[Congressional Record (Bound Edition), Volume 152 (2006), Part 17]
[Senate]
[Pages 22449-22460]
[From the U.S. Government Publishing Office, www.gpo.gov]




               PANDEMIC AND ALL-HAZARDS PREPAREDNESS ACT

  Mr. BURR. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 583, S. 3678.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A 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.

  There being no objection, the Senate proceeded to consider the bill 
which had been reported from the Committee on Health, Education, Labor 
and Pensions, with an amendment to strike all after the enacting clause 
and insert in lieu thereof the following:

                                 S. 3678

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Pandemic 
     and All-Hazards Preparedness Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

TITLE I--NATIONAL PREPAREDNESS AND RESPONSE, LEADERSHIP, ORGANIZATION, 
                              AND PLANNING

Sec. 101. Public health and medical preparedness and response functions 
              of the Secretary of Health and Human Services.
Sec. 102. Assistant Secretary for Preparedness and Response.
Sec. 103. National Health Security Strategy.

             TITLE II--PUBLIC HEALTH SECURITY PREPAREDNESS

Sec. 201. Improving State and local public health security.
Sec. 202. Using information technology to improve situational awareness 
              in public health emergencies.
Sec. 203. Public health workforce enhancements.
Sec. 204. Vaccine tracking and distribution.
Sec. 205. National Science Advisory Board for Biosecurity.

             TITLE III--ALL-HAZARDS MEDICAL SURGE CAPACITY

Sec. 301. National Disaster Medical System.
Sec. 302. Enhancing medical surge capacity.
Sec. 303. Encouraging health professional volunteers.
Sec. 304. Core education and training.
Sec. 305. Partnerships for state and regional hospital preparedness to 
              improve surge capacity.
Sec. 306. Enhancing the role of the Department of Veterans Affairs.

TITLE I--NATIONAL PREPAREDNESS AND RESPONSE, LEADERSHIP, ORGANIZATION, 
                              AND PLANNING

     SEC. 101. PUBLIC HEALTH AND MEDICAL PREPAREDNESS AND RESPONSE 
                   FUNCTIONS OF THE SECRETARY OF HEALTH AND HUMAN 
                   SERVICES.

       Title XXVIII of the Public Health Service Act (42 U.S.C. 
     300hh-11 et seq.) is amended--
       (1) by striking the title heading and inserting the 
     following:

  ``TITLE XXVIII--NATIONAL ALL-HAZARDS PREPAREDNESS FOR PUBLIC HEALTH 
                             EMERGENCIES'';

       (2) by amending subtitle A to read as follows:

``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. 102. ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE.

       (a) Assistant Secretary for Preparedness and Response.--
     Subtitle B of title XXVIII of the Public Health Service Act 
     (42 U.S.C. 300hh-11 et seq.) is amended--
       (1) in the subtitle heading, by inserting ``All-Hazards'' 
     before ``Emergency Preparedness'';
       (2) by redesignating section 2811 as section 2812;
       (3) by inserting after the subtitle heading the following 
     new section:

     ``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.

[[Page 22450]]

       ``(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.''; and
       (4) by striking ``Assistant Secretary for Public Health 
     Emergency Preparedness'' each place it appears and inserting 
     ``Assistant Secretary for Preparedness and Response''.
       (b) Transfer of Functions; References.--
       (1) Transfer of functions.--There shall be transferred to 
     the Office of the Assistant Secretary for Preparedness and 
     Response the functions, personnel, assets, and liabilities of 
     the Assistant Secretary for Public Health Emergency 
     Preparedness as in effect on the day before the date of 
     enactment of this Act.
       (2) References.--Any reference in any Federal law, 
     Executive order, rule, regulation, or delegation of 
     authority, or any document of or pertaining to the Assistant 
     Secretary for Public Health Emergency Preparedness as in 
     effect the day before the date of enactment of this Act, 
     shall be deemed to be a reference to the Assistant Secretary 
     for Preparedness and Response.

     SEC. 103. NATIONAL HEALTH SECURITY STRATEGY.

       Title XXVIII of the Public Health Service Act (300hh-11 et 
     seq.), as amended by section 101, is amended by inserting 
     after section 2801 the following:

     ``SEC. 2802. NATIONAL HEALTH SECURITY STRATEGY.

       ``(a) In General.--
       ``(1) Preparedness and response regarding public health 
     emergencies.--Beginning in 2009 and every four 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) for activities 
     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.''.

