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                                                       Calendar No. 583
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-319

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



 
               PANDEMIC AND ALL-HAZARDS PREPAREDNESS ACT

                                _______
                                

                 August 3, 2006.--Ordered to be printed

                                _______
                                

Mr. Enzi, from the Committee on Health, Education, Labor, and Pensions, 
                        submitted the following

                              R E P O R T

                         [To accompany S. 3678]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 3678) to amend the Public 
Health Service Act with respect to public health security and 
all-hazards preparedness and response, and for other purposes, 
having considered the same, reports favorably thereon with an 
amendment in the nature of a substitute and recommends that the 
bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary of the Bill..................................1
 II. Background and Need for Legislation..............................2
III. Legislative History and Committee Action.........................4
 IV. Cost Estimate....................................................5
  V. Application of Law to the Legislative Branch.....................6
 VI. Regulatory Impact Statement......................................6
VII. Section-by-Section Analysis and Committee Views..................6
VIII.Changes in Existing Law.........................................18


                     I. Purpose and Summary of Bill

    The purpose of S. 3678, the ``Pandemic and All-Hazards 
Preparedness Act'' is to improve the Nation's public health and 
medical preparedness and response capabilities for emergencies, 
whether deliberate, accidental, or natural.
    S. 3678 amends the Public Health Service Act (PHSA) to 
reauthorize Title I of the ``Public Health Security and 
Bioterrorism Preparedness and Response Act of 2002'' for a 
period of 5 years. Specifically, the ``Pandemic and All-Hazards 
Preparedness Act'' does the following:
     Identifies the Secretary of Health and Human 
Services (HHS) as the lead official for all Federal public 
health and medical responses to public health emergencies and 
other incidents covered by the National Response Plan.
     Consolidates Federal public health and medical 
response programs under the re-named Assistant Secretary for 
Preparedness and Response (ASPR), who will lead and coordinate 
HHS preparedness and response activities and advise the 
Secretary of HHS during an emergency. The ASPR will also lead 
the coordination of emergency preparedness and response efforts 
between HHS and other Federal agencies.
     Improves communication and interoperability, and 
enhances coordination between all levels of government.
     Emphasizes that State and local public health 
departments and medical first responders are the infrastructure 
of our Nation's public health security system.
     Promotes public health security preparedness by 
authorizing a nationwide public health situational awareness 
capability to rapidly detect, respond to, and manage public 
health threats.
     Strengthens the State and local public health 
workforce by establishing a demonstration project and grants to 
States, though the National Health Service Corps, for loan 
repayments for individuals who agree to serve in State or local 
health departments in underserved or at-risk areas.
     Enhances the Nation's capacity to handle a major 
medical surge during an emergency by establishing a national 
infrastructure for registering health professional volunteers, 
improving core training, strengthening logistical support, and 
developing a clear organizational framework for health care 
providers.
    The legislation establishes overarching preparedness goals 
for essential Federal, State, and local public health and 
medical capabilities to increase accountability and incentivize 
regional coordination, including:
          (1) Integrating public health and public and private 
        medical capabilities with other first responder 
        systems;
          (2) Developing and maintaining Federal, State, local 
        and tribal essential public health security 
        capabilities;
          (3) Increasing the preparedness and response 
        capabilities, and the surge capacity of hospitals and 
        health care facilities;
          (4) Taking into account the needs of at-risk 
        individuals during a public health emergency;
          (5) Ensuring coordination of Federal, State, local 
        and tribal planning, preparedness and response 
        activities; and
          (6) Maintaining continuity of operations of vital 
        public health and medical services in the event of a 
        public health emergency.

                II. Background and Need for Legislation

    After the terrorist attacks of September 11, 2001 and the 
subsequent anthrax mailings in October, Congress passed the 
``Public Health Security and Bioterrorism Preparedness and 
Response Act of 2002'' (P.L. 107-188) to improve the Nation's 
ability to respond to acts of biological terrorism. However, 
several years later, issued reports indicated the need for 
additional Congressional action.
    In 2005, RAND found that many local public health agencies 
were still unprepared to quickly learn about and respond to 
potentially deadly infectious disease outbreaks (Gaps in Public 
Health Agency Responsiveness to Reports of Suspicious 
Illnesses, August 2005). GAO found that few States have the 
capacity to evaluate, diagnose, and treat 500 or more patients 
in a single incident (Testimony: ``Response Capacity Improving, 
but Much Remains to be Accomplished'', February 2004). The 
Department of Homeland Security also reported that 68 percent 
of States did not feel fully confident that their current 
health disaster plans were adequate enough to manage a 
catastrophic event (DHS Nationwide Plan Review Phase I Report, 
February 2006).
    A prepared and effective public health infrastructure can 
only be built on a robust and well trained public health 
workforce. However, according to the Council on State and 
Territorial Epidemiologists, 48 percent of epidemiologists in 
State and territorial health departments have no academic 
degree in epidemiology (CDC Morbidity and Mortality Weekly 
Report, ``Assessment of Epidemiologic Capacity in State and 
Territorial Health Departments, United States, 2004, May 13, 
2005, 54(18); 457-459). Furthermore, the American Public Health 
Association reported that as much as 45 percent of the State 
government public health workforce is expected to retire in the 
next few years (APHA Issue Brief: Public Health Workforce 
Shortage, December 2004).
    In August 2005, the United States faced one of the worst 
natural disasters in the Nation's history when Hurricanes 
Katrina and Rita devastated much of the Gulf Coast. The local, 
State, and Federal responses to the disaster were uncoordinated 
and inadequate. The White House completed a report on the 
lessons learned from that experience and stated that the 
Department of Health and Human Services ``should lead a unified 
and strengthened public health and medical command for Federal 
disaster response. Public health professionals and emergency 
medical responses should be managed and overseen by HHS, which 
has the greatest health experience and expertise.''
    The Gulf Coast hurricanes coincided with the spread of 
avian influenza, H5N1, overseas. The Wall Street Journal 
reported that 44 percent of Americans felt the United States 
was not prepared to deal with avian flu (Wall Street Journal 
Online/Harris Interactive Healthcare Poll, May 2006). The 
Congressional Budget Office estimate of the number of sick 
individuals who would be hospitalized due to a pandemic 
influenza ranged from 5 to 10 million. However, the United 
States only had approximately 970,000 staffed hospital beds and 
100,000 ventilators, with three-quarters of them in use on any 
given day (A Potential Influenza Pandemic: Possible 
Macroeconomics Effects and Policy Issues, A letter to the 
Honorable William H. Frist, Dec. 8, 2005). The threat of an 
avian flu pandemic and the inadequate response to the 
hurricanes that hit the Gulf Coast were reminders that the 
public health and medical infrastructure plays a critical role 
in national security.
    Through several public hearings and roundtables, the 
committee examined the state of the current public health 
infrastructure and identified gaps that were not addressed in 
current law. The committee found that it was important to 
develop a comprehensive, all-hazards approach to public health 
and medical preparedness, so that the Nation can better respond 
to disasters of all kinds, whether deliberate, accidental or 
natural. The ``Pandemic and All-Hazards Response Act'' builds 
on the lessons learned from the September 11th terrorist 
attacks and Hurricanes Katrina and Rita and improves the 
Nation's public health and medical preparedness and response 
capabilities for health emergencies.

             III. Legislative History and Committee Action

    On March 16, 2006, the committee held a formal hearing on 
the reauthorization of the ``Public Health Security and 
Bioterrorism Preparedness and Response Act of 2002''. The 
Subcommittee on Bioterrorism and Public Health Preparedness 
also held five public hearings and roundtables on public health 
preparedness in the 21st Century (March 28), all-hazards 
medical preparedness and response (April 5), public health 
situational awareness (March 6), and lessons learned from 
Hurricane Katrina during a field hearing held in New Orleans, 
LA (July 16).
    On July 18, 2006, Senators Burr, Kennedy, Enzi, Harkin, 
Gregg, and Frist introduced S. 3678, the ``Pandemic and All-
Hazards Preparedness Act''. On July 19, 2006, the committee 
held an executive session to consider S. 3678. Additional 
cosponsors were added at the executive session, including 
Senators Alexander, Mikulski, Isakson, DeWine, Clinton, Hatch, 
and Roberts. After accepting a substitute amendment offered by 
Senator Burr by unanimous voice vote, the committee approved S. 
3678, as amended, by unanimous voice vote.
    S. 3678 builds upon the implementation of two pieces of 
legislation enacted in recent years--one bill pre-dated the 
terrorist attacks of September 11, 2001; while the other was 
enacted after those attacks.

             THE PUBLIC HEALTH THREATS AND EMERGENCIES ACT

    On November 13, 2000, P.L. 106-505, the ``Public Health 
Improvement Act'' was signed into law. This act was a 
comprehensive package of public health bills that authorized 
funding for a wide range of public health initiatives. Title I 
of this act is known separately as the ``Public Health Threats 
and Emergencies Act''.
    The ``Public Health Threats and Emergencies Act'' amended 
the PHSA to give the Secretary of HHS the authority to 
determine that a public health emergency exists or that a 
disease or disorder presents a public health emergency. This 
legislation allowed the Secretary to take such action as may be 
appropriate to respond to such a public health emergency. The 
act also established a Public Health Emergency Fund to be made 
available to the Secretary of HHS,without fiscal year 
limitations, to carry out appropriate actions if a public health 
emergency is declared.
    P.L. 106-505 also authorized competitive grants to State 
and local governments to identify, detect, monitor, and respond 
to threats to the public health. Grantees could use the funds 
to train public health personnel, develop an electronic network 
by which disease detection and public health information can be 
shared, develop a plan for responding to public health 
emergencies (including significant outbreaks of infectious 
diseases or bioterrorism attacks); and enhance laboratory 
capacity and facilities.
    The act authorized the appropriation of funds for the 
construction of new facilities and renovation of existing 
facilities for the Centers for Disease Control and Prevention 
(CDC), including laboratories, office buildings, and other 
facilities and infrastructure.
    The Secretary of HHS was also directed to establish two 
distinct working groups:
    1. A Working Group on Preparedness for Acts of 
Bioterrorism, in coordination with the Secretary of Defense, to 
address preparedness and readiness for the medical and public 
health effects of a bioterrorist attack.
    2. A Working Group on the Public Health and Medical 
Consequences of Bioterrorism, in coordination with the Director 
of the Federal Emergency Management Agency, the Attorney 
General, and the Secretary of Agriculture to address the public 
health and medical consequences of a bioterrorist attack on the 
civilian population.
    In the wake of the terrorist attacks of September 2001, and 
the anthrax attacks of October 2001, the threat of bioterrorism 
assumed a higher profile in Congress, which led to the passage 
of another law that built on P.L. 106-505.

 THE PUBLIC HEALTH SECURITY AND BIOTERRORISM PREPAREDNESS AND RESPONSE 
                              ACT OF 2002

    On June 12, 2002, P.L. 107-188, the ``Public Health 
Security and Bioterrorism Preparedness and Response Act of 
2002'' was signed into law. This Act reflected new priorities 
in public health preparedness. In some cases, new programs were 
created and funded. In other cases, existing programs were 
expanded, both in scope and in funding.
    Title I of P.L. 107-188, which S. 3678 reauthorizes, 
included several important provisions for building Federal, 
State, and local public health and medical capacity for 
emergencies.
     The act established the new position of Assistant 
Secretary for Public Health Emergency Preparedness at HHS to 
coordinate HHS preparedness activities. This provision also 
authorized the National Disaster Medical System, under the new 
Assistant Secretary to provide for further national capacity 
during public health emergencies. However, NDMS was later 
transferred to the Department of Homeland Security in the 
Homeland Security Act of 2002 (P.L. 107-296).
     A State block grant funding formula was authorized 
to improve State, local, and hospital preparedness for and 
response to bioterrorism and other public health emergencies.
     A system for the advanced registration and 
verification of health professional volunteers was authorized, 
and the establishment of core curriculum materials for public 
health emergencies was required for the education and training 
of health professionals.
     The Strategic National Stockpile, a national 
stockpile of drugs, vaccines and medical devices, was 
established to meet the health needs of the United States in 
times of emergency.
     The Secretary of Veterans Affairs was instructed 
to enhance the readiness of the Department's medical centers 
and research facilities for a chemical or biological attack.

                           IV. Cost Estimate

    Due to time constraints the Congressional Budget Office 
estimate was not included in the report. When received by the 
committee, it will apear in the Congressional Record at a later 
time.

            V. Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1, the Congressional 
Accountability Act (CAA), requires a description of the 
application of this bill to the legislative branch. S. 3678 
would amend the PHSA and reauthorize Title I of P.L. 107-188. 
The committee has determined that there is no impact of this 
bill on the Legislative Branch.

                    VI. Regulatory Impact Statement

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the committee has 
determined that the bill will not have a significant regulatory 
impact.

          VII. Section by Section Analysis and Committee Views


Section 1. Short title

    Pandemic and All-Hazards Preparedness Act.

Section 101. Public health and medical preparedness and response 
        functions of the Secretary of Health and Human Services

    This section amends the PHSA and authorizes the Secretary 
of Health and Human Services to lead all federal public health 
and medical responses to public health emergencies, and 
incidents covered by the National Response Plan developed 
pursuant to the Homeland Security Act of 2002.
    The Secretary of HHS shall establish interagency agreements 
with the Secretaries of Veterans Affairs, Transportation, 
Defense, and Homeland Security in which the Secretary of HHS 
shall assume operational control of emergency public health and 
medical response assets, as necessary, in the event of an 
emergency. These agreements will outline the operational roles 
and relationships of such federal agencies and will pre-
designate assets that can be mobilized in support of HHS in 
response to a catastrophic event. Such agreements may also 
address the coordination of public health preparedness and 
response activities abroad through inclusion of the Secretaries 
of State, Agriculture, and Defense.
    The committee intends for these provisions to clarify the 
roles and responsibilities of Federal officials during 
preparations for and responses to emergencies, whether 
deliberate, accidental, or natural. The lack of a durable 
incident command system, providing clear roles and 
responsibilities, was identified by the White House as a 
problem during the response to Hurricanes Katrina and Rita that 
hit the Gulf Coast in 2005 (Federal Response to Hurricane 
Katrina: Lessons Learned). Lessons learned from the last three 
Top Officials (TOPOFF) exercises also highlighted deficiencies 
in the Federal response to catastrophic deliberate attacks. Of 
principle concern is the ambiguity concerning the Federal 
public health and medical leadership role under the National 
Response Plan. With continued potential threats from an 
influenza pandemic and possible terrorist attacks using 
chemical, biological, radiological or nuclear agents, 
clarifying leadership roles and ensuring unified command and 
control during a public health emergency is vital. The need to 
clarify such roles led the committee to identify the Secretary 
of HHS as the lead Federal official for public health and 
medical preparedness and response, consistent with the National 
Response Plan.

Section 102. Assistant Secretary for Preparedness and Response

    This section re-names the Assistant Secretary for Public 
Health Emergency Preparedness as the Assistant Secretary for 
Preparedness and Response and codifies this position under the 
Secretary of HHS. The President, with the advice and consent of 
the Senate, shall appoint an individual to serve in this 
position.
    Using the approach utilized in the Goldwater-Nicholas 
Department of Defense Reorganization Act of 1986 (P.L. 99-433) 
to restructure the Department of Defense, this section 
consolidates public health and medical authorities, 
responsibilities and resources under the Assistant Secretary 
for Preparedness and Response (ASPR). It is the committee's 
view that aligning these functions under a single individual 
achieves unity of command and control under a clearly 
identified authority. The practical consequence of this 
approach is to consolidate existing Federal preparedness and 
medical response capabilities within HHS under the ASPR, 
including the National Disaster Medical System (NDMS) and its 
Disaster Medical Assistance Teams (DMATs), which are 
transferred from the Department of Homeland Security, the 
Strategic National Stockpile, the Cities Readiness Initiative, 
and the hospital preparedness and public health preparedness 
cooperative agreement programs. The ASPR may also assume other 
duties and authorities as deemed appropriate by the Secretary.
    The committee intends that the Secretary may determine how 
best to administer the hospital preparedness and public health 
preparedness cooperative agreement programs, including by 
maintaining day to day program management at the Centers for 
Disease Control and Prevention and the Health Resources and 
Services Administration, while ensuring that necessary 
oversight, coordination, policy setting, and responsibility is 
maintained by the ASPR. In making any necessary transfers of 
personnel or assets, the Secretary shall ensure an orderly 
transition that minimizes duplication of effort and confusion 
at the state and local levels.
    The Medical Reserve Corps and the Emergency System for 
Advance Registration of Volunteer Health Professionals, which 
are maintained at the state and local levels, shall be 
coordinated by the ASPR and integrated with other Federal 
response capabilities. The ASPR should also promote the use of 
the State Emergency Management Assistance Compact for sharing 
public health and medical mutual aid between states.
    One of the duties of the ASPR is to augment the emergency 
medical services system through medical direction and 
integration. Emergency Medical Services operates at the 
intersection of health care, public health, and public safety 
and is therefore an integral part of the medical and public 
health infrastructure.
    One of the additional duties of the ASPR is to provide 
leadership in international programs, initiatives, and policies 
that deal with public health and medical emergency preparedness 
and response.

Section 103. National health security strategy

    The Committee finds that public health preparedness is an 
integral part of national security. As such, it requires a 
national strategy, continuous assessments and periodic reviews 
to evaluate trends and identify gaps. Therefore, this section 
requires that every 4 years the Secretary of HHS submit to 
Congress a comprehensive national health security strategy. 
Similar to the Quadrennial Defense Review conducted by the 
Department of Defense, this section requires the Secretary of 
HHS to evaluate future challenges to national public health 
security and outline a strategy and plan for public health and 
medical preparedness and response. This strategy should reflect 
an all-hazards approach to public heath emergency preparedness. 
The plan should identify requirements for the capabilities 
necessary to meet the preparedness goals included in this 
section, benchmarks and standards, timelines for accomplishing 
preparedness goals and a process for ensuring continuous 
improvements in preparedness. The strategy should also include 
a plan to collaborate with appropriate foreign governments and 
international public health organizations to enhance public 
health disease situational awareness capabilities.
    The committee recognizes that all catastrophic natural 
disasters and acts of terrorism inflict psychological as well 
as physical harm to its victims. Accordingly, in laying the 
foundation for advancing the goals of public health security 
and medical preparedness, the committee underscores that such 
preparedness must address all aspects of health, including 
mental health. Importantly, the mental health consequences of 
disasters and attacks may be reduced by comprehensive response 
planning that addresses both risk communication and public 
preparedness to mitigate the short and long-term mental health 
impacts from such events. The reported bill anticipates that, 
just as mental health is essential to overall health, mental 
health must be an element of the National Health Security 
Strategy and all aspects of public health and medical 
preparedness and response activities for public health 
emergencies, and must be addressed comprehensively and in a 
fully coordinated manner at the Federal, state and local 
levels.
    As is reflected in the public health security goals, the 
committee recognizes the importance of decontamination of 
medical assets and facilities.
    A critical component of the strategy required in this 
section is creating a robust, trained public health workforce. 
HHS is required to assess the status of and remedies to correct 
near and long-term shortages in the public health workforce. 
Reportedly, 45 percent of the State government public health 
workforce is expected to retire in the next few years. 
Workforce shortages figure prominently in the determination of 
surge capacity. Recent surveys suggest that as many as 46 
percent of local public health workers are unlikely to show up 
for work during an influenza pandemic (BMC Public Health, April 
18, 2006). Current estimates indicate the human case fatality 
rate from H5N1 avian influenza virus is 20 times that of the 
1918 pandemic influenza virus (World Health Organization, June 
2006).
    The committee recognizes that the importance of protecting 
health care workers and health care first responders from 
workplace exposures during a public health emergency is 
inextricably linked to accomplishing the strategy established 
in this section. Health care workers and health care first 
responders are on the frontline in a public health emergency. 
If they are not protected from workplace exposures to hazards, 
they will be unable to care for the rest of the population and 
medical surge capacity will collapse. They are particularly at 
risk in the event of a public health emergency, such as a 
pandemic influenza outbreak. In the SARS outbreak of 2003 that 
occurred in China, other countries in East Asia, and Canada, 
when appropriate protections for workers were not adequate, the 
consequence was a high rate of infection and death among the 
nurses treating SARS patients and the further spread of a 
disease. The committee has identified the development of plans 
as appropriate pre-disaster planning and preparedness 
activities to reduce the risk of workplace exposure during a 
public health emergency and the negative consequences of the 
2003 SARS outbreak.
    The committee recognizes that disasters place children, 
pregnant women, senior citizens and other individuals at risk 
for increased morbidity and mortality. It is not possible to 
entirely specify what constitutes individuals at-risk as it 
depends on the nature of the disaster, the degradation of local 
medical services and infrastructure and other factors including 
language, mobility and other potential disabilities. Children 
represent a special subset of individuals at-risk, however, as 
they comprise several distinct sub-groups such as neonates and 
toddlers that have unique physiological and pharmacological 
considerations. The committee notes and encourages HHS to 
promote appropriate pre-disaster planning and preparedness 
activities at the State and local level to address the medical 
and public health needs of at-risk individuals in local 
communities during a public health emergency.

