[House Report 113-273]
[From the U.S. Government Publishing Office]


113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    113-273

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



 
                 MEDICAL PREPAREDNESS ALLOWABLE USE ACT

                                _______
                                

 November 21, 2013.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

  Mr. McCaul, from the Committee on Homeland Security, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1791]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Homeland Security, to whom was referred 
the bill (H.R. 1791) to amend the Homeland Security Act of 2002 
to codify authority under existing grant guidance authorizing 
use of Urban Area Security Initiative and State Homeland 
Security Grant Program funding for enhancing medical 
preparedness, medical surge capacity, and mass prophylaxis 
capabilities, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Statement of General Performance Goals and Objectives............     6
Duplicative Federal Programs.....................................     6
Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
  Benefits.......................................................     7
Federal Mandates Statement.......................................     7
Preemption Clarification.........................................     7
Disclosure of Directed Rule Makings..............................     7
Advisory Committee Statement.....................................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Medical Preparedness Allowable Use 
Act''.

SEC. 2. USE OF CERTAIN HOMELAND SECURITY GRANT FUNDS FOR ENHANCING 
                    MEDICAL PREPAREDNESS, MEDICAL SURGE CAPACITY, AND 
                    MASS PROPHYLAXIS CAPABILITIES.

  Section 2008 of the Homeland Security Act of 2002 (6 U.S.C. 609) is 
amended--
          (1) in subsection (a), by redesignating paragraphs (10) 
        through (13) as paragraphs (11) through (14), respectively, and 
        by inserting after paragraph (9) the following:
          ``(10) enhancing medical preparedness, medical surge 
        capacity, and mass prophylaxis capabilities, including the 
        development and maintenance of an initial pharmaceutical 
        stockpile, including medical kits, and diagnostics sufficient 
        to protect first responders, their families, immediate victims, 
        and vulnerable populations from a chemical or biological 
        event;''; and
          (2) in subsection (b)(3)(B), by striking ``(a)(10)'' and 
        inserting ``(a)(11)''.

                          Purpose and Summary

    The purpose of H.R. 1791 is to amend the Homeland Security 
Act of 2002 to codify authority under existing grant guidance 
authorizing use of Urban Area Security Initiative and State 
Homeland Security Grant Program funding for enhancing medical 
preparedness, medical surge capacity, and mass prophylaxis 
capabilities.

                  Background and Need for Legislation

    H.R. 1791 amends the Homeland Security Act of 2002 to 
clarify that State Homeland Security Grant Program (SHSGP) and 
Urban Area Security Initiative (UASI) funds may be used to 
enhance medical preparedness, medical surge capacity, and mass 
prophylaxis capabilities. Through hearings and briefings held 
in the Subcommittee in the 112th and 113th Congresses, the 
Committee received information from stakeholders at the 
Federal, State, and local level about the importance of medical 
preparedness. This legislation, and the need to ensure that 
SHSGP and UASI funds remain available for medical preparedness, 
was informed by these events.

