[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2792 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 2792

 To revise and extend certain provisions of the Public Health Security 
        and Bioterrorism Preparedness and Response Act of 2002.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 11, 2006

   Mr. Gregg introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To revise and extend certain provisions of the Public Health Security 
        and Bioterrorism Preparedness and Response Act of 2002.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Emergency Preparedness and Response 
Security, Accountability, and Flexibility Enhancement Act'' or the 
``SAFE Act''.

SEC. 2. ACCOUNTABILITY WITH RESPECT TO PREPAREDNESS FUNDING.

    (a) In General.--Section 319C-1 of the Public Health Service Act 
(42 U.S.C. 247d-3a) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (B), by striking the 
                        period and inserting ``; or''; and
                            (iii) by adding at the end the following:
                    ``(C) a consortium of States that, with respect to 
                the States that make up the consortium, comply with the 
                requirements of subparagraph (A) individually or as 
                part of the consortium.''; and
                    (B) by adding at the end the following:
            ``(3) Achievement of measurable critical benchmarks and 
        performance measures.--In making awards under subsection (a), 
        the Secretary shall develop and require the application of 
        measurable critical benchmarks and performance standards so 
        that grantees can demonstrate achievement with respect to such 
        benchmarks and measures in a reasonable timeframe, as 
        determined by the Secretary. Such benchmarks and measures shall 
        require grantees to--
                    ``(A) annually report grant expenditures to the 
                Secretary and the Secretary of Homeland Security who 
                shall ensure that such information is included on the 
                Federal-Internet based point of access developed under 
                section 2(b) of the SAFE Act; and
                    ``(B) at a minimum, annually test and exercise the 
                emergency preparedness capabilities of the grantee, 
                acting in coordination with the applicable State 
                readiness plan under subsection (c), based on criteria 
                established by the Secretary and the Secretary of 
                Homeland Security.
            ``(4) 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--
                    ``(A) enhance coordination--
                            ``(i) among one or more health care 
                        institutions, including but not limited to 
                        Federal Government medical facilities, academic 
                        medical centers, clinics, health centers, 
                        primary care facilities, or nursing homes; and
                            ``(ii) between entities described in clause 
                        (i) and one or more States, sub-State regions 
                        of States or other sub-State groups, or any 
                        combination of States and sub-State regions; 
                        and
                    ``(B) serve the needs of a defined geographic 
                area.'';
            (2) in subsection (h)--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(3) coordinate with the Secretary of Homeland Security to 
        prevent the duplicative funding of programs or activities and 
        to ensure that the use of awards is in compliance with State 
        plans.'';
            (3) by striking subsection (j) and inserting the following:
    ``(j) Funding.--
            ``(1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated, $1,300,000,000 
        for fiscal year 2007, and such sums as may be necessary for 
        each of fiscal years 2008 through 2010, of which--
                    ``(A) not to exceed $875,000,000 shall be made 
                available in each fiscal year for making awards under 
                subsection (a) to States, notwithstanding the 
                eligibility conditions under subsection (j) (as such 
                subsection existed on the day before the date of 
                enactment of the Emergency Preparedness and Response 
                Security, Accountability, and Flexibility Enhancement 
                Act, for the purpose of enhancing the all-hazards 
                emergency preparedness and medical response 
                capabilities of States; and
                    ``(B) not to exceed 5 percent of the amount made 
                available under subparagraph (A) for each fiscal year 
                shall be made available for Federal, State, and local 
                planning and administrative activities related to 
                awards described in such subparagraph.
            ``(2) Contingent additional authorization.--If a 
        significant change in circumstances warrants an increase in 
        this amount authorized to be appropriated under paragraph (1) 
        for fiscal year 2007, 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 under 
        paragraph (1).
            ``(3) 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.
            ``(4) Degree of risk.--
                    ``(A) In general.--For fiscal year 2006 and any 
                subsequent fiscal year, the Secretary, in coordination 
                with the Secretary of Homeland Security, shall, before 
                making awards pursuant to subsection (a) for such 
                year--
                            ``(i) reserve from the amount appropriated 
                        under paragraph (1) for the fiscal year an 
                        amount determined necessary by the Secretary to 
                        make awards under subsection (a) to eligible 
                        entities that face a particularly high degree 
                        of risk of such a threat, as determined by the 
                        Secretary in coordination with the Secretary of 
                        Homeland Security; and
                            ``(ii) after making the reservation 
                        required under clause (i), provide funds to 
                        eligible entities that have a significant unmet 
                        need, as determined by the Secretary, in 
                        coordination with the Secretary of Homeland 
                        Security, to build capacity to identify, 
                        detect, monitor, and respond to a public health 
                        emergency, which need will not otherwise be met 
                        by awards pursuant to subsection (a).
                    ``(B) Recipients of grants.--Awards pursuant to 
                subparagraph (A) may be supplemental awards to States 
                that receive awards pursuant to subsection (a), or may 
                be awards to eligible entities described in subsection 
                (b)(1)(B) within such States.
            ``(5) Matching requirement.--The Secretary may not make a 
        grant to a State under this section unless the State agrees 
        that, with respect to the costs to be incurred by the State in 
        carrying out the activities for which the grant was awarded, 
        the State will make available (directly or through donations 
        from public or private entities) non-Federal contributions 
        toward such costs in an amount equal to--
                    ``(A) with respect to a State with a population of 
                more than 2,000,000, not less than $1 for each $1 of 
                Federal funds provided in the grant; and
                    ``(B) with respect to a State with a population of 
                2,000,000 or less, not less than $1 for each $4 of 
                Federal funds provided in the grant.''; and
            (4) by adding at the end the following:
    ``(k) Return of Unobligated Funds.--Any portion of an award under 
subsection (a) that remains unobligated after the expiration of the 3-
year period beginning on the date on which the award is made shall be 
returned to the Secretary.''.
    (b) Single Point of Access.--The Secretary of Health and Human 
Services and the Secretary of Homeland Security shall jointly establish 
a single Federal Internet-based point of access to enable States and 
other entities to apply for available Federal assistance for public 
health and hospital preparedness and response to bioterrorism and other 
public health threats, including applying for awards under section 
319C-1 of the Public Health Service Act (42 U.S.C. 247d-3a).

