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108th Congress                                            Rept. 108-115
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     Part 1

======================================================================



 
 TO AMEND TITLE 38, UNITED STATES CODE, TO ENHANCE COOPERATION AND THE 
SHARING OF RESOURCES BETWEEN THE DEPARTMENT OF VETERANS AFFAIRS AND THE 
                         DEPARTMENT OF DEFENSE

                                _______
                                

                  May 19, 2003.--Ordered to be printed

                                _______
                                

   Mr. Smith of New Jersey, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1911]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1911) to amend title 38, United States Code, to 
enhance cooperation and the sharing of resources between the 
Department of Veterans Affairs and the Department of Defense, 
having considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                              Introduction

    The reported bill reflects the Committee's consideration of 
H.R. 1911, to amend title 38, United States Code, to enhance 
cooperation and the sharing of resources between the Department 
of Veterans Affairs and the Department of Defense.
    On May 1, 2003, Honorable John Boozman introduced H.R. 1911 
along with Honorable Christopher H. Smith, Honorable Lane 
Evans, Honorable Rob Simmons, Honorable Jeff Miller, and 
Honorable Ciro D. Rodriguez.
    On May 6, 2003, the Subcommittee on Health met and ordered 
H.R. 1911 reported favorably to the full Committee by unanimous 
voice vote.
    On May 15, 2003, the full Committee met and ordered H.R. 
1911 reported favorably to the House by unanimous voice vote.

                      Summary of the Reported Bill

    H.R. 1911 would:

    1. Expand the mandate of the Department of Veterans 
Affairs (VA) and the Department of Defense (DOD) Joint 
Executive Committee by adding a new section 320 to chapter 3 of 
title 38, United States Code.

    2. Require Joint Executive Committee membership to include 
the Deputy Secretary of Veterans Affairs and the Under 
Secretary of Defense for Personnel and Readiness, along with 
other officers and employees appointed by each Department's 
Secretary.

    3. Require the Deputy Secretary and the Under Secretary to 
determine administrative and procedural guidelines of the 
Committee and ensure adequate support for its operations.

    4. Create subordinate Health and Benefits Executive 
Committees, and other committees or working groups considered 
necessary by the Deputy Secretary and Under Secretary.

    5. Require the development of strategic direction 
recommendations to the Secretaries, and an annual report of 
recommendations to Congress that would identify changes in 
policies, procedures and practices to improve the quality, 
efficiency and effectiveness of the delivery of benefits and 
services to beneficiaries in both Departments.

    6. Mandate that the Committee oversee collaborative 
efforts to promote increased resource sharing between the two 
Departments in benefits and other areas of joint departmental 
concern, in addition to those associated with the delivery of 
health care services to beneficiaries of the Departments; and

    7. Require further improved coordination and opportunities 
for collaboration to maximize resources by sharing the 
acquisition of additional resources, especially capital assets 
such as new facilities, major equipment and technology where 
both Departments have a joint or mutual interest.

