Emergency Preparedness and Response Security, Accountability, and Flexibility Enhancement Act or the SAFE ACT - Amends the Public Health Service Act to revise provisions relating to bioterrorism and other public health emergencies preparedness grants, including to require the Secretary of Health and Human Services to develop measurable critical benchmarks and performance standards.
Authorizes the Secretary to develop a real-time surveillance program for collecting and reporting information on notifiable diseases and conditions (infectious diseases, environmental exposures or poisons, and other conditions, the real-time surveillance and control of which in the United States constitute a critical public health need). Requires the Director of the Centers for Disease Control and Prevention (CDC) to establish a national electronic surveillance program for such diseases. Provides for a health alert in the case of a public health emergency or other circumstance requiring active surveillance.
Requires the Secretary to award grants to enable states to conduct surveillance and report with respect to notifiable diseases. Makes ineligible for certain funding states or health care providers that do not report notifiable diseases.
Allows grantees to use grant funds to develop benchmarks for meeting critical capacity for food or water borne disease detection and response.
Requires the Director to provide for the evaluation of the progress made by state and local governments in meeting the benchmarks established under this Act.
Requires the Secretary to establish procedures for the inspection, screening, and quarantine of live animals entering the United States for commercial purposes.
Requires the federal agency partners of the National Disaster Medical System to conduct a review of the National Disaster Medical System infrastructure.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2792 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 2792
To revise and extend certain provisions of the Public Health Security
and Bioterrorism Preparedness and Response Act of 2002.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 11, 2006
Mr. Gregg introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To revise and extend certain provisions of the Public Health Security
and Bioterrorism Preparedness and Response Act of 2002.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Emergency Preparedness and Response
Security, Accountability, and Flexibility Enhancement Act'' or the
``SAFE Act''.
SEC. 2. ACCOUNTABILITY WITH RESPECT TO PREPAREDNESS FUNDING.
(a) In General.--Section 319C-1 of the Public Health Service Act
(42 U.S.C. 247d-3a) is amended--
(1) in subsection (b)--
(A) in paragraph (1)--
(i) in subparagraph (A), by striking ``or''
at the end;
(ii) in subparagraph (B), by striking the
period and inserting ``; or''; and
(iii) by adding at the end the following:
``(C) a consortium of States that, with respect to
the States that make up the consortium, comply with the
requirements of subparagraph (A) individually or as
part of the consortium.''; and
(B) by adding at the end the following:
``(3) Achievement of measurable critical benchmarks and
performance measures.--In making awards under subsection (a),
the Secretary shall develop and require the application of
measurable critical benchmarks and performance standards so
that grantees can demonstrate achievement with respect to such
benchmarks and measures in a reasonable timeframe, as
determined by the Secretary. Such benchmarks and measures shall
require grantees to--
``(A) annually report grant expenditures to the
Secretary and the Secretary of Homeland Security who
shall ensure that such information is included on the
Federal-Internet based point of access developed under
section 2(b) of the SAFE Act; and
``(B) at a minimum, annually test and exercise the
emergency preparedness capabilities of the grantee,
acting in coordination with the applicable State
readiness plan under subsection (c), based on criteria
established by the Secretary and the Secretary of
Homeland Security.
``(4) Regional coordination.--In making awards under
subsection (a), the Secretary shall give preference to eligible
entities that submit applications that, in the determination of
the Secretary will--
``(A) enhance coordination--
``(i) among one or more health care
institutions, including but not limited to
Federal Government medical facilities, academic
medical centers, clinics, health centers,
primary care facilities, or nursing homes; and
``(ii) between entities described in clause
(i) and one or more States, sub-State regions
of States or other sub-State groups, or any
combination of States and sub-State regions;
and
``(B) serve the needs of a defined geographic
area.'';
(2) in subsection (h)--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) in paragraph (2), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following:
``(3) coordinate with the Secretary of Homeland Security to
prevent the duplicative funding of programs or activities and
to ensure that the use of awards is in compliance with State
plans.'';
(3) by striking subsection (j) and inserting the following:
``(j) Funding.--
``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated, $1,300,000,000
for fiscal year 2007, and such sums as may be necessary for
each of fiscal years 2008 through 2010, of which--
``(A) not to exceed $875,000,000 shall be made
available in each fiscal year for making awards under
subsection (a) to States, notwithstanding the
eligibility conditions under subsection (j) (as such
subsection existed on the day before the date of
enactment of the Emergency Preparedness and Response
Security, Accountability, and Flexibility Enhancement
Act, for the purpose of enhancing the all-hazards
emergency preparedness and medical response
capabilities of States; and
``(B) not to exceed 5 percent of the amount made
available under subparagraph (A) for each fiscal year
shall be made available for Federal, State, and local
planning and administrative activities related to
awards described in such subparagraph.