             TITLE II--PUBLIC HEALTH SECURITY PREPAREDNESS

     SEC. 201. IMPROVING STATE AND LOCAL PUBLIC HEALTH SECURITY.

       Section 319C-1 of the Public Health Service Act (42 U.S.C. 
     247d-3a) is amended--
       (1) by amending the heading to read as follows:

     ``IMPROVING STATE AND LOCAL PUBLIC HEALTH SECURITY.'';

       (2) by striking subsections (a) through (i) and inserting 
     the following:
       ``(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 Assistance 
     Compact 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

[[Page 22451]]

       ``(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 systems 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 the immediately preceding 
     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 immediately 
     preceding 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.'';
       (3) by redesignating subsection (j) as subsection (h);
       (4) in subsection (h), as so redesignated--
       (A) by striking paragraphs (1) through (3)(A) and inserting 
     the following:
       ``(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 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

[[Page 22452]]

     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 
     activities supported 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.'';
       (B) in paragraph (4)(A)--
       (i) by striking ``2003'' and inserting ``2007''; and
       (ii) by striking ``(A)(i)(I)'';
       (C) in paragraph (4)(D), by striking ``2002'' and inserting 
     ``2006'';
       (D) in paragraph (5)--
       (i) by striking ``2003''and inserting ``2007''; and
       (ii) By striking ``(A)(i)(I)''; and
       (E) by striking paragraph (6) and inserting the following:
       ``(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.''; and
       (5) by adding at the end the following:
       ``(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. 202. USING INFORMATION TECHNOLOGY TO IMPROVE SITUATIONAL 
                   AWARENESS IN PUBLIC HEALTH EMERGENCIES.

       Section 319D of the Public Health Service Act (42 U.S.C. 
     247d-4) is amended--
       (1) in subsection (a)(1), by inserting ``domestically and 
     abroad'' after ``public health threats''; and
       (2) by adding at the end the following:
       ``(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.

[[Page 22453]]

       ``(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. 203. PUBLIC HEALTH WORKFORCE ENHANCEMENTS.

       (a) Demonstration Project.--Subpart III of part D of title 
     III of the Public Health Service Act (42 U.S.C. 254l) is 
     amended by adding at the end the following:

     ``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.''.
       (b) Grants for Loan Repayment Program.--Section 338I of the 
     Public Health Service Act (42 U.S.C. 254q-1) is amended by 
     adding at the end the following:
       ``(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. 204. VACCINE TRACKING AND DISTRIBUTION.

       Section 319A of the Public Health Service Act (42 U.S.C. 
     247d-1) is amended to read as follows:

     ``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

[[Page 22454]]

     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. 205. NATIONAL SCIENCE ADVISORY BOARD FOR BIOSECURITY.

       The National Science Advisory Board for Biosecurity shall, 
     when requested by the Secretary of Health and Human Services, 
     provide to relevant Federal departments and agencies, advice, 
     guidance, or recommendations concerning--
       (1) a core curriculum and training requirements for workers 
     in maximum containment biological laboratories; and
       (2) periodic evaluations of maximum containment biological 
     laboratory capacity nationwide and assessments of the future 
     need for increased laboratory capacity;

             TITLE III--ALL-HAZARDS MEDICAL SURGE CAPACITY

     SEC. 301. NATIONAL DISASTER MEDICAL SYSTEM.