                                Hearings

    No hearings were held on H.R. 1791 in the 113th Congress. 
However, the Committee held a number of hearings on the issue 
of medical preparedness and medical countermeasures in the 
112th Congress.
    On March 17, 2011, the Subcommittee held a hearing entitled 
``Ensuring Effective Preparedness, Response, and Recovery for 
Events Impacting Health Security.'' The Subcommittee received 
testimony from Dr. Alexander G. Garza, MD, MPH, Assistant 
Secretary for Health Affairs and Chief Medical Officer, 
Department of Homeland Security.
    On April 13, 2011, the Subcommittee began a series of 
hearings entitled ``Taking Measure of Countermeasures.'' The 
first day of hearings was subtitled ``A Review of Government 
and Industry Efforts to Protect the Homeland Through 
Accelerated Research, Development, and Acquisition of Chemical, 
Biological, Radiological, and Nuclear Medical 
Countermeasures.'' The Subcommittee received testimony from Ms. 
Cynthia Bascetta, Managing Director, Health Care, Government 
Accountability Office; Dr. Segaran P. Pillai, Chief Medical and 
Science Advisor, Chemical and Biological Division, Science and 
Technology Directorate, Department of Homeland Security; Dr. 
Richard J. Hatchett, Chief Medical Officer and Deputy Director, 
Strategic Sciences and Management, Department of Health and 
Human Services; Dr. Gerald W. Parker, Deputy Assistant to the 
Secretary of Defense, Chemical and Biological Defense, 
Department of Defense; Ms. Phyllis Arthur, Senior Director, 
Vaccines, Immunotherapeutics, and Diagnostics Policy, 
Biotechnology Industry Organization; Mr. John M. Clerici, 
Principal, Tiber Creek Partners LLC; and Dr. Daniel Fagbuyi, 
Medical Director, Disaster Preparedness and Emergency 
Management, Children's National Medical Center.
    On May 12, 2011, the Subcommittee convened the second day 
of hearings, subtitled ``A Review of Efforts to Protect the 
Homeland Through Distribution and Dispensing of CBRN Medical 
Countermeasures.'' The Subcommittee received testimony from Dr. 
Alexander Garza, Assistant Secretary for Health Affairs and 
Chief Medical Officer, Office of Health Affairs, Department of 
Homeland Security; Rear Admiral Ali Khan, Director, Office of 
Public Health Preparedness and Response, Centers for Disease 
Control and Prevention, Department of Health and Human 
Services; Mr. Mike McHargue, Director of Emergency Operations, 
Division of Emergency Medical Operations; Florida Department of 
Health; Mr. David Starr, Director, Countermeasures Response 
Unit, New York City Department of Health and Mental Hygiene; 
Chief Lawrence E. Tan, Emergency Medical Services Division, New 
Castle County, Delaware, testifying on behalf of the Emergency 
Services Sector Coalition on Medical Countermeasures; and Dr. 
Jeffrey Levi, Executive Director, Trust for America's Health.
    On April 17, 2012, the Subcommittee held a third day of 
hearings on ``Taking Measure of Countermeasures.'' The hearing 
was subtitled ``Protecting the Protectors,'' and the 
Subcommittee received testimony from Dr. James D. Polk, 
Principal Deputy Assistant Secretary, Office of Health Affairs, 
Department of Homeland Security; Mr. Edward J. Gabriel, 
Principal Deputy Assistant Secretary, Preparedness and 
Response, Department of Health and Human Services; Chief Al H. 
Gillespie, President and Chairman of the Board, International 
Association of Fire Chiefs; Mr. Bruce Lockwood, Second Vice 
President, USA Council, International Association of Emergency 
Managers; Sheriff Chris Nocco, Pasco County Sheriff's Office, 
Pasco County, Florida; and Mr. Manuel Peralta, Director of 
Safety and Health, National Association of Letter Carriers.

                        Committee Consideration

112th Congress
    In the 112th Congress, H.R. 5997, the predecessor bill, was 
introduced in the House on June 21, 2012, by Mr. Bilirakis, Mr. 
Clarke of Michigan, Mr. Turner of New York, and Mr. Rogers of 
Alabama; and referred to the Committee on Homeland Security. 
Within the Committee, H.R. 5997 was referred to the 
Subcommittee on Emergency Preparedness, Response, and 
Communications.
    The House considered H.R. 5997 under Suspension of the 
Rules on November 27, 2012, and passed the bill, amended, by a 
\2/3\ recorded vote of 397 yeas and 1 nay (Roll No. 609).

113th Congress
    The Committee on Homeland Security met on October 29, 2013, 
to consider H.R. 1791, and ordered the measure to be reported 
to the House with a favorable recommendation by voice vote. The 
Committee took the following actions:
    The Committee agreed to H.R. 1791, as amended, by voice 
vote.
    The Chair discharged the Subcommittee on Emergency 
Preparedness, Response, and Communications from further 
consideration of H.R. 1791.
    The following amendments were offered:
An amendment to H.R. 1791 offered by Ms. Jackson Lee (#1); was 
WITHDRAWN by unanimous consent.

    Page 2, line 19, strike the period at the end and insert ``; and''.
    Page 2, after line 19, insert the following: (3) by adding at the 
end of subsection (b) a new paragraph entitled ``(6) Transparency to 
Law Enforcement Entities.''

An amendment to H.R. 1791 offered by Mr. Thompson (#2); was 
WITHDRAWN by unanimous consent.