Section 201. Improving state and local health security

    This section reauthorizes through 2011 HHS cooperative 
agreements for states, political subdivisions or consortium of 
such entities to enhance public health security preparedness. 
New requirements are included that the committee intends will 
ensure fiscal accountability, progress measured through 
evidence-based benchmarks and objective standards as determined 
by the Secretary, and regular exercises. HHS is authorized to 
provide technical assistance to entities to assist in achieving 
preparedness goals. This section also establishes a new state 
matching requirement, beginning in 2009, to ensure a shared 
financial responsibility between Federal and State investments 
in public health preparedness and to ensure maintenance of 
state efforts.
    While allowing states to apply for funding as part of a 
consortium, the committee does not intend this section to 
change any funding formulas or amounts to individual states. 
The committee intends to encourage regionalized funding 
opportunities and inter-state collaboration. A consortium would 
be eligible to receive the same amount of funding as each 
entity would have been eligible to receive on its own, unless 
the Secretary determines that a funding incentive is necessary 
to encourage states to develop regional approaches to 
preparedness that cross state boundaries.
    The funds authorized in this section are primarily intended 
to assist states and localities in developing and sustaining 
the minimum essential public health security capabilities 
identified in section 103. However, this list should be 
interpreted broadly as the committee recognizes that there are 
a broad range of activities that will assist entities in 
achieving these capabilities.
    States and localities are required to participate in 
regular drills and exercises and report back to HHS on the 
strengths and weaknesses identified in such exercises, and 
corrective measures taken to address such material weaknesses. 
HHS should evaluate and disseminate best practices and lessons 
learned through such activities. These best practices and 
lessons learned should undergo peer review and be disseminated 
and shared widely. This best practice effort should be closely 
coordinated and jointly disseminated with the Department of 
Homeland Security's Lessons Learned Information System (LLIS).
    Additionally, the committee supports the research performed 
by the Agency for Healthcare Research and Quality with regard 
to best practices and standards of care during disasters. The 
committee also recommends the Secretary to support public 
health systems research that contributes to the development of 
evidence-based benchmarks and objective standards to measure 
public health preparedness.
    The committee recognizes that no state is prepared unless 
every community in the state is prepared. This section 
therefore requires the Secretary to evaluate the emergency 
preparedness plans and exercises and compliance with benchmarks 
and standards by States and political subdivisions. This 
evaluation should distinguish between preparedness activities 
that have statewide impact and those that necessarily take 
place at the local level and that are in direct coordination 
with local emergency management plans, local first responders, 
and local hospitals, health care providers, schools, 
businesses, and others.
    The committee recognizes that local health departments and 
other emergency medical first responders (regardless of their 
form of governance) will be the first responders to any public 
health emergency that affects the communities they serve. The 
committee requires the Secretary to establish procedures for 
ensuring funding of local entities, to provide assistance in 
instances where local consensus, approval or concurrence with 
entities' spending plans has not been achieved, and to inform 
all parties in advance about such procedures and assistance. 
Thecommittee intends that nothing in this section be 
interpreted to weaken existing HHS/CDC requirements for local 
consensus, approval or concurrence.

Section 202. Using information technology to improve situational 
        awareness in public health emergencies

    This section requires the Secretary of HHS to build on 
existing State and local public health situational awareness 
capabilities to establish a near real-time nationwide public 
health situational awareness capability to enhance early 
detection of, rapid response to, and management of potentially 
catastrophic infectious disease outbreaks and public health 
emergencies.
    It is the committee's view that HHS should establish 
explicit goals and a coherent strategy for achieving adequate 
``situational awareness'' relevant to public health emergencies 
before making additional major investments in related 
information technology systems. The strategy should include 
clear timelines and goals for building these systems at local, 
State, regional and national levels.
    This strategy should adopt a network of systems 
architecture that allows entities such as Federal, State, 
tribal and local agencies, organizations that monitor zoonotic 
diseases, public and private sector health care entities, 
pharmacies, Poison Control Centers, clinical laboratories and 
others to share data and information. Each system will transmit 
a minimal set of key data to a national expert system that will 
compile and analyze the data and disseminate information to 
member systems on a near real-time basis. Data and analyses 
should be available to all participating members, except when 
prohibited by law. This architecture is intended to provide 
flexibility to the member systems and foster greater 
communication between local and State partners and between 
State and Federal agencies. To the extent appropriate and 
feasible, the committee expects the Secretary to work with 
other Departments within the Administration and work with 
foreign governments, international organizations, and private 
sector entities to facilitate the exchange of public health 
data or summaries of such data with the public health reporting 
networks of such governments, organizations, and entities.
    In addition, it is essential that the Nation make it a 
priority to ensure that there are robust and redundant 
communication connections between health care providers--
especially hospitals--and public health departments. These 
connections are essential to situational awareness and informed 
decisionmaking during public health emergencies.
    The nationwide public health situational awareness capacity 
implemented by the Secretary should take into account public 
health data collection and reporting systems maintained by 
foreign governments, international organizations, and the 
private sector, to enhance early detection of public health 
threats abroad. The committee encourages the Secretary to 
continue to work with the World Health Organizations and other 
stakeholders to improve situational awareness of potentially 
catastrophic infectious diseases. This strategy should include 
an emphasis on States bordering Canada and Mexico, and would 
encourage cooperative work that improves and strengthens 
situational awareness capabilities in those areas.
    An eligible entity that receives a grant under this 
subsection (f)(4)(A) is strongly recommended to use the funds 
awarded to purchase and implement the use of the most 
innovative and advanced automated rapid detection diagnostic 
medical laboratory equipment available to analyze real-time 
clinical specimens for pathogens of public health or 
bioterrorism significance.
    Amounts made available to carry out subsection (f)(4)(B) 
should be used to supplement and not supplant other Federal, 
State or local funds provided for such center or professional 
organization.

Section 203. Public health workforce enhancements

    This section builds on an existing demonstration project 
and grants to States through the National Health Service Corps. 
It authorizes a new demonstration project for loan repayments 
to individuals who agree to complete their service obligation 
in a state or local health department that serves a health 
professional shortage area or area at high risk of a public 
health emergency. The Secretary must report to Congress within 
3 years regarding the impact of such demonstration project and 
the feasibility of permanently allowing such placements in the 
National Health Service Corps Loan Repayment Program. The 
committee expects that this report will provide initial useful 
data to be supplemented by additional information on the impact 
of such project. The section also authorizes competitive grants 
to States to fund State loan repayment programs for individuals 
who serve in a State or local health department in a health 
professional shortage area or other area at risk of a public 
health emergency, as determined by the Secretary.
    The demonstration project and any health professionals who 
are selected to participate in such project should be placed so 
as to enhance local public health capabilities but not disrupt 
or limit community access to basic medical care.

Section 204. Vaccine tracking and distribution

    With the United States having experienced multiple 
shortages of seasonal flu vaccine since 2000, the committee 
notes the interest in developing a system to track the 
distribution of vaccine supplies, especially as we face the 
threat of pandemic influenza. It is the goal of this section to 
promote communication so as to help maximize the delivery and 
availability of vaccines to patients, with a particular focus 
on high priority populations.
    This section requires the Secretary to promote 
communication between state and local public health officials 
and such manufacturers, wholesalers and distributors as agree 
to participate regarding the effective distribution of seasonal 
influenza vaccine. The committee intends for this communication 
to be voluntary for manufacturers, distributors and 
wholesalers, and the committee encourages all relevant entities 
to participate in the communication. The language does not 
provide the Secretary with the authority to apply or enforce 
any sanctions or reward for participation on such entities that 
choose not to participate in this communication. The committee 
does intend for this communication to include estimates of high 
priority populations, as determined by the Secretary, in state 
and local jurisdictions in order to inform Federal, state and 
local decision makers during vaccine shortages and supply 
disruptions. It is the sense of the committee that in 
developing such estimates, the Secretary should work in 
conjunction withState and local health departments and 
incorporate existing information available through Federal, State and 
local databases, and surveys to better guide the distribution of 
influenza vaccine.
    The committee recognizes CDC's efforts since 2004 to work 
with State and local public health officials, provider groups, 
manufacturers, distributors and other stakeholders to improve 
seasonal flu vaccine communication and distribution through the 
Flu Vaccine Finder. The committee appreciates these efforts, 
and encourages CDC to continue to work with such entities to 
grow and expand these efforts as necessary. The committee 
encourages State, local and tribal public health officials to 
work through the CDC to obtain information relevant to the 
effective distribution of seasonal flu vaccine.
    While a tracking system is one component of helping to 
develop a stable vaccine market, the committee recognizes that 
another important component is raising awareness of the 
importance of flu vaccines. The committee would like to 
highlight the CDC's efforts in this area, and emphasize that it 
is important for them to carry out such efforts in conjunction 
with State and local health departments, provider groups, mass 
vaccination clinics, health care institutions, and groups 
representing high priority populations.

Section 205. National Science Advisory Board for Biosecurity

    This section authorizes the National Science Advisory Board 
for Biosecurity, at the request of the Secretary, to provide 
advice, guidance or recommendations to relevant Federal 
departments concerning evaluations of biosafety level 4 
laboratory capacity nationwide and a core curriculum for 
workers in such laboratories. The committee recognizes that the 
CDC has a role in training workers for and providing oversight 
of these laboratories and expects the NSABB to collaborate with 
CDC when appropriate.

Section 301. National Disaster Medical System

    This section transfers the National Disaster Medical System 
(NDMS) from the Department of Homeland Security to the 
Department of Health and Human Services. The committee believes 
that the best way to ensure a coordinated public health and 
medical response to emergencies is to have clear lines of 
authority and unity of command. Based on the White House report 
following Hurricane Katrina in 2005, which recommended 
transferring NDMS back to HHS, the committee authorizes such 
transfer effective January 1, 2007.
    The Secretary of HHS, in coordination with the Secretaries 
of Homeland Security, Defense, and Veterans Affairs, shall 
conduct a joint review of NDMS that includes an evaluation of 
the roles and mission of NDMS in the future; the roles and 
responsibilities of the Departments of Homeland Security, 
Defense, and Veterans Affairs in support of NDMS; the 
appropriate organizational structure, size and number of teams, 
and methods for deploying teams; a plan for providing initial 
and ongoing logistical support, including appropriate cache 
inventory and deployment, and communications capabilities; 
Federal capabilities, including Federal facilities and mobile 
medical assets that are capable of being used during a public 
health emergency and pre-designating such capabilities and 
facilities; methods to integrate other medical response assets, 
including assets supported jointly by public and private 
funding, with such System; methods to increase health care 
facility participation and the capacity of the facilities 
involved; requirements to strengthen necessary medical 
evacuation capabilities; and other matters determined 
appropriate by such Secretaries.
    Based on the joint review, the Secretary shall modify the 
policies of the National Disaster Medical System as the 
Secretary deems necessary, including with respect to command 
and coordination of overall operations, team deployments, and 
participating hospitals; enrolling, licensing, and 
credentialing of system participants; training, exercising, and 
continuing education of system participants; methods for 
providing logistical support; medical evacuation; and 
participating hospital requirements, benefits, and methods to 
increase hospital participation.
    As the United States continues to re-evaluate its disaster 
preparedness, the needs of children in both bioterrorism 
attacks and natural disasters need to be addressed at all 
levels. In the wake of Hurricane Katrina, where the Nation was 
faced not only with large numbers of displaced and dehydrated 
children but also with the large scale evacuation of children's 
hospitals, the creation of a more robust pediatric specialty 
team response should be examined. The teams stationed in Boston 
and Atlanta are examples of how high quality pediatric care can 
be taken into the disaster field using Pediatric Specialty 
Teams (PST's). One example of a new program in formation is 
PST-Ohio. This group combines the talents of Ohio's network of 
7 children's hospitals and offers a potential model of PST's 
across the Nation by combining the resources of several 
children's hospitals to form a team so that not one hospital in 
particular has to shoulder the burden of staffing changes 
during deployment, drawing of talent across many specialties, 
and allowing rapid deployment of a regional asset.
    As the National Disaster Medical System is transferred to 
HHS, the committee encourages the development of pediatric 
specialty teams to help augment the current Disaster Medical 
Assistance Team (DMAT) infrastructure.
    Building on the authority given to the Secretary in the 
Project Bioshield Act of 2004, this section also authorizes the 
Secretary to extend the waiver of the Emergency Medical 
Treatment and Active Labor Act in the case of a pandemic 
infectious disease that is declared a public health emergency 
under section 319 of the PHSA, for 60 days or such less time 
upon the termination of the applicable public health emergency 
declaration. The committee strongly supports modifying such 
waiver requirements to permit hospital emergency rooms to 
follow State pandemic plans during an outbreak of pandemic 
influenza, which may include separate triage facilities or 
vaccination sites. This approach will ensure patients receive 
the care they need during a pandemic.
    This section also reauthorizes and expands the scope of the 
National Advisory Committee on Children and Terrorism (NACCT) 
to include at-risk individuals, including pregnant women, 
senior citizens, and other individuals who have special public 
health and medical needs during a public health emergency, as 
determined by the Secretary. The Advisory Committee was 
disbanded in 2003, following the release of recommendations to 
the Secretary. The committee encourages the Secretary to review 
and take into account the findings of the NACCT.
    The intent of this expansion is not to deemphasize the 
issues faced by pediatric populations, but to revitalize our 
efforts in developing an all-hazards response capacity in which 
the public health and medical needs of children are effectively 
addressed. The committee notes that some of this work will 
entail cooperation with other Federal agencies, including the 
Department of Education, and believes that such coordination 
should be a priority for the Assistant Secretary for 
Preparedness and Response.

Section 302. Enhancing medical surge capacity

    This section requires the Secretary of HHS to evaluate 
strategies to improve medical surge capacity, such as 
considering the acquisition and operation of mobile medical 
assets and utilization of Federal facilities, including former 
health care facilities from Federal departments and agencies. 
The committee encourages the Secretary to consider establishing 
memorandum of understanding with other Federal departments and 
agencies to permit such facilities to be used to augment local 
surge capacity in the event of a disaster. This section 
requires the Secretary to consider joint public and private 
sector funding of mobile medical assets that can be utilized by 
the Secretary to respond to public health emergencies.

Section 303. Encouraging health professional volunteers

    This section codifies the existing local volunteer Medical 
Reserve Corps (MRC) and establishes a national infrastructure 
to utilize the deployment of willing health professional 
volunteers during a national public health emergency. This 
section is not intended to federalize state or local MRC teams. 
The section provides the national infrastructure so that 
willing MRC volunteers can be utilized to augment Federal 
medical responses to catastrophic emergencies. When activating 
or deploying MRC volunteers who are managed locally, the 
committee encourages the Secretary and local officials to also 
notify relevant State officials. The committee recommends that 
the Secretary use discretion in deploying members of the MRC 
who are already serving in areas designated as health 
professional shortage areas so as not to exacerbate the health 
professional need in the MRC members' areas of origin.
    The MRC should utilize the Emergency System for Advance 
Registration of Volunteer Health Professionals (ESAR-VHP) to 
verify the credentials of MRC volunteers. In addition, MRC 
volunteers should have completed core training, as determined 
by the Secretary.
    MRC volunteers, if designated by the Secretary as 
intermittent Federal response personnel and deployed during a 
public health emergency, would receive liability and disability 
protections, consistent with the National Disaster Medical 
System. The liability protection for volunteers of the MRC is 
intended to cover actions performed within the scope of their 
employment and will not cover actions taken outside the scope 
of their employment.
    This section also builds on the existing ESAR-VHP by 
requiring the Secretary to link existing state-based 
verification systems into a single interoperable network of 
systems. Such verification network shall be used to quickly 
identify and utilize pre-registered health professional 
volunteers in an emergency. In order to protect the 
confidentiality of such health professional volunteers, the 
Secretary shall establish and require the application of and 
compliance with measures to ensure the effective security of, 
integrity of, and access to the data included in the network.

Section 304. Core education and training

    This section requires the Secretary to refocus and 
consolidate current health professions curricula development 
and training programs funded by the Health Resources and 
Services Administration to establish core public health and 
medical response curricula and training. Such curricula and 
training shall establish minimum levels of expertise 
appropriate to the type of trainee. These courses could be 
tiered to include basic, advanced, and specialized levels of 
training. The training would be designed for those included in 
ESAR-VHP, or participating in MRC and DMAT.
    The Secretary of HHS, in collaboration with the Secretary 
of Defense could convene expert panels to develop these 
curricula that would be aimed at training health care providers 
treating patients, including at risk individuals, who were 
victims of natural disasters or deliberate attacks involving 
chemical, biological, radiological and nuclear and explosive 
agents. In partnership with the Secretary of Veterans Affairs 
and other public and private entities, the Secretary of HHS 
should provide for the dissemination and teaching of these 
materials for health professional volunteers including 
physicians, nurses, pharmacists, emergency medical technicians, 
mental health providers, and allied and support personnel, 
including public health, law enforcement and fire fighters, who 
may provide basic first aid or pre-hospital medical care. Such 
dissemination could be implemented through classroom, field, or 
on line instruction and could emphasize a train-the-trainer 
approach to effectively train large numbers of volunteers. The 
committee recommends that the materials developed under this 
section be comprehensive and implementable. The core content 
included in such materials can be expanded to address 
particular local or regional all-hazards emergency preparedness 
training needs. To maximize the effectiveness of such 
materials, the committee finds that the content should be 
disseminated through training modalities such as distance 
learning and train the trainer approaches.
    The committee affirms the need to ensure that mental health 
preparedness is a component of such training. It is the sense 
of the committee that the training provided through this 
section should improve the care for mental health consequences 
in the event of a public health emergency and ensure that 
health and mental health professionals, and volunteers are able 
to respond effectively to the psychological needs of affected 
individuals, relief personnel and communities. Such response 
may include identifying symptoms of mental health distress and 
referring affected persons, as needed, for mental health care.
    The committee also affirms the need to include a focus on 
protecting health care workers and health care first responders 
from workplace exposures during public health emergencies as a 
component of this training.
    This section also expands the CDC's Epidemic Intelligence 
Service Program by 20 officer positions for individuals who 
agree to practice in underserved areas.
    This section also authorizes the existing Centers for 
Public Health Preparedness program, administered by the CDC. To 
be eligible for funding through this program, accredited 
schools of public health must agree to develop core public 
health curricula and training for use by such schools. Eligible 
schools of public health must also collaborate with a state or 
local health department to ensure that any materials and 
trainings being developed by such school meet the needs of such 
department and are not duplicative of existing materials and 
trainings. The committee finds that the field of public health 
is extremely diverse and individuals graduating from schools of 
public health have varying skills and knowledge. The committee 
intends for the schools of public health that are Centers for 
Public Health Preparedness to develop core preparedness 
curricula and training that reflect the essential public health 
security capabilities identified in section 103.
    This section also authorizes the Secretary of HHS to 
establish a research agenda for public health preparedness and 
response systems in order to document outcomes and establish 
evidence-based public health benchmarks and standards. The 
committee finds that public health systems research is a 
priority because there has been tremendous financial investment 
made to date for public health preparedness with no evidence-
based measures for evaluating progress or preparedness. Over 
time, this research will contribute sufficiently to the 
knowledge base to further develop benchmarks and standards. The 
schools of public health that are Centers for Public Health 
Preparedness shall conduct public health systems research that 
is consistent with the agenda established by the Secretary.
    In developing metrics and evaluating best practices under 
this section, the committee encourages CDC to take into account 
the continued work of the CDC Advanced Practice Centers. CDC 
has funded eight local Advanced Practice Centers at local 
health departments to develop, test and evaluate cutting-edge 
preparedness tools for local health departments. The committee 
encourages the development of best practices by local health 
departments to aid other local health departments in achieving 
critical benchmarks. The committee notes that CDC now requires 
all grantees to measure progress in pandemic influenza 
preparedness by using an innovative computer model for mass 
vaccination clinic operations developed by one such Advanced 
Practice Center. The committee does not intend anything in this 
Act to preclude continued funding of the Advanced Practice 
Centers and encourages their continued collaboration with 
Centers for Public Health Preparedness.