       (a) National Disaster Medical System.--Section 2812 of 
     subtitle B of title XXVIII of the Public Health Service Act 
     (42 U.S.C. 300hh-11 et seq.), as redesignated by section 102, 
     is amended--
       (1) by striking the section heading and inserting 
     ``NATIONAL DISASTER MEDICAL SYSTEM'';
       (2) by striking subsection (a);
       (3) by redesignating subsections (b) through (h) as 
     subsections (a) through (g);
       (4) in subsection (a), as so redesignated--
       (A) in paragraph (2)(B), by striking ``Federal Emergency 
     Management Agency'' and inserting ``Department of Homeland 
     Security''; and
       (B) in paragraph (3)(C), by striking ``Public Health 
     Security and Bioterrorism Preparedness and Response Act of 
     2002'' and inserting ``Pandemic and All-Hazards Preparedness 
     Act'';
       (5) in subsection (b), as so redesignated, by--
       (A) striking the subsection heading and inserting 
     ``Modifications'';
       (B) redesignating paragraph (2) as paragraph (3); and
       (C) striking paragraph (1) and inserting the following:
       ``(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.'';
       (6) by striking ``subsection (b)'' each place it appears 
     and inserting ``subsection (a)'';
       (7) by striking ``subsection (d)'' each place it appears 
     and inserting ``subsection (c)''; and
       (8) in subsection (g), as so redesignated, by striking 
     ``2002 through 2006'' and inserting ``2007 through 2011''.
       (b) Transfer of National Disaster Medical System to the 
     Department of Health and Human Services.--There shall be 
     transferred to the Secretary of Health and Human Services the 
     functions, personnel, assets, and liabilities of the National 
     Disaster Medical System of the Department of Homeland 
     Security, including the functions of the Secretary of 
     Homeland Security and the Under Secretary for Emergency 
     Preparedness and Response relating thereto.
       (c) Conforming Amendments to the Homeland Security Act of 
     2002.--The Homeland Security Act of 2002 (6 U.S.C. 312(3)(B), 
     313(5))) is amended--
       (1) in section 502(3)(B), by striking ``, the National 
     Disaster Medical System,''; and
       (2) in section 503(5), by striking ``, the National 
     Disaster Medical System''.
       (d) Update of Certain Provision.--Section 319F(b)(2) of the 
     Public Health Service Act (42 U.S.C. 247d-6(b)(2)) is 
     amended--
       (1) in the paragraph heading, by striking ``Children and 
     terrorism'' and inserting ``At-risk individuals and public 
     health emergencies'';
       (2) in subparagraph (A), by striking ``Children and 
     Terrorism'' and inserting ``At-Risk Individuals and Public 
     Health Emergencies'';
       (3) in subparagraph (B)--
       (A) in clause (i), by striking ``bioterrorism as it relates 
     to children'' and inserting ``public health emergencies as 
     they relate to at-risk individuals'';
       (B) in clause (ii), by striking ``children'' and inserting 
     ``at-risk individuals''; and
       (C) in clause (iii), by striking ``children'' and inserting 
     ``at-risk individuals'';
       (4) in subparagraph (C), by striking ``children'' and all 
     that follows through the period and inserting ``at-risk 
     populations.''; and
       (5) in subparagraph (D), by striking ``one year'' and 
     inserting ``six years''.
       (e) Conforming Amendment.--Section 319F(b)(3)(B) of the 
     Public Health Service Act (42 U.S.C. 247d-6(b)(3)(B)) is 
     amended by striking ``and the working group under subsection 
     (a)''.
       (f) Effective Date.--The amendments made by subsections (b) 
     and (c) shall take effect on January 1, 2007.

     SEC. 302. ENHANCING MEDICAL SURGE CAPACITY.

       (a) In General.--Title XXVIII of the Public Health Service 
     Act (300hh-11 et seq.), as amended by section 103, is amended 
     by inserting after section 2802 the following:

     ``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.''.
       (b) EMTALA.--
       (1) In general.--Section 1135(b) of the Social Security Act 
     (42 U.S.C. 1320b-5(b)) is amended--
       (A) in paragraph (3), by striking subparagraph (B) and 
     inserting the following:
       ``(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;'';
       (B) in the third sentence, by striking ``and shall be 
     limited to'' and inserting ``and, except in the case of a 
     waiver or modification to which the fifth sentence of this 
     subsection applies, shall be limited to''; and
       (C) by adding at the end the following: ``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.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect on the date of the enactment of this Act 
     and shall apply to public health emergencies declared 
     pursuant to section 319 of the Public Health Service Act (42 
     U.S.C. 247d) on or after such date.

     SEC. 303. ENCOURAGING HEALTH PROFESSIONAL VOLUNTEERS.

       (a) Volunteer Medical Reserve Corps.--Title XXVIII of the 
     Public Health Service Act (42 U.S.C. 300hh-11 et seq.), as 
     amended by this Act, is amended by inserting after section 
     2812 the following:

     ``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.

[[Page 22455]]

       ``(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, taking into 
     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.''.
       (b) Encouraging Health Professions Volunteers.--Section 
     319I of the Public Health Service Act (42 U.S.C. 247d-7b) is 
     amended--
       (1) by redesignating subsections (e) and (f) as subsections 
     (j) and (k), respectively;
       (2) by striking subsections (a) and (b) and inserting the 
     following:
       ``(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.'';
       (3) in subsection (c), strike ``system'' and insert 
     ``network'';
       (4) by striking subsection (d) and inserting the following:
       ``(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.''; and
       (5) in subsection (k) (as so redesignated), by striking 
     ``2006'' and inserting ``2011''.