``(2) Contingent additional authorization.--If a
significant change in circumstances warrants an increase in
this amount authorized to be appropriated under paragraph (1)
for fiscal year 2007, there are authorized to be appropriated
such sums as may be necessary for such year for carrying out
this section, in addition to the amount authorized under
paragraph (1).
``(3) Supplement not supplant.--Amounts appropriated under
paragraph (1) shall be used to supplement and not supplant
other State and local public funds provided for activities
under this section.
``(4) Degree of risk.--
``(A) In general.--For fiscal year 2006 and any
subsequent fiscal year, the Secretary, in coordination
with the Secretary of Homeland Security, shall, before
making awards pursuant to subsection (a) for such
year--
``(i) reserve from the amount appropriated
under paragraph (1) for the fiscal year an
amount determined necessary by the Secretary to
make awards under subsection (a) to eligible
entities that face a particularly high degree
of risk of such a threat, as determined by the
Secretary in coordination with the Secretary of
Homeland Security; and
``(ii) after making the reservation
required under clause (i), provide funds to
eligible entities that have a significant unmet
need, as determined by the Secretary, in
coordination with the Secretary of Homeland
Security, to build capacity to identify,
detect, monitor, and respond to a public health
emergency, which need will not otherwise be met
by awards pursuant to subsection (a).
``(B) Recipients of grants.--Awards pursuant to
subparagraph (A) may be supplemental awards to States
that receive awards pursuant to subsection (a), or may
be awards to eligible entities described in subsection
(b)(1)(B) within such States.
``(5) Matching requirement.--The Secretary may not make a
grant to a State under this section unless the State agrees
that, with respect to the costs to be incurred by the State in
carrying out the activities for which the grant was awarded,
the State will make available (directly or through donations
from public or private entities) non-Federal contributions
toward such costs in an amount equal to--
``(A) with respect to a State with a population of
more than 2,000,000, not less than $1 for each $1 of
Federal funds provided in the grant; and
``(B) with respect to a State with a population of
2,000,000 or less, not less than $1 for each $4 of
Federal funds provided in the grant.''; and
(4) by adding at the end the following:
``(k) Return of Unobligated Funds.--Any portion of an award under
subsection (a) that remains unobligated after the expiration of the 3-
year period beginning on the date on which the award is made shall be
returned to the Secretary.''.
(b) Single Point of Access.--The Secretary of Health and Human
Services and the Secretary of Homeland Security shall jointly establish
a single Federal Internet-based point of access to enable States and
other entities to apply for available Federal assistance for public
health and hospital preparedness and response to bioterrorism and other
public health threats, including applying for awards under section
319C-1 of the Public Health Service Act (42 U.S.C. 247d-3a).
SEC. 3. NATIONAL NOTIFIABLE DISEASE SURVEILLANCE PROGRAM.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended--
(1) by striking section 314; and
(2) by inserting after section 311, the following:
``SEC. 311A. NATIONAL NOTIFIABLE DISEASE SURVEILLANCE PROGRAM.
``(a) In General.--The Secretary is authorized to develop a real-
time surveillance program for collecting and reporting information on
notifiable diseases and conditions.
