p.82.

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Congressional Research Service

24

FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Medal of Honor (MoH) Process

Background: In recent years, critics of the MoH review process have noted it as being lengthy

and bureaucratic which may have led to some records being lost and conclusions drawn based on

competing eyewitness and forensic evidence. One controversial nomination is that of Sgt. Rafael

Peralta, who was nominated by the Marine commandant for allegedly smothering a grenade in

Fallujah, Iraq, and saving the lives of several comrades in 2004. Marines who witnessed his

actions insisted that although Peralta was gravely wounded, he was able to smother the grenade.

However, some forensic experts disagreed, contending that he was already brain-dead and thus

unable to voluntarily move on his own. The situation became more confused when Marines

serving with Peralta recanted their stories.14 Also the medals process was tarnished when the

Pentagon was alleged to have created false narratives to justify medals awarded in the highprofile cases of Army Ranger Pat Tillman and Army Pfc. Jessica Lynch.15

House-Passed H.R. 4435

Sec. 573 states “No later than 30

days after the date of the enactment

of this Act, the Secretary of the

Navy shall submit to the

Committees on Armed Services of

the Senate and House of

Representatives a report describing

the Navy review, findings, and

actions pertaining to the Medal of

Honor nomination of Marine Corps

Sergeant Rafael Peralta. The report

shall account for all evidence

submitted with regard to the case.”

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

No provision.

Sec. 572. “Authorization for award of

the Medal of Honor to members of the

Armed Forces for acts of valor during

World War I.” This section would

waive the time limitations specified in

section 3 3744 of title 10, United

States Code and to the awarding of

certain medals to persons who served

in the Armed Forces during World

War I. Under this section, the

President may consider awarding the

Medal of Honor to William Shemin and

Henry Johnson for the acts of valor

during World War I.

Discussion: Peralta’s case bears similarities to that of Marine Cpl. William "Kyle" Carpenter,

who jumped on an enemy grenade to save a fellow Marine in Afghanistan. Carpenter, who is

medically retired, was awarded the Medal of Honor on June 19, 2014, at the White House for his

actions. Advocates for Peralta’s nomination may seek to draw parallels between the two cases

which may further open the review process for scrutiny.

References: CRS Report 95-519, Medal of Honor: History and Issues, by (name redacted) and

(name redacted); and

CRS Point of Contact: (name redacted), x7-.....

14

Londono, Ernesto, “Comrades say Marine heroism tale of Iraq veteran was untrue,” The Washington Post, February,

21, 2014.

15

Zucchino, David, and Tony Perry, “Why so few Medal of Honor awards?,” The Los Angeles Times, October 4, 2010,

at http://articles.latimes.com/print/2010/oct/04/nation/la-na-1004-medal-20101004-1

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*TRICARE Beneficiary Cost-Sharing

Background: TRICARE is a health care program serving uniformed service members, retirees,

their dependents, and survivors. In its FY2015 budget request, the Administration proposed to

replace TRICARE Prime, Standard, and Extra with a consolidated TRICARE plan, increase copays for pharmaceuticals, and establishing a new enrollment fee for future enrollees in the

TRICARE-for-Life program (that acts like a Medigap supplement plan for Medicare-eligible

retirees).

House-Passed H.R. 4435

No provision.

Senate CommitteeReported

S. 2410

Only adopted one of the

budget proposals, Section 702,

concerning pharmacy

copayments, discussed

separately in next section.

Proposed Final Version

H.R. 3979

Only adopted one of the budget

proposals. Section 702 is a modified

version of the Senate Provision (Sec.

702), concerning pharmacy

copayments. It is discussed

separately in next section.

Discussion: The House Armed Services Committee report states:

The committee remains focused on making certain that the Department cost-saving measures

are centered on achieving the most efficient Military Health System possible before

significant cost sharing burdens is placed on TRICARE beneficiaries. The current

Department proposal to fundamentally alter the structure of TRICARE and increase

associated fees is concerning in light of concurrently proposed reductions in compensation.16

The joint explanatory statement for H.R. 3979 states that the Administration cost-sharing

proposals have not been rejected, but that additional action is deferred pending the report of the

Military Compensation and Retirement Modernization Commission expected in February 2015:

