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<bill bill-stage="Introduced-in-House" bill-type="olc" dms-id="H42BE210A493A46918F5269E474B59E17" key="H" public-private="public"><metadata xmlns:dc="http://purl.org/dc/elements/1.1/">
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<dc:title>116 HR 4228 IH: Rare disease Advancement, surveillance Research, and Education Act of 2019</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2019-09-06</dc:date>
<dc:format>text/xml</dc:format>
<dc:language>EN</dc:language>
<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights>
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<form>
<distribution-code display="yes">I</distribution-code><congress display="yes">116th CONGRESS</congress><session display="yes">1st Session</session><legis-num display="yes">H. R. 4228</legis-num><current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber><action display="yes"><action-date date="20190906">September 6, 2019</action-date><action-desc><sponsor name-id="C001072">Mr. Carson of Indiana</sponsor> (for himself, <cosponsor name-id="H001067">Mr. Hudson</cosponsor>, <cosponsor name-id="B001285">Ms. Brownley of California</cosponsor>, <cosponsor name-id="B001275">Mr. Bucshon</cosponsor>, <cosponsor name-id="D000191">Mr. DeFazio</cosponsor>, <cosponsor name-id="D000610">Mr. Deutch</cosponsor>, <cosponsor name-id="F000466">Mr. Fitzpatrick</cosponsor>, <cosponsor name-id="J000032">Ms. Jackson Lee</cosponsor>, <cosponsor name-id="L000570">Mr. Luján</cosponsor>, <cosponsor name-id="M000087">Mrs. Carolyn B. Maloney of New York</cosponsor>, <cosponsor name-id="M001160">Ms. Moore</cosponsor>, <cosponsor name-id="M001202">Mrs. Murphy</cosponsor>, <cosponsor name-id="N000147">Ms. Norton</cosponsor>, <cosponsor name-id="R000606">Mr. Raskin</cosponsor>, <cosponsor name-id="R000616">Mr. Rouda</cosponsor>, <cosponsor name-id="S001201">Mr. Suozzi</cosponsor>, and <cosponsor name-id="W000813">Mrs. Walorski</cosponsor>) introduced the following bill; which was referred to the <committee-name committee-id="HIF00">Committee on Energy and Commerce</committee-name></action-desc></action><legis-type>A BILL</legis-type><official-title display="yes">To expand and improve the programs and activities of the Department of Health and Human Services
			 for awareness, education, research, surveillance, diagnosis, and treatment
			 concerning rare diseases and conditions.</official-title></form>
	<legis-body id="H247929F3AB6844DD91897BA933A272BC" style="OLC">
 <section id="HEFF02CCE69EF45E0A37E6253A7F81F10" section-type="section-one"><enum>1.</enum><header>Short title</header><text display-inline="no-display-inline">This Act may be cited as the <quote><short-title>Rare disease Advancement, surveillance Research, and Education Act of 2019</short-title></quote> or the <quote><short-title>RARE Act of 2019</short-title></quote>.</text> </section><section id="H319077E4B2194983AE1732DFE9D5303C"><enum>2.</enum><header>NIH rare disease regional centers of excellence</header><text display-inline="no-display-inline">Paragraph (1) of section 402A(a) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/282a">42 U.S.C. 282a(a)</external-xref>) is amended by adding at the end the following: <quote>In addition to the amounts authorized to be appropriated by the preceding sentence, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2020 through 2024 for carrying out section 481A (relating to rare disease regional centers of excellence).</quote>.</text>
 </section><section id="H82DFB4C0F9344122B09F36A4E98AD554"><enum>3.</enum><header>CDC Surveillance of Rare Diseases and Conditions</header><text display-inline="no-display-inline">Title III of the Public Health Service Act is amended by inserting after section 317T of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/247b-22">42 U.S.C. 247b–22</external-xref>) the following:</text>
			<quoted-block id="HD5B49EEF932A44F58BB3916CC901EB1A" style="OLC">
				<section id="H68A8D844737843CEA63E167D9804EC18"><enum>317U.</enum><header>CDC surveillance of rare diseases and conditions</header>