Section 305. Partnerships for state and regional hospital preparedness 
        to improve surge capacity

    This section reauthorizes through 2011 cooperative 
agreements to enhance the capacity of hospitals and other 
health care facilities for responding to emergencies. The 
Secretary shall continue to distribute funds to states and 
political subdivisions through the existing funding formula. In 
order to encourage regional health care partnerships, the 
Secretary may also distribute funds to partnerships of 
hospitals and other health care facilities that partner with a 
State or political subdivision and apply for funds directly 
from HHS. The Secretary may not award a cooperative agreement 
to a partnership unless the application is coordinated with an 
applicable state emergency preparedness plan.
    The Secretary shall give preferences to partnerships that 
include a significant percentage of the hospitals and health 
care facilities within the geographic area served by such 
partnership. The Committee encourages the Secretary to take 
into account partnerships that incorporate emergency medical 
services as well as other health care facilities. Preferences 
shall also be awarded for partnerships that include at least 
one hospital that is a participant in the NDMS, partnerships 
that are located in a geographic area that faces a high degree 
of risk as determined in consultation with the Department of 
Homeland Security, and partnerships that have a significant 
need for funds to achieve the medical preparedness goals 
identified in section 103. In order to ensure a more robust 
NDMS, the committee encourages all hospitals to participate in 
NDMS. The committee believes that it is important to ensure an 
appropriate consideration of risk in making awards under this 
section. Risk is challenging to quantify, but the committee 
suggests that the Secretary of HHS, in consultation with the 
Secretary of the Department of Homeland Security, develops an 
objective formula for risk based on a quantitative assessment. 
This section should not be interpreted as precluding regional 
coordination across international borders with Canada or 
Mexico.
    The funds authorized in this section are intended to 
achieve the medical preparedness goals identified in section 
103. However, this list should be interpreted broadly as the 
committee recognizes that there are a broad range of activities 
that will assist entities in achieving these goals. The 
committee approves of the limitation for state administrative 
expenses included in the recent grant guidance from the Health 
Resources and Services Administration.
    At the Secretary's discretion, the funds authorized in this 
section may be used to fund regional training medical centers 
and to support activities and programs that will provide for a 
coordinated medical response to emergencies. Such centers would 
support dynamic, flexible plans that would enable health care 
providers to respond effectively to the rapidly changing 
situations that occur during a disaster.

Section 306. Enhancing the role of the Department of Veterans Affairs

    This section authorizes the Department of Veterans Affairs 
(VA) to organize, train and equip its personnel and medical 
treatment facilities to support responses to public health 
emergencies consistent with the National Response Plan. It also 
authorizes the VA to provide medical logistical support on a 
reimbursable basis for federal disaster responses to public 
health emergencies. The committee intends for HHS to utilize 
the VA's existing extensive medical procurement system to 
minimize duplication of effort and reduce costs by avoiding the 
creation of a new separate HHS logistics system.

                     VIII. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



[SEC. 319A. NATIONAL NEEDS TO COMBAT THREATS TO PUBLIC HEALTH.

    [(a) Capacities.--
          [(1) In General.--Not later than 1 year after the 
        date of the enactment of this section, the Secretary, 
        and such Administrators, directors, or Commissioners, 
        as may be appropriate, and in collaboration with State 
        and local health officials, shall establish reasonable 
        capacities that are appropriate for national, State, 
        and local public health systems and the personnel or 
        work forces of such systems. Such capacities shall be 
        revised every five years, or more frequently as the 
        Secretary determines to be necessary.
          [(2) Basis.--The capacities established under 
        paragraph (1) shall improve, enhance or expand the 
        capacity of national, State and local public health 
        agencies to detect and respond effectively to 
        significant public health threats, including major 
        outbreaks of infectious disease, pathogens resistant to 
        antimicrobial agents and acts of bioterrorism. Such 
        capacities may include the capacity to--
                  [(A) recognize the clinical signs and 
                epidemiological characteristic of significant 
                outbreaks of infectious disease;
                  [(B) identify disease-causing pathogens 
                rapidly and accurately;
                  [(C) develop and implement plans to provide 
                medical care for persons infected with disease-
                causing agents and to provide preventive care 
                as needed for individuals likely to be exposed 
                to disease-causing agents;
                  [(D) communicate information relevant to 
                significant public health threats rapidly to 
                local, State and national health agencies, and 
                health care providers; or
                  [(E) develop or implement policies to prevent 
                the spread of infectious disease or 
                antimicrobial resistance.
      [(b) Supplement Not Supplant.--Funds appropriated under 
this section shall be used to supplement and not supplant other 
Federal, State, and local public funds provided for activities 
under this section.
    [(c) Technical Assistance.--The Secretary shall provide 
technical assistance to the States to assist such States in 
fulfilling the requirements of this section.
    [(d) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $4,000,000 for 
fiscal year 2001, and such sums as may be necessary for each 
subsequent fiscal year through 2006.]

SEC. 319A. VACCINE TRACKING AND DISTRIBUTION.

    (a) Tracking.--The Secretary, together with relevant 
manufacturers, wholesalers, and distributors as may agree to 
cooperate, may track the initial distribution of federally 
purchased influenza vaccine in an influenza pandemic. Such 
tracking information shall be used to inform Federal, State, 
local, and tribal decision makers during an influenza pandemic.
    (b) Distribution.--The Secretary shall promote 
communication between State, local, and tribal public health 
officials and such manufacturers, wholesalers, and distributors 
as agree to participate, regarding the effective distribution 
of seasonal influenza vaccine. Such communication shall include 
estimates of high priority populations, as determined by the 
Secretary, in State, local, and tribal jurisdictions in order 
to inform Federal, State, local, and tribal decision makers 
during vaccine shortages and supply disruptions.
    (c) Confidentiality.--The information submitted to the 
Secretary or its contractors, if any, under this section or 
under any other section of this Act related to vaccine 
distribution information shall remain confidential in 
accordance with the exception from the public disclosure of 
trade secrets, commercial or financial information, and 
information obtained from an individual that is privileged and 
confidential, as provided for in section 552(b)(4) of title 5, 
United States Code, and subject to the penalties and exceptions 
under sections 1832 and 1833 of title 18, United States Code, 
relating to the protection and theft of trade secrets, and 
subject to privacy protections that are consistent with the 
regulations promulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act of 1996. None of 
such information provided by a manufacturer, wholesaler, or 
distributor shall be disclosed without its consent to another 
manufacturer, wholesaler, or distributor, or shall be used in 
any manner to give a manufacturer, wholesaler, or distributor a 
proprietary advantage.
    (d) Guidelines.--The Secretary, in order to maintain the 
confidentiality of relevant information and ensure that none of 
the information contained in the systems involved may be used 
to provide proprietary advantage within the vaccine market, 
while allowing State, local, and tribal health officials access 
to such information to maximize the delivery and availability 
of vaccines to high priority populations, during times of 
influenza pandemics, vaccine shortages, and supply disruptions, 
in consultation with manufacturers, distributors, wholesalers 
and State, local, and tribal health departments, shall develop 
guidelines for subsections (a) and (b).
    (e) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, such sums for 
each of fiscal years 2007 through 2011.
    (f) Report to Congress.--As part of the National Health 
Security Strategy described in section 2802, the Secretary 
shall provide an update on the implementation of subsections 
(a) through (d).

           *       *       *       *       *       *       *


SEC. 319C-1. [GRANTS TO IMPROVE STATE, LOCAL, AND HOSPITAL PREPAREDNESS 
                    FOR AND RESPONSE TO BIOTERRORISM AND OTHER PUBLIC 
                    HEALTH EMERGENCIES.]  IMPROVING STATE AND LOCAL 
                    PUBLIC HEALTH SECURITY.