``(b) Notifiable Diseases.--Not later than 180 days after the date
of enactment of the Emergency Preparedness and Response Security,
Accountability, and Flexibility Enhancement Act, and annually
thereafter, the Secretary, in consultation with State and local health
authorities and appropriate private professional societies, shall
certify a list of infectious diseases, environmental exposures or
poisons, and other conditions, the real-time surveillance and control
of which, in each State and territory of the United States, constitute
a critical public health need. For purposes of this part, the term
`notifiable disease' means a disease, exposures or poison, or other
condition that appears on the list under this section.
``(c) Federal Informatics Activities.--
``(1) In general.--In order to meet the urgent need for
critical electronic surveillance of notifiable diseases, the
Director of the Centers for Disease Control and Prevention, in
consultation with State and local health authorities, shall,
not later than 1 year after the date of enactment of the
Emergency Preparedness and Response Security, Accountability,
and Flexibility Enhancement Act, establish and maintain a
national electronic surveillance program that includes the
following components:
``(A) Procedures to provide for the collection (in
a standardized form) and analysis of data on all
notifiable diseases and on certain other conditions
that States or regions elect to report to the program.
``(B) A procedure to enable all major public and
private clinical laboratories to automatically report
data, in compliance with the regulations promulgated
under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996, to the
program concerning notifiable diseases, antimicrobial
resistance testing, and other data determined
appropriate by the Director.
``(C) A procedure to provide for syndromic and
disease-specific surveillance by monitoring, in
compliance with the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996, of private sector health-
related electronic data (such as pharmaceutical
purchase data and health insurance claims data).
``(D) A procedure to enable States to report data
on suspicious cases of conditions that are not on the
notifiable disease list but that may warrant further
investigation.
``(E) A procedure to enable the program to
automatically identify certain trends and suspicious
patterns with respect to data reported to the program.
``(F) A procedure to enable the program to provide
regular reports to regional, State, and local
government entities concerning disease trends,
suspicious disease patterns, incidence and prevalence
of diseases, laboratory data, and other information
determined appropriate. Such information shall include
data on comparative national disease trends.
``(G) A procedure to enable the program to collect
and analyze data from certain seminal veterinary and
environmental sources where appropriate.
``(H) A procedure to enable the program to export
data in a form appropriate for aggregation, statistical
analysis, and reporting.
``(I) A procedure to enable the program to receive
and report data relating to non-notifiable diseases,
including vital records, registries, chronic disease,
and maternal and child health data.
``(2) Timeliness of reporting.--The procedures developed
under paragraph (1) for the reporting of data shall ensure that
such data are reported in a timely manner.
``(3) Private sector resources.--To meet the deadline
described in paragraph (1), the Director of the Centers for
Disease Control and Prevention may, on a temporary or permanent
basis, implement systems or products developed by the private
sector.
``(4) Authority for contracts.--In carrying out this
subsection, the Director of the Centers for Disease Control and
Prevention may enter into contracts with public and private
entities.
``(d) National Biointelligence Unit.--The Director of the Centers
for Disease Control and Prevention shall analyze data maintained by the
national electronic surveillance program under subsection (b), and data
from other sources, to report on the prevalence and incidence of
notifiable diseases and conditions, trends and patterns in public
health, emerging health problems, regional differences, and other
analyses determined appropriate by the Director of the Centers for
Disease Control and Prevention.
``(e) Federal Technical Assistance, Communication, and
Coordination.--
``(1) In general.--In carrying out this section, the
Secretary shall provide technical assistance to, and provide
for appropriate communications to the public, scientific,
public health and medical communities, and other key
stakeholders, and to provide for the coordination of the
activities of--
``(A) State and local health authorities to
integrate State and local surveillance activities and
systems with the national notifiable disease
surveillance program developed under this section and
to generally improve State and local notifiable disease
reporting and communications; and
``(B) private corporations, professional
associations, or other entities that may have sources
of surveillance data or access to health care
providers, health officials, or other individuals who
would need to participate in a surveillance program.