     SEC. 304. CORE EDUCATION AND TRAINING.

       Section 319F of the Public Health Service Act (42 U.S.C. 
     247d-6) is amended--
       (1) by striking subsection (a) and inserting the following;
       ``(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.'';
       (2) by striking subsections (c) through (g) and inserting 
     the following:
       ``(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

[[Page 22456]]

     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(b)(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 others 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.'';
       (3) by redesignating subsection (h) as subsection (e);
       (4) by inserting after subsection (e) (as so redesignated), 
     the following:
       ``(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.''; and
       (5) by striking subsections (i) and (j).

     SEC. 305. PARTNERSHIPS FOR STATE AND REGIONAL HOSPITAL 
                   PREPAREDNESS TO IMPROVE SURGE CAPACITY.

       Section 319C-2 of the Public Health Service Act (42 U.S.C. 
     247d-3b) is amended to read as follows:

     ``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)(3).
       ``(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 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. An entity described in 
     subsection (b)(1)(A) shall make such reports available to the 
     lead health official of the State in which such partnership 
     is located.
       ``(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

[[Page 22457]]

     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. 306. ENHANCING THE ROLE OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) In General.--Section 8117 of title 38, United States 
     Code, is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by--
       (i) striking ``chemical or biological attack'' and 
     inserting ``a public health emergency (as defined in section 
     2801 of the Public Health Service Act)'';
       (ii) striking ``an attack'' and inserting ``such an 
     emergency''; and
       (iii) striking ``public health emergencies'' and inserting 
     ``such emergencies''; and
       (B) in paragraph (2)--
       (i) in subparagraph (A), by striking ``; and'' and 
     inserting a semicolon;
       (ii) in subparagraph (B), by striking the period and 
     inserting a semicolon; and
       (iii) by adding at the end the following:
       ``(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.'';
       (2) in subsection (c), by striking ``a chemical or 
     biological attack or other terrorist attack.'' and inserting 
     ``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.'';
       (3) in subsection (d), by--
       (A) striking ``develop and'';
       (B) striking ``biological, chemical, or radiological 
     attacks'' and inserting ``public health emergencies''; and
       (C) by inserting ``consistent with section 319F(a) of the 
     Public Health Service Act'' before the period; and
       (4) in subsection (e)--
       (A) in paragraph (1), by striking ``2811(b)'' and inserting 
     ``2812''; and
       (B) in paragraph (2)--
       (i) by striking ``bioterrorism and other''; and
       (ii) by striking ``319F(a)'' and inserting ``319F''.
       (b) Authorization of Appropriations.--Section 8117 of title 
     38, United States Code, is amended by adding at the end the 
     following:
       ``(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.''.