We note that while the Department of Defense (DOD) legislative proposal included proposed

changes to the TRICARE pharmaceutical co-pays for fiscal years 2015 through 2024; this

agreement includes changes beginning in fiscal year 2015. By adopting co-payment changes

beginning the first year of the proposal, the agreement preserves the option for Congress to

achieve most of the savings requested by DOD. This approach does not constitute a rejection

of the DOD proposal, which was endorsed by the Joint Chiefs of Staff. Rather, consideration

of further changes to co-pays is deferred until after the committees receive the report of the

Military Compensation and Retirement Modernization Commission, which is due in

February 2015. The two committees commit to consider proposed changes to co-pays that

are included in the FY 2016 budget request as part of the consideration of the National

Defense Authorization Act for Fiscal Year 2016.We note that if sequestration-level budgets

remain in effect for Fiscal Year 2016 and beyond, DOD will need to make painful cuts and

achieve substantial savings across its entire budget in order to avoid an unacceptable

reduction in readiness of the Armed Forces of the United States.17

16

H.Rept. 113-446 page 162.

Rules Committee Print 113-58, Joint Explanatory Statement to the Carl Levin and Howard P. ‘Buck’ McKeon

National Defense Authorization Act for Fiscal Year 2015, page 96. Available at http://rules.house.gov/sites/

republicans.rules.house.gov/files/113-2/PDF/113-S1847-JES.pdf

17

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The web site of the Military Compensation and Retirement Modernization Commission is

http://mldc.whs.mil/ and an interim report providing detailed information on the military health

care program and its costs is available there.

Reference(s): Previously discussed in CRS Report R43184, FY2014 National Defense

Authorization Act: Selected Military Personnel Issues, coordinated by (name redacted); CRS Report

R42651, FY2013 National Defense Authorization Act: Selected Military Personnel Policy Issues,

coordinated by (name redacted); CRS Report R41874,

FY2012 National Defense

Authorization Act: Selected Military Personnel Policy Issues, coordinated by (name redacted);

CRS Report R40711, FY2010 National Defense Authorization Act: Selected Military Personnel

Policy Issues, coordinated by (name redacted); and CRS Report RL34590,

FY2009 National

Defense Authorization Act: Selected Military Personnel Policy Issues, coordinated by (name red

acted).

CRS Point of Contact: Don Jansen, x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

*TRICARE Pharmacy Copayments

Background: TRICARE beneficiaries have access to a pharmacy program that allows outpatient

prescriptions to be filled through military pharmacies, TRICARE Pharmacy Home Delivery, and

TRICARE retail network and non-network pharmacies. Active duty service members have no

pharmacy copayments when using military pharmacies, TRICARE Pharmacy Home Delivery, or

TRICARE retail network pharmacies. Military pharmacies will provide free-of-charge a 90-day

supply of formulary medications for prescriptions written by both civilian and military providers.

Non-formulary medicines generally are not available at military pharmacies. For up to a 90-day

supply, there are copayments for brand name and non-formulary medications (currently $13 and

$43, respectively), but not for generic medications dispensed through TRICARE Pharmacy Home

Delivery. For TRICARE retail network pharmacies the copayments for a 30-day supply currently

are $5 for generic, $17 for brand name, and $44 for non-formulary drugs. It is DOD policy to use

generic medications instead of brand-name medications whenever possible. The Administration’s

FY2015 budget request proposed a series of annual increases in the amount of copayments for

fiscal years 2015 through 2024.

House-Passed H.R. 4435

No provision.

Senate CommitteeReported

S. 2410

Section 702 would specify

TRICARE pharmaceutical copays for fiscal years 2015

through 2024, similar to the

Administration proposal, and

would require that non-generic

maintenance medications be

refilled through military

treatment facilities or the

TRICARE Pharmacy Home

Delivery program.

Proposed Final Version

H.R. 3979

Section 702 would increase current

copayment amounts by $3 and

require that non-generic

maintenance medications be refilled

through military treatment facilities

or the TRICARE Pharmacy Home

Delivery program. It would also

require the Government

Accountability Office to report on a

previously established mail-order

maintenance drug requirement pilot

program.