``(2) Financial assistance.--Assistance provided under
paragraph (1)(B) may include financial assistance for the
purpose of formatting or translating data into a form that is
most compatible and appropriate for use in the national
notifiable disease surveillance program developed under this
section.
``(3) Health alert registration and information.--
``(A) Registration.--Each health care provider and
facility that receives funds under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) or that
receives funds under a State program under title XIX of
such Act (42 U.S.C. 1396 et seq.) shall annually submit
to the Secretary a registration that contains the e-
mail address or fax number of the provider or facility
for purposes of enabling the Secretary to provide
health alerts in the case of a public health emergency
or other circumstance requiring active surveillance.
``(B) Establishment of system.--The Secretary shall
establish a system to maintain the information provided
by providers and facilities under subparagraph (A).
Such system shall be designed--
``(i) to enable providers and facilities--
``(I) to provide and update
information contained in the system;
and
``(II) to request information or to
elect to receive additional types of
non-emergency health alerts or
communications; and
``(ii) to enable the Director of the
Centers for Disease Control and Prevention to
provide updated contact information for
providers and facilities to State and local
health authorities for the purpose of emergency
health communications.
``(f) Grants to States for Disease Reporting.--
``(1) Grants.--The Secretary shall award grants to States
to enable such States to conduct passive, active, and when
appropriate syndromic surveillance, and timely reporting
activities with respect to notifiable diseases.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1), a State shall prepare and submit to the
Secretary an application at such time, in such manner, and
containing such information as the Secretary may require,
including--
``(A) a description of the manner in which grants
funds will be used to enhance the timeliness and
comprehensiveness of the State's effort to report
notifiable diseases to the program under subsection
(c); and
``(B) a plan for identifying and reporting to the
Secretary the identity of health care providers and
facilities that consistently fail to report to the
State instances of notifiable diseases in a timely
manner.
``(3) Enhanced grant.--In the case of a State that submits
a plan, as part of the application under paragraph (2), to
transition State and local reporting of notifiable diseases to
an electronic system that is compatible with the program under
subsection (c), the amount of the grant awarded to a State
under paragraph (1) shall be increased by an amount determined
by the Secretary to be necessary to complete such transition.
``(4) Supplement not supplant funds for activities.--A
State shall use amounts received under a grant under this
subsection to supplement and not supplant other funds made
available by the State for the conduct of reporting activities
with respect to notifiable diseases.
``(5) Reduction in block grant funding.--For fiscal year
beginning with fiscal year 2008, if the Secretary determines
that a State is not reporting all notifiable diseases to the
program established under subsection (c) in a timely manner
through the use of an electronic system that is compatible with
the program, the State shall not be eligible to receive a grant
under part A of title XIX for such fiscal year.
``(6) Failure to report.--A health care provider or
facility shall not be eligible to receive funds under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or
under a State program under title XIX of such Act (42 U.S.C.
1396 et seq.) if the Secretary determines, based on a State
notification received under the plan described in paragraph
(2)(B), that such provider or facility has consistently failed
to report, in a timely manner, instances of notifiable diseases
to the State for submission to the program under subsection
(c).
``(g) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this
section.''.
SEC. 4. ENHANCING CRITICAL CAPACITY FOR ILLNESS DETECTION.
Section 319C(c) of the Public Health Service Act (42 U.S.C. 247d-
3(c)) is amended--
(1) in paragraph (3), by striking ``and'' at the end;
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(5) develop benchmarks for meeting critical capacity for
food or water borne disease detection and response.''.
SEC. 5. EVALUATION OF PUBLIC HEALTH CAPACITY OUTCOMES.
Section 319C-1(b) of the Public Health Service Act (42 U.S.C. 247d-
3a(b)), as amended by section 2(a), is further amended by adding at the
end the following:
``(5) Evaluation of public health capacity outcomes.--The
Director of the Centers for Disease Control and Prevention
shall enter into contracts with independent entities for the
periodic evaluation of the progress made by State and local
governments in meeting the benchmarks established in the plan
under paragraph (1)(A)(ii)(V).''.