                       Background and Discussion

    In 1982, Congress enacted Public Law 97-174, (``the Sharing 
Act'') to foster more effective sharing of health care 
resources between the former Veterans Administration, now the 
Department of Veterans Affairs (VA), and the Department of 
Defense (DOD). The law was introduced not only to remove legal 
barriers, but also to provide incentives for military and VA 
health care executives to engage in health resources sharing 
through local agreements, joint ventures, national sharing 
initiatives, and other collaborative efforts pointed to better 
and more efficient use of Federal health care resources.
    The Sharing Act provides virtually unlimited authority to 
both VA and DOD to share health resources across the entire 
spectrum of health care and health related activities. With the 
advent of the Sharing Act, a flurry of VA-DOD sharing activity 
occurred, with hundreds of agreements having been executed 
between military and VA medical centers and clinics. However, 
over the succeeding years, sharing waned because military 
health care shifted from a facilities-based system to a very 
large contract effort through the advent of the TRICARE 
program.
    The Sharing Act gave local health care executives 
flexibility in establishing sharing agreements, including 
conducting negotiations, developing reimbursement methods and 
bartering services, as well as governing review and approval 
processes to minimize bureaucratic delay from Washington. As an 
incentive to share, it provided that a facility furnishing the 
services would be permitted to retain funds earned from such 
sharing. To encourage establishment of sharing as an important 
priority, the Sharing Act required the VA's Chief Medical 
Director (now the Under Secretary for Health) and DOD's 
Assistant Secretary for Health Affairs to recognize health 
resources sharing as an ongoing responsibility. The Sharing Act 
established a VA-DOD committee that was charged with reviewing 
policies and practices relating to sharing, identifying new or 
potential opportunities, and making recommendations to the 
Under Secretary, Assistant Secretary and Congress to promote 
increased sharing. However, the Committee believes that the 
Joint Committee has not achieved its full potential.
    On July 27, 2001, Honorable Christopher H. Smith, Chairman 
of the Veterans' Affairs Committee, introduced H.R. 2667, the 
Department of Defense-Department of Veterans Affairs Health 
Resources Access Improvement Act of 2001. The Committee hoped 
this bill would spur new opportunities for sharing across both 
Departments. H.R. 2667 sought to establish a health care 
facilities sharing demonstration project in keeping with the 
intent of the original legislation for VA-DOD sharing. Under 
the bill, five qualifying sites across the country would be 
selected for participation in a demonstration project. The 
purpose of the demonstration project was to identify and 
measure the advantages of sharing, and work through the 
challenges of the two systems becoming true partners in health 
care delivery. The two Departments' medical information systems 
are incompatible, but this legislation would have created a 
framework for greater technology compatibility. By making such 
systems communicate better, the Departments could better ensure 
continuity of care, equality of access, uniform quality of 
service and seamless transmission of data.
    On March 7, 2002, the Subcommittee on Health and the 
Committee on Armed Services Subcommittee on Military Personnel 
held a joint hearing to examine collaboration and health 
resources sharing by the two Departments, including 
consideration of H.R. 2667. Chairman Smith testified to urge 
both Subcommittees to aggressively increase resource sharing 
between these two massive health care systems. Under Secretary 
Chu of DOD assured the Committees that he and Deputy Secretary 
Mackay share a common vision of quality health care for the men 
and women serving our country, their families, and those that 
have served. According to Secretary Chu, the cooperative 
efforts of DOD and VA are focused on a proactive partnership 
that meets the missions of both agencies while benefiting the 
service member, veteran and taxpayer with new initiatives and 
increased efficiency. Most of the original concepts and 
objectives of H.R. 2667 were incorporated in Subtitle VII of 
Public Law 107-314, the Bob Stump National Defense 
Authorization Act for Fiscal Year 2003.
    H.R. 1911, introduced by Honorable John Boozman, would 
modify section 8111(c) of title 38, United States Code, 
concerning the sharing of Department of Veterans Affairs (VA) 
and Department of Defense (DOD) health care resources. Section 
721 of the Bob Stump National Defense Authorization Act for 
Fiscal Year 2003 amended section 8111(c) to create a DOD-VA 
Health Executive Committee with certain mandates for 
collaborative activities between the Departments. It provides 
for oversight of health care issues by the Under Secretary of 
Defense for Personnel and Readiness and the Deputy Secretary of 
Veterans Affairs. This bill would establish a DOD-VA Joint 
Executive Committee to expand oversight of collaborative 
efforts to include health, benefits, and other areas as 
determined by the co-chairs, and to promote increased resource 
sharing.
    Existing law allows each Department to determine 
individually the number of employees each would designate to 
support the committee, but requires each one to share equally 
in the cost, notwithstanding parity in the numbers. It also 
requires a permanent staff be assigned to the committee. This 
bill would delete these personnel requirements, thereby 
enhancing the flexibility of each Department to use their 
personnel in the most efficient manner possible, while at the 
same time authorizing the establishment of subordinate 
committees and work groups as deemed appropriate by the co-
chairs.
    Existing law specifically authorizes the recommendations of 
the committee for sharing of resources to improve access, 
quality, and cost effectiveness. Under H.R. 1911, the committee 
would also identify changes in policies to improve services, 
efficiencies, and opportunities for collaboration for delivery 
of benefits and services to beneficiaries of both Departments.

