[Federal Register Volume 83, Number 201 (Wednesday, October 17, 2018)]
[Notices]
[Pages 52454-52455]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-22522]



[[Page 52454]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2018-0094; NIOSH-321]


Implementation of Section 2695 (42 U.S.C. 300ff-131) Public Law 
111-87: Infectious Diseases and Circumstances Relevant to Notification 
Requirements: Definition of Emergency Response Employee

AGENCY: Centers for Disease Control and Prevention, HHS.

ACTION: Notice and request for comment.

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SUMMARY: The Centers for Disease Control and Prevention (CDC), within 
the Department of Health and Human Services (HHS), is adding a 
definition of the term ``emergency response employees'' to the 
definitions section of the document entitled ``Implementation of 
Section 2695 (42 U.S.C. 300ff-131) Public Law 111-87: Infectious 
Diseases and Circumstances Relevant to Notification Requirements,'' 
which contains a list of potentially life-threatening infectious 
diseases to which emergency response employees may be exposed and 
companion guidelines published by the National Institute for 
Occupational Safety and Health (NIOSH), pursuant to the Ryan White HIV/
AIDS Treatment Extension Act of 2009.

DATES: Comments must be received by December 17, 2018.

ADDRESSES: 
    Written comments: You may submit comments by any of the following 
methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments to the docket.
     Mail: NIOSH Docket Office, Robert A. Taft Laboratories, 
MS-C34, 1090 Tusculum Avenue, Cincinnati, OH 45226.
    Instructions: All submissions received must include the agency name 
(Centers for Disease Control and Prevention, HHS) and docket number 
(CDC-2018-0094; NIOSH-321) for this action. All relevant comments, 
including any personal information provided, will be posted without 
change to http://www.regulations.gov. For detailed instructions on 
submitting public comments, see the ``Public Participation'' heading of 
the SUPPLEMENTARY INFORMATION section of this document.

FOR FURTHER INFORMATION CONTACT: Rachel Weiss, Office of the Director, 
NIOSH; 1090 Tusculum Avenue, MS:C-48, Cincinnati, OH 45226; telephone 
(855) 818-1629 (this is a toll-free number); email [email protected].

SUPPLEMENTARY INFORMATION: 

I. Public Participation

    Interested parties may participate in this activity by submitting 
written views, opinions, recommendations, and data. Comments received, 
including attachments and other supporting materials, are part of the 
public record and subject to public disclosure. Do not include any 
information in your comment or supporting materials that you do not 
wish to be disclosed. Although your name, contact information, or other 
information that identifies you in the body of your comments will be on 
public display, NIOSH will review all submissions and may choose (but 
is not required) to redact or withhold submissions containing private 
or proprietary information such as Social Security numbers, medical 
information, and/or inappropriate language. You may submit comments on 
any topic related to this action. All public comments will be posted in 
the docket for this action at https://www.regulations.gov.

II. Statutory Authority

    The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 
1990 (Pub. L. 101-381) was reauthorized in 1996, 2000, 2006, and 2009. 
The most recent reauthorization, the Ryan White HIV/AIDS Treatment 
Extension Act of 2009 (Pub. L. 111-87), amended the Public Health 
Service Act (PHS Act, 42 U.S.C. 201-300ii) and requires the HHS 
Secretary to establish the following: A list of potentially life-
threatening infectious diseases, including emerging infectious 
diseases, to which emergency response employees (ERE) may be exposed in 
responding to emergencies; guidelines describing circumstances in which 
EREs may be exposed to these diseases, taking into account the 
conditions under which emergency response is provided; and guidelines 
describing the manner in which medical facilities should make 
determinations about exposures.
    In a Federal Register notice published on July 14, 2010, the HHS 
Secretary delegated this responsibility to the CDC Director.\1\ The CDC 
Director further assigned the responsibility to the NIOSH Director and 
formally re-delegated the authority to develop the list and guidelines 
to NIOSH on August 27, 2018.\2\
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    \1\ 75 FR 40842.
    \2\ 83 FR 50379 (October 4, 2018).
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III. Background