SEC. 6. INSPECTION, SCREENING, AND QUARANTINING OF LIVE ANIMALS.
Section 362 of the Public Health Service Act (42 U.S.C. 265) is
amended by adding at the end the following: ``The Secretary shall
establish procedures for the appropriate inspection, screening, and
quarantine of live animals entering the United States for commercial
purposes, including procedures to protect domestic animal and human
populations from diseases carried by imported live animals''.
SEC. 7. NATIONAL DISASTER MEDICAL SYSTEM.
(a) Coordination.--Section 2811(b) of the Public Health Service Act
(42 U.S.C. 300hh-11) is amended by adding at the end the following:
``(4) Coordination of planning and preparedness
activities.--
``(A) In general.--The Federal agency partners of
the National Disaster Medical System shall coordinate
all planning and preparedness activities of the
National Disaster Medical System with the Secretary of
Homeland Security in a manner that ensures that such
activities are consistent with the National Response
Plan, the National Incident Management System, and
Homeland Security Presidential Directives #5 and #8.
``(B) Definition.--In this section, the term
`Federal agency partners of the National Disaster
Medical System' means the Department of Homeland
Security, the Department of Health and Human Services,
the Department of Defense, and the Department of
Veterans Affairs.'';
(b) Joint Review.--Section 2811 of the Public Health Service Act
(42 U.S.C. 300hh-11) is amended--
(1) by redesignating subsection (h) as subsection (i); and
(2) by inserting after subsection (g), the following:
``(h) Joint Review.--
``(1) In general.--Not later than December 31, 2007, the
Federal agency partners of the National Disaster Medical System
in coordination with the Secretary of Homeland Security shall
conduct a joint review of the National Disaster Medical System
infrastructure including organization, various teams, staffing
levels, training programs, equipment and supplies, supply chain
management and interoperability, and the role of each of the
Federal agency partners of the National Disaster Medical
System, and any other applicable issues.
``(2) Modifications.--Based on the results of the review
conducted under paragraph (1), the Secretary of Homeland
Security shall, with respect to the National Disaster Medical
System--
``(A) modify the policies of the System for the
deployment of System assets during a national
emergency, including command and coordination,
licensure, credentialing or privileging, resource
typing and allocation, supplies and logistics, and
inter-agency and public communications;
``(B) refine, standardize, and implement training
curricula for System participants based on the
modifications made under subparagraph (A), including
planning for continuing educational programs to ensure
that System participants are aware of programmatic
changes within the System; and
``(C) refine, implement, and maintain standards for
System staffing, equipment, and supply-chain management
to ensure the adequacy of available assets in the
System.''.
(c) Miscellaneous Provisions.--Section 2811 of the Public Health
Service Act (42 U.S.C. 300hh-11) is amended--
(1) in subsection (b)(3)--
(A) in subparagraph (A)--
(i) by redesignating clauses (i) and (ii)
as clauses (ii) and (iii), respectively; and
(ii) by inserting before clause (ii) (as so
redesignated), the following:
``(i) provide an initial rapid Federal
medical response, consistent with the National
Response Plan and National Incident Management
System, to an emergency and to maintain
capability to sustain disaster medical
operations through an established transition
period as determined by the Federal agency
partners of the National Disaster Medical
System;''; and
(B) by adding at the end the following:
``(D) Continued monitoring of performance.--The
Secretary of Homeland Security, acting through the
Chief Medical Officer, shall design, develop, and
implement quantitative standards and metrics under
which programmatic changes with respect to the National
Disaster Medical System may be isolated, measured,
validated, and revised if needed on a real-time basis
as determined by the performance of the System in
drills and exercises or actual deployments.
``(E) Nonduplication of activities.--The National
Disaster Medical System shall carry out activities in
coordination with Department of Health and Human
Services emergency response teams (including the
uniformed corps of the United States Public Health
Service and the Medical Reserve Corps) to minimize
duplicative activities.''; and
(2) in subsection (i) (as so redesignated), by striking
``2002 through 2006'' and inserting ``2006 through 2010''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S4476)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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