    [(a) In General.--To enhance the security of the United 
States with respect to bioterrorism and other public health 
emergencies, the Secretary shall make awards of grants or 
cooperative agreements to eligible entities to enable such 
entities to conduct the activities described in subsection (d).
    [(b) Eligible Entities.--
          [(1) In general.--To be eligible to receive an award 
        under subsection (a), an entity shall--
                  [(A)(i) be a State; and
                          [(ii) prepare and submit to the 
                        Secretary an application at such time, 
                        and in such manner, and containing such 
                        information as the Secretary may 
                        require, including an assurance that 
                        the State--
                                  [(I) has completed an 
                                evaluation under section 
                                319B(a), or an evaluation that 
                                is substantially equivalent to 
                                an evaluation described in such 
                                section (as determined by the 
                                Secretary);
                                  [(II) has prepared, or will 
                                (within 60 days of receiving an 
                                award under this section) 
                                prepare, a Bioterrorism and 
                                Other Public Health Emergency 
                                Preparedness and Response Plan 
                                in accordance with subsection 
                                (c);
                                  [(III) has established a 
                                means by which to obtain public 
                                comment and input on the plan 
                                prepared under subclause (II), 
                                and on the implementation of 
                                such plan, that shall include 
                                an advisory committee or other 
                                similar mechanism for obtaining 
                                comment from the public at 
                                large as well as from other 
                                State and local stakeholders;
                                  [(IV) will use amounts 
                                received under the award in 
                                accordance with the plan 
                                prepared under subclause (II), 
                                including making expenditures 
                                to carry out the strategy 
                                contained in the plan; and
                                  [(V) with respect to the plan 
                                prepared under subclause (II), 
                                will establish reasonable 
                                criteria to evaluate the 
                                effective performance of 
                                entities that receive funds 
                                under the award and include 
                                relevant benchmarks in the 
                                plan; or
                  [(B)(i) be a political subdivision of a State 
                or a consortium of 2 or more such subdivisions; 
                and
                          [(ii) prepare and submit to the 
                        Secretary an application at such time, 
                        and in such manner, and containing such 
                        information as the Secretary may 
                        require.
          [(2) Coordination with statewide plans.--An award 
        under subsection (a) to an eligible entity described in 
        paragraph (1)(B) may not be made unless the application 
        of such entity is in coordination with, and consistent 
        with, applicable Statewide plans described in 
        subsection (d)(1).
    [(c) Bioterrorism and Other Public Health Emergency 
Preparedness and Response Plan.--Not later than 60 days after 
receiving amounts under an award under subsection (a), an 
eligible entity described in subsection (b)(1)(A) shall prepare 
and submit to the Secretary a Bioterrorism and Other Public 
Health Emergency Preparedness and Response Plan. Recognizing 
the assessment of public health needs conducted under section 
319B, such plan shall include a description of activities to be 
carried out by the entity to address the needs identified in 
such assessment (or an equivalent assessment).
    [(d) Use of Funds.--An award under subsection (a) may be 
expended for activities that may include the following and 
similar activities:
          [(1) To develop Statewide plans (including the 
        development of the Bioterrorism and Other Public Health 
        EmergencyPreparedness and Response Plan required under 
subsection (c)), and community-wide plans for responding to 
bioterrorism and other public health emergencies that are coordinated 
with the capacities of applicable national, State, and local health 
agencies and health care providers, including poison control centers.
          [(2) To address deficiencies identified in the 
        assessment conducted under section 319B.
          [(3) To purchase or upgrade equipment (including 
        stationary or mobile communications equipment), 
        supplies, pharmaceuticals or other priority 
        countermeasures to enhance preparedness for and 
        response to bioterrorism or other public health 
        emergencies, consistent with the plan described in 
        subsection (c).
          [(4) To conduct exercises to test the test the 
        capability and timeliness of public health emergency 
        response activities.
          [(5) To develop and implement the trauma care and 
        burn center care components of the State plans for the 
        provision of emergency medical services.
          [(6) To improve training or workforce development to 
        enhance public health laboratories.
          [(7) To train public health and health care personnel 
        to enhance the ability of such personnel--
                  [(A) to detect, provide accurate 
                identification of, and recognize the symptoms 
                and epidemiological characteristics of exposure 
                to a biological agent that may cause a public 
                health emergency; and
                  [(B) to provide treatment to individuals who 
                are exposed to such an agent.
          [(8) To develop, enhance, coordinate, or improve 
        participation in systems by which disease detection and 
        information about biological attacks and other public 
        health emergencies can be rapidly communicated among 
        national, State, and local health agencies, emergency 
        response personnel, and health care providers and 
        facilities to detect and respond to a bioterrorist 
        attack or other public health emergency, including 
        activities to improve information technology and 
        communications equipment available to health care and 
        public health officials for use in responding to a 
        biological threat or attack or other public health 
        emergency.
          [(9) To enhance communication to the public of 
        information on bioterrorism and other public health 
        emergencies, including through the use of 2-1-1 call 
        centers.
          [(10) To address the health security needs of 
        children and other vulnerable populations with respect 
        to bioterrorism and other public health emergencies.
          [(11) To provide training and develop, enhance, 
        coordinate, or improve methods to enhance the safety of 
        workers and workplaces in the event of bioterrorism.
          [(12) To prepare and plan for contamination 
        prevention efforts related to public health that may be 
        implemented in the event of a bioterrorist attack, 
        including training and planning to protect the health 
        and safety of workers conducting the activities 
        described in this paragraph.
          [(13) To prepare a plan for triage and transport 
        management in the event of bioterrorism or other public 
        health emergencies.
          [(14) To enhance the training of health care 
        professionals to recognize and treat the mental health 
        consequences of bioterrorism or other public health 
        emergencies.
          [(15) To enhance the training of health care 
        professionals to assist in providing appropriate health 
        care for large numbers of individuals exposed to a 
        bioweapon.
          [(16) To enhance training and planning to protect the 
        health and safety of personnel, including health care 
        professionals, involved in responding to a biological 
        attack.
          [(17) To improve surveillance, detection, and 
        response activities to prepare for emergency response 
        activities including biological threats or attacks, 
        including training personnel in these and other 
        necessary functions and including early warning and 
        surveillance networks that use advanced information 
        technology to provide early detection of biological 
        threats or attacks.
          [(18) To develop, enhance, and coordinate or improve 
        the ability of existing telemedicine programs to 
        provide health care information and advice as part of 
        the emergency public health response to bioterrorism or 
        other public health emergencies.
    [Nothing in this subsection may be construed as 
establishing new regulatory authority or as modifying any 
existing regulatory authority.
    [(e) Priorities in Use of Grants.--
          [(1) In general.--
                  [(A) Priorities.--Except as provided in 
                subparagraph (B), the Secretary shall, in 
                carrying out the activities described in this 
                section, address the following hazards in the 
                following priority:
                          [(i) Bioterrorism or acute outbreaks 
                        of infectious diseases.
                          [(ii) Other public health threats and 
                        emergencies.
                  [(B) Determination of the secretary.--In the 
                case of the hazard involved, the degree of 
                priority that would apply to the hazard based 
                on the categories specified in clauses (i) and 
                (ii) of subparagraph (A) may be modified by the 
                Secretary if the following conditions are met:
                          [(i) The Secretary determines that 
                        the modification is appropriate on the 
                        basis of the following factors:
                                  [(I) The extent to which 
                                eligible entities are 
                                adequately prepared for 
                                responding to hazards within 
                                the category specified in 
                                clause (i) of subparagraph (A).
                                  [(II) There has been a 
                                significant change in the 
                                assessment of risks to the 
                                public health posed by hazards 
                                within the category specified 
                                in clause (ii) of such 
                                subparagraphs.
                          [(ii) Prior to modifying the 
                        priority, the Secretary notifies the 
                        appropriate committees of the Congress 
                        of the determination of the Secretary 
                        under clause (i) of this subparagraph.
          [(2) Areas of emphasis within categories.--The 
        Secretary shall determine areas of emphasis within the 
        category of hazards specified in clause (i) of 
        paragraph (1)(A), and shall determine areas of emphasis 
        within the category of hazards specified in clause (ii) 
        of such paragraph, based on an assessment of the risk 
        and likely consequences of such hazards and on an 
        evaluation of Federal, State, and local needs, and may 
        also take into account the extent to which receiving an 
        award under subsection (a) will develop capacities that 
        can be sued for public health emergencies of varying 
        types.
    [(f) Certain Activities.--In administering activities under 
section 319C(c)(4) or similar activities, the Secretary shall, 
where appropriate, give priority to activities that include 
State or local government financial commitments, that seek to 
incorporate multiple public health and safety services or 
diagnostic databases into an integrated public health entity, 
and that cover geographic areas lacking advanced diagnostics 
and laboratory capabilities.
    [(g) Coordination With Local Medical Response System.--An 
eligible entity and local Metropolitan medical Response Systems 
shall, to the extent practicable, ensure that activities 
carried out under an award under subsection 9a) are coordinated 
with activities that are carried out by local Metropolitan 
Medical Response Systems.
    [(h) Coordination of Federal Activities.--In making awards 
under subsection (a), the Secretary shall--
          [(1) annually notify the Director of the Federal 
        emergency Management Agency, the Director of the Office 
        of Justice Programs, and the Director of the National 
        Domestic Preparedness Office, as to the amount, 
        activities covered under, and status of such awards; 
        and
          [(2) coordinate such awards with other activities 
        conducted or supported by the Secretary to enhance 
        preparedness for bioterrorism and other public heatlh 
        emergencies.
    [(i) Definition.--For purposes of this section, the term 
``eligible entity'' means an entity that meets the conditions 
described in subparagraph (A) or (B) of subsection (b)(1).]
    (a) In General.--To enhance the security of the United 
States with respect to public health emergencies, the Secretary 
shall award cooperative agreements to eligible entities to 
enable such entities to conduct the activities described in 
subsection (d).
    (b) Eligible Entities.--To be eligible to receive an award 
under subsection (a), an entity shall--
          (1)(A) be a State;
          (B) be a political subdivision determined by the 
        Secretary to be eligible for an award under this 
        section (based on criteria described in subsection 
        (h)(4); or
          (C) be a consortium of entities described in 
        subparagraph (A); and
          (2) prepare and submit to the Secretary an 
        application at such time, and in such manner, and 
        containing such information as the Secretary may 
        require, including--
                  (A) an All-Hazards Public Health Emergency 
                Preparedness and Response Plan which shall 
                include--
                          (i) a description of the activities 
                        such entity will carry out under the 
                        agreement to meet the goals identified 
                        under section 2802;
                          (ii) a pandemic influenza plan 
                        consistent with the requirements of 
                        paragraphs (2) and (5) of subsection 
                        (g);
                          (iii) preparedness and response 
                        strategies and capabilities that take 
                        into account the medical and public 
                        health needs of at-risk individuals in 
                        the event of a public health emergency;
                          (iv) a description of the mechanism 
                        the entity will implement to utilize 
                        the Emergency Management 
AssistanceCompact or other mutual aid agreements for medical and public 
health mutual aid; and
                          (v) a description of how the entity 
                        will include the State Area Agency on 
                        Aging in public health emergency 
                        preparedness;
                  (B) an assurance that the entity will report 
                to the Secretary on an annual basis (or more 
                frequently as determined by the Secretary) on 
                the evidence-based benchmarks and objective 
                standards established by the Secretary to 
                evaluate the preparedness and response 
                capabilities of such entity;
                  (C) an assurance that the entity will 
                conduct, on at least an annual basis, an 
                exercise or drill that meets any criteria 
                established by the Secretary to test the 
                preparedness and response capabilities of such 
                entity, and that the entity will report back to 
                the Secretary within the application of the 
                following year on the strengths and weaknesses 
                identified through such exercise or drill, and 
                corrective actions taken to address material 
                weaknesses;
                  (D) an assurance that the entity will provide 
                to the Secretary the data described under 
                section 319D(d)(3) as determined feasible by 
                the Secretary;
                  (E) an assurance that the entity will conduct 
                activities to inform and educate the hospitals 
                within the jurisdiction of such entity on the 
                role of such hospitals in the plan required 
                under subparagraph (A);
                  (F) an assurance that the entity, with 
                respect to the plan described under 
                subparagraph (A), has developed and will 
                implement an accountability system to ensure 
                that such entity make satisfactory annual 
                improvement and describe such system in the 
                plan under subparagraph (A);
                  (G) a description of the means by which to 
                obtain public comment and input on the plan 
                described in subparagraph (A) and on the 
                implementation of such plan, that shall include 
                an advisory committee or other similar 
                mechanism for obtaining comment from the public 
                and from other State, local, and tribal 
                stakeholders; and
                  (H) as relevant, a description of the process 
                used by the entity to consult with local 
                departments of public health to reach 
                consensus,approval, or concurrence on the 
relative distribution of amounts received under this section.
  (c) Limitation.--Beginning in fiscal year 2009, the Secretary 
may not award a cooperative agreement to a State unless such 
State is a participant in the Emergency System for Advance 
Registration of Volunteer Health Professionals described in 
section 319I.
  (d) Use of Funds.--
          (1) In general.--An award under subsection (a) shall 
        be expended for activities to achieve the preparedness 
        goals described under paragraphs (1), (2), (4), (5), 
        and (6) of section 2802(b).
          (2) Effect of section.--Nothing in this subsection 
        may be construed as establishing new regulatory 
        authority or as modifying any existing regulatory 
        authority.
  (e) Coordination With Local Response Capabilities.--An entity 
shall, to the extent practicable, ensure that activities 
carried out under an award under subsection (a) are coordinated 
with activities of relevant Metropolitan Medical Response 
Systems, local public health departments, the Cities Readiness 
Initiative, and local emergency plans.
  (f) Consultation With Homeland Security.--In making awards 
under subsection (a), the Secretary shall consult with the 
Secretary of Homeland Security to--
          (1) ensure maximum coordination of public health and 
        medical preparedness and response activities with the 
        Metropolitan Medical Response System, and other 
        relevant activities;
          (2) minimize duplicative funding of programs and 
        activities;
          (3) analyze activities, including exercises and 
        drills, conducted under this section to develop 
        recommendations and guidance on best practices for such 
        activities; and
          (4) disseminate such recommendations and guidance, 
        including through expanding existing lessons learned 
        information system to create a single Internet-based 
        point of access for sharing and distributing medical 
        and public health best practices and lessons learned 
        from drills, exercises, disasters, and other 
        emergencies.
  (g) Achievement of Measurable Evidence-Based Benchmarks and 
Objective Standards.--
          (1) In general.--Not later than 180 days after the 
        date of enactment of the Pandemic and All-Hazards 
        Preparedness Act, the Secretary shall develop or where 
        appropriate adopt, and require the application of 
        measurable evidence-based benchmarks and objective 
        standards that measure levels of preparedness with 
        respect to the activities described in this section and 
        with respect to activities described in section 319C-2. 
        In developing such benchmarks and standards, the 
        Secretary shall consult with and seek comments from 
        State, local, and tribal officials and private 
        entities, as appropriate. Where appropriate, the 
        Secretary shall incorporate existing objective 
        standards. Such benchmarks and standards shall, at a 
        minimum, require entities to--
                  (A) demonstrate progress toward achieving the 
                preparedness goals described in section 2802 in 
                a reasonable timeframe determined by the 
                Secretary;
                  (B) annually report grant expenditures to the 
                Secretary (in a form prescribed by the 
                Secretary) who shall ensure that such 
                information is included on the Federal 
                Internet-based point of access developed under 
                subsection (f); and
                  (C) at least annually, test and exercise the 
                public health and medical emergency 
                preparedness and response capabilities of the 
                grantee, based on criteria established by the 
                Secretary.
          (2) Criteria for pandemic influenza plans.--
                  (A) In general.--Not later than 180 days 
                after the date of enactment of the Pandemic and 
                All-Hazards Preparedness Act, the Secretary 
                shall develop and disseminate to the chief 
                executive officer of each State criteria for an 
                effective State plan for responding to pandemic 
                influenza.
                  (B) Rule of construction.--Nothing in this 
                section shall be construed to require the 
                duplication of Federal efforts with respect to 
                the development of criteria or standards, 
                without regard to whether such efforts were 
                carried out prior to or after the date of 
                enactment of this section.
          (3) Technical assistance.--The Secretary shall, as 
        determined appropriate by the Secretary, provide to a 
        State, upon request, technical assistance in meeting 
        the requirements of this section, including the 
        provision of advice by experts in the development of 
        high-quality assessments, the setting of State 
        objectives and assessment methods, the development of 
        measures of satisfactory annual improvement that are 
        valid and reliable, and other relevant areas.
          (4) Notification of failures.--The Secretary shall 
        develop and implement a process to notify entities that 
        are determined by the Secretary to have failed to meet 
        the requirements of paragraph (1) or (2). Such process 
        shall provide such entities with the opportunity to 
        correct such noncompliance. An entity that fails to 
        correct such noncompliance shall be subject to 
        paragraph (5).
          (5) Withholding of amounts from entities that fail to 
        achieve benchmarks or submit influenza plan.--Beginning 
        with fiscal year 2009, and in each succeeding fiscal 
        year, the Secretary shall--
                  (A) withhold from each entity that has failed 
                substantially to meet the benchmarks and 
                performance measures described in paragraph (1) 
                for a previous fiscal year (beginning with 
                fiscal year 2008), pursuant to the process 
                developed under paragraph (4), the amount 
                described in paragraph (6); and
                  (B) withhold from each entity that has failed 
                to submit to the Secretary a plan for 
                responding to pandemic influenza that meets the 
                criteria developed under paragraph (2), the 
                amount described in paragraph (6).
          (6) Amounts described.--
                  (A) In general.--The amounts described in 
                this paragraph are the following amounts that 
                are payable to an entity for activities 
                described in section 319C-1 or 319C-2:
                          (i) For the fiscal year immediately 
                        following a fiscal year in which an 
                        entity experienced a failure described 
                        in subparagraph (A) or (B) of paragraph 
                        (5) by the entity, an amount equal to 
                        10 percent of the amount the entity was 
                        eligible to receive for such fiscal 
                        year.
                          (ii) For the fiscal year immediately 
                        following two consecutive fiscal years 
                        in which an entity experienced such a 
                        failure, an amount equal to 15 percent 
                        of the amount the entity was eligible 
                        to receive for such fiscal year, taking 
                        into account the withholding of funds 
                        for the immediately preceding fiscal 
                        year under clause (i).
                          (iii) For the fiscal year immediately 
                        following three consecutive fiscal 
                        years in which an entity experienced 
                        such a failure, an amount equal to 20 
                        percent of the amount the entity was 
                        eligible to receive for such fiscal 
                        year, taking into account the 
                        withholding of funds for the 
                        immediatelypreceding fiscal years under 
clauses (i) and (ii).
                          (iv) For the fiscal year immediately 
                        following four consecutive fiscal years 
                        in which an entity experienced such a 
                        failure, an amount equal to 25 percent 
                        of the amount the entity was eligible 
                        to receive for such a fiscal year, 
                        taking into account the withholding of 
                        funds for the immediately preceding 
                        fiscal years under clauses (i), (ii), 
                        and (iii).
                  (B) Separate accounting.--Each failure 
                described in subparagraph (A) or (B) of 
                paragraph (5) shall be treated as a separate 
                failure for purposes of calculating amounts 
                withheld under subparagraph (A).
          (7) Reallocation of amounts withheld.--
                  (A) In general.--The Secretary shall make 
                amounts withheld under paragraph (6) available 
                for making awards under section 319C-2 to 
                entities described in subsection (b)(1) of such 
                section.
                  (B) Preference in reallocation.--In making 
                awards under section 319C-2 with amounts 
                described in subparagraph (A), the Secretary 
                shall give preference to eligible entities (as 
                described in section 319C-2(b)(1)) that are 
                located in whole or in part in States from 
                which amounts have been withheld under 
                paragraph (6).
          (8) Waiver or reduce withholding.--The Secretary may 
        waive or reduce the withholding described in paragraph 
        (6), for a single entity or for all entities in a 
        fiscal year, if the Secretary determines that 
        mitigating conditions exist that justify the waiver or 
        reduction.
    [(j)] (h) Funding.--
        [(1) Authorizations of appropriations.--
                  [(A) Fiscal year 2003.--
                          [(i) Authorizations.--For the purpose 
                        of carrying out this section, there is 
                        authorized to be appropriated 
                        $1,600,000,000 for fiscal year 2003, of 
                        which--
                                  [(I) $1,080,000,000 is 
                                authorized to be appropriated 
                                for awards pursuant to 
                                paragraph (3) (subject to the 
                                authority of the Secretary to 
                                make awards pursuant to 
                                paragraphs (4) and (5)); and
                                  [(II) $520,000,000 is 
                                authorized to be appropriated--
                                          [(aa) for awards 
                                        under subsection (a) to 
                                        States, notwithstanding 
                                        the eligibility 
                                        conditions under 
                                        subsection (b), for the 
                                        purpose of enhancing 
                                        the preparedness of 
                                        hospitals (including 
                                        children's hospitals), 
                                        clinics, health 
                                        centers, and primary 
                                        care facilities 
forbioterrorism and other public health emergencies; and
                                          [(bb) for Federal, 
                                        State, and local 
                                        planning and 
                                        administrative 
                                        activities related to 
                                        such purpose.
                          [(ii) Contingent additional 
                        authorization.--If a significant change 
                        in circumstances warrants an increase 
                        in the amount authorized to be 
                        appropriated under clause (i) for 
                        fiscal year 2003, there are authorized 
                        to be appropriated such sums as may be 
                        necessary for such year for carrying 
                        out this section, in addition to the 
                        amount authorized in clause (i).
                  [(B) Other fiscal years.--For the purpose of 
                carrying out this section, there are authorized 
                to be appropriated such sums as may be 
                necessary for each of the fiscal years 2004 
                through 2006.
          [(2) Supplement not supplant.--Amounts appropriated 
        under paragraph (1) shall be used to supplement and not 
        supplant other State and local public funds provided 
        for activities under this section.
          [(3) State bioterrorism and other public health 
        emergency preparedness and response block grant for 
        fiscal year 2003.--
                  [(A) In general.--For fiscal year 2003, the 
                Secretary shall, in an amount determined in 
                accordance with subparagraphs (B) through (D), 
                make an award under subsection (a) to each 
                State, notwithstanding the eligibility 
                conditions described in subsection (b), that 
                submits to the Secretary an application for the 
                award that meets the criteria of the Secretary 
                for the receipt of such an award and that meets 
                other implementation conditions established by 
                the Secretary for such awards. No other awards 
                may be made under subsection (a) for such 
                fiscal year, except as provided in paragraph 
                (1)(A)(i)(II) and paragraphs (4) and (5).]
          (1) Authorization of appropriations.--
                  (A) In general.--For the purpose of carrying 
                out this section, there is authorized to be 
                appropriated $824,000,000 fiscal year 2007 for 
                awards pursuant to paragraph (3) (subject to 
                the authority of the Secretary to make awards 
                pursuant to paragraphs (4) and (5)), and such 
                sums as may be necessary for each of fiscal 
                years 2008 through 2011.
                  (B) Coordination.--There are authorized to be 
                appropriated, $10,000,000 for fiscal year 2007 
                to carry out subsection (f)(3).
                  (C) Requirement for state matching funds.--
                Beginning in fiscal year 2009, in the case of 
                any State or consortium of two or more States, 
                the Secretary may not award a cooperative 
                agreement under this section unless the State 
                or consortium of States agree that, with 
                respect to the amount of the cooperative 
                agreement awarded by the Secretary, the State 
                or consortium of States will make available 
                (directly or through donations from public or 
                private entities) non-Federal contributions in 
                an amount equal to--
                          (i) for the first fiscal year of the 
                        cooperative agreement, not less than 5 
                        percent of such costs ($1 for each $20 
                        of Federal funds provided in the 
                        cooperative agreement); and
                          (ii) for any second fiscal year of 
                        the cooperative agreement, and for any 
                        subsequent fiscal year of such 
                        cooperative agreement, not less than 10 
                        percent of such costs ($1 for each $10 
                        of Federal funds provided in the 
                        cooperative agreement).
                  (D) Determination of amount of non-federal 
                contributions.--As determined by the Secretary, 
                non-Federal contributions required in 
                subparagraph (C) may be provided directly or 
                through donations from public or private 
                entities and may be in cash or in kind, fairly 
                evaluated, including plant, equipment or 
                services. Amounts provided by the Federal 
                government, or services assisted or subsidized 
                to any significant extent by the Federal 
                government, may not be included in determining 
                the amount of such non-Federal contributions.
          (2) Maintaining state funding.--
                  (A) In general.--An entity that receives an 
                award under this section shall maintain 
                expenditures for public health security at a 
                level that is not less than the average level 
                of such expenditures maintained by the entity 
                for the preceding 2 year period.
                  (B) Rule of construction.--Nothing in this 
                section shall be construed to prohibit the use 
                of awards under this section to pay salary and 
                related expenses of public health and other 
                professionals employed by State, local, or 
                tribal public health agencies who are carrying 
                out activitiessupported by such awards 
(regardless of whether the primary assignment of such personnel is to 
carry out such activities).
          (3) Determination of amount.--
                  (A) In general.--The Secretary shall award 
                cooperative agreements under subsection (a) to 
                each State or consortium of 2 or more States 
                that submits to the Secretary an application 
                that meets the criteria of the Secretary for 
                the receipt of such an award and that meets 
                other implementation conditions established by 
                the Secretary for such awards.

           *       *       *       *       *       *       *

          (4) Certain political subdivisions.--
                  (A) In general.--For fiscal year [2003] 2007, 
                the Secretary may, before making awards 
                pursuant to paragraph (3) for such year, 
                reserve from the amount appropriated under 
                paragraph (1)[(A)(i)(I)] for the year an amount 
                determined necessary by the Secretary to make 
                awards under subsection (a) to political 
                subdivisions that have a substantial number of 
                residents, have a substantial local 
                infrastructure for responding to public health 
                emergencies, and face a high degree of risk 
                from bioterrorist attacks or other public 
                health emergencies. Not more than three 
                political subdivisions may receive awards 
                pursuant to this subparagraph.

           *       *       *       *       *       *       *

                  (D) Continuity of funding.--In determining 
                whether to make an award pursuant to 
                subparagraph (A) to a political subdivision, 
                the Secretary may consider, as a factor 
                indicating that the award should be made, that 
                the political subdivision received public 
                health funding from the Secretary for fiscal 
                year [2002] 2006.
          (5) Significant unmet needs; degree of risk.--
                  (A) In general.--For fiscal year [2003] 2007, 
                the Secretary may, before making awards 
                pursuant to paragraph (3) for such year, 
                reserve awards pursuant to paragraph (3) for 
                such year, reserve from the amount appropriated 
                under paragraph (1)[(A)(i)(I)] for the year an 
                amount determined necessary by the Secretary to 
                make awards under subsection (a) to eligible 
                entities that--
                          (i) * * *

           *       *       *       *       *       *       *

          [(6) Funding of local entities.--For fiscal year 
        2003, the Secretary shall in making awards under this 
        section ensure that appropriate portions of such awards 
        are made available to political subdivisions, local 
        departments of public health hospitals (including 
        children's hospitals), clinics, health centers, or 
        primary care facilities, or consortia of such 
        entities.]
          (6) Funding of local entities.--The Secretary shall, 
        in making awards under this section, ensure that with 
        respect to the cooperative agreement awarded, the 
        entity make available appropriate portions of such 
        award to political subdivisions and local departments 
        of public health through a process involving the 
        consensus, approval or concurrence with such local 
        entities.
  (i) Administrative and Fiscal Responsibility.--
          (1) Annual reporting requirements.--Each entity shall 
        prepare and submit to the Secretary annual reports on 
        its activities under this section and section 319C-2. 
        Each such report shall be prepared by, or in 
        consultation with, the health department. In order to 
        properly evaluate and compare the performance of 
        different entities assisted under this section and 
        section 319C-2 and to assure the proper expenditure of 
        funds under this section and section 319C-2, such 
        reports shall be in such standardized form and contain 
        such information as the Secretary determines (after 
        consultation with the States) to be necessary to--
                  (A) secure an accurate description of those 
                activities;
                  (B) secure a complete record of the purposes 
                for which funds were spent, and of the 
                recipients of such funds;
                  (C) describe the extent to which the entity 
                has met the goals and objectives it set forth 
                under this section or section 319C-2; and
                  (D) determine the extent to which funds were 
                expended consistent with the entity's 
                application transmitted under this section or 
                section 319C-2.
          (2) Audits; implementation.--
                  (A) In general.--Each entity receiving funds 
                under this section or section 319C-2 shall, not 
                less often than once every 2 years, audit its 
                expenditures from amounts received under this 
                section or section 319C-2. Such audits shall be 
                conducted by an entity independent of the 
                agency administering a program funded under 
                this section or section 319C-2 in accordance 
                with the Comptroller General's standards for 
                auditing governmental organizations, programs, 
                activities, and functions and generally 
                accepted auditing standards. Within 30 days 
                following the completion of each audit report, 
                the entity shall submit a copy of that audit 
                report to the Secretary.
                  (B) Repayment.--Each entity shall repay to 
                the United States amounts found by the 
                Secretary, after notice and opportunity for a 
                hearing to the entity, not to have been 
                expended in accordance with this section or 
                section 319C-2 and, if such repayment is not 
                made, the Secretary may offset such amounts 
                against the amount of any allotment to which 
                the entity is or may become entitled under this 
                section or section 319C-2 or may otherwise 
                recover such amounts.
                  (C) Withholding of payment.--The Secretary 
                may, after notice and opportunity for a 
                hearing, withhold payment of funds to any 
                entity which is not using its allotment under 
                this section or section 319C-2 in accordance 
                with such section. The Secretary may withhold 
                such funds until the Secretary finds that the 
                reason for the withholding has been removed and 
                there is reasonable assurance that it will not 
                recur.
          (3) Maximum carryover amount.--
                  (A) In general.--For each fiscal year, the 
                Secretary, in consultation with the States and 
                political subdivisions, shall determine the 
                maximum percentage amount of an award under 
                this section that an entity may carryover to 
                the succeeding fiscal year.
                  (B) Amount exceeded.--For each fiscal year, 
                if the percentage amount of an award under this 
                section unexpended by an entity exceeds the 
                maximum percentage permitted by the Secretary 
                under subparagraph (A), the entity shall return 
                to the Secretary the portion of the unexpended 
                amount that exceeds the maximum amount 
                permitted to be carried over by the Secretary.
                  (C) Action by secretary.--The Secretary shall 
                make amounts returned to the Secretary under 
                subparagraph (B) available for awards under 
                section 319C-2(b)(1). In making awards under 
                section 319C-2(b)(1) with amounts collected 
                under this paragraph the Secretary shall give 
                preference to entities that are located in 
                whole or in part in States from which amounts 
                have been returned under subparagraph (B).
                  (D) Waiver.--An entity may apply to the 
                Secretary for a waiver of the maximum 
                percentage amount under subparagraph (A). Such 
                an application for a waiver shall include an 
                explanation why such requirement should not 
                apply to the entity and the steps taken by such 
                entity to ensure that all funds under an award 
                under this section will be expended 
                appropriately.
                  (E) Waive or reduce withholding.--The 
                Secretary may waive the application of 
                subparagraph (B) for a single entity pursuant 
                to subparagraph (D) or for all entities in a 
                fiscal year, if the Secretary determines that 
                mitigating conditions exist that justify the 
                waiver or reduction.