    Page 2, after line 19, insert a new section entitled ``Sec. 3. 
Reauthorization of Metropolitan Medical Response Grant Program.''

An amendment to H.R. 1791 offered by Mr. Payne (#3); was AGREED 
TO by voice vote.

    Page 2, line 16, strike ``and immediate victims'' and insert the 
following: ``immediate victims, and vulnerable populations''.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report legislation and amendments 
thereto.
    No recorded votes were requested during consideration of 
H.R. 1791.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has held oversight 
hearings and made findings that are reflected in this report.
    In hearings and briefings during the 112th and 113th 
Congresses, the Committee heard about the importance of medical 
countermeasures from representatives of the emergency response 
community. SHSGP and UASI grant guidance currently authorizes 
funding to be used to support medical preparedness activities. 
However, this guidance is drafted and released on a yearly 
basis and there is no guarantee these expenditures will be 
authorized in the future. As a result of this bill, State and 
local governments, including first responders, gain certainty 
that items such as medical equipment and countermeasures, and 
pre-deployed medical kits for first responders and their 
families, similar to those provided to postal workers 
participating in the National U.S. postal medical 
countermeasures dispensing pilot program, may continue to be 
procured.
    The Committee notes the contribution that Federal homeland 
security grant funds, including those used for medical 
preparedness activities, have made to state and local response 
capabilities. This was most recently demonstrated in the 
response to the Boston Marathon bombings, where the seamless 
medical response undoubtedly saved lives.
    At the Full Committee markup of H.R. 1791, Ranking Member 
Thompson offered an amendment to reauthorize the Metropolitan 
Medical Response System (MMRS) through FY 2016 at the FY 2010 
level. During consideration of the amendment, Chairman McCaul 
recognized the benefits grant funds, including those used for 
medical preparedness activities, have provided with respect to 
response capabilities, noting that the benefits of grant 
investments were demonstrated during the response to the Boston 
Marathon bombings. Ranking Member Thompson withdrew his 
amendment after Chairman McCaul stated that he would work with 
him and other Members of this Committee to seek possible 
legislative opportunities to authorize grant programs to ensure 
that first responders have the tools they need to meet their 
vital missions and that capabilities have been attained to date 
are not lost and to identify necessary offsets.
    During consideration of H.R. 1791, Emergency Preparedness, 
Response, and Communications Ranking Member Donald Payne, Jr. 
offered an amendment to ensure that countermeasures could be 
made available to vulnerable populations. In the view of the 
Committee, the term ``vulnerable populations'' includes 
children, the elderly, individuals with disabilities, and those 
in underserved communities. Children, in particular, are of 
concern to the Committee. This bill highlights the need to 
acquire and plan for the distribution of countermeasures to 
those populations and permits grant funding to be used for 
those activities.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
1791, the Medical Preparedness Allowable Use Act, would result 
in no new or increased budget authority, entitlement authority, 
or tax expenditures or revenues.

                  Congressional Budget Office Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, November 6, 2013.
Hon. Michael McCaul,
Chairman, Committee on Homeland Security,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1791, the Medical 
Preparedness Allowable Use Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Daniel 
Hoople.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 1791--Medical Preparedness Allowable Use Act

    H.R. 1791 would allow certain grants from the Federal 
Emergency Management Agency (FEMA) to be used for enhancing 
medical preparedness, medical surge capacity, and mass 
prophylaxis capabilities. CBO estimates that implementing this 
legislation would not affect federal expenditures for those 
grants and would have no impact on the federal budget over the 
next five years. Enacting this legislation would not affect 
direct spending or revenues; therefore, pay-as-you-go 
procedures do not apply.
    H.R. 1791 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    FEMA's Urban Area Security Initiative (UASI) and State 
Homeland Security Grant Program (SHSGP) provide grants to state 
and local governments to prevent, prepare for, protect against, 
and respond to acts of terrorism. Funds may be used for a 
variety of activities that include developing emergency 
management plans, training and conducting exercises, purchasing 
equipment, and paying salaries and expenses. The Congress 
provided $913 million for those two programs in fiscal year 
2013.
    The bill would expand the eligible use of UASI and SHSGP 
funds, as defined in statute, to include activities that 
enhance medical preparedness, medical surge capacity, and mass 
prophylaxis capabilities. Examples of permissible activities 
include the purchase of medical kits and diagnostics to protect 
first responders and victims. Because such items are already 
included on FEMA's authorized equipment list for those grants, 
CBO expects that implementing this language would have no 
effect on net discretionary spending over the next five years.
    The CBO staff contact for this estimate is Daniel Hoople. 
The estimate was approved by Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, H.R. 1791 contains the following 
general performance goals, and objectives, including outcome 
related goals and objectives authorized.
    The objective of this legislation is to ensure that SHSGP 
and UASI grants are able to be used for medical preparedness 
activities.