    On November 2, 2011, CDC published a notice in the Federal Register 
entitled Implementation of Section 2695 (42 U.S.C. 300ff-131) Public 
Law 111-87: Infectious Diseases and Circumstances Relevant to 
Notification Requirements.\3\ The notice included ``a list of 
potentially life-threatening infectious diseases, including emerging 
infectious diseases, to which EREs may be exposed in responding to 
emergencies . . .; guidelines describing circumstances in which 
employees may be exposed to these diseases; and guidelines describing 
the manner in which medical facilities should make determinations about 
exposures.'' The list and guidelines published in that notice did not 
include a definition for ``emergency response employee.''
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    \3\ 76 FR 67736.
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    Upon reconsideration following additional requests to clarify the 
meaning of ``emergency response employee,'' NIOSH is adding a 
definition of the term ``emergency response employee'' to the 
definitions section of the list and guidelines. ``Emergency response 
employee'' means:

firefighters, law enforcement officers, paramedics, emergency 
medical technicians, funeral service practitioners, and other 
individuals (including employees of legally organized and recognized 
volunteer organizations, without regard to whether such employees 
receive nominal compensation) who, in the course of professional 
duties, respond to emergencies in the geographic area involved.

    The definition effectively identifies those employees who may be 
exposed to a potentially life-threatening infectious disease while 
attending to, treating, assisting or transporting a victim of an 
emergency taken to a medical facility as a result of the emergency (see 
42 U.S.C. 300ff-133(a)). The definition's reference to ``other 
individuals'' provides NIOSH with discretion in determining whether 
additional categories of EREs may be included in the future. By 
including this definition, all interested parties, including those 
responsible for reporting when an ERE has been exposed to a potentially 
life-threatening infectious disease, ERE employers, medical facilities, 
state public health officers, the EREs themselves, and the public will 
know which individuals and entities fall within the scope of the 
notification procedures and guidelines.
    This definition was originally included in the Ryan White CARE Act 
of 1990 and amended by the Ryan White CARE Act Amendments of 1996 (Pub. 
L. 104-146), and, therefore, codified in the

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PHS Act. The notification provisions, including the definition of 
``emergency response employee,'' were then removed from the Ryan White 
HIV/AIDS Treatment Modernization Act of 2006 and the PHS Act.\4\ The 
term ``emergency response employee,'' however, continued to be used in 
a different part of the statutes pertaining to responsibilities 
assigned to the Health Resources and Services Administration (HRSA).\5\ 
When Congress reinstated the notification provisions in Part G of the 
Ryan White HIV/AIDS Treatment Extension Act of 2009, a definition of 
ERE was not included.
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    \4\ The notification provisions now included in Part G were 
formerly found in Part E, which was deleted because the intent of 
the 2006 reauthorization was, in part, to eliminate programs ``which 
had never been funded or re-examined in the last two 
reauthorizations.'' Congress then ``deleted definitions which were 
no longer relevant (e.g., designated officer of emergency response 
employees, emergency, emergency response employee, employer of 
emergency response employees, and exposed),'' which were located in 
Part D of the original statute. See H.R. REP. NO. 109-695, at 12 
(2006).
    \5\ 42 U.S.C. 300ff-62.
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    NIOSH has interpreted the legislative history and the development 
of the Ryan White CARE Act of 1990 and subsequent reauthorizations to 
indicate that Congress's failure to restore the original definition of 
ERE was unintentional and merely an oversight. Including the original 
statutory definition in the NIOSH list and guidelines would allow the 
notification provisions to be implemented as Congress originally 
intended.
    Including the definition of ``emergency response employee'' in the 
definitions section of the list and guidelines is within NIOSH's 
authority, pursuant to the August 27, 2018 re-delegation for the sec. 
2695 duties. Implicit in this directive is the need to identify the 
types of EREs who transport or serve victims of emergencies taken to 
medical facilities, in order to improve the notification system 
allowing EREs to receive timely diagnosis and post-exposure medical 
treatment for infectious disease exposures. NIOSH therefore has the 
authority to include the definition of ``emergency response employees'' 
in the list and guidelines.
    After consideration of public comment submitted to the docket for 
this action, NIOSH will update the guidelines and list with the ERE 
definition and re-publish them on the NIOSH Ryan White HIV/AIDS 
Treatment Extension Act of 2009 topic page, at https://www.cdc.gov/niosh/topics/ryanwhite/.

John J. Howard,
Director, National Institute for Occupational Safety and Health, 
Centers for Disease Control and Prevention.
[FR Doc. 2018-22522 Filed 10-16-18; 8:45 am]
 BILLING CODE 4163-19-P