  Mr. BURR. Mr. President, I rise today in support of S. 3678, the 
Pandemic and All-Hazards Preparedness Act. This bipartisan bill, which 
was drafted closely with Senator Kennedy, will improve our public 
health and medical preparedness and responses during emergencies and 
disasters. I thank the Senator from Massachusetts for his partnership 
on this important legislation. I also thank Chairman Enzi for his 
leadership, Majority Leader Frist, Senator Gregg and all 14 bipartisan 
cosponsors of this legislation for their hard work and support.
  S. 3678 achieves two overarching goals. It reauthorizes the 
Bioterrorism Act of 2002, which was signed into law following the 
terrorist attacks of September 11 and expired at the end of September, 
and it builds on the Project Bioshield Act of 2004, to speed up the 
development of drug and vaccine countermeasures against bioterrorist 
and other public health threats.
  In June 2002, President Bush signed the Bioterrorism Act into law and 
stated the legislation was proof that ``When people of both parties 
work together, they can work on behalf of our country.'' Over the last 
2 years, S. 3678 has been developed through the same bipartisan 
process. We all understand that the threats of bioterrorism and other 
public health emergencies, such as pandemic flu, are very real and we 
are committed to act now to protect the American people.
  We know we must act now, before avian flu reaches our shores, before 
the next hurricane devastates a great city, before a bioterrorist 
attack kills an innocent American.
  The threat of bioterrorism remains. Around the world, radical 
religious groups are being urged to establish new terror cells that 
specialize in biological warfare. It is increasingly easy to access 
Internet guides to bioterrorism, including methods for contaminating 
food and water supplies and spreading deadly microbes using do-it-
yourself sprayers.
  We often think of smallpox and anthrax as the gravest bioterrorism 
threats; however, as science and technology advance, the number of 
worrisome agents is expanding. In fact, the Department of Homeland 
Security recently determined that an additional nine biological agents 
present material threats against the United States sufficient to affect 
national security.
  It is clear we will not keep up with new and emerging threats if we 
continue to be constrained by practices and procedures which require, 
for example, a decade to develop a new drug or vaccine countermeasure. 
Instead, we must take a faster, more creative approach to developing 
flexible, dynamic defenses against these threats.
  Hurricanes Katrina and Rita proved once again that Mother Nature can 
be extremely destructive. And now, the United States is preparing for a 
potential flu pandemic that may be carried by birds. The biodefense 
plan laid out in this bill will enable us to be more flexible and will 
allow us to rapidly respond to all-hazards emergencies--be they 
natural, deliberate, or accidental.
  We take five key actions in S. 3678, which will better prepare the 
Nation for the all-hazards public health emergencies of the future.
  First, the bill puts someone in charge. After Hurricane Katrina, it 
was unclear who was in charge of our public health and medical response 
to this devastating storm. I believe unity of command and control is 
the key to rapid emergency response. This legislation identifies the 
Secretary of Health and Human Services as the lead Federal official for 
public health and medical response to emergencies, thereby eliminating 
confusion and chaos and increasing accountability and predictability. 
S. 3678 also unifies HHS preparedness and response programs under a 
renamed Assistant Secretary for Preparedness and Response, ensuring 
someone in the Federal Government is constantly improving our 
preparedness.
  Second, S. 3678 funds State and local preparedness. We know the best 
emergency response begins at the local level. My bill reauthorizes over 
$1 billion per year in grants from HHS for State and local public 
health and medical preparedness. Authorization for these important 
grant programs expired in September 2006. The legislation also stresses 
accountability and fiscal responsibility in order to measure the 
progress made through these funds, and it requires States to match 
Federal investments in preparedness, beginning in 2009.
  Third, the bill improves public health security. Public health 
departments across the country have varying abilities to identify a 
case of bird flu and contain its spread. S. 3678 establishes a set of 
key capabilities that all health departments must strive for. It also 
modernizes how public health departments detect, respond to, and manage 
public health threats, by collecting instant electronic information 
which will enable public health officials to make informed decisions 
before, during, and after a public health emergency.
  Fourth, S. 3678 will speed up emergency medical response. During the 
response to Hurricane Katrina, it was too difficult for willing health 
care providers to volunteer their time and provide much-needed medical 
expertise to the gulf coast region. My bill makes it easier for health 
care providers to volunteer in emergency situations, and it enables the 
Secretary of Health and Human Services to provide liability protections 
for approved volunteers. This legislation also promotes the use of 
mobile hospitals and alternative Federal facilities which can help 
handle an increased number of patients during an emergency. 
Additionally, the bill improves planning and logistics for health care 
providers and volunteers to ensure emergency medical care can be 
delivered faster during a disaster.
  Finally, the bill ensures the development of more drug and vaccine 
countermeasures to combat public health

[[Page 22458]]