Discussion: Section 716 of the National Defense Authorization Act for Fiscal Year 2013

established a pilot program requiring that maintenance medications for TRICARE for Life

beneficiaries be filled through military treatment facilities or TRICARE Pharmacy Home

Delivery. Section 702 of H.R. 3979 would terminate the pilot program and expand the

requirement to all TRICARE beneficiaries. Maintenance medications are those used on a regular

basis for chronic health conditions such as high cholesterol or blood pressure. They do not

include medications needed for a sudden illness or infection. Section 702 would also increase

existing copayment requirements across-the-board by $3.

The Congressional Budget Office estimated that removing retail pharmacies as an option for

refilling prescriptions for maintenance medications would save roughly $375 million per year.

Reference(s): Previously discussed in CRS Report R43184, FY2014 National Defense

Authorization Act: Selected Military Personnel Issues, coordinated by (name redacted) and CRS

Report R42651, FY2013 National Defense Authorization Act: Selected Military Personnel Policy

Issues, coordinated by (name redacted). C

ongressional Budget Office Cost Estimate: S.

2410 dated October 21, 2014, page 12.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

CRS Point of Contact: Don Jansen, x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Mental Health Assessments

Background: Person-to-person mental health assessments are required under current law (10

U.S.C. 1074m) to be provided to each member of the armed forces who is deployed in support of

a contingency operation once during the period beginning 120 days before the date of the

deployment, once during the period beginning 90 days after the date of redeployment from the

contingency operation and ending 180 days after such redeployment date, and not later than once

during each of (1) the period beginning 180 days after the date of redeployment from the

contingency operation and ending 18 months after such redeployment date; and (2) the period

beginning 18 months after such redeployment date and ending 30 months after such

redeployment date. The purpose of these mental health assessments is to identify post-traumatic

stress disorder, suicidal tendencies, and other behavioral health conditions.

House-Passed H.R.

4435

Senate Committee-Reported

S. 2410

Proposed Final Version

H.R. 3979

Section 701 would

require DOD to

administer a person-toperson mental health

assessment to deployed

personnel once every six

months.

Section 701 would require DOD to

administer a person-to-person mental

health assessment to Active Duty and

Selected Reserve members each year. It

also would require an annual report on

the tools and processes used to

provide the assessments.

Section 701 would require DOD to

administer a person-to-person mental health

assessment to Active Duty and Selected

Reserve members each year as well as once

during each 180-day period in which a

member is deployed. It also would require an

annual report on the tools and processes used

to provide the assessments.

Discussion: Requiring DOD to administer a mental health assessment to deployed personnel

every six months would require the deployment of an additional 20 mental health professionals

and cost $35 million over the 2015-2019 periods according to Congressional Budget Office

(CBO) estimate for H.R. 4435. The CBO’s cost estimate for the annual person-to-person mental

health assessment required by section states:

Section 701 would require DoD to administer an annual mental health assessment to all

members on active duty and in the selected reserve. Based on information from DoD, most

of the services perform annual assessments that would meet the requirements of section 701.

However, the Air Force and Air National Guard currently require such assessments at

intervals of three and five years, respectively. Based on information from DoD, CBO

estimates that implementing section 701 would require the Air Force and Air National Guard

to perform an additional 240,000 mental health assessments each year, at a cost of about $35

each (the assessments may be performed over the phone). In total, after accounting for

inflation, CBO estimates section 701 would require an increase in spending subject to

appropriation of $43 million over the 2015-2019 periods. Costs would be lower in the first

year because of the time needed to establish regulations and procedures.

Presumably the estimated cost for the H.R. 3979 provision would not be significantly more than

that for S. 2410 because mental health assessments administered to deployed troops would satisfy

the annual requirement.

Reference(s): Congressional Budget Office Cost Estimate: H.R. 4435 dated May 16, 2014.

Congressional Budget Office Cost Estimate: S. 2410 dated October 21, 2014.

CRS Point of Contact: Don Jansen, x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Elimination of Inpatient Mental Health Day Limits

Background: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity

Act of 2008 (MHPAEA, P.L. 110-343) generally prevents group health plans and health insurance

issuers that provide mental health or substance use disorder benefits from imposing less favorable

limitations on those benefits than on medical/surgical benefits. The MHPAEA originally applied

to group health plans and group health insurance coverage and was amended by the Patient

Protection and Affordable Care Act (P.L. 111-148), as amended by the Health Care and Education

Reconciliation Act of 2010 (P.L. 111-152), to also apply to individual health insurance coverage.