 <subsection id="H2BF87FB1C7604FE89CE0A744FF4FC929"><enum>(a)</enum><header>In general</header><text>The Secretary may, as appropriate—</text> <paragraph id="H7CFD8F74803E44D2A6783A0B90B4CBDD"><enum>(1)</enum><text>enhance and expand infrastructure and activities to track the epidemiology of up to 4 rare diseases and conditions selected under subsection (c)(1); and</text>
 </paragraph><paragraph id="HE6B57BD6136040368BA1B06B96FB80F3"><enum>(2)</enum><text>incorporate information obtained through such activities into an integrated surveillance system to be known as the National Rare Disease or Condition Surveillance System.</text>
 </paragraph></subsection><subsection id="HE273636BC4834CFE9A43052D08620818"><enum>(b)</enum><header>Research</header><text>The Secretary shall ensure that the National Rare Disease or Condition Surveillance System is designed in a manner that provides information that facilitates further research on rare diseases and conditions.</text>
 </subsection><subsection id="H4E53746FF288405C8916704DF896EA4F"><enum>(c)</enum><header>Content</header><text>In carrying out subsection (a), the Secretary—</text> <paragraph id="H6725EB34D1B9439BAD5F808B2F462A8A"><enum>(1)</enum><text display-inline="yes-display-inline">shall select up to 4 rare diseases and conditions that are determined by the Secretary to have—</text>
 <subparagraph id="HA3F48D40C8C740989554FDF2524B3944"><enum>(A)</enum><text>a high rate of mortality or morbidity; or</text> </subparagraph><subparagraph id="H1672008A62CE4922B9EDD379C9783192"><enum>(B)</enum><text>potential for meaningful research and treatment;</text>
 </subparagraph></paragraph><paragraph id="H680B6B382A8F4611A6D6C9107BBD4713"><enum>(2)</enum><text>shall provide for the collection and storage of information on the incidence and prevalence of such rare diseases and conditions in the United States;</text>
 </paragraph><paragraph id="H2F0A695927DD4BF68BE367CE74F87955"><enum>(3)</enum><text>to the extent practicable, shall provide for the collection and storage of other available information on such rare diseases and conditions, including information related to persons living with such a rare disease or condition who choose to participate in surveillance activities, and including information on—</text>
 <subparagraph id="HA21743C066DF48E59044003286B8D8B2"><enum>(A)</enum><text>demographics, such as age, race, ethnicity, sex, geographic location, family history, and other information, as appropriate;</text>
 </subparagraph><subparagraph id="HBCE8F3D19CAC45CFADFD7D460FF32F02"><enum>(B)</enum><text>risk factors that may be associated with the rare disease or condition, such as genetic and environmental risk factors and other information, as appropriate; and</text>
 </subparagraph><subparagraph id="H1240B1ED0BC04B1B996507B4421E659E"><enum>(C)</enum><text>diagnosis and progression markers;</text> </subparagraph></paragraph><paragraph id="H77646EFC5EE04861B4F76C36CCF6DC33"><enum>(4)</enum><text>to the extent practicable, shall provide for the collection and storage of information relevant to analysis on such rare diseases and conditions, such as information concerning—</text>
 <subparagraph id="HCE4CB91EFB7E4166B853703E281C2B77"><enum>(A)</enum><text>the natural history of the diseases and conditions;</text> </subparagraph><subparagraph id="H23B78B5BE13D451D9F3DB001CC48AEB0"><enum>(B)</enum><text>the prevention of the disease or condition, including secondary diseases and conditions;</text>
 </subparagraph><subparagraph id="HA4A7CAD1927B4D8AB38E7BF55EF84C83"><enum>(C)</enum><text>the detection, management, and treatment approaches for the diseases and conditions; and</text> </subparagraph><subparagraph id="H55CC2F313D574FB08BB54C123348F8F1"><enum>(D)</enum><text>the development of outcomes measures; and</text>
 </subparagraph></paragraph><paragraph id="HCA72870418424DC089F01CE1368436F4"><enum>(5)</enum><text>may address issues identified during the consultation process under subsection (d).</text> </paragraph></subsection><subsection id="H946EF39A24ED42D8A5914D72653FAAE9"><enum>(d)</enum><header>Consultation</header><text>In carrying out this section, the Secretary shall consult with individuals with appropriate expertise, which may include—</text>