emergencies. The process for developing a new medical countermeasure 
still takes up to a decade and costs hundreds of millions of dollars. 
S. 3678 will improve our ability to quickly develop drugs and vaccines 
to protect against threats such as bird flu and bioterrorism. It 
reorganizes and enhances HHS medical countermeasure research, 
development, and procurement activities, through the Biomedical 
Advanced Research and Development Authority, or BARDA. Modeled after 
the Defense Advanced Research Projects Agency's successes in defense 
research, BARDA will bring innovation to a process that is simply too 
slow to combat terrorist activities or Mother Nature.
  Making the Government more dynamic, nimble, and accountable will 
bring more and better medical countermeasures to the public faster case 
of emergency.
  In closing, I applaud my Senate colleagues for taking a decisive step 
forward today in improving the Nation's preparedness for all-hazards 
public health emergencies--including acts of terrorism and those 
brought to us by Mother Nature, by passing S. 3678, the Pandemic and 
All-Hazards Preparedness Act.
  I would like to thank the staff of my Subcommittee on Bioterrorism 
and Public Health Preparedness for their hard work, Jennifer Bryning, 
Kendall Byrum, Jenny Ware, Heidi Swygard, former staff director, Dr. 
Bob Kadlec, and former Senate fellow, David Marcozzi. Also, thank you 
to the majority leader's staff, especially Elizabeth Hall. Thank you to 
Chairman Enzi's staff, Katherine McGuire, Ilyse Schuman, Steve 
Northrup, and David Schmickel. Thank you to Senator Kennedy's staff for 
their hard work, David Bowen, and Caya Lewis. And thank you to Senator 
Gregg's staff for their support, David Fisher, and Richard Weiblinger.
  Earlier this year, I had the opportunity to travel to the Gulf Coast 
to learn from the disaster of Hurricane Katrina. It is our solemn 
responsibility to do all we can to make sure our Federal response is 
better. I want to also thank the many State and local public health 
officials from across the country, the hospitals, health care 
providers, elected officials, patients, EMT personnel and citizens who 
gave us their ideas and shared their experiences in this process. 
Together, we have laid out a plan to improve our Nation's public health 
and to better respond to disasters in the future.
  Mr. KENNEDY. Mr. President, this afternoon, the Senate will consider 
legislation that will have far-reaching effects on the Nation's 
readiness for bioterrorist attacks, epidemics, and other public health 
emergencies.
  The passage of the bill today is the culmination of a long process 
that our subcommittee, under the able leadership of Senator Burr, 
conducted to evaluate recommendations for renewing and strengthening 
the public health legislation enacted in 2002 and the BioShield 
proposal enacted the following year.
  That was no small challenge. Our lack of preparedness was painfully 
clear to the hundreds of thousands of Americans who suffered and are 
still suffering in the aftermath of Hurricane Katrina.
  Today we face the possibility of a pandemic or a bioterrorist attack, 
which could be as bad as a Hurricane Katrina in every community in 
America. We know that we are not yet ready for a catastrophe of that 
scale.
  We need new medicines and new vaccines to protect against the disease 
threats of the twenty-first century. Yet many biotechnology companies 
are unwilling to invest in this area because of its uncertain 
commercial rewards.
  Congress previously enacted the BioShield law to provide a guaranteed 
market for these products, but that program has been implemented poorly 
and has failed to live up to its promise.
  Our legislation makes improvements in BioShield and supplements it by 
creating a new agency based on the successful model of DARPA, which has 
enhanced the development of important new products for our national 
defense. In recent years, the innovative research funded by DARPA has 
led to breakthroughs in supercomputers, robotics, materials science, 
nanotechnology, and in many other areas. Through the creation of a new 
agency, the Biomedical Advanced Research and Development Agency, we can 
emulate that success in the development of new vaccines and medicines.
  But creating new products is only half the story. The newest vaccines 
and the most sophisticated technology are of little value if our 
hospitals and health agencies are overwhelmed and underequipped.
  Time and again, Congress has called on the administration to take the 
steps needed to protect America against these new threats. But time and 
again, the response has been insufficient.
  In 2000, Congress enacted the Frist-Kennedy legislation to provide a 
framework for bioterrorism preparedness. In the first year after the 
legislation was enacted, these programs received just $1 million out of 
the $360 million called for by the legislation.
  Even in the aftermath of the September 11 attacks, the administration 
initially proposed only $50 million to upgrade our hospitals and 
emergency rooms, and requested only $125 million to improve our health 
agencies. Thanks to the leadership of Senator Daschle, Senator Frist, 
and Senator Byrd, and of now-Senator Burr when he served in the House, 
Congress rejected these recommendations and provided over half a 
billion dollars for hospital readiness and nearly a billion dollars for 
health agencies.
  Yet the administration has cut these needed funds. The support for 
hospital readiness through HRSA has decreased from $518 million in 2003 
to $483 this year. The story is the same in the CDC program to improve 
our health agencies. Funding has dropped from $939 million in 2003 to 
$834 million this year.
  Is it any wonder that study after study shows that America is not 
ready for a biological attack? Our former colleague, Senator Lowell 
Weicker, is chairman of the board of the Trust for America's Health, 
which convened a panel of experts in public health to assess each 
State's readiness for bioterrorism. The sad story is that no State was 
fully ready. Even the most prepared States scored only 8 out of 10 on 
measures of basic preparedness.
  And these measures don't ask the impossible. One measure is whether a 
State has plans to ensure continuity of care in an emergency. Another 
is whether the State can provide additional ventilator beds for ten--
yes, just ten--additional patients. Even on these basic measures of 
readiness the majority of States scored a five or worse--and four 
States scored only a woeful 2 out of 10.
  We have seen the consequences of failure. Now we must prepare for 
success.
  With this bill, we take many important steps to increase our 
preparedness and response capabilities for public health emergencies. 
This bill will increase our medical surge capacity, strengthen our 
public health infrastructure, and clarify the responsibilities of 
Federal officials.
  The first response to emergencies happens at the State and local 
level. But State and local governments were quickly overwhelmed by the 
magnitude of the tragedy during Hurricane Katrina and would soon be 
overwhelmed in a pandemic. Federal assistance is essential. But for the 
past 4 years, we have been giving States money for public health 
preparedness without giving them adequate guidance on how to spend it. 
This bill reauthorizes these grants to State and local public health 
departments, but now provides benchmarks, performance standards and 
increased technical assistance from HHS that will allow State and local 
governments to improve their performance.
  Accurate and up-to-the-minute information is essential to managing an 
emergency. Health information technology is the key to a more effective 
health care system in so many areas, and it can immeasurably improve 
our ability to monitor a health emergency. Our legislation includes an 
important program to harness the power of health IT to aid our health 
emergency response.

