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[From the U.S. Government Publishing Office]


111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     111-647
======================================================================
 
                 DENTAL EMERGENCY RESPONDER ACT OF 2010

                                _______
                                

 September 28, 2010.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Waxman, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 903]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 903) to amend the Public Health Service Act to 
enhance the roles of dentists and allied dental personnel in 
the Nation's disaster response framework, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Consideration..........................................     2
Committee Votes..................................................     3
Committee Oversight Findings and Recommendations.................     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Statement of General Performance Goals and Objectives............     3
Constitutional Authority Statement...............................     3
Earmarks and Tax and Tariff Benefits.............................     3
Federal Advisory Committee Statement.............................     4
Applicability of Law to Legislative Branch.......................     4
Federal Mandates Statement.......................................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Cost Estimate........................     4
Section-by-Section Analysis of the Legislation...................     5
Explanation of Amendment.........................................     5
Changes in Existing Law Made by the Bill, as Reported............     6

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Dental Emergency Responder Act of 
2010''.

SEC. 2. DENTAL EMERGENCY RESPONDERS: PUBLIC HEALTH AND MEDICAL 
                    RESPONSE.

  (a) National Health Security Strategy.--Section 2802(b)(3) of the 
Public Health Service Act (42 U.S.C. 300hh-1(b)(3)) is amended--
          (1) in the matter preceding subparagraph (A), by inserting 
        ``and which may include dental health facilities'' after 
        ``mental health facilities''; and
          (2) in subparagraph (D), by inserting ``(which may include 
        such dental health assets)'' after ``medical assets''.
  (b) All-Hazards Public Health and Medical Response Curricula and 
Training.--Section 319F(a)(5)(B) of the Public Health Service Act (42 
U.S.C. 247d-6(a)(5)(B)) is amended by striking ``public health or 
medical'' and inserting ``public health, medical, or dental''.

SEC. 3. DENTAL EMERGENCY RESPONDERS: HOMELAND SECURITY.

  (a) National Response Framework.--Paragraph (6) of section 2 of the 
Homeland Security Act of 2002 (6 U.S.C. 101) is amended by inserting 
``and dental'' after ``emergency medical''.
  (b) National Preparedness System.--Subparagraph (B) of section 
653(b)(4) of the Post-Katrina Emergency Management Reform Act of 2006 
(6 U.S.C. 753(b)(4)) is amended by striking ``public health and 
medical'' and inserting ``public health, medical, and dental''.
  (c) Chief Medical Officer.--Paragraph (5) of section 516(c) of the 
Homeland Security Act of 2002 (6 U.S.C. 321e(c)) is amended by striking 
``medical community'' and inserting ``medical and dental communities''.

                          Purpose and Summary

    H.R. 903, the ``Dental Emergency Responder Act of 2010'', 
was introduced on February 4, 2009, by Rep. Bart Stupak (D-MI) 
and subsequently referred to the Committee on Energy and 
Commerce.
    The goal of H.R. 903 is to include dental professionals and 
facilities into various components of the nation's emergency 
response preparedness framework.

                  Background and Need for Legislation

    Recent disasters--the terrorist attacks of September 11, 
2001, and Hurricanes Katrina and Rita--have made clear the 
critical need for a prepared, robust national medical response 
structure. Currently, however, the term ``medical responder'' 
(as used in relevant disaster-related federal law) does not 
include an important part of such a structure--dentists, allied 
dental personnel, and dental facilities. These individuals and 
offices are both eager and willing to participate and otherwise 
assist in supporting medical and public health responses to 
disasters. The purpose of this legislation is to provide them 
with the statutory authority to do so. With minimal additional 
training, they could readily fit into an all-hazards emergency 
healthcare response effort.