 <paragraph id="H4534D93EDEA24038B117A36AD7C49135"><enum>(1)</enum><text>epidemiologists with experience in disease surveillance;</text> </paragraph><paragraph id="HFF6967AD90DA44649D659EC8C112C64D"><enum>(2)</enum><text>representatives of national voluntary health associations that—</text>
 <subparagraph id="H8872F05BCF1E4958A9570B1EC8246919"><enum>(A)</enum><text>focus on rare diseases or conditions; and</text> </subparagraph><subparagraph id="H309F18E0F2944C4BAE3886D4423FFEA1"><enum>(B)</enum><text>have demonstrated experience in research, care, or patient services;</text>
 </subparagraph></paragraph><paragraph id="HDA796D3B80764166973F3EABB9B51480"><enum>(3)</enum><text>health information technology experts or other information management specialists;</text> </paragraph><paragraph id="H48590ACA61FF456FB9BDADA9998A41B1"><enum>(4)</enum><text>clinicians with expertise in rare diseases or conditions;</text>
 </paragraph><paragraph id="H52B43C17232F49CDB34A195264EC759F"><enum>(5)</enum><text>research scientists with expertise in rare diseases or conditions, or experience conducting translational research or utilizing surveillance systems for scientific research purposes; and</text>
 </paragraph><paragraph id="HFA4E691264C848EBB3C6A13CBCAB995D"><enum>(6)</enum><text>patients and caregivers of patients with rare diseases or conditions.</text> </paragraph></subsection><subsection id="HD5D7139F7F464860A5EB0FB934543EF9"><enum>(e)</enum><header>Grants</header><text>The Secretary may award grants to, or enter into contracts or cooperative agreements with, public or private nonprofit entities to carry out activities under this section.</text>
 </subsection><subsection id="HEE9F3A3E693048D78373DBF0000297EF"><enum>(f)</enum><header>Coordination with other Federal, State, and local agencies</header><text>Subject to subsection (h), the Secretary shall—</text> <paragraph id="H187502A371EB40F1802E224CB4DE65B9"><enum>(1)</enum><text>make information and analysis in the National Rare Disease or Condition Surveillance System available, as appropriate—</text>
 <subparagraph id="H8D8878335C2C4E4CB589107159230742"><enum>(A)</enum><text>to Federal departments and agencies, such as the National Institutes of Health and the Department of Veterans Affairs; and</text>
 </subparagraph><subparagraph id="HBB8E99ADBA9D4C47927B55D974194D58"><enum>(B)</enum><text>to State and local agencies; and</text> </subparagraph></paragraph><paragraph id="H939CB93496D94D5C9C637E3A4622A7C9"><enum>(2)</enum><text>identify, build upon, leverage, and coordinate among existing data and surveillance systems, surveys, registries, and other Federal public health infrastructure, wherever practicable.</text>
 </paragraph></subsection><subsection id="H6C77222C048141678B96D10FBC34C382"><enum>(g)</enum><header>Public access</header><text>Subject to subsection (h), the Secretary shall ensure that information and analysis in the National Rare Disease or Conditions Surveillance System are available, as appropriate, to the public, including researchers.</text>
 </subsection><subsection id="H80E47CA1E54E4E9C8F0BA2961137DBCF"><enum>(h)</enum><header>Privacy</header><text>The Secretary shall ensure that information and analysis in the National Rare Disease or Condition Surveillance System are made available only to the extent permitted by applicable Federal and State law, and in a manner that protects personal privacy, to the extent required by applicable Federal and State privacy law, at a minimum.</text>
 </subsection><subsection id="HF75A3354539E47F8BF1E80B7740D41B3"><enum>(i)</enum><header>Supplement not supplant</header><text display-inline="yes-display-inline">The activities under this section may supplement, but shall not supplant, any activities with respect to spina bifida, muscular dystrophy, or fragile X syndrome that are ongoing as of the date of enactment of this section.</text>
					</subsection><subsection id="H9599BD5C3B8E4817A5696106F1593853"><enum>(j)</enum><header>Reports</header>
 <paragraph id="HA3F39FC1D3904FF6A55A09413E380FF0"><enum>(1)</enum><header>Report on information and analyses</header><text>Not later than 2 years after the date on which any system is established under this section, the Secretary shall submit an interim report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives regarding aggregate information collected pursuant to this section and epidemiological analyses, as appropriate. Such report shall be posted on the Internet website of the Department of Health and Human Services and shall be updated biennially.</text>