                      Section-By-Section Analysis

    Section 1(a)(1) of the bill would establish a Joint 
Executive Committee by amending Chapter 3 of Title 38, United 
States Code.

    Section 320(a)(1) would establish an interagency committee 
to be known as the Department of Veterans Affairs-Department of 
Defense Joint Executive Committee.

    Section 320(a)(2)(A) would require the Committee to be 
composed of the Deputy Secretary of Veterans Affairs, along 
with other officers and employees appointed by the Secretary of 
Veterans Affairs.

    Section 320(a)(2)(B) would require the Committee to also be 
composed of the Under Secretary of Defense for Personnel and 
Readiness, along with other officers and employees appointed by 
the Secretary of Defense.

    Section 320(b)(1) would require the Deputy Secretary of 
Veterans Affairs and the Under Secretary of Defense for 
Personnel and Readiness to determine the administrative and 
procedural guidelines of the Committee, and ensure adequate 
support for its operations.

    Section 320(b)(2) would create a subordinate Health 
Executive Committee, a subordinate Benefits Executive 
Committee, and other committees or working groups considered 
necessary by the Deputy Secretary and Under Secretary.

    Section 320(c)(1) would require the Committee recommend to 
the Secretaries strategic direction for the joint coordination 
and sharing efforts between and within the two Departments and 
to oversee the implementation of those efforts.

    Section 320(c)(2) would require the Committee to submit to 
the two Secretaries and to Congress an annual report containing 
recommendations.

    Section 320(d) would require the Committee to do the 
following in making recommendations in their annual report 
under subsection (c)(2): paragraph (1) would require the 
Committee to review existing policies, procedures, and 
practices relating to the coordination and sharing of resources 
between the two Departments; paragraph (2) would require the 
Committee to identify changes in policies, procedures, and 
practices that would promote mutually beneficial coordination, 
use, or exchange of services and resources of the two 
Departments, with the goal of improving the quality, 
efficiency, and effectiveness of the delivery of benefits and 
services to veterans, service members, military retirees and 
their families; paragraph (3) would require the Committee to 
identify and assess further opportunities for the coordination 
and collaboration between the Departments that would not 
adversely affect the range of services, the quality of care, or 
the established priorities for benefits provided by either 
Department; paragraph (4) would require the Committee to review 
the plans of both Departments for the acquisition of additional 
resources, especially new facilities and major equipment and 
technology, in order to assess the potential effect of such 
plans on further opportunities for the coordination and sharing 
of resources; and paragraph (5) would require the Committee to 
review the implementation of activities designed to promote the 
coordination and sharing of resources between the Departments.

                    Performance Goals and Objectives

    The Department of Veterans Affairs and the Department of 
Defense establish performance goals and objectives in annual 
performance plans that are subject to the Committee's regular 
oversight and evaluation by the U.S. General Accounting Office. 
The Departments also publish performance and accountability 
reports for each fiscal year.

               Congressional Budget Office Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                       Washington, DC, May 13, 2003
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC

    Dear Mr. Chairman: As you requested, the Congressional 
Budget Office has prepared the enclosed cost estimate for H.R. 
1911, a bill to amend title 38, United States Code, to enhance 
cooperation and the sharing of resources between the Department 
of Veterans Affairs and the Department of Defense.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sam 
Panpenfuss, who can be reach at 226-2840.

            Sincerely,
                                       Douglas Holtz-Eakin,
                                                           Director
    Enclosure. 