None of these provisions are applicable to the TRICARE program. TRICARE currently limits

inpatient psychiatric care for patients age 19 and older to 30 days per fiscal year or in any single

admission and to 45 days per fiscal year or in any single admission for patients age 18 and

younger. Limitations may be waived if determined to be medically or psychologically necessary.

House-Passed H.R. 4435

No provision.

Senate CommitteeReported

S. 2410

Section 703 would

amend Section 1079 of

Title 10 of the United

States Code to remove

TRICARE’s limits on

inpatient mental health

services.

Proposed Final Version

H.R. 3979

Section 703 would amend Section 1079 of

Title 10 of the United States Code to

remove TRICARE limits on inpatient

mental health services.

Discussion: The Congressional Budget Office cost estimate for S. 2410 states:

Section 703 would remove certain limitations on inpatient mental health coverage under

TRICARE. Specifically, beneficiaries would no longer be subject to the annual limit on stays

at inpatient mental health facilities, which is currently 30 days for adults and 45 days for

children. In addition, children would no longer be subject to the 150-day annual limit for

stays at Residential Treatment Centers. DoD is currently allowed to issue waivers that allow

beneficiaries to exceed the annual limits. However, based on an examination of data from

DoD, CBO believes that at least some beneficiaries will have their inpatient stays curtailed

because of the current restrictions, and that removal of those restrictions would result in

longer stays and an increase in costs to DoD.

Based on data from DoD, CBO estimates that about 650 TRICARE beneficiaries who are not

Medicare-eligible would extend their stays at inpatient mental health facilities each year if

the current restrictions are eliminated, and that they would extend their stays by about 26

days, on average. With an average cost of about $700 per day, CBO estimates section 703

would increase spending subject to appropriation by about $12 million per year, or $67

million over the 2015-2019 periods after adjustments for annual inflation.

Reference(s): Congressional Budget Office Cost Estimate: H.R. 4435 dated May 16, 2014.

Congressional Budget Office Cost Estimate: S. 2410 dated October 21, 2014, page 13.

CRS Point of Contact: Don Jansen, x7-.....

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Review of Military Health System Modernization

Background: DOD implemented a reorganization of the military health system on October 1,

2013. This included the creation of a new Defense Health Agency and Enhanced Multi-Service

Markets. In reports to Congress, DOD has communicated its intent to consolidate or eliminate

some underutilized services offered through certain military treatment facilities.

House-Passed H.R. 4435

Section 714 would require the Secretary

of Defense to submit a report to the

congressional defense committees on the

military medical treatment facility

modernization study directed by the

Resource Management Decision of the

Department of Defense MP-D–01. The

report would be required to include the

study data used by the Secretary and the

results of the study with regard to

recommendations to restructure or

realign military medical treatment

facilities. It also would require the

Comptroller General, not later than 180

days after the Secretary submits the

required report, to submit a report to

the congressional defense committees.

The Comptroller General report would

include an assessment of the study

methodology and data used by the

Secretary. The Secretary would be

prohibited from realigning or

restructuring a military medical treatment

facility until 120 days following the date

the Comptroller General is required to

submit the report.

Senate CommitteeReported

S. 2410

Section 736 would require

the Comptroller General

to submit a report

assessing the Military

Health System

Modernization Study of the

Department of Defense to

the congressional defense

committees no later than

180 days after enactment.

Proposed Final Version

H.R. 3979

Section 713 would require the Secretary

of Defense to submit a report to the

congressional defense committees on the

military medical treatment facility

modernization study directed by the

Resource Management Decision of the

Department of Defense MP-D–01. The

report would include the study data, for a

6-year period, used by the Secretary of

Defense and the results of the study with

regard to recommendations to

restructure or realign military medical

treatment facilities. It would also include

assessments of whether the military

medical treatment facilities included in

the modernization study have a helipad

capable of receiving medical evacuation

airlift patients arriving on the primary

evacuation aircraft platform for the

military installation served; and whether

the Secretary consulted with the

appropriate training directorate, training

and doctrine command, and forces

command of the military department

concerned with respect to the frequency

of high-tempo, live-fire military

operations, and treating battlefield-like

injuries, at locations that serve as military

training centers. It also would require the

Comptroller General, not later than 180

days after the Secretary submits the

required report, to submit a report to

the congressional defense committees.

