Exchanging support and medical care with allies

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1. Swapping support instead of buying it

Several provisions of title 10 let the Defense Department share support with allies rather than buy it outright. Two of them trade support, one of them only at equal value. The first, 10 U.S.C. 2350f, covers communications support and related supplies and services (10 U.S.C. 2350f(a)). The second, 10 U.S.C. 2350m, covers surface transportation through a European exchange program (10 U.S.C. 2350m(a)(1)). Both sit alongside the general acquisition and cross-servicing authority, which is covered in what an acquisition and cross-servicing agreement is.

2. Communications support arrangements

Section 2350f describes itself as an alternative way of obtaining communications support and related supplies and services (10 U.S.C. 2350f(a)). The Secretary of Defense, subject to the Secretary of State’s approval, may enter a bilateral arrangement with an allied country or allied international organization. A multilateral arrangement with several allied countries and organizations is also possible. In return for receiving communications support and related supplies and services, the United States agrees to provide an equivalent value of the same in return. An arrangement may run for no more than five years.

An allied country means a NATO member, Australia, New Zealand, Japan or the Republic of Korea, or another country designated by the Secretary of Defense with State concurrence (10 U.S.C. 2350f(d)(1)). An allied international organization means NATO, or any other international organization designated the same way (10 U.S.C. 2350f(d)(2)).

3. Settling imbalances

The statute deals with exchanges that do not balance (10 U.S.C. 2350f(b)(1)). Every arrangement must provide that credits and liabilities from an unequal exchange are settled by direct payment to the party that provided more. The parties may agree when to make settlements. Final settlement must come no later than 30 days after the arrangement’s term ends.

The parties must reconcile accrued credits and liabilities every year (10 U.S.C. 2350f(b)(2)). Any American liability found in a reconciliation is charged to the Defense Department appropriation then available for communications support and related supplies and services. Payments the United States receives are credited to the appropriation that funded the support provided (10 U.S.C. 2350f(b)(3)).

4. The European surface exchange program

Section 2350m lets the Secretary of Defense, with the Secretary of State’s concurrence, authorize Defense Department participation in the Surface Exchange of Services (SEOS) program of the Movement Coordination Centre Europe (10 U.S.C. 2350m(a)(1)). Participation may include two kinds of exchange (10 U.S.C. 2350m(a)(2)). One is the reciprocal exchange or transfer of surface transportation, either reimbursed or by replacement in kind. The other is the exchange of surface transportation services of equal value.

Participation must follow a written arrangement or agreement between the Secretary of Defense, with State concurrence, and the Centre (10 U.S.C. 2350m(b)(1)). The congressional defense committees must be notified of any such arrangement (10 U.S.C. 2350m(b)(2)). If Defense facilities, equipment or funds support the program, the arrangement must spell out any equitable cost-sharing or other funding arrangement (10 U.S.C. 2350m(b)(3)). Credits or liabilities from unequal exchanges must be settled through the program at least once every five years (10 U.S.C. 2350m(b)(4)).

5. Paying for and staffing the program

The Secretary of Defense may pay the Department’s equitable share of the operating expenses of the Centre and the program from operation and maintenance funds (10 U.S.C. 2350m(c)(1)). The Secretary may also assign service members or civilian employees to duty at the Centre, within billets authorized for United States European Command, as needed to meet the Department’s obligations (10 U.S.C. 2350m(c)(2)).

Money received through the program is credited, at the Secretary’s option, to one of two places (10 U.S.C. 2350m(d)). It may go to the appropriation, fund or account used to incur the obligation for which it was received. It may instead go to an appropriate appropriation, fund or account currently available for the purposes of the original spending.

6. Reporting and limits

Within 30 days after the end of each fiscal year in which the authority is in effect, the Secretary must report to the congressional defense committees on the Department’s participation that year (10 U.S.C. 2350m(e)(1)). The report describes the Department’s equitable share of the program’s costs and activities (10 U.S.C. 2350m(e)(2)). It also describes any amounts received, including the country each came from.

One limit concerns sealift. Nothing in the section authorizes the use of foreign sealift in violation of section 2631 of title 10 (10 U.S.C. 2350m(f)). Cargo preference is covered in cargo preference and flag carriers. Other cross-servicing settlement methods are covered in paying for cross-servicing transactions.

7. Moving patients across national lines

A further authority covers patient movement (10 U.S.C. 2350p(a)). Subject to appropriations, the Secretary of Defense, with the Secretary of State’s concurrence, may conclude a memorandum of understanding or other formal agreement with partner governments. Such an agreement may provide for the interchangeable, nonreimbursable use of one country’s patient movement personnel and equipment aboard another country’s aircraft, vessels or vehicles (10 U.S.C. 2350p(a)(1)). It may provide for mutual recognition of national credentials, certifications and licenses of personnel, and of approvals of equipment (10 U.S.C. 2350p(a)(2)). It may also adopt agreed standards for patient movement, including harmonized treatment standards where beneficial and lawful (10 U.S.C. 2350p(a)(3)).

Patient movement means moving wounded, ill, injured or other persons, including contaminated, contagious and potentially exposed patients, to obtain medical, surgical, mental health or dental care (10 U.S.C. 2350p(d)(3)). Partner countries are NATO members, Australia, Japan, New Zealand, the Republic of Korea and any other country designated by the Secretary of Defense with State concurrence (10 U.S.C. 2350p(d)(2)).

Before any agreement, the Secretary of Defense must certify in writing that the partner’s credentials and approvals meet or exceed American standards for similar personnel and equipment (10 U.S.C. 2350p(b)(1)). The Secretary must also certify that they will provide care comparable to, or better than, the Department’s own. The certification goes to the defense and foreign affairs committees within 15 days, and must be reviewed and recertified at least once a year (10 U.S.C. 2350p(b)(2)). If a partner cannot be recertified, the Department’s use of its personnel or equipment is suspended until it can be (10 U.S.C. 2350p(c)).

8. Medical cooperation with four close partners

A provision added in December 2025 lets the Secretary of Defense conclude agreements with the governments of Australia, Canada, New Zealand and the United Kingdom (10 U.S.C. 2350t(a) and 10 U.S.C. 2350t(b)(1)). The purpose is to support military medical cooperation or improve operational medical interoperability. Cooperation may cover information exchange, interoperability including credentialing, education and training, research and trials, medical logistics and patient movement, among other areas (10 U.S.C. 2350t(b)(2)).

Key terms

Equal value exchange	Support provided in return for support of the same value, rather than for cash.
Liquidation	Settlement of the balance left by an unequal exchange.
Annual reconciliation	The yearly matching of credits and liabilities under a communications arrangement.
SEOS program	The Surface Exchange of Services program of the Movement Coordination Centre Europe.
Patient movement	Moving the wounded, ill or injured to obtain care, under shared standards.

Every statement above links to the document behind it. The full source list for this piece is on the sources page.

This page describes public United States government programs for general information. It is not legal, regulatory or procurement advice, and it does not address the facts of any particular case.

How Sentfore supports this

Moving people and equipment across allied networks still needs coordination on the ground. Sentfore works at the delivery end of defense programs in difficult environments, providing secure movement, protective security, facilities and life support. Requirements can be sent through the contact page.