               Congressional Budget Office Cost Estimate

  H.R.1911, A bill to amend title 38, United States Code, to enhance 
  cooperation and the sharing of resources between the Department of 
             Veterans Affairs and the Department of Defense

                      As introduced on May 1, 2003

    H.R. 1911 would establish a joint executive committee 
composed of the Deputy Secretary of Veterans Affairs, the Under 
Secretary of Defense for Personnel and Readiness, and other 
employees of the Department of Veterans Affairs (VA) and the 
Department of Defense (DOD) that the respective department 
Secretaries may designate. This committee would be charged with 
promoting inter-departmental cooperation that would improve the 
quality of all benefits received by veterans, members of the 
military, military retirees, and their families.
    Under the bill, the committee would review current 
procedures and policies relating to the coordination and 
sharing of resources between the two departments along with 
acquisition plans for new facilities and major equipment. The 
committee would then be charged with identifying opportunities 
for further cooperation that would mutually benefit veterans, 
servicemembers, and retirees and their families in an annual 
report to the Congress.
    The joint executive committee would replace an existing 
committee that, under current law, is only concerned with 
cooperation between VA and DOD regarding the provision of 
health care. Because there would be no substantial change in 
the nature of the committee, CBO estimates that this proposal 
would have a negligible cost, subject to the availability of 
appropriated funds. Enacting the bill would not affect direct 
spending or receipts.
    H.R. 1911 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact is Sam Papenfuss, who can be reached 
at 226-2840. This estimate was approved by Peter H. Fontaine, 
Deputy Assistant Director for Budget Analysis.

                     Statement of Federal Mandates

    The preceding Congressional Budget Office cost estimate 
states that the reported bill contains no intergovernmental or 
private sector mandates as defined in the Unfunded Mandates 
Reform Act.

                  Applicability to Legislative Branch

    The reported bill would not be applicable to the 
legislative branch under the Congressional Accountability Act, 
Public Law 104-1.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *


PART I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


               CHAPTER 3--DEPARTMENT OF VETERANS AFFAIRS

Sec.
301.    Department.
     * * * * * * *
320.    Department of Veterans Affairs-Department of Defense Joint 
          Executive Committee.
     * * * * * * *

Sec. 320. Department of Veterans Affairs-Department of Defense Joint 
                    Executive Committee.

    (a) Joint Executive Committee.--(1) There is established on 
interagency committee to be known as the Department of Veterans 
Affairs-Department of Defense Joint Executive Committee 
(hereinafter in this section referred to as the ``Committee'').
    (2) The Committee is composed of--
          (A) the Deputy Secretary of Veterans Affairs and such 
        other officers and employees of the Department of 
        Veterans Affairs as the Secretary of Veterans Affairs 
        may designate; and
          (B) the Under Secretary of Defense for Personnel and 
        Readiness and such other officers and employees of the 
        Department of Defense as the Secretary of Defense may 
        designate.
    (b) Administrative Matters.--(1) The Deputy Secretary of 
Veterans Affairs and the Under Secretary of Defense shall 
determine the size and structure of the Committee, as well as 
the administrative and procedural guidelines for the operation 
of the Committee.
    (2) The two Departments shall supply appropriate staff and 
resources to provide administrative support and services. 
Support for such purposes shall be provided at a level 
sufficient for the efficient operation of the Committee, 
including a subordinate Health Executive Committee, a 
subordinate Benefits Executive Committee, and such other 
committees or working groups as considered necessary by the 
Deputy Secretary and Under Secretary.
    (c) Recommendations.--(1) The Committee shall recommend to 
the Secretaries strategic direction for the joint coordination 
and sharing efforts between and within the two Departments 
under section 8111 of this title and shall oversee 
implementation of those efforts.
    (2) The Committee shall submit to the two Secretaries and 
to Congress an annual report containing such recommendations as 
the Committee considers appropriate.
    (d) Functions.--In order to enable the Committee to make 
recommendations in its annual report under subsection (c)(2), 
the Committee shall do the following:
          (1) Review existing policies, procedures, and 
        practices relating to the coordination and sharing of 
        resources between the two Departments.
          (2) Identify changes in policies, procedures, and 
        practices that, in the judgment of the Committee, would 
        promote mutually beneficial coordination, use, or 
        exchange of use, of services and resources of the two 
        Departments, with the goal of improving the quality, 
        efficiency and effectiveness of the delivery of 
        benefits and services to veterans, service members, 
        military retirees and their families through an 
        enhanced Department of Veterans Affairs and Department 
        of Defense partnership.
          (3) Identify and assess further opportunities for the 
        coordination and collaboration between the Departments 
        that, in the judgment of the Committee, would not 
        adversely affect the range of services, the quality of 
        care, or the established priorities for benefits 
        provided by either Department.
          (4) Review the plans of both Departments for the 
        acquisition of additional resources, especially new 
        facilities and major equipment and technology, in order 
        to assess the potential effect of such plans on further 
        opportunities for the coordination and sharing of 
        resources.
          (5) Review the implementation of activities designed 
        to promote the coordination and sharing of resources 
        between the Departments.