 </paragraph><paragraph id="HD0AD3D644F6F4E399642371C9988F2D8"><enum>(2)</enum><header>Implementation report</header><text>Not later than 4 years after the date of the enactment of this section, the Secretary shall submit a report to the Congress concerning the implementation of this section. Such report shall include information on—</text>
 <subparagraph id="H5802FBDEE02F4128AB8AB5CED950E1EC"><enum>(A)</enum><text>the development and maintenance of the National Rare Disease or Condition Surveillance System;</text> </subparagraph><subparagraph id="H6D12579EDA1448E498BB04578064FD28"><enum>(B)</enum><text>the type of information collected and stored in the surveillance system;</text>
 </subparagraph><subparagraph id="H37DFBACB7AC6416FA9AD6ADEFBB77B7D"><enum>(C)</enum><text>the use and availability of such information, including guidelines for such use; and</text> </subparagraph><subparagraph id="H3FEA506EEB2E4D7F8C56D211095213E8"><enum>(D)</enum><text>the use and coordination of databases that collect or maintain information on rare diseases or conditions.</text>
 </subparagraph></paragraph></subsection><subsection id="HC43BC657D8004FEB98D9E1C920F666BA"><enum>(k)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="H6319672803F34A3D91D90196492B08A8"><enum>(1)</enum><header>National voluntary health association</header><text>The term <term>national voluntary health association</term> means a national nonprofit organization with chapters, other affiliated organizations, or networks in States throughout the United States with experience serving the population of individuals with a rare disease or condition and have demonstrated experience in rare disease or condition research, care, and patient services.</text>
 </paragraph><paragraph id="HB2A825E7D8C74316A5001DB90753649D"><enum>(2)</enum><header>Rare</header><text>The term <term>rare</term>, with respect to a disease or condition, means having a prevalence of fewer than 200,000 individuals in the United States.</text>
 </paragraph></subsection><subsection id="HCFDDEE59FE9B49A1A53FAC9AC2C0A33C"><enum>(l)</enum><header>Authorization of appropriations</header><text>To carry out this section, there are authorized to be appropriated $10,000,000 for each of fiscal years 2020 through 2025.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
		</section><section id="HB73D1A144B9445E68EE211A34B554257"><enum>4.</enum><header>Increasing health professionals’ awareness of rare diseases</header>
 <subsection id="HC1A121BB31A246C99D3960CC0D07C362"><enum>(a)</enum><header>In general</header><text>The Director of the Agency for Healthcare Research and Quality shall expand and intensify the activities of the Agency to increase the awareness and knowledge of health care providers about rare diseases and conditions.</text>
 </subsection><subsection id="H91019BBAA30E460D8AD0EFC4CC1BA82F"><enum>(b)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section, the term <term>rare diseases and conditions</term>, with respect to a disease or condition, means having a prevalence of fewer than 200,000 individuals in the United States.</text>
			</subsection></section><section id="H0619D270E09D47CEBA116EAF0E1019D3"><enum>5.</enum><header>Report</header>
 <subsection id="H19F1D7E910F54AD097CCC0B1D3A4CE92"><enum>(a)</enum><header>In general</header><text>The Secretary of Health and Human Services shall seek to enter into an arrangement with the National Academies (or another appropriate entity if the National Academies decline) to update and republish, by not later than 3 years after the date of enactment of this Act, the 2010 report of the National Academies entitled <quote>Rare Diseases and Orphan Products: Accelerating Research and Development</quote>.</text>
 </subsection><subsection id="H3BDDA04AA7444CD18575E5917AEA6FA9"><enum>(b)</enum><header>Authorization of appropriations</header><text>To carry out this section, there is authorized to be appropriated $1,000,000.</text> </subsection></section></legis-body></bill> 