[[Page 22459]]

  We must learn the lessons of the past and see that our hospitals and 
health professionals can treat the victims of disease, that our health 
agencies can detect disease threats rapidly and accurately and that all 
parts of our society have adequate plans to contain a disease outbreak. 
This bill takes the right steps to better prepare our Nation for the 
next public health emergency, no matter what its source. I urge my 
colleagues to approve this proposal and to work with us to see that we 
can send it to the President's desk before the end of the Congress.
  Mr. LIEBERMAN. Mr. President, I wanted to give my thanks to Senators 
Burr and Kennedy for working with me and my esteemed colleagues, 
Senators Cochran, Obama, Kohl, and Landrieu, to pass a bill that 
together makes a difference to the health and well-being of Americans 
in the event of a public health emergency--natural or man-made. We saw 
in Hurricane Katrina that local, State, and Federal governments were 
not adequately prepared for a situation that could have been much 
worse. Also, much of the public was not prepared and could not get out 
of harm's way because of issues of capacity and trust. Regardless of 
our preparation then, it is clear that the government and the public 
must become better prepared now. We must come up with a disaster 
preparedness and response system which does a better job of knowing 
what is happening not in government cubicles but on the ground, which 
is able to prioritize the allocation and delivery of finite resources, 
and which utilizes our cumulative man and woman-power to work together 
to get anything that needs to be done, done.
  This is not a perfect bill, but S. 3678, the Pandemic and All-Hazards 
Preparedness Act, does improve the ability of the Federal Government to 
coordinate response to emergencies and disasters. It centralizes 
command and control of Federal public health and medical emergency 
response and for the first time ever, lists the needs of at-risk 
individuals in emergencies as a national preparedness goal.
  Considering the needs of at-risk populations in public health 
emergencies and disasters is perhaps the most vital way to reduce 
casualties when treatment options are limited, environmental exposures 
place the public at risk and or when evacuation is necessary to get 
people out of harm's way. In disasters, the burden of casualties almost 
always fall on populations with unequal ability to protect themselves. 
These populations are termed special-needs populations, at-risk 
populations or at-risk individuals. They are populations who possess 
unique needs or limitations and may as a result not be able to receive, 
comprehend, or respond to public health messaging during emergencies in 
the way that bests support their safety and well-being. They are 
populations that may not able to fully address their own preparedness 
for, response to, and recovery from public health emergencies. At-risk 
individuals include the elderly, children, pregnant women, the poor, 
disabled, individuals with limited English proficiency, and others. 
Forty million Americans are over 65 years old, a number that will reach 
71 million by 2030. There are over 70 million children under age 18. 
There are approximately 7 million pregnant women. Fourteen percent of 
Americans are limited in activity due to a chronic health condition.
  I thank Senators Burr and Kennedy for having the vision to address 
at-risk individuals in S. 3678 but also the willingness to work with 
Senators Cochran, Obama, Kohl, and Landrieu and me to make the language 
concerning at-risk individuals even stronger. The Lieberman-Cochran 
amendment, which has been incorporated into the final S. 3678 managers' 
package, publicly designates a person with a budget, who would ideally 
be called the Director Office of At-Risk Individuals, to oversee the 
implementation of the national preparedness goal concerning at-risk 
individuals; assist Federal agencies responsible with planning for, 
responding to, and recovering from public health emergencies in 
addressing the needs of at-risk individuals; provide guidance to State 
and local public health grant recipients as to how to incorporate the 
needs of at-risk individuals in emergency preparedness and response 
strategies; and develop and disseminate best principles and practices 
regarding outreach to and care of at-risk individuals in public health 
emergencies.
  Senators Cochran, Obama, Kohl, and Landrieu and I believe that a new 
director of At-Risk Individuals will be a great resource to the 
Assistant Secretary in keeping the needs of at-risk individuals central 
as the Secretary works to implement the Nation's disaster preparedness 
goals across the Federal agencies. In the past, the Nation has not done 
enough to break down the artificial silos between the agencies charged 