           *       *       *       *       *       *       *


[SEC. 319C-2. PARTNERSHIPS FOR COMMUNITY AND HOSPITAL PREPAREDNESS.

    [(a) Grants.--The Secretary shall make awards of grants or 
cooperative agreements to eligible entities to enable such 
entities to improve community and hospital preparedness for 
bioterrorism and other public health emergencies.
    [(b) Eligibility.--To be eligible for an award under 
subsection (a), an entity shall--
          [(1) be a partnership consisting of--
                  [(A) one or more hospitals (including 
                children's hospitals), clinics, health centers, 
                or primary care facilities; and
                  [(B)(i) one or more political subdivisions of 
                States;
                  [(ii) one or more States; or
                  [(iii) one or more States and one or more 
                political subdivisions of States; and
          [(2) prepare, in consultation with the Chief 
        Executive Officer of the State, District, or territory 
        in which the hospital, clinic, health center, or 
        primary care facility described the paragraph (1)(A) is 
        located, and submit to the Secretary, an application at 
        such time, in such manner, and containing such 
        information as the Secretary may require.
    [(c) Regional Coordination.--In making awards under 
subsection (a), the Secretary shall give preference to eligible 
entities that submit applications that, in the determination of 
the Secretary, will--
          [(1) enhance coordination--
                  [(A) among the entities described in 
                subsection (b)(1)(A); and
                  [(B) between such entities and the entities 
                described in subsection (b)(1)(B); and
          [(2) serve the needs of a defined geographic area.
    [(d) Consistency of Planned Activities.--An entity 
described in subsection (b)(1) shall utilize amounts received 
under an award under subsection (a) in a manner that is 
coordinated and consistent, as determined by the Secretary, 
with an applicable State Bioterrorism and Other Public Health 
Emergency Preparedness and Response Plan.
    [(e) Use of Funds.--An award under subsection (a) may be 
expended for activities that may include the following and 
similar activities--
          [(1) planning and administration for such award;
          [(2) preparing a plan for triage and transport 
        management in the event of bioterrorism or other public 
        health emergencies;
          [(3) enhancing the training of health care 
        professionals to improve the ability of such 
        professionals to recognize the symptoms of exposure to 
        a potential bioweapon, to make appropriate diagnosis, 
        and to provide treatment to those individuals so 
        exposed;
          [(4) enhancing the training of health care 
        professionals to recognize and treat the mental health 
        consequences of bioterrorrism or other public health 
        emergencies;
          [(5) enhancing the training of health care 
        professionals to assist in providing appropriate health 
        care for large numbers of individuals exposed to a 
        bioweapon;
          [(6) enhancing training and planning to protect the 
        health and safety of personnel involved in responding 
        to a biological attack;
          [(7) developing and implementing the trauma care and 
        burn center care components of the State plans for the 
        provision of emergency medical services; or
          [(8) conducting such activities as are described in 
        section 319C-1(d) that are appropriate for hospitals 
        (including children's hospitals), clinics, health 
        centers, or primary care facilities.
    [(f) Limitation on Awards.--A political subdivision of a 
State shall not participate in more than one partnership 
described in subsection (b)(1).
    [(g) Priorities in Use of Grants.--
          [(1) In general.--
                  [(A) Priorities.--Except as provided in 
                subparagraph (B), the Secretary shall, in 
                carrying out the activities described in this 
                section, address the following hazards in the 
                following priority:
                          [(i) Bioterrorism or acute outbreaks 
                        of infectious diseases.
                          [(ii) Other public health threats and 
                        emergencies.
                  [(B) Determination of the secretary.--In the 
                case of the hazard involved, the degree of 
                priority that would apply to the hazard based 
                on the categories specified in clauses (i) and 
                (ii) of subparagraph (A) may be modified by the 
                Secretary if the following conditions are met:
                          [(i) The Secretary determines that 
                        the modification is appropriate on the 
                        basis of the following factors:
                                  [(I) The intent to which 
                                eligible entities are 
                                adequately prepared for 
                                responding to hazards within 
                                the category specified in 
                                clause (i) of subparagraph (A).
                                  [(II) There has been a 
                                significant change in the 
                                assessment of risks to the 
                                public health posed by hazards 
                                within the category specified 
                                in clause (ii) of such 
                                subparagraph.
                          [(ii) Prior to modifying the 
                        priority, the Secretary notifies the 
                        appropriate committees of the Congress 
                        of the determination of the Secretary 
                        under clause (i) of this subparagraph.
          [(2) Areas of emphasis within categories.--The 
        Secretary shall determine areas of emphasis within the 
        category of hazards specified in clause (i) of 
        paragraph (1)(A), and shall determine in clause (ii) of 
        such paragraph, based on an assessment of the risk and 
        likely consequences of such hazards and on an 
        evaluation of Federal, State, and local needs, and may 
        also take into account the extent to which receiving an 
        award under subsection (a) will develop capacities that 
        can be used for public health emergencies of varying 
        types.
    [(h) Coordination With Local Medical Response System.--An 
eligible entity and local Metropolitan Medical Response Systems 
shall, to the extent practicable, ensure that activities 
carried out under an award under subsection (a) are coordinated 
with activities that are carried out by local Metropolitan 
Medical Response Systems.
    [(i) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of fiscal 
years 2004 through 2006.]

SEC. 319C-2. PARTNERSHIPS FOR STATE AND REGIONAL HOSPITAL PREPAREDNESS 
                    TO IMPROVE SURGE CAPACITY.

    (a) In General.--The Secretary shall award competitive 
grants or cooperative agreements to eligible entities to enable 
such entities to improve surge capacity and enhance community 
and hospital preparedness for public health emergencies.
    (b) Eligibility.--To be eligible for an award under 
subsection (a), an entity shall--
          (1)(A) be a partnership consisting of--
                  (i) one or more hospitals, at least one of 
                which shall be a designated trauma center, 
                consistent with section 1213(c);
                  (ii) one or more other local health care 
                facilities, including clinics, health centers, 
                primary care facilities, mental health centers, 
                mobile medical assets, or nursing homes; and
                  (iii)(I) one or more political subdivisions;
                  (II) one or more States; or
                  (III) one or more States and one or more 
                political subdivisions; and
          (B) prepare, in consultation with the Chief Executive 
        Officer and the lead health officials of the State, 
        District, or territory in which the hospital and health 
        care facilities described in subparagraph (A) are 
        located, and submit to the Secretary, an application at 
        such time, in such manner, and containing such 
        information as the Secretary may require; or
          (2)(A) be an entity described in section 319C-
        1(b)(1); and
          (B) submit an application at such time, in such 
        manner, and containing such information as the 
        Secretary may require, including the information or 
        assurances required under section 319C-1(b)(2) and an 
        assurance that the State will retain not more than 25 
        percent of the funds awarded for administrative and 
        other support functions.
    (c) Use of Funds.--An award under subsection (a) shall be 
expended for activities to achieve the preparedness goals 
described under paragraphs (1), (3), (4), (5), and (6) of 
section 2802(b).
    (d) Preferences.--
          (1) Regional coordination.--In making awards under 
        subsection (a), the Secretary shall give preference to 
        eligible entities that submit applications that, in the 
        determination of the Secretary--
                  (A) will enhance coordination--
                          (i) among the entities described in 
                        subsection (b)(1)(A)(i); and
                          (ii) between such entities and the 
                        entities described in subsection 
                        (b)(1)(A)(ii); and
                  (B) include, in the partnership described in 
                subsection (b)(1)(A), a significant percentage 
                of the hospitals and health care facilities 
                within the geographic area served by such 
                partnership.
          (2) Other preferences.--In making awards under 
        subsection (a), the Secretary shall give preference to 
        eligible entities that, in the determination of the 
        Secretary--
                  (A) include one or more hospitals that are 
                participants in the National Disaster Medical 
                System;
                  (B) are located in a geographic area that 
                faces a high degree of risk, as determined by 
                the Secretary in consultation with the 
                Secretary of Homeland Security; or
                  (C) have a significant need for funds to 
                achieve the medical preparedness goals 
                described in section 2802(b)(2).
    (e) Consistency of Planned Activities.--The Secretary may 
not award a cooperative agreement to an eligible entity 
described in subsection (b)(1) unless the application submitted 
by the entity is coordinated and consistent with an applicable 
State All-Hazards Public Health Emergency Preparedness and 
Response Plan and relevant local plans, as determined by the 
Secretary in consultation with relevant State health officials.
    (f) Limitation on Awards.--A political subdivision shall 
not participate in more than one partnership described in 
subsection (b)(1).
    (g) Coordination With Local Response Capabilities.--An 
eligible entity shall, to the extent practicable, ensure that 
activities carried out under an award under subsection (a) are 
coordinated with activities of relevant local Metropolitan 
Medical Response Systems, local Medical Reserve Corps, the 
Cities Readiness Initiative, and local emergency plans.
    (h) Maintenance of State Funding.--
          (1) In general.--An entity that receives an award 
        under this section shall maintain expenditures for 
        health care preparedness at a level that is not less 
        than the average level of such expenditures maintained 
        by the entity for the preceding 2 year period.
          (2) Rule of construction.--Nothing in this section 
        shall be construed to prohibit the use of awards under 
        this section to pay salary and related expenses of 
        public health and other professionals employed by 
        State, local, or tribal agencies who are carrying out 
        activities supported by such awards (regardless of 
        whether the primary assignment of such personnel is to 
        carry out such activities).
    (i) Performance and Accountability.--The requirements of 
section 319C-1(g) and (i) shall apply to entities receiving 
awards under this section (regardless of whether such entities 
are described under subsection (b)(1)(A) or (b)(2)(A)) in the 
same manner as such requirements apply to entities under 
section 319C-1.
    (j) Authorization of Appropriations.--
          (1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated 
        $474,000,000 for fiscal year 2007, and such sums as may 
        be necessary for each of fiscal years 2008 through 
        2011.
          (2) Reservation of amounts for partnerships.--Prior 
        to making awards described in paragraph (3), the 
        Secretary may reserve from the amount appropriated 
        under paragraph (1) for a fiscal year, an amount 
        determined appropriate by the Secretary for making 
        awards to entities described in subsection (b)(1)(A).
          (3) Awards to states and political subdivisions.--
                  (A) In general.--From amounts appropriated 
                for a fiscal year under paragraph (1) and not 
                reserved under paragraph (2), the Secretary 
                shall make awards to entities described in 
                subsection (b)(2)(A) that have completed an 
                application as described in subsection 
                (b)(2)(B).
                  (B) Amount.--The Secretary shall determine 
                the amount of an award to each entity described 
                in subparagraph (A) in the same manner as such 
                amounts are determined under section 319C-1(h).

SEC. 319D. REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.

    (a) Facilities; Capacities.--
          (1) Findings.--Congress finds that the Centers for 
        Disease Control and Prevention has an essential role in 
        defending against and combatting public health threats 
        domestically and abroad and requires secure and modern 
        facilities, and expanded and improve capabilities 
        related to bioterrorism and other public health 
        emergencies, sufficient to enable such Centers to 
        conduct this important mission.

           *       *       *       *       *       *       *

    (c) * * *

           *       *       *       *       *       *       *

    (d) Public Health Situational Awareness.--
          (1) In general.--Not later than 2 years after the 
        date of enactment of the Pandemic and All-Hazards 
        Preparedness Act, the Secretary, in collaboration with 
        State, local, and tribal public health officials, shall 
        establish a near real-time electronic nationwide public 
        health situational awareness capability through an 
        interoperable network of systems to share data and 
        information to enhance early detection of rapid 
        response to, and management of, potentially 
        catastrophic infectious disease outbreaks and other 
        public health emergencies that originate domestically 
        or abroad. Such network shall be built on existing 
        State situational awareness systems or enhanced systems 
        that enable such connectivity.
          (2) Strategic plan.--Not later than 180 days after 
        the date of enactment the Pandemic and All-Hazards 
        Preparedness Act, the Secretary shall submit to the 
        appropriate committees of Congress, a strategic plan 
        that demonstrates the steps the Secretary will 
        undertake to develop, implement, and evaluate the 
        network described in paragraph (1), utilizing the 
        elements described in paragraph (3).
          (3) Elements.--The network described in paragraph (1) 
        shall include data and information transmitted in a 
        standardized format from--
                  (A) State, local, and tribal public health 
                entities, including public health laboratories;
                  (B) Federal health agencies;
                  (C) zoonotic disease monitoring systems;
                  (D) public and private sector health care 
                entities, hospitals, pharmacies, poison control 
                centers or professional organizations in the 
                field of poison control, and clinical 
                laboratories, to the extent practicable and 
                provided that such data are voluntarily 
                provided simultaneously to the Secretary and 
                appropriate State, local, and tribal public 
                health agencies; and
                  (E) such other sources as the Secretary may 
                deem appropriate.
          (4) Rule of construction.--Paragraph (3) shall not be 
        construed as requiring separate reporting of data and 
        information from each source listed.
          (5) Required activities.--In establishing and 
        operating the network described in paragraph (1), the 
        Secretary shall--
                  (A) utilize applicable interoperability 
                standards as determined by the Secretary 
                through a joint public and private sector 
                process;
                  (B) define minimal data elements for such 
                network;
                  (C) in collaboration with State, local, and 
                tribal public health officials, integrate and 
                build upon existing State, local, and tribal 
                capabilities, ensuring simultaneous sharing of 
                data, information, and analyses from the 
                network described in paragraph (1) with State, 
                local, and tribal public health agencies; and
                  (D) in collaboration with State, local, and 
                tribal public health officials, develop 
                procedures and standards for the collection, 
                analysis, and interpretation of data that 
                States, regions, or other entities collect and 
                report to the network described in paragraph 
                (1).
    (e) State and Regional Systems To Enhance Situational 
Awareness in Public Health Emergencies.--
          (1) In general.--To implement the network described 
        in section (d), the Secretary may award grants to 
        States to enhance the ability of such States to 
        establish or operate a coordinated public health 
        situational awareness system for regional or Statewide 
        early detection of, rapid response to, and management 
        of potentially catastrophic infectious disease 
        outbreaks and public health emergencies, in 
        collaboration with public health agencies, sentinel 
        hospitals, clinical laboratories, pharmacies, poison 
        control centers, other health care organizations, and 
        animal health organizations within such States.
          (2) Eligibility.--To be eligible to receive a grant 
        under paragraph (1), the State shall submit to the 
        Secretary an application at such time, in such manner, 
        and containing such information as the Secretary may 
        require, including an assurance that the State will 
        submit to the Secretary--
                  (A) reports of such data, information, and 
                metrics as the Secretary may require;
                  (B) a report on the effectiveness of the 
                systems funded under the grant; and
                  (C) a description of the manner in which 
                grant funds will be used to enhance the 
                timelines and comprehensiveness of efforts to 
                detect, respond to, and manage potentially 
                catastrophic infectious disease outbreaks and 
                public health emergencies.
          (3) Use of funds.--A State that receives an award 
        under this subsection--
                  (A) shall establish, enhance, or operate a 
                coordinated public health situational awareness 
                system for regional or Statewide early 
                detection of, rapid response to, and management 
                of potentially catastrophic infectious disease 
                outbreaks and public health emergencies; and
                  (B) may award grants or contracts to entities 
                described in paragraph (1) within or serving 
                such State to assist such entities in improving 
                the operation of information technology 
                systems, facilitating the secure exchange of 
                data and information, and training personnel to 
                enhance the operation of the system described 
                in paragraph (A).
          (4) Limitation.--Information technology systems 
        acquired or implemented using grants awarded under this 
        section must be compliant with--
                  (A) interoperability and other technological 
                standards, as determined by the Secretary; and
                  (B) data collection and reporting 
                requirements for the network described in 
                subsection (d).
          (5) Independent evaluation.--Not later than 4 years 
        after the date of enactment of the Pandemic and All-
        Hazards Preparedness Act, the Government Accountability 
        Office shall conduct an independent evaluation, and 
        submit to the Secretary and the appropriate committees 
        of Congress a report, concerning the activities 
        conducted under this subsection and subsection (d).
  (f) Grants for Real-Time Surveillance Improvement.--
          (1) In general.--The Secretary may award grants to 
        eligible entities to carry out projects described under 
        paragraph (4).
          (2) Eligible entity.--For purposes of this section, 
        the term ``eligible entity'' means an entity that is--
                  (A)(i) a hospital, clinical laboratory, 
                university; or
                  (ii) poison control center or professional 
                organization in the field of poison control; 
                and
                  (B) a participant in the network established 
                under subsection (d).
          (3) Application.--Each eligible entity desiring a 
        grant under this section shall submit to the Secretary 
        an application at such time, in such manner, and 
        containing such information as the Secretary may 
        require.
          (4) Use of funds.--
                  (A) In general.--An eligible entity described 
                in paragraph (2)(A)(i) that receives a grant 
                under this section shall use the funds awarded 
                pursuant to such grant to carry out a pilot 
                demonstration project to purchase and implement 
                the use of advanced diagnostic medical 
                equipment to analyze real-time clinical 
                specimens for pathogens of public health or 
                bioterrorism significance and report any 
                results from such project to State, local, and 
                tribal public health entities and the network 
                established under subsection (d).
                  (B) Other entities.--An eligible entity 
                described in paragraph (2)(A)(ii) that receives 
                a grant under this section shall use the funds 
                awarded pursuant to such grant to--
                          (i) improve the early detection, 
                        surveillance, and investigative 
                        capabilities of poison control centers 
                        for chemical, biological, radiological, 
                        and nuclear events by training poison 
                        information personnel to improve the 
                        accuracy of surveillance data, 
                        improving the definitions used by the 
                        poison control centers for 
                        surveillance, and enhancing timely and 
                        efficient investigation of data 
                        anomalies;
                          (ii) improve the capabilities of 
                        poison control centers to provide 
                        information to health care providers 
                        and the public with regard to chemical, 
                        biological, radiological, or nuclear 
                        threats or exposures, in consultation 
                        with the appropriate State, local, and 
                        tribal public health entities; or
                          (iii) provide surge capacity in the 
                        event of a chemical, biological, 
                        radiological, or nuclear event through 
                        the establishment of alternative poison 
                        control center worksites and the 
                        training of nontraditional personnel.
  (g) Authorization of Appropriations.--
          (1) Fiscal year 2007.--There are authorized to be 
        appropriated to carry out subsections (d), (e), and (f) 
        $102,000,000 for fiscal year 2007, of which $35,000,000 
        is authorized to be appropriated to carry out 
        subsection (f).
          (2) Subsequent fiscal years.--There are authorized to 
        be appropriated such sums as may be necessary to carry 
        out subsections (d), (e), and (f) for each of fiscal 
        years 2008 through 2011.

           *       *       *       *       *       *       *


SEC. 319F. PUBLIC HEALTH COUNTERMEASUERS TO A BIO-TERRORIST ATTACK.