SEC. 3. NATIONAL NOTIFIABLE DISEASE SURVEILLANCE PROGRAM.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended--
            (1) by striking section 314; and
            (2) by inserting after section 311, the following:

``SEC. 311A. NATIONAL NOTIFIABLE DISEASE SURVEILLANCE PROGRAM.

    ``(a) In General.--The Secretary is authorized to develop a real-
time surveillance program for collecting and reporting information on 
notifiable diseases and conditions.
    ``(b) Notifiable Diseases.--Not later than 180 days after the date 
of enactment of the Emergency Preparedness and Response Security, 
Accountability, and Flexibility Enhancement Act, and annually 
thereafter, the Secretary, in consultation with State and local health 
authorities and appropriate private professional societies, shall 
certify a list of infectious diseases, environmental exposures or 
poisons, and other conditions, the real-time surveillance and control 
of which, in each State and territory of the United States, constitute 
a critical public health need. For purposes of this part, the term 
`notifiable disease' means a disease, exposures or poison, or other 
condition that appears on the list under this section.
    ``(c) Federal Informatics Activities.--
            ``(1) In general.--In order to meet the urgent need for 
        critical electronic surveillance of notifiable diseases, the 
        Director of the Centers for Disease Control and Prevention, in 
        consultation with State and local health authorities, shall, 
        not later than 1 year after the date of enactment of the 
        Emergency Preparedness and Response Security, Accountability, 
        and Flexibility Enhancement Act, establish and maintain a 
        national electronic surveillance program that includes the 
        following components:
                    ``(A) Procedures to provide for the collection (in 
                a standardized form) and analysis of data on all 
                notifiable diseases and on certain other conditions 
                that States or regions elect to report to the program.
                    ``(B) A procedure to enable all major public and 
                private clinical laboratories to automatically report 
                data, in compliance with the regulations promulgated 
                under section 264(c) of the Health Insurance 
                Portability and Accountability Act of 1996, to the 
                program concerning notifiable diseases, antimicrobial 
                resistance testing, and other data determined 
                appropriate by the Director.
                    ``(C) A procedure to provide for syndromic and 
                disease-specific surveillance by monitoring, in 
                compliance with the regulations promulgated under 
                section 264(c) of the Health Insurance Portability and 
                Accountability Act of 1996, of private sector health-
                related electronic data (such as pharmaceutical 
                purchase data and health insurance claims data).
                    ``(D) A procedure to enable States to report data 
                on suspicious cases of conditions that are not on the 
                notifiable disease list but that may warrant further 
                investigation.
                    ``(E) A procedure to enable the program to 
                automatically identify certain trends and suspicious 
                patterns with respect to data reported to the program.
                    ``(F) A procedure to enable the program to provide 
                regular reports to regional, State, and local 
                government entities concerning disease trends, 
                suspicious disease patterns, incidence and prevalence 
                of diseases, laboratory data, and other information 
                determined appropriate. Such information shall include 
                data on comparative national disease trends.
                    ``(G) A procedure to enable the program to collect 
                and analyze data from certain seminal veterinary and 
                environmental sources where appropriate.
                    ``(H) A procedure to enable the program to export 
                data in a form appropriate for aggregation, statistical 
                analysis, and reporting.
                    ``(I) A procedure to enable the program to receive 
                and report data relating to non-notifiable diseases, 
                including vital records, registries, chronic disease, 
                and maternal and child health data.
            ``(2) Timeliness of reporting.--The procedures developed 
        under paragraph (1) for the reporting of data shall ensure that 
        such data are reported in a timely manner.
            ``(3) Private sector resources.--To meet the deadline 
        described in paragraph (1), the Director of the Centers for 
        Disease Control and Prevention may, on a temporary or permanent 
        basis, implement systems or products developed by the private 
        sector.
            ``(4) Authority for contracts.--In carrying out this 
        subsection, the Director of the Centers for Disease Control and 
        Prevention may enter into contracts with public and private 
        entities.
    ``(d) National Biointelligence Unit.--The Director of the Centers 
for Disease Control and Prevention shall analyze data maintained by the 
national electronic surveillance program under subsection (b), and data 
from other sources, to report on the prevalence and incidence of 
notifiable diseases and conditions, trends and patterns in public 
health, emerging health problems, regional differences, and other 
analyses determined appropriate by the Director of the Centers for 
Disease Control and Prevention.
    ``(e) Federal Technical Assistance, Communication, and 
Coordination.--
            ``(1) In general.--In carrying out this section, the 
        Secretary shall provide technical assistance to, and provide 
        for appropriate communications to the public, scientific, 
        public health and medical communities, and other key 