                        Committee Consideration

    H.R. 903, the ``Dental Emergency Responder Act of 2010'', 
was introduced by Rep. Stupak (D-MI) on February 4, 2009, and 
referred to the Committee on Energy and Commerce. The bill was 
subsequently referred to the Subcommittee on Health on February 
9, 2009. The Subcommittee met in open markup session to 
consider H.R. 903 on July 22, 2010. An amendment in the nature 
of a substitute (manager's amendment) by Subcommittee Chairman 
Pallone was adopted by a voice vote. Subsequently, H.R. 903 was 
forwarded to the full Committee, amended, by a voice vote.
    On July 28, 2010, the Committee on Energy and Commerce met 
in open markup session and considered H.R. 903 as approved by 
the Subcommittee. There were no amendments offered in full 
Committee and subsequently the Committee ordered H.R. 903 
favorably reported to the House, as amended by the Subcommittee 
on Health, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Waxman ordering H.R. 903 reported to the House, 
as amended, was approved by a voice vote. There were no record 
votes taken during consideration of this bill.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the oversight findings and recommendations of the Committee are 
reflected in the descriptive portions of this report, including 
the finding that dentists, allied dental personnel, and dental 
facilities should be incorporated into the nation's emergency 
response preparedness framework.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee adopts 
as its own the analysis of H.R. 903 prepared by the Director of 
the Congressional Budget Office.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the performance goals and 
objectives of the Committee are reflected in the descriptive 
portions of this report, including the goal to incorporate 
dentists, allied dental personnel, and dental facilities into 
the nation's emergency response preparedness framework.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
constitutional authority for H.R. 903 is provided under Article 
I, section 8, clauses 3 and 18 of the Constitution of the 
United States.

                  Earmarks and Tax and Tariff Benefits

    H.R. 903 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the 
House of Representatives.

                  Federal Advisory Committee Statement

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., section 5(b) of the Federal 
Advisory Committee Act.

             Applicability of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to terms and conditions of 
employment or access to public services and accommodations. 
H.R. 903 contains no such provisions.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act of 1974 (as amended by section 101(a)(2) of the 
Unfunded Mandates Reform Act, P.L. 104-4) requires a statement 
on whether the provisions of the report include unfunded 
mandates. In compliance with this requirement the Committee 
adopts as its own the estimates of federal mandates prepared by 
the Director of the Congressional Budget Office.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(2) of rule XIII of the Rules of the 
House of Representatives, the Committee adopts as its own the 
cost estimate of H.R. 903 prepared by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    With respect to the requirements of clause 3(c)(3) of rule 
XIII of the Rules of the House of Representatives and section 
402 of the Congressional Budget Act of 1974, the Committee has 
received the following cost estimate for H.R. 903 from the 
Director of Congressional Budget Office:

                                                   August 27, 2010.
Hon. Henry A. Waxman,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 903, the Dental 
Emergency Responder Act of 2010.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 903--Dental Emergency Responder Act of 2010

    H.R. 903 would amend responsibilities of federal agencies 
that are tasked with developing and implementing the National 
Health Security Strategy under the Public Health Service Act 
and the National Response Plan under the Homeland Security Act 
of 2002. The bill would direct the Secretary of Health and 
Human Services to include, under the preparedness goals of the 
National Health Security Strategy, dental health facilities as 
entities to prepare for and respond to public health 
emergencies. The bill also would include dental personnel 
within the definition of emergency response provider and 
require federal agencies with responsibilities under the 
National Response Plan to address the preparedness and 
deployment of dental resources.
    Based on the cost of similar requirements, CBO estimates 
that implementing H.R. 903 would have a negligible impact on 
federal spending over the next five years; any additional 
spending would be subject to the availability of appropriated 
funds. Enacting this legislation would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures do 
not apply.
    H.R. 903 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Lisa Ramirez-
Branum. The estimate was approved by Peter H. Fontaine, 
Assistant Director for Budget Analysis.

             Section-by-Section Analysis of the Legislation


Section 1. Short title; table of contents

    Section 1 designates the short title of the Act as the 
``Dental Emergency Responder Act of 2010''.

Section 2. Dental emergency responders: public health and medical 
        response

    Section 2(a) amends section 2802(b)(3) of the Public Health 
Service Act to include dental health facilities in the National 
Health Security Strategy.
    Section 2(b) amends section 319F(a)(5)(B) of the Public 
Health Service Act to include dental entities in the All-
Hazards Public Health and Medical Response Curricula and 
Training.

Section 3. Dental emergency responders: homeland security

    Section 3(a) amends paragraph 6 of section 2 of the 
Homeland Security Act of 2002 to include dental providers in 
the National Response Framework.
    Section 3(b) amends subparagraph (B) of section 653(b)(4) 
of the Post-Katrina Emergency Management Reform Act of 2006 to 
include dental resources in the National Preparedness System.
    Section 3(c) amends paragraph (5) of section 516(c) of the 
Homeland Security Act to include coordination with the dental 
community as a responsibility of the Chief Medical Officer of 
the Department of Homeland Security.