    [(a) Working Group on Bioterrorism and Other Public Health 
Emergencies.--
          [(1) In general.--The Secretary, in coordination with 
        the Secretary of Agriculture, the Attorney General, the 
        Director of Central Intelligence, the Secretary of 
        Defense, the Secretary of Energy, the Administrator of 
        the Environmental Protection Agency, the Director of 
        the Federal Emergency Management Agency, the Secretary 
        of Homeland Security, the Secretary of Labor, the 
        Secretary of Veterans Affairs, and with other similar 
        Federal officials as determined appropriate, shall 
        establish a working group on the prevention, 
        preparedness, and response to bioterrorism and other 
        public health emergencies. Such joint working group, or 
        subcommittees thereof, shall meet periodically for the 
        purpose of consultation on, assisting in, and making 
        recommendations on--
                  [(A) responding to a bioterrorist attack, 
                including the provision of appropriate safety 
                and health training and protective measures for 
                medical, emergency service, and other personnel 
                responding to such attacks;
                  [(B) prioritizing countermeasures required to 
                treat, prevent, or identify exposure to a 
                biological agent or toxin pursuant to section 
                351A;
                  [(C) facilitation of the awarding of grants, 
                contacts, or cooperative agreements for the 
                development, manufacture, distribution, supply-
                chain management, and purchase of priority 
                countermeasures;
                  [(D) research on pathogens likely to be used 
                in a biological threat on the civilian 
                population;
                  [(E) development of shared standards for 
                equipment to detect and to protect against 
                biological agents and toxins;
                  [(F) assessment of the priorities for and 
                enhancement of the preparedness of public 
                health institutions, providers of medical care, 
                and other emergency service personnel 
                (including firefighters) to detect, diagnose, 
                and respond (including mental health response) 
                to a biological threat or attack;
                  [(G) in the recognition that medical and 
                public health professionals are likely to 
                provide much of the first response to such an 
                attack, development and enhancement of the 
                quality of joint planning and training programs 
                that address the public health and medical 
                consequences of a biological threat or attack 
                on the civilian population between--
                          [(i) local firefighters, ambulance 
                        personnel, police and public security 
                        officers, or other emergency response 
                        personnel (including private response 
                        contractors); and
                          [(ii) hospitals, primary care 
                        facilities, and public health agencies;
                  [(H) development of strategies for Federal, 
                State, and local agencies to communicate 
                information to the public regarding biological 
                threats or attacks;
                  [(I) ensuring that the activities under this 
                subsection address the health security needs of 
                children and other vulnerable populations;
                  [(J) strategies for decontaminating 
                facilities contaminated as a result of a 
                biological attack, including appropriate 
                protections for the safety of workers 
                conducting such activities;
                  [(K) subject to compliance with other 
                provisions of Federal law, clarifying the 
                responsibilities among Federal officials for 
                the investigation of suspicious outbreaks of 
                disease and other potential public health 
                emergencies, and for related revisions of the 
                interagency plan known as the Federal response 
                plan; and
                  [(L) in consultation with the National 
                Highway Traffic Safety Administration and the 
                U.S. Fire Administration, ways to enhance 
                coordination among Federal agencies involved 
                with State, local and community based emergency 
                medical services, including issuing a report 
                that--
                          [(i) identifies needs of community-
                        based emergency medical services; and
                          [(ii) identifies ways to streamline 
                        and enhance the process through which 
                        Federal agencies support community-
                        based emergency medical services.
          [(2) Consultation with experts.--In carrying out 
        subparagraphs (B) and (C) of paragraph (1), the working 
        group under such paragraph shall consult with the 
        pharmaceutical, biotechnology, and medical device 
        industries, and other appropriate experts.
          [(3) Use of subcommittees regarding consultation 
        requirements.--With respect to a requirement under law 
        that the working group under paragraph (1) be consulted 
        on a matter, the working group may designate an 
        appropriate subcommittee of the working group to engage 
        in the consultation.
          [(4) Discretion in exercise of duties.--
        Determinations made by the working group under 
        paragraph (1) with respect to carrying out duties under 
        such paragraph are matters committed to agency 
        discretion for purposes of section 701(a) of title 5, 
        United States Code.
          [(5) Rule of construction.--This subsection may not 
        be construed as establishing new regulatory authority 
        for any of the officials specified in paragraph (1), or 
        as having any legal effect on any other provision of 
        law, including the responsibilities and authorities of 
        the Environmental Protection Agency.]
  (a) All-Hazards Public Health and Medical Response Curricula 
and Training.--
          (1) In general.--The Secretary, in collaboration with 
        the Secretary of Defense, and in consultation with 
        relevant public and private entities, shall develop 
        core health and medical response curricula and 
        trainings by adapting applicable existing curricula and 
        training programs to improve responses to public health 
        emergencies.
          (2) Curriculum.--The public health and medical 
        response training program may include course work 
        related to--
                  (A) medical management of casualties, taking 
                into account the needs of at-risk individuals;
                  (B) public health aspects of public health 
                emergencies;
                  (C) mental health aspects of public health 
                emergencies;
                  (D) national incident management, including 
                coordination among Federal, State, local, 
                tribal, international agencies, and other 
                entities; and
                  (E) protecting health care workers and health 
                care first responders from workplace exposures 
                during a public health emergency.
          (3) Peer review.--On a periodic basis, products 
        prepared as part of the program shall be rigorously 
        tested and peer-reviewed by experts in the relevant 
        fields.
          (4) Credit.--The Secretary and the Secretary of 
        Defense shall--
                  (A) take into account continuing professional 
                education requirements of public health and 
                healthcare professions; and
                  (B) cooperate with State, local, and tribal 
                accrediting agencies and with professional 
                associations in arranging for students enrolled 
                in the program to obtain continuing 
                professional education credit for program 
                courses.
          (5) Dissemination and training.--
                  (A) In general.--The Secretary may provide 
                for the dissemination and teaching of the 
                materials described in paragraphs (1) and (2) 
                by appropriate means, as determined by the 
                Secretary.
                  (B) Certain entities.--The education and 
                training activities described in subparagraph 
                (A) may be carried out by Federal public health 
                or medical entities, appropriate educational 
                entities, professional organizations and 
                societies, private accrediting organizations, 
                and other nonprofit institutions or entities 
                meeting criteria established by the Secretary.
                  (C) Grants and contracts.--In carrying out 
                this subsection, the Secretary may carry out 
                activities directly or through the award of 
                grants and contracts, and may enter into 
                interagency agreements with other Federal 
                agencies.
    (b) Advice to the Federal Government.--
          (1) Required advisory committees.--* * *
          (2) National advisory committee on [children and 
        terrorism] At-risk individuals and public health 
        emergencies.--
                  (A) In general.--For purposes of paragraph 
                (1), the Secretary shall establish an advisory 
                committee to be known as the National Advisory 
                Committee on [Children and Terrorism] At-Risk 
                Individuals and Public Health Emergencies 
                (referred to in this paragraph as the 
                ``Advisory Committee'').
                  (B) Duties.--The Advisory Committee shall 
                provide recommendations regarding--
                          (i) the preparedness of the health 
                        care (including mental health care) 
                        system to respond to [bioterrorism as 
                        it relates to children] public health 
                        emergencies as they relate to at-risk 
                        individuals;
                          (ii) needed changes to the health 
                        care and emergency medical service 
                        systems and emergency medical services 
                        protocols to meet the special needs of 
                        [children] at-risk individuals; and
                          (iii) changes, if necessary, to the 
                        national stockpile under section 121 of 
                        the Public Health Security and 
                        Bioterrorism Preparedness and Response 
                        Act of 2002 to meet the emergency 
                        health security of [children] at-risk 
                        individuals.
                  (C) Composition.--The Advisory Committee 
                shall be composed of such Federal officials as 
                may be appropriate to address the special needs 
                of the diverse population groups of [children, 
                and child health experts on infectious disease, 
                environmental health, toxicology, and other 
                relevant professional disciplines] at-risk 
                populations.
                  (D) Termination.--The Advisory Committee 
                terminates [one year] six years after the date 
                of the enactment of the Public Health Security 
                and Bioterrorism Preparedness and Response Act 
                of 2002.

           *       *       *       *       *       *       *

          (3) Emergency public information and communications 
        advisory committee.--
                  (A) In general.--* * *

           *       *       *       *       *       *       *

                  (B) Duties.--The EPIC Advisory Committee 
                shall make recommendations to the Secretary 
                [and the working group under subsection (a)] 
                and report on appropriate ways to communicate 
                public health information regarding 
                bioterrorism and other public health 
                emergencies to the public.

           *       *       *       *       *       *       *

    [(c) Strategy for Communication of Information Regarding 
Bioterrorism and Other Public Health Emergencies.--In 
coordination with working group under subsection (a), the 
Secretary shall develop a strategy for effectively 
communicating information regarding bioterrorism and other 
public health emergencies, and shall develop means by which to 
communicate such information. The Secetary may carry out the 
preceding sentence directly or through grants, contracts, or 
cooperative agreements.
    [(d) Recommendation of Congress Regarding Official Federal 
Internet Site on Bioterrorism.--It is the recommendation of 
Congress that there should be established an official Federal 
Internet site on bioterrorism, either directly or through 
provision of a grant to an entity that has expertise in 
bioterrorism and the development of websites, that should 
include information relevant to diverse populations (including 
messages directed at the general public and such relevant 
groups as medical personnel, public safety workers, and 
agricultural workers) and links to appropriate State and local 
government sites.
    [(e) Grants.--
          [(1) In general.--The Secretary, in coordination with 
        the working group established under subsection (b) \1\, 
        shall, on a competitive basis and following scientific 
        or technical review, award grants to or enter into 
        cooperative agreements with eligible entities to enable 
        such entities to increase their capacity to detect, 
        diagnose, and respond to acts of bioterrorism upon the 
        civilian population.
          [(2) Eligibility.--To be an eligible entity under 
        this subsection, such entity must be a State, political 
        subdivision of a State, a consortium of two or more 
        States or political subdivisions of States, or a 
        hospital, clinic, or primary care facility \2\.
          [(3) Use of funds.--An entity that receives a grant 
        under this subsection shall use such funds for 
        activities that are consistent with the prorities 
        identified by the working group under subsection (b) 
        \3\, including--
                  [(A) training health care professionals and 
                public health personnel to enhance the ability 
                of such personnel to recognize the symptoms and 
                epidemiological characteristics of exposure to 
                a potential bioweapon;
                  [(B) addressing rapid and accurate 
                identification of potential bioweapons;
                  [(C) coordinating medical care for 
                individuals exposed to bioweapons; and
                  [(D) facilitating and coordinating rapid 
                communication of data generated from a 
                bioterrorist attack between national, State, 
                and local health agencies, and health care 
                providers.
          [(4) Coordination.--The Secretary, in awarding grants 
        under this subsection, shall--
                  [(A) notify the Director of the Office of 
                Justice Programs, and the Director of the 
                National Domestic Preparedness Office annually 
                as to the amount and status of grants awarded 
                under this subsection; and
                  [(B) coordinate grants awarded under this 
                subsection with grants awarded by the Office of 
                Emergency Preparedness and the Centers for 
                Disease Control and Prevention for the purpose 
                of improving the capacity of health care 
                providers and public health agencies to respond 
                to bioterrorist attacks on the civilian 
                population.
          [(5) Activities.--An entity that receives a grant 
        under this subsection shall, to the greatest extent 
        practicable, coordinate activities carried out with 
        such funds with the activities of a local Metropolitan 
        Medical Response System.
    [(f) Federal Assistance.--The Secretary shall ensure that 
the Department of Health and Human Services is able to provide 
such assistance as may be needed to State and local health 
agencies to enable such agencies to respond effectively to 
bioterrorist attacks.
    [(g) Education; Training Regarding Pediatric Issues.--
          [(1) Materials; core curriculum.--The Secretary, in 
        collaboration with members of the working group 
        described in subsection (b) \1\, and professional 
        organizations and societies, shall--
                  [(A) develop materials for teaching the 
                elements of a core curriculum for the 
                recognition and identification of potential 
                bioweapons and other agents that may create a 
                public health emergency, and for the care of 
                victims of such emergencies, recognizing the 
                special needs of children and other vulnerable 
                populations, to public health officials, 
                medical professionals, emergency physicians and 
                other emergency department staff, laboratory 
                personnel, and other personnel working in 
                health care facilities (including poison 
                control centers);
                  [(B) develop a core curriculum and materials 
                for community-wide planning by State and local 
                governments, hospitals and other health care 
                facilities, emergency response units, and 
                appropriate public and private sector entities 
                to respond to a bioterrorist attack or other 
                public health emergency; and
                  [(C) develop materials for proficiency 
                testing of laboratory and other public health 
                personnel for the recognition and 
                identification of potential bioweapons and 
                other agents that may create a public health 
                emergency; and
                  [(D) provide for dissemination and teaching 
                of the materials described in subparagraphs (A) 
                through (C) by appropriate means, which may 
                include telemedicine, long-distance learning, 
                or other such means.
          [(2) Certain entities.--The entities through which 
        education and training activities described in 
        paragraph (1) may be carried out include Public Health 
        Preparedness Centers, the Public Health Service's Noble 
        Training Center, the Emerging Infections Program, the 
        Epidemic Intelligence Service, the Public Health 
        Leadership Institute, multi-State, multi-institutional 
        consortia, other appropriate educational entities, 
        professional organizations and societies, private 
        accrediting organizations, and other nonprofit 
        institutions or entities meeting criteria established 
        by the Secretary.
          [(3) Grants and contracts.--In carrying out paragraph 
        (1), the Secretary may carry out activities directly 
        and through the award of grants and contracts, and may 
        enter into interagency cooperative agreements with 
        other Federal agencies.
          [(4) Health-related assistance for emergency response 
        personnel training.--The Secretary, in consultation 
        with the Attorney General and the Director of the 
        Federal Emergency Management Agency, may provide 
        technical assistance with respect to health-related 
        aspects of emergency response personnel training 
        carried out by the Department of Justice and the 
        Federal Emergency Management Agency.]
    ``(c) Expansion of Epidemic Intelligence Service Program.--
The Secretary may establish 20 officer positions in the 
Epidemic Intelligence Service Program, in addition to the 
number of the officer positions offered under such Program in 
2006, for individuals who agree to participate, for a period of 
not less than 2 years, in the Career Epidemiology Field Officer 
program in a State, local, or tribal health department that 
serves a health professional shortage area (as defined under 
section 332(a)), a medically underserved population (as defined 
under section 330(b)(3)), or a medically underserved area or 
area at high risk of a public health emergency as designated by 
the Secretary.
    (d) Centers for Public Health Preparedness; Core Curricula 
and Training.--
          (1) In general.--The Secretary may establish at 
        accredited schools of public health, Centers for Public 
        Health Preparedness (hereafter referred to in this 
        section as the ``Centers'').
          (2) Eligibility.--To be eligible to receive an award 
        under this subsection to establish a Center, an 
        accredited school of public health shall agree to 
        conduct activities consistent with the requirements of 
        this subsection.
          (3) Core curricula.--The Secretary, in collaboration 
        with the Centers and other public or private entities 
        shall establish core curricula based on established 
        competencies leading to a 4-year bachelor's degree, a 
        graduate degree, a combined bachelor and master's 
        degree, or a certificate program, for use by each 
        Center. The Secretary shall disseminate such curricula 
        to other accredited schools of public health and other 
        health professions schools determined appropriate by 
        the Secretary, for voluntary use by such schools.
          (4) Core competency-based training program.--The 
        Secretary, in collaboration with the Centers and other 
        public or private entities shall facilitate the 
        development of a competency-based training program to 
        train public health practitioners. The Centers shall 
        use such training program to train public health 
        practitioners. The Secretary shall disseminate such 
        training program to other accredited schools of public 
        health, health professions schools, and other public or 
        private entities as determined by the Secretary, for 
        voluntary use by such entities.
          (5) Content of core curricula and training program.--
        The Secretary shall ensure that the core curricula and 
        training program established pursuant to this 
        subsection respond to the needs of State, local, and 
        tribal public health authorities and integrate and 
        emphasize essential public health security capabilities 
        consistent with section 2802(c)(2).
          (6) Academic-workforce communication.--As a condition 
        of receiving funding from the Secretary under this 
        subsection, a Center shall collaborate with a State, 
        local, or tribal public health department to--
                  (A) define the public health preparedness and 
                response needs of the community involved;
                  (B) assess the extent to which such needs are 
                fulfilled by existing preparedness and response 
                activities of such school or health department, 
                and how such activities may be improved;
                  (C) prior to developing new materials or 
                trainings, evaluate and utilize relevant 
                materials and trainings developed by other 
                Centers; and
                  (D) evaluate community impact and the 
                effectiveness of any newly developed materials 
                or trainings.
          (7) Public health systems research.--In consultation 
        with relevant public and private entities, the 
        Secretary shall define the existing knowledge base for 
        public health preparedness and response systems, and 
        establish a research agenda based on Federal, State, 
        local, and tribal public health preparedness 
        priorities. As a condition of receiving funding from 
        the Secretary under this subsection, a Center shall 
        conduct public health systems research that is 
        consistent with the agenda described under this 
        paragraph.
    [(h)](e) Accelerated Research and Development on Priority 
Pathogens and Countermeasures.--
          (1) In general.--* * *

           *       *       *       *       *       *       *

      (f) Authorization of Appropriations.--
          (1) Fiscal year 2007.--There are authorized to be 
        appropriated to carry out this section for fiscal year 
        2007--
                  (A) to carry out subsection (a)--
                          (i) $5,000,000 to carry out 
                        paragraphs (1) through (4); and
                          (ii) $7,000,000 to carry out 
                        paragraph (5);
                  (B) to carry out subsection (c), $3,000,000; 
                and
                  (C) to carry out subsection (d), $31,000,000, 
                of which $5,000,000 shall be used to carry out 
                paragraphs (3) through (5) of such subsection.
          (2) Subsequent fiscal years.--There are authorized to 
        be appropriated such sums as may be necessary to carry 
        out this section for fiscal year 2008 and each 
        subsequent fiscal year.
    [(i) General Accounting Office Report \1\.--Not later than 
180 days after the date of the enactment of this section, the 
Comptroller General shall submit to the Committee on Health, 
Education, Labor, and Pensions and the Committee on 
Appropriations of the Senate and the Committee on Commerce and 
the Committee on Appropriations of the House of Representatives 
a report that describes--
          [(1) Federal activities primarily related to research 
        on, preparedness for, and the management of the public 
        health and medical consequences of a bioterrorist 
        attack against the civilian population;
          [(2) the coordination of the activities described in 
        paragraph (1);
          [(3) the amount of Federal funds authorized or 
        appropriated for the activities described in paragraph 
        (1); and
          [(4) the effectiveness of such efforts in preparing 
        national, State, and local authorities to address the 
        public health and medical consequences of a potential 
        bioterrorist attack against the civilian population.
    [(j) Supplement Not Supplant.--Funds appropriated under 
this section shall be used to supplement and not supplant other 
Federal, State, and local public funds provided for activities 
under this section.]

           *       *       *       *       *       *       *


SEC. 319I. EMERGENCY SYSTEM FOR ADVANCE REGISTRATION OF HEALTH 
                    PROFESSIONS VOLUNTEERS.