        stakeholders, and to provide for the coordination of the 
        activities of--
                    ``(A) State and local health authorities to 
                integrate State and local surveillance activities and 
                systems with the national notifiable disease 
                surveillance program developed under this section and 
                to generally improve State and local notifiable disease 
                reporting and communications; and
                    ``(B) private corporations, professional 
                associations, or other entities that may have sources 
                of surveillance data or access to health care 
                providers, health officials, or other individuals who 
                would need to participate in a surveillance program.
            ``(2) Financial assistance.--Assistance provided under 
        paragraph (1)(B) may include financial assistance for the 
        purpose of formatting or translating data into a form that is 
        most compatible and appropriate for use in the national 
        notifiable disease surveillance program developed under this 
        section.
            ``(3) Health alert registration and information.--
                    ``(A) Registration.--Each health care provider and 
                facility that receives funds under title XVIII of the 
                Social Security Act (42 U.S.C. 1395 et seq.) or that 
                receives funds under a State program under title XIX of 
                such Act (42 U.S.C. 1396 et seq.) shall annually submit 
                to the Secretary a registration that contains the e-
                mail address or fax number of the provider or facility 
                for purposes of enabling the Secretary to provide 
                health alerts in the case of a public health emergency 
                or other circumstance requiring active surveillance.
                    ``(B) Establishment of system.--The Secretary shall 
                establish a system to maintain the information provided 
                by providers and facilities under subparagraph (A). 
                Such system shall be designed--
                            ``(i) to enable providers and facilities--
                                    ``(I) to provide and update 
                                information contained in the system; 
                                and
                                    ``(II) to request information or to 
                                elect to receive additional types of 
                                non-emergency health alerts or 
                                communications; and
                            ``(ii) to enable the Director of the 
                        Centers for Disease Control and Prevention to 
                        provide updated contact information for 
                        providers and facilities to State and local 
                        health authorities for the purpose of emergency 
                        health communications.
    ``(f) Grants to States for Disease Reporting.--
            ``(1) Grants.--The Secretary shall award grants to States 
        to enable such States to conduct passive, active, and when 
        appropriate syndromic surveillance, and timely reporting 
        activities with respect to notifiable diseases.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1), a State shall prepare and submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may require, 
        including--
                    ``(A) a description of the manner in which grants 
                funds will be used to enhance the timeliness and 
                comprehensiveness of the State's effort to report 
                notifiable diseases to the program under subsection 
                (c); and
                    ``(B) a plan for identifying and reporting to the 
                Secretary the identity of health care providers and 
                facilities that consistently fail to report to the 
                State instances of notifiable diseases in a timely 
                manner.
            ``(3) Enhanced grant.--In the case of a State that submits 
        a plan, as part of the application under paragraph (2), to 
        transition State and local reporting of notifiable diseases to 
        an electronic system that is compatible with the program under 
        subsection (c), the amount of the grant awarded to a State 
        under paragraph (1) shall be increased by an amount determined 
        by the Secretary to be necessary to complete such transition.
            ``(4) Supplement not supplant funds for activities.--A 
        State shall use amounts received under a grant under this 
        subsection to supplement and not supplant other funds made 
        available by the State for the conduct of reporting activities 
        with respect to notifiable diseases.
            ``(5) Reduction in block grant funding.--For fiscal year 
        beginning with fiscal year 2008, if the Secretary determines 
        that a State is not reporting all notifiable diseases to the 
        program established under subsection (c) in a timely manner 
        through the use of an electronic system that is compatible with 
        the program, the State shall not be eligible to receive a grant 
        under part A of title XIX for such fiscal year.
            ``(6) Failure to report.--A health care provider or 
        facility shall not be eligible to receive funds under title 
        XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or 
        under a State program under title XIX of such Act (42 U.S.C. 
        1396 et seq.) if the Secretary determines, based on a State 
        notification received under the plan described in paragraph 
        (2)(B), that such provider or facility has consistently failed 
        to report, in a timely manner, instances of notifiable diseases 
        to the State for submission to the program under subsection 
        (c).
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 4. ENHANCING CRITICAL CAPACITY FOR ILLNESS DETECTION.