           *       *       *       *       *       *       *


PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

           *       *       *       *       *       *       *


   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
    FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL 
PROPERTY

           *       *       *       *       *       *       *


Sec. 8111. Sharing of Department of Veterans Affairs and Department of 
                    Defense health-care resources

    (a)  * * *
    (b) Joint Requirements for Secretaries of Veterans Affairs 
and Defense.--To facilitate the mutually beneficial 
coordination, use, or exchange of use of the health care 
resources of the two Departments, the two Secretaries shall 
carry out the following functions:
          (1)  * * *
          (2) Jointly fund the interagency committee provided 
        for under [subsection (c)] section 320 of this title.

           *       *       *       *       *       *       *

    [(c) DOD-VA Health Executive Committee.-(1) There is 
established an interagency committee to be known as the 
Department of Veterans Affairs-Department of Defense Health 
Executive Committee (hereinafter in this section referred to as 
the ``Committee''). The Committee is composed of--
          [[(A) the Deputy Secretary of Veterans Affairs and 
        such other officers and employees of the Department of 
        Veterans Affairs as the Secretary of Veterans Affairs 
        may designate; and
          [(B) the Under Secretary of Defense for Personnel and 
        Readiness and such other officers and employees of the 
        Department of Defense as the Secretary of Defense may 
        designate.
    [(2)(A) During odd-numbered fiscal years, the Deputy 
Secretary of Veterans Affairs shall chair the Committee. During 
even-numbered fiscal years, the Under Secretary of Defense 
shall chair the Committee.
    [(B) The Deputy Secretary and the Under Secretary shall 
determine the size and structure of the Committee, as well as 
the administrative and procedural guidelines for the operation 
of the Committee. The two Departments shall share equally the 
Committee's cost of personnel and administrative support and 
services. Support for such purposes shall be provided at a 
level sufficient for the efficient operation of the Committee, 
including a permanent staff and, as required, other temporary 
working groups of appropriate departmental staff and outside 
experts.
    [(3) The Committee shall recommend to the Secretaries 
strategic direction for the joint coordination and sharing 
efforts between and within the two Departments under this 
section and shall oversee implementation of those efforts.
    [(4) The Committee shall submit to the two Secretaries and 
to Congress an annual report containing such recommendations as 
the Committee considers appropriate.
    [(5) In order to enable the Committee to make 
recommendations in its annual report under paragraph (4), the 
Committee shall do the following:
          [(A) Review existing policies, procedures, and 
        practices relating to the coordination and sharing of 
        health care resources between the two Departments.
          [(B) Identify changes in policies, procedures, and 
        practices that, in the judgment of the Committee, would 
        promote mutually beneficial coordination, use, or 
        exchange of use of the health care resources of the two 
        Departments, with the goal of improving the access to, 
        and quality and cost effectiveness of, the health care 
        provided by the Veterans Health Administration and the 
        Military Health System to the beneficiaries of both 
        Departments.
          [(C) Identify and assess further opportunities for 
        the coordination and sharing of health care resources 
        between the Departments that, in the judgment of the 
        Committee, would not adversely affect the range of 
        services, the quality of care, or the established 
        priorities for care provided by either Department.
          [(D) Review the plans of both Departments for the 
        acquisition of additional health care resources, 
        especially new facilities and major equipment and 
        technology, in order to assess the potential effect of 
        such plans on further opportunities for the 
        coordination and sharing of health care resources.
          [(E) Review the implementation of activities designed 
        to promote the coordination and sharing of health care 
        resources between the Departments.
    [(6) The Committee chairman, under procedures jointly 
developed by the two Secretaries, may require the Inspector 
General of either or both Departments to assist in activities 
under paragraph (5)(E).]
    (d) Joint Incentives Program.--(1) Pursuant to subsection 
(b)(4), the two Secretaries shall carry out a program to 
identify, provide incentives to, implement, fund, and evaluate 
creative coordination and sharing initiatives at the facility, 
intraregional, and nationwide levels. The program shall be 
administered by the [Committee established in subsection (c)] 
Department of Veterans Affairs-Department of Defense Joint 
Executive Committee, under procedures jointly prescribed by the 
two Secretaries.