    [(a) In General.--The Secretary shall, directly or through 
an award of a grant, contract, or cooperative agreement, 
establish and maintain a system for the advance registration of 
health professionals for the purpose of verifying the 
credentials, licenses, accreditations, and hospital privileges 
of such professionals when, during public health emergencies, 
the professionals volunteer to provide health services 
(referred to in this section as the ``verification system''). 
In carrying out the preceding sentence, the Secretary shall 
provide for an electronic database for the verification system.
    [(b) Certain Criteria.--The Secretary shall establish 
provisions regarding the promptness and efficiency of the 
system in collecting, storing, updating, and disseminating 
information on the credentials, licenses, accreditations, and 
hospital privileges of volunteers described in subsection (a).]
  (a) In General.--Not later than 12 months after the date of 
enactment of the Pandemic and All-Hazards Preparedness Act, the 
Secretary shall link existing State verification systems to 
maintain a single national interoperable network of systems, 
each system being maintained by a State or group of States, for 
the purpose of verifying the credentials and licenses of health 
care professionals who volunteer to provide health services 
during a public health emergency (such network shall be 
referred to in this section as the ``verification network'').
  (b) Requirements.--The interoperable network of systems 
established under subsection (a) shall include--
          (1) with respect to each volunteer health 
        professional included in the system--
                  (A) information necessary for the rapid 
                identification of, and communication with, such 
                professionals; and
                  (B) the credentials, certifications, 
                licenses, and relevant training of such 
                individuals; and
          (2) the name of each member of the Medical Reserve 
        Corps, the National Disaster Medical System, and any 
        other relevant federally-sponsored or administered 
        programs determined necessary by the Secretary.
    (c) Other Assistance.--The Secretary may make grants and 
provide technical assistance to States and other public or 
nonprofit private entities for activities relating to the 
verification [system] network developed under subsection (a).
    [(d) Coordination Among States.--The Secretary may 
encourage each State to provide legal authority during a public 
health emergency for health professionals authorized in another 
State to provide certain health services to provide such health 
services in the State.]
  (d) Accessibility.--The Secretary shall ensure that the 
network established under subsection (a) is electronically 
accessible by State, local, and tribal health departments and 
can be linked with the identification cards under section 2813.
  (e) Confidentiality.--The Secretary shall establish and 
require the application of and compliance with measures to 
ensure the effective security of, integrity of, and access to 
the data included in the network.
  (f) Coordination.--The Secretary shall coordinate with the 
Secretary of Veterans Affairs and the Secretary of Homeland 
Security to assess the feasibility of integrating the 
verification network under this section with the VetPro system 
of the Department of Veterans Affairs and the National 
Emergency Responder Credentialing System of the Department of 
Homeland Security. The Secretary shall, if feasible, integrate 
the verification network under this section with such VetPro 
system and the National Emergency Responder Credentialing 
System.
  (g) Updating of Information.--The States that are 
participants in the network established under subsection (a) 
shall, on at least a quarterly basis, work with the Director to 
provide for the updating of the information contained in such 
network.
  (h) Clarification.--Inclusion of a health professional in the 
verification network established pursuant to this section shall 
not constitute appointment of such individual as a Federal 
employee for any purpose, either under section 2812(c) or 
otherwise. Such appointment may only be made under section 2812 
or 2813.
  (i) Health Care Provider Licenses.--The Secretary shall 
encourage States to establish and implement mechanisms to waive 
the application of licensing requirements applicable to health 
professionals, who are seeking to provide medical services 
(within their scope of practice), during a national, State, 
local, or tribal public health emergency upon verification that 
such health professionals are licensed and in good standing in 
another State and have not been disciplined by any State health 
licensing or disciplinary board.
    [(e)] (j) Rule of Construction.--This section may not be 
construed as authorizing the Secretary to issue requirements 
regarding the provision by the States of credentials, licenses, 
accreditations, or hospital privileges.
    [(f)] (k) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated $2,000,000 for fiscal year 2002, and such sums as 
may be necessary for each of the fiscal years 2003 through 
[2006] 2011.

           *       *       *       *       *       *       *


                      Part D--Primary Health Care


Subpart I--Health Centers

           *       *       *       *       *       *       *



      Subpart III--Scholarship Program and Loan Repayment Program

           NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM

    Sec. 338A. * * *

           *       *       *       *       *       *       *


SEC. 338I. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.

    (a) In General.--
          (1) Authority for grants.--* * *

           *       *       *       *       *       *       *

    (i) Authorization of Appropriations.--
          (1) In General.--* * *

           *       *       *       *       *       *       *

    (j) Public Health Loan Repayment.--
          (1) In general.--The Secretary may award grants to 
        States for the purpose of assisting such States in 
        operating loan repayment programs under which such 
        States enter into contracts to repay all or part of the 
        eligible loans borrowed by, or on behalf of, 
        individuals who agree to serve in State, local, or 
        tribal health departments that serve health 
        professional shortage areas or other areas at risk of a 
        public health emergency, as designated by the 
        Secretary.
          (2) Loans eligible for repayment.--To be eligible for 
        repayment under this subsection, a loan shall be a loan 
        made, insured, or guaranteed by the Federal Government 
        that is borrowed by, or on behalf of, an individual to 
        pay the cost of attendance for a program of education 
        leading to a degree appropriate for serving in a State, 
        local, or tribal health department as determined by the 
        Secretary and the chief executive officer of the State 
        in which the grant is administered, at an institution 
        of higher education (as defined in section 102 of the 
        Higher Education Act of 1965), including principal, 
        interest, and related expenses on such loan.
          (3) Applicability of existing requirements.--With 
        respect to awards made under paragraph (1)--
                  (A) the requirements of subsections (b), (f), 
                and (g) shall apply to such awards; and
                  (B) the requirements of subsection (c) shall 
                apply to such awards except that with respect 
                to paragraph (1) of such subsection, the State 
                involved may assign an individual only to 
                public and nonprofit private entities that 
                serve health professional shortage areas or 
                areas at risk of a public health emergency, as 
                determined by the Secretary.
          (4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, such sums as may be necessary for each of 
        fiscal years 2007 through 2010.

SEC. 338L. DEMONSTRATION PROJECT.

    (a) Program Authorized.* * *

           *       *       *       *       *       *       *


SEC. 338M. PUBLIC HEALTH DEPARTMENTS.

  (a) In General.--To the extent that funds are appropriated 
under subsection (e), the Secretary shall establish a 
demonstration project to provide for the participation of 
individuals who are eligible for the Loan Repayment Program 
described in section 338B and who agree to complete their 
service obligation in a State health department that provides a 
significant amount of service to health professional shortage 
areas or areas at risk of a public health emergency, as 
determined by the Secretary, or in a local or tribal health 
department that serves a health professional shortage area or 
an area at risk of a public health emergency.
  (b) Procedure.--To be eligible to receive assistance under 
subsection (a), with respect to the program described in 
section 338B, an individual shall--
          (1) comply with all rules and requirements described 
        in such section (other than section 338B(f)(1)(B)(iv)); 
        and
          (2) agree to serve for a time period equal to 2 
        years, or such longer period as the individual may 
        agree to, in a State, local, or tribal health 
        department, described in subsection (a).
  (c) Designations.--The demonstration project described in 
subsection (a), and any healthcare providers who are selected 
to participate in such project, shall not be considered by the 
Secretary in the designation of health professional shortage 
areas under section 332 during fiscal years 2007 through 2010.
  (d) Report.--Not later than 3 years after the date of 
enactment of this section, the Secretary shall submit a report 
to the relevant committees of Congress that evaluates the 
participation of individuals in the demonstration project under 
subsection (a), the impact of such participation on State, 
local, and tribal health departments, and the benefit and 
feasibility of permanently allowing such placements in the Loan 
Repayment Program.
  (e) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for each of fiscal years 2007 through 2010.

           *       *       *       *       *       *       *


[TITLE XXVIII--NATIONAL PREPAREDNESS FOR BIOTERRORISM AND OTHER PUBLIC 
                          HEALTH EMERGENCIES]

   TITLE XXVIII_NATIONAL ALL-HAZARDS PREPAREDNESS FOR PUBLIC HEALTH 
                              EMERGENCIES

[Subtitle A--National Preparedness and Response Planning, Coordinating, 
                             and Reporting

[SEC. 2801. NATIONAL PREPAREDNESS PLAN.

    [(a) In General.--
          [(1) Preparedness and response regarding public 
        health emergencies.--The Secretary shall further 
        develop and implement a coordinated strategy, building 
        upon the core public health capabilities established 
        pursuant to section 319A, for carrying out health-
        related activities to prepare for and respond 
        effectively to bioterrorism and other public health 
        emergencies, including the preparation of a plan under 
        this section. The Secretary shall periodically 
        thereafter review and, as appropriate, revise the plan.
          [(2) National approach.--In carrying out paragraph 
        (1), the Secretary shall collaborate with the States 
        toward the goal of ensuring that the activities of the 
        Secretary regarding bioterrorism and other public 
        health emergencies are coordinated with activities of 
        the States, including local governments.
          [(3) Evaluation of progress.--The plan under 
        paragraph (2) shall provide for specific benchmarks and 
        outcome measures for evaluating the progress of the 
        Secretary and the States, including local governments, 
        with respect to the plan under paragraph (1), including 
        progress toward achieving the goals specified in 
        subsection (b).
    [(b) Preparedness Goals.-The plan under subsection (a) 
should include provisions in furtherance of the following:
          [(1) Providing effective assistance to State and 
        local governments in the event of bioterrorism or other 
        public health emergency.
          [(2) Ensuring that State and local governments have 
        appropriate capacity to detect and respond effectively 
        to such emergencies, including capacities for the 
        following:
                  [(A) Effective public health surveillance and 
                reporting mechanisms at the State and local 
                levels.
                  [(B) Appropriate laboratory readiness.
                  [(C) Properly trained and equipped emergency 
                response, public health, and medical personnel.
                  [(D) Health and safety protection of workers 
                responding to such an emergency.
                  [(E) Public health agencies that are prepared 
                to coordinate health services (including mental 
                health services) during and after such 
                emergencies.
                  [(F) Participation in communications networks 
                that can effectively disseminate relevant 
                information in a timely and secure manner to 
                appropriate public and private entities and to 
                the public.
          [(3) Developing and maintaining medical 
        countermeasures (such as drugs, vaccines and other 
        biological products, medical devices, and other 
        supplies) against biological agents and toxins that may 
        be involved in such emergencies.
          [(4) Ensuring coordination and minimizing duplication 
        of Federal, State, and local planning, preparedness, 
        and response activities, including during the 
        investigation of a suspicious disease outbreak or other 
        potential public health emergency.
          [(5) Enhancing the readiness of hospitals and other 
        health care facilities to respond effectively to such 
        emergencies.
    [(c) Reports to Congress.--
          [(1) In general.--Not later than one year after the 
        date of the enactment of the Public Health Security and 
        Bioterrorism Preparedness and Response Act of 2002, and 
        biennially thereafter, the Secretary shall submit to 
        the Committee on Energy and Commerce of the House of 
        Representatives, and the Committee on Health, 
        Education, Labor, and Pensions of the Senate, a report 
        concerning progress with respect to the plan under 
        subsection (a), including progress toward achieving the 
        goals specified in subsection (b).
          [(2) Additional authority.--Reports submitted under 
        paragraph (1) by the Secretary (other than the first 
        report) shall make recommendations concerning--
                  [(A) any additional legislative authority 
                that the Secretary determines is necessary for 
                fully implementing the plan under subsection 
                (a), including meeting the goals under 
                subsection (b); and
                  [(B) any additional legislative authority 
                that the Secretary determines is necessary 
                under section 319 to protect the public health 
                in the event of an emergency described in 
                section 319(a).
    [(d) Rule of Construction.--This section may not be 
construed as expanding or limiting any of the authorities of 
the Secretary that, on the day before the date of the enactment 
of the Public Health Security and Bioterrorism Preparedness and 
Response Act of 2002, were in effect with respect to preparing 
for and responding effectively to bioterrorism and other public 
health emergencies.]

 Subtitle A--National All-Hazards Preparedness and Response Planning, 
                      Coordinating, and Reporting

SEC. 2801. PUBLIC HEALTH AND MEDICAL PREPAREDNESS AND RESPONSE 
                    FUNCTIONS.

    (a) In General.--The Secretary of Health and Human Services 
shall lead all Federal public health and medical response to 
public health emergencies and incidents covered by the National 
Response Plan developed pursuant to section 502(6) of the 
Homeland Security Act of 2002, or any successor plan.
    (b) Interagency Agreement.--The Secretary, in collaboration 
with the Secretary of Veterans Affairs, the Secretary of 
Transportation, the Secretary of Defense, the Secretary of 
Homeland Security, and the head of any other relevant Federal 
agency, shall establish an interagency agreement, consistent 
with the National Response Plan or any successor plan, under 
which agreement the Secretary of Health and Human Services 
shall assume operational control of emergency public health and 
medical response assets, as necessary, in the event of a public 
health emergency.

SEC. 2802. NATIONAL HEALTH SECURITY STRATEGY.

    (a) In General.--
          (1) Preparedness and response regarding public health 
        emergencies.--Beginning in 2009 and every 4 years 
        thereafter, the Secretary shall prepare and submit to 
        the relevant Committees of Congress a coordinated 
        strategy and any revisions thereof, and an accompanying 
        implementation plan for public health emergency 
        preparedness and response. The strategy shall identify 
        the process for achieving the preparedness goals 
        described in subsection (b) and shall be consistent 
        with the National Preparedness Goal, the National 
        Incident Management System, and the National Response 
        Plan developed pursuant to section 502(6) of the 
        Homeland Security Act of 2002, or any successor plan.
          (2) Evaluation of progress.--The National Health 
        Security Strategy shall include an evaluation of the 
        progress made by Federal, State, local, and tribal 
        entities, based on the evidence-based benchmarks and 
        objective standards that measure levels of preparedness 
        established pursuant to section 319C-1(g). Such 
        evaluation shall include aggregate and State-specific 
        breakdowns of obligated funding spent by major category 
        (as defined by the Secretary) foractivities funded 
through awards pursuant to sections 319C-1 and 319C-2.
          (3) Public health workforce.--In 2009, the National 
        Health Security Strategy shall include a national 
        strategy for establishing an effective and prepared 
        public health workforce, including defining the 
        functions, capabilities, and gaps in such workforce, 
        and identifying strategies to recruit, retain, and 
        protect such workforce from workplace exposures during 
        public health emergencies.
  (b) Preparedness Goals.--The strategy under subsection (a) 
shall include provisions in furtherance of the following:
          (1) Integration.--Integrating public health and 
        public and private medical capabilities with other 
        first responder systems, including through--
                  (A) the periodic evaluation of Federal, 
                State, local, and tribal preparedness and 
                response capabilities through drills and 
                exercises; and
                  (B) integrating public and private sector 
                public health and medical donations and 
                volunteers.
          (2) Public health.--Developing and sustaining 
        Federal, State, local, and tribal essential public 
        health security capabilities, including the following:
                  (A) Disease situational awareness 
                domestically and abroad, including detection, 
                identification, and investigation.
                  (B) Disease containment including 
                capabilities for isolation, quarantine, social 
                distancing, and decontamination.
                  (C) Risk communication and public 
                preparedness.
                  (D) Rapid distribution and administration of 
                medical countermeasures.
          (3) Medical.--Increasing the preparedness, response 
        capabilities, and surge capacity of hospitals, other 
        health care facilities (including mental health 
        facilities), and trauma care and emergency medical 
        service systems with respect to public health 
        emergencies, which shall include developing plans for 
        the following:
                  (A) Strengthening public health emergency 
                medical management and treatment capabilities.
                  (B) Medical evacuation and fatality 
                management.
                  (C) Rapid distribution and administration of 
                medical countermeasures.
                  (D) Effective utilization of any available 
                public and private mobile medical assets and 
                integration of other Federal assets.
                  (E) Protecting health care workers and health 
                care first responders from workplace exposures 
                during a public health emergency.
          (4) At-risk individuals.--
                  (A) Taking into account the public health and 
                medical needs of at-risk individuals in the 
                event of a public health emergency.
                  (B) For purpose of the Pandemic and All-
                Hazards Preparedness Act, the term ``at-risk 
                individuals'' means children, pregnant women, 
                senior citizens and other individuals who have 
                special needs in the event of a public health 
                emergency, as determined by the Secretary.
          (5) Coordination.--Minimizing duplication of, and 
        ensuring coordination between Federal, State, local, 
        and tribal planning, preparedness, and response 
        activities (including the State Emergency Management 
        Assistance Compact). Such planning shall be consistent 
        with the National Response Plan, or any successor plan, 
        and National Incident Management System and the 
        National Preparedness Goal.
          (6) Continuity of operations.--Maintaining vital 
        public health and medical services to allow for optimal 
        Federal, State, local, and tribal operations in the 
        event of a public health emergency.

SEC. 2804. ENHANCING MEDICAL SURGE CAPACITY.

    (a) Study of Enhancing Medical Surge Capacity.--As part of 
the joint review described in section 2812(b), the Secretary 
shall evaluate the benefits and feasibility of improving the 
capacity of the Department of Health and Human Services to 
provide additional medical surge capacity to local communities 
in the event of a public health emergency. Such study shall 
include an assessment of the need for and feasibility of 
improving surge capacity through--
          (1) acquisition and operation of mobile medical 
        assets by the Secretary to be deployed, on a 
        contingency basis, to a community in the event of a 
        public health emergency; and
          (2) other strategies to improve such capacity as 
        determined appropriate by the Secretary.
    (b) Authority To Acquire and Operate Mobile Medical 
Assets.--In addition to any other authority to acquire, deploy, 
and operate mobile medical assets, the Secretary may acquire, 
deploy, and operate mobile medical assets if, taking into 
consideration the evaluation conducted under subsection (a), 
such acquisition, deployment, and operation is determined to be 
beneficial and feasible in improving the capacity of the 
Department of Health and Human Services to provide additional 
medical surge capacity to local communities in the event of a 
public health emergency.
    (c) Using Federal Facilities To Enhance Medical Surge 
Capacity.--
          (1) Analysis.--The Secretary shall conduct an 
        analysis of whether there are Federal facilities which, 
        in the event of a public health emergency, could 
        practicably be used as facilities in which to provide 
        health care.
          (2) Memoranda of understanding.--If, based on the 
        analysis conducted under paragraph (1), the Secretary 
        determines that there are Federal facilities which, in 
        the event of a public health emergency, could be used 
        as facilities in which to provide health care, the 
        Secretary shall, with respect to each such facility, 
        seek to conclude a memorandum of understanding with the 
        head of the Department or agency that operates such 
        facility that permits the use of such facility to 
        provide health care in the event of a public health 
        emergency.

           *       *       *       *       *       *       *


      Subtitle B--All-Hazards Emergency Preparedness and Response

SEC. 2811. COORDINATION OF PREPAREDNESS FOR AND RESPONSE TO ALL-HAZARDS 
                    PUBLIC HEALTH EMERGENCIES.

    (a) In General.--There is established within the Department 
of Health and Human Services the position of the Assistant 
Secretary for Preparedness and Response. The President, with 
the advice and consent of the Senate, shall appoint an 
individual to serve in such position. Such Assistant Secretary 
shall report to the Secretary.
    (b) Duties.--Subject to the authority of the Secretary, the 
Assistant Secretary for Preparedness and Response shall carry 
out the following functions:
          (1) Leadership.--Serve as the principal advisor to 
        the Secretary on all matters related to Federal public 
        health and medical preparedness and response for public 
        health emergencies.
          (2) Personnel.--Register, credential, organize, 
        train, equip, and have the authority to deploy Federal 
        public health and medical personnel under the authority 
        of the Secretary, including the National Disaster 
        Medical System, and coordinate such personnel with the 
        Medical Reserve Corps and the Emergency System for 
        Advance Registration of Volunteer Health Professionals.
          (3) Countermeasures.--
                  (A) Oversight.--Oversee advanced research, 
                development, and procurement of qualified 
                countermeasures (as defined in section 319F-1) 
                and qualified pandemic or epidemic products (as 
                defined in section 319F-3).
                  (B) Strategic national stockpile.--Maintain 
                the Strategic National Stockpile in accordance 
                with section 319F-2, including conducting an 
                annual review (taking into account at-risk 
                individuals) of the contents of the stockpile, 
                including non-pharmaceutical supplies, and make 
                necessary additions or modifications to the 
                contents based on such review.
          (4) Coordination.--
                  (A) Federal integration.--Coordinate with 
                relevant Federal officials to ensure 
                integration of Federal preparedness and 
                response activities for public health 
                emergencies.
                  (B) State, local, and tribal integration.--
                Coordinate with State, local, and tribal public 
                health officials, the Emergency Management 
                Assistance Compact, health care systems, and 
                emergency medical service systems to ensure 
                effective integration of Federal public health 
                and medical assets during a public health 
                emergency.
                  (C) Emergency medical services.--Promote 
                improved emergency medical services medical 
                direction, system integration, research, and 
                uniformity of data collection, treatment 
                protocols, and policies with regard to public 
                health emergencies.
          (5) Logistics.--In coordination with the Secretary of 
        Veterans Affairs, the Secretary of Homeland Security, 
        the General Services Administration, and other public 
        and private entities, provide logistical support for 
        medical and public health aspects of Federal responses 
        to public health emergencies.
          (6) Leadership.--Provide leadership in international 
        programs, initiatives, and policies that deal with 
        public health and medical emergency preparedness and 
        response.
    (c) Functions.--The Assistant Secretary for Preparedness 
and Response shall--
          (1) have authority over and responsibility for the 
        functions, personnel, assets, and liabilities of the 
        following--
                  (A) the National Disaster Medical System (in 
                accordance with section 301 of the Pandemic and 
                All-Hazards Preparedness Act);
                  (B) the Hospital Preparedness Cooperative 
                Agreement Program pursuant to section 319C-2; 
                and
                  (C) the Public Health Preparedness 
                Cooperative Agreement Program pursuant to 
                section 319C-1;
          (2) exercise the responsibilities and authorities of 
        the Secretary with respect to the coordination of--
                  (A) the Medical Reserve Corps pursuant to 
                section 2813;
                  (B) the Emergency System for Advance 
                Registration of Volunteer Health Professionals 
                pursuant to section 319I;
                  (C) the Strategic National Stockpile; and
                  (D) the Cities Readiness Initiative; and
          (3) assume other duties as determined appropriate by 
        the Secretary.