The Comptroller General would include

an assessment of the study methodology

and data used by the Secretary. The

Secretary would be prohibited from

realigning or restructuring a military

medical treatment facility until 90 days

following the date the Comptroller

General is required to submit the report.

Discussion: Section 714 of the House bill would delay DOD’s planned changes. The section

requires DOD to submit a report to the congressional defense committees on an internal DOD

military medical treatment facility modernization study and the Government Accountability

Office to subsequently report upon that report. The Congressional Budget Office estimates that

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

the delays in planned changes would increase costs to DOD by about $135 million over the 20152019 period. Assuming the study required by Section 713 of H.R. 3979 would have a similar

effect as Section 714 of H.R. 4435 one might assume a similar resulting cost estimate.

Reference(s): Congressional Budget Office Cost Estimate: H.R. 4435 dated May 16, 2014.

CRS Point of Contact: Don Jansen, x7-.....

Congressional Research Service

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Authority for Provisional TRICARE Coverage for

Emerging Health Care Services and Supplies

Background: In general, by federal law, TRICARE payments are prohibited for “any service or

supply which is not medically or psychologically necessary to prevent, diagnose, or treat a mental

or physical illness, injury, or bodily malfunction.” The purpose of this provision, common in

health care payment programs, is to prevent TRICARE beneficiaries from being exposed to less

than fully developed and tested drugs, devices and/or medical procedures and to avoid the

associated risk of unnecessary or unproven treatment.

House-Passed H.R.

4435

No provision.

Senate CommitteeReported

S. 2410

Section 705 would amend

section 1073 of Title 10,

United States Code, to

authorize the Secretary of

Defense to provide

provisional coverage or

authorization of certain

health care product and

services that do not meet

the hierarchy of reliable

evidence as prescribed in

federal regulations for the

TRICARE program.

Proposed Final Version

H.R. 3979

Section 704 would amend chapter 55 of Title 10 United

States Code, to include a new section (1079c) that would

authorize the Secretary of Defense, acting through the

Assistant Secretary of Defense for Health Affairs, to

provide provisional coverage for certain services or

supplies if the Secretary determines that such service or

supply is widely recognized in the United States as being

safe and effective. The Secretary may arrange for an

evaluation of a product or service from the Institute of

Medicine or another independent entity. The Secretary’s

determination to approve or disapprove a service or

supply would be final.

Discussion: The TRICARE Policy Manual18 explains how the prohibition on non-medically

necessary services and supplies are implemented. It states that regulations and program policies

restrict benefits to those drugs, devices, treatments, or procedures for which the safety and

efficacy have been proven to be comparable or superior to conventional therapies. Any drug,

device, medical treatment, or procedure whose safety and efficacy has not been established is

unproven and is excluded from coverage.

A drug, device, medical treatment, or procedure is unproven

•

if the drug or device cannot be lawfully marketed without the approval or

clearance of the U.S. Food and Drug Administration (FDA) and approval or

clearance for marketing has not been given at the time the drug or device is

furnished to the patient; or

•

if a medical device with an Investigational Device Exemption (IDE) approved by

the FDA is categorized by the FDA as experimental/investigational (FDA

Category A),

18

See TRICARE Policy Manual 6010.57-M, February 1, 2008. Chapter 1, Section 2.1 “Unproven Drugs, Devices,

Medical Treatments, And Procedures” at 1983 http://manuals.tricare.osd.mil/DisplayManualFile.aspx?Manual=TP08&

Change=123&Type=AsOf&Filename=C1S2_1.PDF&highlight=

xml%3dhttp%3a%2f%2fmanuals.tricare.osd.mil%2fPdfHighlighter.aspx%3fDocId%3d35929%26Index%3dD%253a%

255cIndex%255cTP08%26HitCount%3d7%26hits%3d4e%2b229%2b309%2b31f%2b32d%2b34d%2b395%2b.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

unless reliable evidence shows that any medical treatment or procedure has been the subject of

well-controlled studies of clinically meaningful endpoints, which have determined its maximum

tolerated dose, its toxicity, its safety, and its efficacy as compared with standard means of

treatment or diagnosis.