                        Explanation of Amendment

    Rep. Pallone (D-NJ) offered an amendment in the nature of a 
substitute during Subcommittee mark up. This amendment made two 
technical changes in the bill clarifying that the Department of 
Health and Human Services has the discretion, but is not 
required, to include dentists and dental facilities in the 
national response framework. The amendment was adopted by voice 
vote.

         Changes in Existing Law Made by the Bill, as Reported

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

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *



Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



SEC. 319F. PUBLIC HEALTH COUNTERMEASURES TO A BIOTERRORIST ATTACK.

  (a) All-Hazards Public Health and Medical Response Curricula 
and Training.--
          (1) * * *

           *       *       *       *       *       *       *

          (5) Dissemination and training.--
                  (A) * * *
                  (B) Certain entities.--The education and 
                training activities described in subparagraph 
                (A) may be carried out by Federal [public 
                health or medical] public health, medical, or 
                dental entities, appropriate educational 
                entities, professional organizations and 
                societies, private accrediting organizations, 
                and other nonprofit institutions or entities 
                meeting criteria established by the Secretary.

           *       *       *       *       *       *       *


   TITLE XXVIII--NATIONAL ALL-HAZARDS PREPAREDNESS FOR PUBLIC HEALTH 
                              EMERGENCIES

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

           *       *       *       *       *       *       *


SEC. 2802. NATIONAL HEALTH SECURITY STRATEGY.

  (a) * * *
  (b) Preparedness Goals.--The National Health Security 
Strategy shall include provisions in furtherance of the 
following:
          (1) * * *

           *       *       *       *       *       *       *

          (3) Medical.--Increasing the preparedness, response 
        capabilities, and surge capacity of hospitals, other 
        health care facilities (including mental health 
        facilities and which may include dental 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) * * *

           *       *       *       *       *       *       *

                  (D) Effective utilization of any available 
                public and private mobile medical assets (which 
                may include such dental health assets) and 
                integration of other Federal assets.

           *       *       *       *       *       *       *

                              ----------                              


HOMELAND SECURITY ACT OF 2002

           *       *       *       *       *       *       *



SEC. 2. DEFINITIONS.

  In this Act, the following definitions apply:
          (1) * * *

           *       *       *       *       *       *       *

          (6) The term ``emergency response providers'' 
        includes Federal, State, and local governmental and 
        nongovernmental emergency public safety, fire, law 
        enforcement, emergency response, emergency medical and 
        dental (including hospital emergency facilities), and 
        related personnel, agencies, and authorities.

           *       *       *       *       *       *       *


TITLE V--NATIONAL EMERGENCY MANAGEMENT

           *       *       *       *       *       *       *


SEC. 516. CHIEF MEDICAL OFFICER.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Responsibilities.--The Chief Medical Officer shall have 
the primary responsibility within the Department for medical 
issues related to natural disasters, acts of terrorism, and 
other man-made disasters, including--
          (1) * * *

           *       *       *       *       *       *       *

          (5) serving as the Department's primary point of 
        contact for State, local, and tribal governments, the 
        [medical community] medical and dental communities, and 
        others within and outside the Department, with respect 
        to medical and public health matters;

           *       *       *       *       *       *       *

                              ----------                              


POST-KATRINA EMERGENCY MANAGEMENT REFORM ACT OF 2006

           *       *       *       *       *       *       *



TITLE VI--NATIONAL EMERGENCY MANAGEMENT

           *       *       *       *       *       *       *


             Subtitle C--Comprehensive Preparedness System

CHAPTER 1--NATIONAL PREPAREDNESS SYSTEM

           *       *       *       *       *       *       *



SEC. 653. FEDERAL PREPAREDNESS.

  (a) * * *
  (b) Operational Plans.--An operations plan developed under 
subsection (a)(4) shall meet the following requirements:
          (1) * * *

           *       *       *       *       *       *       *

          (4) The operations plan shall address, as 
        appropriate, the following matters:
                  (A) * * *
                  (B) The preparedness and deployment of 
                [public health and medical] public health, 
                medical, and dental resources, including 
                resources to address the needs of evacuees and 
                populations with special needs.

           *       *       *       *       *       *       *