with the health aspects of disaster planning and response, which is 
vital for the public in general but particularly to at-risk individuals 
in disasters. At-risk individuals are not monolithic, and their 
identities change depending upon the type, location, and character of 
disasters. Yet they are many, and their existence poses consistent 
challenges which must be addressed. These groups include people with 
disabilities, the elderly, non-English speakers, children, the poor, 
and the homeless. We understand that there is often significant overlap 
between at-risk groups. Individuals who are homeless, for example, are 
also poor and often disabled.
  Senators Cochran, Obama, Kohl, and Landrieu and I also believe that a 
new director of At-Risk Individuals will also be a great resource to 
States, which will now have to incorporate the needs of at-risk 
individuals into disaster plans as a condition of receiving Federal 
disaster preparedness funding. The process by which the needs of at-
risk individuals are incorporated into State, let alone Federal 
disaster plans is not obvious and will require both accumulation and 
dissemination of expertise. The committee envisions the Office of At-
Risk Individuals as an ideal repository and resource for information in 
this regard. This information can be gathered from entities already 
doing excellent work in the field. Within HHS, this includes the 
Administration on Aging, the Office on Disability, and Administration 
on Developmental Disabilities. Within DHS, this includes the Office for 
Civil Rights and Civil Liberties, the Preparedness Directorate, and the 
Interagency Coordinating Council on Emergency Preparedness and 
Individuals with Disabilities. Within the community, this includes 
organizations like C.A.R.D. in California and the Kellogg Foundation's 
Redefining Readiness Projects. Within Academia, this includes work done 
by the Center for Civilian Biodefense Studies in Maryland and the New 
York Academy of Medicine. Nationally, this includes the National 
Organization on Disability's Emergency Preparedness, Initiative, the 
Center for Disability and Special Needs Preparedness, and the American 
Academy of Pediatrics.
  Finally, Senators Cochran, Obama, Kohl, and Landrieu and I believe 
that a new Director of At-Risk Individuals can be an important source 
of funding and support for a community engagement process focused on 
organizing ordinary citizens to prepare and to respond to public health 
emergencies. The public is not a passive entity and must be viewed as a 
valuable partner in disaster planning and response. Communities are 
better able, for example, to identify the location of their special 
needs populations, to communicate with them, and to intervene in ways 
that are consistent with the reality of people's lives. In addition, 
during disasters, the governmental response is often delayed, and 
people must be able to protect themselves why they wait for help. Last 
of all, community-derived public health emergency plans must be 
coordinated with local, State and Federal disaster plans and the new 
Office of At-Risk Individuals can fund opportunities to bring all key 
stakeholders together.
  The AARP, the American Red Cross, United Cerebral Palsy, and the 
American Academy of Pediatrics have all endorsed this important 
amendment. These are groups that most would agree know much about at-
risk individuals, disaster preparedness and response.

[[Page 22460]]

  In short, the process of addressing the needs of at-risk individuals 
during public health emergencies is a necessary and immense task that 
must be overseen. A new Director of At-Risk Individuals with a budget 
of up to $5 million as specified in S. 3678 will provide the focus, 
expertise, personnel, and institutional memory to assure that the at-
risk language in S. 3678 is followed and that the Government, in 
planning for and responding to emergencies, keeps the needs of all 
Americans, front and center.
  I thank Senators Burr and Kennedy again for writing and passing S. 
3678 and being open to the Lieberman-Cochran language.
  Mr. BURR. Mr. President, I ask unanimous consent that the amendment 
at the desk be agreed to, the committee-reported amendment, as amended, 
be agreed to, the bill, as amended, be read a third time and passed, 
the motion to reconsider be laid upon the table, and that any 
statements relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 5210) was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'') The committee amendment in the nature of a substitute, 
as amended, was agreed to.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  The bill (S. 3678), as amended, was passed.
  The PRESIDING OFFICER. The majority leader.
  Mr. FRIST. Mr. President, we will be closing down in a few moments. I 
have several quick pieces of business to do first.

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