Cost-sharing may be allowed for services or supplies when there is no logical or causal

relationship between the unproven drug, device, treatment, or procedure and the treatment at issue

or where such a logical or causal relationship cannot be established with a sufficient degree of

certainty. This cost-sharing is authorized when

•

treatment that is not related to the unproven drug, device, treatment, or procedure

(e.g., medically necessary treatment the beneficiary would have received in the

absence of the unproven drug, device, treatment, or procedure);

•

treatment which is a necessary follow-up to the unproven drug, device, treatment,

or procedure but which might have been necessary in the absence of the

unproven treatment.

In making a determination that a drug, device, medical treatment, or procedure has moved from

the status of unproven to the position of nationally accepted medical practice; TRICARE uses the

following hierarchy of reliable evidence:

Well controlled studies of clinically meaningful endpoints, published in refereed medical

literature. These include

•

published formal technology assessments,

•

the published reports of national professional medical associations,

•

published national medical policy organization positions, and

•

the published reports of national expert opinion organizations.

TRICARE policy and benefit structure is never based solely that of other government medical

programs, including Medicare, because each operates under its own statutes and regulations.

TRICARE coverage may only be based on its governing statutes and regulations.

Section 704 presumably would, among other things, allow TRICARE to address situations such

as Laboratory Developed Tests (LDTs). These are considered “medical devices” by the FDA. By

regulation, TRICARE coverage is limited to FDA approved LDTs. A recent change in medical

coding allowed TRICARE to identify when LDTs were being reimbursed when it had previously

unknowingly paid for them. The Defense Health Agency (DHA) has stated that it recognizes that

some FDA non-approved LDTs may help providers and patients with certain treatment decisions.

In order to determine which FDA non-approved LDTs may be appropriate for coverage under

TRICARE, the DHA is in the process of designing a new demonstration project. This new effort

would expand upon an existing demonstration project, which provides coverage for certain LDTs

that inform clinical decision making in cancer diagnosis and treatment.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Potential spending increases associated with this provision might be offset by potential reductions

in spending under DOD’s Supplemental Care program which is not subject to the TRICARE

limitations.19

Reference(s): Congressional Budget Office Cost Estimate: H.R. 4435 dated May 16, 2014.

Congressional Budget Office Cost Estimate: S. 2410 dated October 21, 2014, page 13.

CRS Point of Contact: Don Jansen, x7-.....

19

See 32 CFR 199.16 - Supplemental Health Care Program for active duty members.

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FY2015 National Defense Authorization Act: Selected Military Personnel Issues

Availability of Breastfeeding Support, Supplies, and

Counseling under the TRICARE Program

Background: Current TRICARE coverage for breastfeeding support supplies is limited to

hospital-grade electric breast pumps (including services and supplies related to the use of the

pump) for the mother of a premature infant. Electric breast pumps are specifically excluded for

reasons of personal convenience, such as to facilitate a mother’s return to work, even if prescribed

by a physician. Basic electric and manual breast pumps likewise are excluded. This policy

contrasts with the regulations promulgated pursuant to the Patient Protection and Affordable Care

Act (P.L. 111-148) requiring group health insurance to cover comprehensive prenatal and

postnatal lactation support, counseling, and equipment without cost-sharing.

House-Passed H.R. 4435

Section 703 would amend section 1079 of Title 10, United States

Code, to authorize breastfeeding support, supplies, and counseling

during pregnancy and the postpartum period as a covered benefit

for TRICARE beneficiaries.

Senate

CommitteeReported

S. 2410

Proposed Final

Version

H.R. 3979

Section 704 is identical

to the House

provision.

Section 706 is

identical to the

House provision.

Discussion: The provision would authorize TRICARE coverage of “breastfeeding support,

supplies (including breast pumps and associated equipment), and counseling as appropriate

during pregnancy and the postpartum period.” Normal TRICARE cost-sharing requirements

would still apply. CBO did not score this provision.

CRS Point of Contact: Don Jansen, x7-.....

Author Contact Information

(name redacted), Coordinator

Analyst in Defense Budget and Military Manpower

*redacted*@crs.loc.gov, 7-....

(name redacted)

Specialist in Defense Health Care Policy

*redacted*@crs.loc.gov, 7-....

(name redacted)

Specialist in Military Manpower Policy

*redacted*@crs.loc.gov, 7-....

Acknowledgments

David Burrelli, Specialist in Military Manpower Policy, was the previous coordinator for this report.

Congressional Research Service

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