           *       *       *       *       *       *       *

    (e) Guidelines and Policies for Implementation of 
Coordination and Sharing Recommendations, Contracts, and 
Agreements.--(1) To implement the recommendations made by the 
[Committee under subsection (c)(2)] Department of Veterans 
Affairs-Department of Defense Joint Executive Committee with 
respect to health care resources, as well as to carry out other 
health care contracts and agreements for coordination and 
sharing initiatives as they consider appropriate, the two 
Secretaries shall jointly issue guidelines and policy 
directives. Such guidelines and policies shall provide for 
coordination and sharing that--
          (A)  * * *

           *       *       *       *       *       *       *

    (f) Annual Joint Report.--(1)  * * *
    (2) Each report under this section shall include the 
following:
        (A)  * * *
          [(B) The assessment of further opportunities 
        identified under subparagraph (C) of subsection (c)(5) 
        for the sharing of health-care resources between the 
        two Departments.
          [(C) Any recommendation made under subsection (c)(4) 
        during such fiscal year.]
          (B) The assessment of further opportunities 
        identified by the Department of Veterans Affairs-
        Department of Defense Joint Executive Committee under 
        subsection (d)(3) of section 320 of this title for the 
        sharing of health-care resources between the two 
        Departments.
          (C) Any recommendation made by that committee under 
        subsection (c)(2) of that section during that fiscal 
        year.

           *       *       *       *       *       *       *

    (3) In addition to the matters specified in paragraph (2), 
the two Secretaries shall include in the annual report under 
this subsection an overall status report of the progress of 
health resources sharing between the two Departments as a 
consequence of subtitle C of title VII of the Bob Stump 
National Defense Authorization Act for Fiscal Year 2003 (Public 
Law 107-314) and of other sharing initiatives taken during the 
period covered by the report. Such status report shall indicate 
the status of such sharing and shall include appropriate data 
as well as analyses of that data. The annual report shall 
include the following:
          (A)  * * *

           *       *       *       *       *       *       *

    (4) In addition to the matters specified in paragraphs (2) 
and (3), the two Secretaries shall include in the annual report 
under this subsection for each year through 2008 the following:
          (A) A description of the measures taken, or planned 
        to be taken, to implement the health resources sharing 
        project under section 722 of the Bob Stump National 
        Defense Authorization Act for Fiscal Year 2003 (Public 
        Law 107-314) and any cost savings anticipated, or cost 
        sharing achieved, at facilities participating in the 
        project, including information on improvements in 
        access to care, quality, and timeliness, as well as 
        impediments encountered and legislative recommendations 
        to ameliorate such impediments.
          (B) A description of the use of the waiver authority 
        provided by section 722(d)(1) of the Bob Stump National 
        Defense Authorization Act for Fiscal Year 2003 (Public 
        Law 107-314), including--
                  (i)  * * *

           *       *       *       *       *       *       *

    (5) In addition to the matters specified in paragraphs (2), 
(3), and (4), the two Secretaries shall include in the annual 
report under this subsection for each year through 2009 a 
report on the pilot program for graduate medical education 
under section 725 of the Bob Stump National Defense 
Authorization Act for Fiscal Year 2003 (Public Law 107-314), 
including activities under the program during the preceding 
year and each Secretary's assessment of the efficacy of 
providing education and training under that program.

           *       *       *       *       *       *       *