                      Duplicative Federal Programs

    The Committee finds that H.R. 1791 does not contain any 
provision that establishes or reauthorizes a program known to 
be duplicative of another Federal program.

   Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    In compliance with rule XXI of the Rules of the House of 
Representatives, this bill, as reported, contains no 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(e), 9(f), or 9(g) of the rule 
XXI.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                        Preemption Clarification

    In compliance with section 423 of the Congressional Budget 
Act of 1974, requiring the report of any Committee on a bill or 
joint resolution to include a statement on the extent to which 
the bill or joint resolution is intended to preempt State, 
local, or Tribal law, the Committee finds that H.R. 1791 does 
not preempt any State, local, or Tribal law.

                  Disclosure of Directed Rule Makings

    The Committee estimates that H.R. 1791 would require no 
directed rule makings.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section provides that the bill may be cited as the 
``Medical Preparedness Allowable Use Act.''

Sec. 2. Use of certain Homeland Security Grant funds for enhancing 
        medical preparedness, medical surge capacity, and mass 
        prophylaxis

    This section amends section 2008 of the Homeland Security 
Act to codify the use of State Homeland Security Grant Program 
and Urban Area Security Initiative funds for enhancing medical 
preparedness, medical surge capacity, and mass prophylaxis 
capabilities.

         Changes in Existing Law Made by the Bill, as Reported

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

HOMELAND SECURITY ACT OF 2002

           *       *       *       *       *       *       *



TITLE XX--HOMELAND SECURITY GRANTS

           *       *       *       *       *       *       *


Subtitle A--Grants to States and High-Risk Urban Areas

           *       *       *       *       *       *       *


SEC. 2008. USE OF FUNDS.

  (a) Permitted Uses.--The Administrator shall permit the 
recipient of a grant under section 2003 or 2004 to use grant 
funds to achieve target capabilities related to preventing, 
preparing for, protecting against, and responding to acts of 
terrorism, consistent with a State homeland security plan and 
relevant local, tribal, and regional homeland security plans, 
through--
          (1) * * *

           *       *       *       *       *       *       *

          (10) enhancing medical preparedness, medical surge 
        capacity, and mass prophylaxis capabilities, including 
        the development and maintenance of an initial 
        pharmaceutical stockpile, including medical kits, and 
        diagnostics sufficient to protect first responders, 
        their families, immediate victims, and vulnerable 
        populations from a chemical or biological event;
          [(10)] (11) paying salaries and benefits for 
        personnel, including individuals employed by the grant 
        recipient on the date of the relevant grant 
        application, to serve as qualified intelligence 
        analysts, regardless of whether such analysts are 
        current or new full-time employees or contract 
        employees;
          [(11)] (12) paying expenses directly related to 
        administration of the grant, except that such expenses 
        may not exceed 3 percent of the amount of the grant;
          [(12)] (13) any activity permitted under the Fiscal 
        Year 2007 Program Guidance of the Department for the 
        State Homeland Security Grant Program, the Urban Area 
        Security Initiative (including activities permitted 
        under the full-time counterterrorism staffing pilot), 
        or the Law Enforcement Terrorism Prevention Program; 
        and
          [(13)] (14) any other appropriate activity, as 
        determined by the Administrator.
  (b) Limitations on Use of Funds.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Limitations on discretion.--
                  (A) * * *
                  (B) Analysts.--If amounts awarded to a grant 
                recipient under section 2003 or 2004 are used 
                for paying salary or benefits of a qualified 
                intelligence analyst under subsection [(a)(10)] 
                (a)(11), the Administrator shall make such 
                amounts available without time limitations 
                placed on the period of time that the analyst 
                can serve under the grant.

           *       *       *       *       *       *       *