           *       *       *       *       *       *       *


SEC. [2811.] 2812.[COORDINATION OF PREPAREDNESS FOR AND RESPONSE TO 
                    BIOTERRORISM AND OTHER PUBLIC HEALTH EMERGENCIES] 
                    NATIONAL DISASTER MEDICAL SYSTEM

    [(a) Assistant Secretary for Public Health Emergency 
Preparedness.--
          [(1) In general.--There is established within the 
        Department of Health and Human Services the position of 
        Assistant Secretary for Public Health Emergency 
        Preparedness. The President shall appoint an individual 
        to serve in such position. Such Assistant Secretary 
        shall report to the Secretary.
          [(2) Duties.--Subject to the authority of the 
        Secretary, the Assistant Secretary for Public Health 
        Emergency Preparedness shall carry out the following 
        duties with respect to bioterrorism and other public 
        health emergencies:
                  [(A) Coordinate on behalf of the Secretary--
                          [(i) interagency interfaces between 
                        the Department of Health and Human 
                        Services (referred to in this paragraph 
                        as the ``Department'') and other 
                        departments, agencies, and offices of 
                        the United States; and
                          [(ii) interfaces between the 
                        Department and State and local entities 
                        with responsibility for emergency 
                        preparedness.
                  [(B) Coordinate the operations of the 
                National Disaster Medical System and any other 
                emergency response activities within the 
                Department of Health and Human Services that 
                are related to bioterrorism and other public 
                health emergencies.
                  [(C) Coordinate the efforts of the Department 
                to bolster State and local emergency 
                preparedness for a bioterrorist attack or other 
                public health emergency, and evaluate the 
                progress of such entities in meeting the 
                benchmarks and other outcome measures contained 
                in the national plan and in meeting the core 
                public health capabilities established pursuant 
                to 319A.
                  [(D) Any other duties determined appropriate 
                by the Secretary.]
    [(b)](a) National Disaster Medical System.--
          (1) In general.--The Secretary shall provide for the 
        operation in accordance with this section of a system 
        to be known as the National Disaster Medical System. 
        The Secretary shall designate the [Assistant Secretary 
        for Public Health Emergency Preparedness] Assistant 
        Secretary for Preparedness and Response as the head of 
        the National Disaster Medical System, subject to the 
        authority of the Secretary.
          (2) Federal and state collaborative system.--
                  (A) In general.--*  *  *
                  (B) Participating federal agencies.--The 
                Federal agencies referred to in subparagraph 
                (A) are the Department of Health and Human 
                Services, the [Federal Emergency Management 
                Agency] Department of Homeland Security, the 
                Department of Defense, and the Department of 
                Veterans Affairs.
          (3) Purpose of system.--
                  (A) In general.--*  *  *

           *       *       *       *       *       *       *

                  (C) Test for mobilization of system.--During 
                the one-year period beginning on the date of 
                the enactment of the [Public Health Security 
                and Bioterrorism Preparedness and Response Act 
                of 2002] Pandemic and All-Hazards Preparedness 
                Act, the Secretary shall conduct an exercise to 
                test the capability and timeliness of the 
                National Disaster Medical System to mobilize 
                and otherwise respond effectively to a 
                bioterrorist attack or other public health 
                emergency that affects two or more geographic 
                locations concurrently. Thereafter, the 
                Secretary may periodically conduct such 
                exercises regarding the National Disaster 
                Medical System as the Secretary determines to 
                be appropriate.
    [(c)](b) [Criteria] Modifications._
          [(i) In general.--The Secretary shall establish 
        criteria for the operation of the National Disaster 
        Medical System.
          (1) In general.--Taking into account the findings 
        from the joint review described under paragraph (2), 
        the Secretary shall modify the policies of the National 
        Disaster Medical System as necessary.
          (2) Joint review and medical surge capacity strategic 
        plan.--Not later than 180 days after the date of 
        enactment of the Pandemic and All-Hazards Preparedness 
        Act, the Secretary, in coordination with the Secretary 
        of Homeland Security, the Secretary of Defense, and the 
        Secretary of Veterans Affairs, shall conduct a joint 
        review of the National Disaster Medical System. Such 
        review shall include an evaluation of medical surge 
        capacity, as described by section 2804(a). As part of 
        the National Health Security Strategy under section 
        2802, the Secretary shall update the findings from such 
        review and further modify the policies of the National 
        Disaster Medical System as necessary.
          [(2)](3) Participation agreements for non-federal 
        entities.--* * *
                  (A) Provisions relating to the custody and 
                use of Federal personal property by such 
                entities, which may in the discretion of the 
                Secretary include authorizing the custody and 
                use of such property to respond to emergency 
                situations for which the National Disaster 
                Medical System has not been activated by the 
                Secretary pursuant to [subsection (b)] 
                subsection (a)(3)(A). Any such custody and use 
                of Federal personal property shall be on a 
                reimbursable basis.

           *       *       *       *       *       *       *

    [(d)](c) Intermittent Disaster-Response Personnel.--
          (1) In general.--* * *
          (2) Liability.--For purposes of section 224(a) and 
        the remedies described in such section, an individual 
        appointed under paragraph (1) shall, while acting 
        within the scope of such appointment, be considered to 
        be an employee of the Public Health Service performing 
        medical, surgical, dental, or related functions. With 
        respect to the participation of individuals appointed 
        under paragraph (1) in training programs authorized by 
        the [Assistant Secretary for Public Health Emergency 
        Preparedness] or Assistant Secretary for Preparedness 
        and Response or a comparable official of any Federal 
        agency specified in [subsection (b)] subsection (2)(B), 
        acts of individuals so appointed that are within the 
        scope of such participation shall be considered within 
        the scope of the appointment under paragraph (1) 
        (regardless of whether the individuals receive 
        compensation for such participation).
    [(e)](d) Certain Employment Issues Regarding Intermittent 
Appointments.--
          (1) Intermittent disaster-response appointee.--For 
        purposes of this subsection, the term ``intermittent 
        disaster-response appointee'' means an individual 
        appointed by the Secretary under [subsection (d)] 
        subsection (c).
          (2) Compensation for work injuries.--An intermittent 
        disaster-response appointee shall, while acting in the 
        scope of such appointment, be considered to be an 
        employee of the Public Health Service performing 
        medical, surgical, dental, or related functions, and an 
        injury sustained by such an individual shall be deemed 
        ``in the performance of duty'', for purposes of chapter 
        81 of title 5, United States Code, pertaining to 
        compensation for work injuries. With respect to the 
        participation of individuals appointed under 
        [subsection (d)] subsection in training programs 
        authorized by the [Assistant Secretary for Public 
        Health Emergency Preparedness] Assistant Secretary for 
        Preparedness and Response or a comparable official of 
        any Federal agency specified in [subsection (b)] 
        subsection (2)(B), injuries sustained by such an 
        individual, while acting within the scope of such 
        participation, also shall be deemed ``in the 
        performance of duty'' for purposes of chapter 81 of 
        title 5, United States Code (regardless of whether the 
        individuals receive compensation for such 
        participation). In the event of an injury to such an 
        intermittent disaster-response appointee, the Secretary 
        of Labor shall be responsible for making determinations 
        as the whether the claimant is entitled to compensation 
        or other benefits in accordance with chapter 81 of 
        title 5, United States Code.
          (3) Employment and reemployment rights.--
                  (A) In general.--Service as an intermittent 
                disaster-response appointee when the Secretary 
                activates the National Disaster Medical System 
                or when the individual participates in a 
                training program authorized by the [Assistant 
                Secretary for Public Health Emergency 
                Preparedness] Assistant Secretary for 
                Preparedness and Response or a comparable 
                official of any Federal agency specified in 
                [subsection (b)] subsection (2)(B) shall be 
                deemed ``service in the uniformed services'' 
                for purposes of chapter 43 of title 38, United 
                States Code, pertaining to employment and 
                reemployment rights of individuals who have 
                performed service in the uniformed services 
                (regardless of whether the individual receives 
                compensation for such participation). All 
                rights and obligations of such persons and 
                procedures for assistance, enforcement, and 
                investigation shall be as provided for in 
                chapter 43 of title 38, United States Code.

           *       *       *       *       *       *       *

    [(f)(e)] Rule of Construction Regarding Use of Commissioned 
Corps.--* * *
    [(g)(f)] Definition.--For purposes of this section, the 
term ``auxiliary services'' includes mortuary services, 
veterinary services, and other services that are determined by 
the Secretary to be appropriate with respect to the needs 
referred to in [subsection (b)] subsection (a)(3)(A).
    [(h)](g) Authorization of Appropriations.--For the purpose 
of providing for the [Assistant Secretary for Public Health 
Emergency Preparedness] Assistant Secretary for Preparedness 
and Response and the operations of the National Disaster 
Medical System, other than purposes for which amounts in the 
Public Health Emergency Fund under section 319 are available, 
there are authorized to be appropriated such sums as may be 
necessary for each of the fiscal years [2002 through 2006] 2007 
through 2011.

           *       *       *       *       *       *       *


SEC. 2813. VOLUNTEER MEDICAL RESERVE CORPS.

    (a) In General.--Not later than 180 days after the date of 
enactment of the Pandemic and All-Hazards Preparedness Act, the 
Secretary, in collaboration with State, local, and tribal 
officials, shall build on State, local, and tribal programs in 
existence on the date of enactment of such Act to establish and 
maintain a Medical Reserve Corps (referred to in this section 
as the ``Corps'') to provide for an adequate supply of 
volunteers in the case of a Federal, State, local, or tribal 
public health emergency. The Corps shall be headed by a 
Director who shall be appointed by the Secretary and shall 
oversee the activities of the Corps chapters that exist at the 
State, local, and tribal levels.
    (b) State, Local, and Tribal Coordination.--The Corps shall 
be established using existing State, local, and tribal teams 
and shall not alter such teams.
    (c) Composition.--The Corps shall be composed of 
individuals who--
          (1)(A) are health professionals who have appropriate 
        professional training and expertise as determined 
        appropriate by the Director of the Corps; or
          (B) are non-health professionals who have an interest 
        in serving in an auxiliary or support capacity to 
        facilitate access to health care services in a public 
        health emergency;
          (2) are certified in accordance with the 
        certification program developed under subsection (d);
          (3) are geographically diverse in residence;
          (4) have registered and carry out training exercises 
        with a local chapter of the Medical Reserve Corps; and
          (5) indicate whether they are willing to be deployed 
        outside the area in which they reside in the event of a 
        public health emergency.
    (d) Certification; Drills.--
          (1) Certification.--The Director, in collaboration 
        with State, local, and tribal officials, shall 
        establish a process for the periodic certification of 
        individuals who volunteer for the Corps, as determined 
        by the Secretary, which shall include the completion by 
        each individual of the core training programs developed 
        under section 319F, as required by the Director. Such 
        certification shall not supercede State licensing or 
        credentialing requirements.
          (2) Drills.--In conjunction with the core training 
        programs referred to in paragraph (1), and in order to 
        facilitate the integration of trained volunteers into 
        the health care system at the local level, Corps 
        members shall engage in periodic training exercises to 
        be carried out at the local level.
    (e) Deployment.--During a public health emergency, the 
Secretary shall have the authority to activate and deploy 
willing members of the Corps to areas of need, takinginto 
consideration the public health and medical expertise required, with 
the concurrence of the State, local, or tribal officials from the area 
where the members reside.
    (f) Expenses and Transportation.--While engaged in 
performing duties as a member of the Corps pursuant to an 
assignment by the Secretary (including periods of travel to 
facilitate such assignment), members of the Corps who are not 
otherwise employed by the Federal Government shall be allowed 
travel or transportation expenses, including per diem in lieu 
of subsistence.
    (g) Identification.--The Secretary, in cooperation and 
consultation with the States, shall develop a Medical Reserve 
Corps Identification Card that describes the licensure and 
certification information of Corps members, as well as other 
identifying information determined necessary by the Secretary.
    (h) Intermittent Disaster-Response Personnel.--
          (1) In general.--For the purpose of assisting the 
        Corps in carrying out duties under this section, during 
        a public health emergency, the Secretary may appoint 
        selected individuals to serve as intermittent personnel 
        of such Corps in accordance with applicable civil 
        service laws and regulations. In all other cases, 
        members of the Corps are subject to the laws of the 
        State in which the activities of the Corps are 
        undertaken.
          (2) Applicable protections.--Subsections (c)(2), (d), 
        and (e) of section 2812 shall apply to an individual 
        appointed under paragraph (1) in the same manner as 
        such subsections apply to an individual appointed under 
        section 2812(c).
          (3) Limitation.--State, local, and tribal officials 
        shall have no authority to designate a member of the 
        Corps as Federal intermittent disaster-response 
        personnel, but may request the services of such 
        members.
    (i) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $22,000,000 for 
fiscal year 2007, and such sums as may be necessary for each of 
fiscal years 2008 through 2011.

           *       *       *       *       *       *       *


HOMELAND SECURITY ACT OF 2002

           *       *       *       *       *       *       *



              TITLE V--EMERGENCY PREPAREDNESS AND RESPONSE

SEC. 501. * * *

           *       *       *       *       *       *       *


SEC. 502. RESPONSIBILITIES.

           *       *       *       *       *       *       *


          (3) providing the Federal Government's response to 
        terrorist attacks and major disasters, including--
                  (A) managing such response;
                  (B) directing the Domestic Emergency Support 
                Team[, the National Disaster Medical System,] 
                and (when operating as an organizational unit 
                of the Department pursuant to this title) the 
                Nuclear Incident Response Team;

           *       *       *       *       *       *       *


SEC. 503. FUNCTIONS TRANSFERRED.

           *       *       *       *       *       *       *


                  (5) The Office of Emergency Preparedness[, 
                the National Disaster Medical System,] and the 
                Metropolitan Medical Response System of the 
                Department of Health and Human Services, 
                including the functions of the Secretary of 
                Health and Human Services and the Assistant 
                Secretary for Public Health Emergency 
                Preparedness relating thereto.

           *       *       *       *       *       *       *


SOCIAL SECURITY ACT

           *       *       *       *       *       *       *



      AUTHORITY TO WAIVE REQUIREMENTS DURING NATIONAL EMERGENCIES

    Sec. 1135. (a) Purpose.--* * *

           *       *       *       *       *       *       *

    (b) Secretarial Authority.--* * *
          (1)(A)* * *

           *       *       *       *       *       *       *

          (3) * * *
                  (A) * * *
                  [(B) the direction or relocation of an 
                individual to receive medical screening in an 
                alternate location pursuant to an appropriate 
                State emergency preparedness plan;]
                  (B) the direction or relocation of an 
                individual to receive medical screening in an 
                alternative location--
                          (i) pursuant to an appropriate State 
                        emergency preparedness plan; or
                          (ii) in the case of a public health 
                        emergency described in subsection 
                        (g)(1)(B) that involves a pandemic 
                        infectious disease, pursuant to a State 
                        pandemic preparedness plan or a plan 
                        referred to in clause (i), whichever is 
                        applicable in the State;

           *       *       *       *       *       *       *

          (7) * * *

           *       *       *       *       *       *       *

Insofar as the Secretary exercises authority under paragraph 
(6) with respect to individuals enrolled in a Medicare+Choice 
plan, to the extent possible given the circumstances, the 
Secretary shall reconcile payments made on behalf of such 
enrollees to ensure that the enrollees do not pay more than 
would be required had they received services from providers 
within the network of the plan and may reconcile payments to 
the organization offering the plan to ensure that such 
organization pays for services for which payment is included in 
the capitation payment it receives under part C of title XVIII. 
A waiver or modification provided for under paragraph (3) or 
(7) shall only be in effect if such actions are taken in a 
manner that does not discriminate among individuals on the 
basis of their source of payment or of their ability to pay, 
[and shall be limited to] and, except in the case of a waiver 
or modification to which the fifth sentence of this subsection 
applies, shall be limited to a 72-hour period beginning upon 
implementation of a hospital disaster protocol. A waiver or 
modification under such paragraph (7) shall be withdrawn after 
such period and the provider shall comply with the requirements 
under such paragraph for any patient still under the care of 
the provider.  If a public health emergency described in 
subsection (g)(1)(B) involves a pandemic infectious disease 
(such as pandemic influenza), the duration of a waiver or 
modification under paragraph (3) shall be determined in 
accordance with subsection (e) as such subsection applies to 
public health emergencies.

           *       *       *       *       *       *       *


                           UNITED STATES CODE

                                TITLE 38

Sec. 8117. Emergency preparedness

    (a) Readiness of Department medical centers.--(1) The 
Secretary shall take appropriate actions to provide for the 
readiness of Department medical centers to protect the patients 
and staff of such centers from [chemical or biological attack] 
a public health emergency (as defined in section 2801 of the 
Public Health Service Act) or otherwise to respond to such [an 
attack] such an emergency so as to enable such centers to 
fulfill their obligations as part of the Federal response to 
[public health emergencies] such emergencies.
    (2) Actions under paragraph (1) shall include--
          (A) the provision of decontamination equipment and 
        personal protection equipment at Department medical 
        centers [and];
          (B) the provision of training in the use of such 
        equipment to staff of such centers[.];
                  (C) organizing, training, and equipping the 
                staff of such centers to support the activities 
                carried out by the Secretary of Health and 
                Human Services under section 2801 of the Public 
                Health Service Act in the event of a public 
                health emergency and incidents covered by the 
                National Response Plan developed pursuant to 
                section 502(6) of the Homeland Security Act of 
                2002, or any successor plan; and
                  (D) providing medical logistical support to 
                the National Disaster Medical System and the 
                Secretary of Health and Human Services as 
                necessary, on a reimbursable basis, and in 
                coordination with other designated Federal 
                agencies.
    (b) * * *

           *       *       *       *       *       *       *

    (c) Tracking of pharmaceuticals and medical supplied and 
equipment.--The Secretary shall develop and maintain a 
centralized system for tracking the current location and 
availability of pharmaceuticals, medical supplies, and medical 
equipment throughout the Department health care system in order 
to permit the ready identification and utilization of such 
pharmaceuticals, supplies, and equipment for a variety of 
purposes, including responses to [a chemical or biological 
attack or other terrorist attack.] a public health emergency. 
The Secretary shall, through existing medical procurement 
contracts, and on a reimbursable basis, make available as 
necessary, medical supplies, equipment, and pharmaceuticals in 
response to a public health emergency in support of the 
Secretary of Health and Human Services.
    (d) Training.--The Secretary, shall ensure that the 
Department centers, in consultation with the accredited medical 
school affiliates of such medical centers, [develop and] 
implement curricula to train resident physicians and health 
care personnel in medical matters relating to [biological, 
chemical, or radiological attacks] public health emergencies or 
attacks from an incendiary or other explosive weapon consistent 
with section 319F(a) of the Public Health Service Act.
    (e) Participation in National Disaster Medical System.--(1) 
The Secretary shall establish and maintain a training program 
to facilitate the participation of the staff of Department 
medical centers, and of the community partners of such centers, 
in the National Disaster Medical System established pursuant to 
section [2811(b)] 2812 of the Public Health Service Act (42 
U.S.C. 300hh-11(b)).
    (2) The Secretary shall establish and maintain the training 
program under paragraph 91) in accordance with the 
recommendations of the working group on the prevention, 
preparedness, and response to [bioterrorism and other] public 
health emergencies established under section [319F(a)] 319F of 
the Public Health Service Act (42 U.S.C. 247d-6(a)).

           *       *       *       *       *       *       *

    (g) Authorization of Appropriations.--There are authorized 
to be appropriated, such sums as may be necessary to carry out 
this section for each of fiscal years 2007 through 2011.

           *       *       *       *       *       *       *