    Section 319C(c) of the Public Health Service Act (42 U.S.C. 247d-
3(c)) is amended--
            (1) in paragraph (3), by striking ``and'' at the end;
            (2) in paragraph (4), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(5) develop benchmarks for meeting critical capacity for 
        food or water borne disease detection and response.''.

SEC. 5. EVALUATION OF PUBLIC HEALTH CAPACITY OUTCOMES.

    Section 319C-1(b) of the Public Health Service Act (42 U.S.C. 247d-
3a(b)), as amended by section 2(a), is further amended by adding at the 
end the following:
            ``(5) Evaluation of public health capacity outcomes.--The 
        Director of the Centers for Disease Control and Prevention 
        shall enter into contracts with independent entities for the 
        periodic evaluation of the progress made by State and local 
        governments in meeting the benchmarks established in the plan 
        under paragraph (1)(A)(ii)(V).''.

SEC. 6. INSPECTION, SCREENING, AND QUARANTINING OF LIVE ANIMALS.

    Section 362 of the Public Health Service Act (42 U.S.C. 265) is 
amended by adding at the end the following: ``The Secretary shall 
establish procedures for the appropriate inspection, screening, and 
quarantine of live animals entering the United States for commercial 
purposes, including procedures to protect domestic animal and human 
populations from diseases carried by imported live animals''.

SEC. 7. NATIONAL DISASTER MEDICAL SYSTEM.

    (a) Coordination.--Section 2811(b) of the Public Health Service Act 
(42 U.S.C. 300hh-11) is amended by adding at the end the following:
            ``(4) Coordination of planning and preparedness 
        activities.--
                    ``(A) In general.--The Federal agency partners of 
                the National Disaster Medical System shall coordinate 
                all planning and preparedness activities of the 
                National Disaster Medical System with the Secretary of 
                Homeland Security in a manner that ensures that such 
                activities are consistent with the National Response 
                Plan, the National Incident Management System, and 
                Homeland Security Presidential Directives #5 and #8.
                    ``(B) Definition.--In this section, the term 
                `Federal agency partners of the National Disaster 
                Medical System' means the Department of Homeland 
                Security, the Department of Health and Human Services, 
                the Department of Defense, and the Department of 
                Veterans Affairs.'';
    (b) Joint Review.--Section 2811 of the Public Health Service Act 
(42 U.S.C. 300hh-11) is amended--
            (1) by redesignating subsection (h) as subsection (i); and
            (2) by inserting after subsection (g), the following:
    ``(h) Joint Review.--
            ``(1) In general.--Not later than December 31, 2007, the 
        Federal agency partners of the National Disaster Medical System 
        in coordination with the Secretary of Homeland Security shall 
        conduct a joint review of the National Disaster Medical System 
        infrastructure including organization, various teams, staffing 
        levels, training programs, equipment and supplies, supply chain 
        management and interoperability, and the role of each of the 
        Federal agency partners of the National Disaster Medical 
        System, and any other applicable issues.
            ``(2) Modifications.--Based on the results of the review 
        conducted under paragraph (1), the Secretary of Homeland 
        Security shall, with respect to the National Disaster Medical 
        System--
                    ``(A) modify the policies of the System for the 
                deployment of System assets during a national 
                emergency, including command and coordination, 
                licensure, credentialing or privileging, resource 
                typing and allocation, supplies and logistics, and 
                inter-agency and public communications;
                    ``(B) refine, standardize, and implement training 
                curricula for System participants based on the 
                modifications made under subparagraph (A), including 
                planning for continuing educational programs to ensure 
                that System participants are aware of programmatic 
                changes within the System; and
                    ``(C) refine, implement, and maintain standards for 
                System staffing, equipment, and supply-chain management 
                to ensure the adequacy of available assets in the 
                System.''.
    (c) Miscellaneous Provisions.--Section 2811 of the Public Health 
Service Act (42 U.S.C. 300hh-11) is amended--
            (1) in subsection (b)(3)--
                    (A) in subparagraph (A)--
                            (i) by redesignating clauses (i) and (ii) 
                        as clauses (ii) and (iii), respectively; and
                            (ii) by inserting before clause (ii) (as so 
                        redesignated), the following:
                            ``(i) provide an initial rapid Federal 
                        medical response, consistent with the National 
                        Response Plan and National Incident Management 
                        System, to an emergency and to maintain 
                        capability to sustain disaster medical 
                        operations through an established transition 
                        period as determined by the Federal agency 
                        partners of the National Disaster Medical 
                        System;''; and
                    (B) by adding at the end the following:
                    ``(D) Continued monitoring of performance.--The 
                Secretary of Homeland Security, acting through the 
                Chief Medical Officer, shall design, develop, and 
                implement quantitative standards and metrics under 
                which programmatic changes with respect to the National 
                Disaster Medical System may be isolated, measured, 
                validated, and revised if needed on a real-time basis 
                as determined by the performance of the System in 
                drills and exercises or actual deployments.
                    ``(E) Nonduplication of activities.--The National 
                Disaster Medical System shall carry out activities in 
                coordination with Department of Health and Human 
                Services emergency response teams (including the 
                uniformed corps of the United States Public Health 
                Service and the Medical Reserve Corps) to minimize 
                duplicative activities.''; and
            (2) in subsection (i) (as so redesignated), by striking 
        ``2002 through 2006'' and inserting ``2006 through 2010''.
                                 <all>