SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Pandemic and All-Hazards Preparedness and Advancing 
Innovation Act of 2018’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—STRENGTHENING THE NATIONAL HEALTH SECURITY 
STRATEGY 
Sec. 101. National Health Security Strategy. 
TITLE II—IMPROVING PREPAREDNESS AND RESPONSE 
Sec. 201. Improving benchmarks and standards for preparedness and response. 
Sec. 202. Amendments to preparedness and response programs. 
Sec. 203. Regional health care emergency preparedness and response systems. 
Sec. 204. Military and civilian partnership for trauma readiness. 
Sec. 205. Public health and health care system situational awareness and bio-
surveillance capabilities. 
Sec. 206. Strengthening and supporting the public health emergency rapid re-
sponse fund. 
Sec. 207. Improving all-hazards preparedness and response by public health 
emergency volunteers. 
Sec. 208. Clarifying State liability law for volunteer health care professionals. 
Sec. 209. Report on adequate national blood supply. 
Sec. 210. Report on the public health preparedness and response capabilities 
and capacities of hospitals, long-term care facilities, and other 
health care facilities. 
TITLE III—REACHING ALL COMMUNITIES 
Sec. 301. Strengthening and assessing the emergency response workforce. 
Sec. 302. Health system infrastructure to improve preparedness and response. 
Sec. 303. Considerations for at-risk individuals. 
Sec. 304. Improving emergency preparedness and response considerations for 
children. 
Sec. 305. National advisory committees on disasters. 
Sec. 306. Guidance for participation in exercises and drills. 
TITLE IV—PRIORITIZING A THREAT-BASED APPROACH 
Sec. 401. Assistant Secretary for Preparedness and Response. 
Sec. 402. Public Health Emergency Medical Countermeasures Enterprise. 
Sec. 403. Strategic National Stockpile. 
Sec. 404. Preparing for pandemic influenza, antimicrobial resistance, and other 
significant threats. 
Sec. 405. Reporting on the Federal Select Agent Program.
TITLE V—INCREASING COMMUNICATION IN MEDICAL 
COUNTERMEASURE ADVANCED RESEARCH AND DEVELOPMENT 
Sec. 501. Medical countermeasure budget plan. 
Sec. 502. Material threat and medical countermeasure notifications. 
Sec. 503. Availability of regulatory management plans. 
Sec. 504. The Biomedical Advanced Research and Development Authority and 
the BioShield Special Reserve Fund. 
Sec. 505. Additional strategies for combating antibiotic resistance. 
TITLE VI—ADVANCING TECHNOLOGIES FOR MEDICAL 
COUNTERMEASURES 
Sec. 601. Administration of countermeasures. 
Sec. 602. Updating definitions of other transactions. 
Sec. 603. Medical countermeasure master files. 
Sec. 604. Animal rule report. 
Sec. 605. Review of the benefits of genomic engineering technologies and their 
potential role in national security. 
Sec. 606. Report on vaccines development. 
Sec. 607. Strengthening mosquito abatement for safety and health. 
TITLE VII—MISCELLANEOUS PROVISIONS 
Sec. 701. Reauthorizations and extensions. 
Sec. 702. Location of materials in the stockpile. 
Sec. 703. Cybersecurity. 
Sec. 704. Technical amendments. 
Sec. 705. Formal strategy relating to children separated from parents and 
guardians as a result of zero tolerance policy. 
Sec. 706. Reporting relating to children separated from parents and guardians 
as a result of zero tolerance policy. 
Sec. 707. Technical correction. 
Sec. 708. Savings clause. 
TITLE I—STRENGTHENING THE 
NATIONAL HEALTH SECURITY 
STRATEGY 
SEC. 101. NATIONAL HEALTH SECURITY STRATEGY. 
Section 2802 of the Public Health Service Act (42 
U.S.C. 300hh–1) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘2014’’ and inserting 
‘‘2018’’; and
(ii) by striking the second sentence 
and inserting the following: ‘‘Such Na-
tional Health Security Strategy shall de-
scribe potential emergency health security 
threats and identify the process for achiev-
ing the preparedness goals described in 
subsection (b) to be prepared to identify 
and respond to such threats and shall be 
consistent with the national preparedness 
goal (as described in section 504(a)(19) of 
the Homeland Security Act of 2002), the 
National Incident Management System (as 
defined in section 501(7) of such Act), and 
the National Response Plan developed pur-
suant to section 504 of such Act, or any 
successor plan.’’; 
(B) in paragraph (2), by inserting before 
the period at the end of the second sentence the 
following: ‘‘, and an analysis of any changes to 
the evidence-based benchmarks and objective 
standards under sections 319C–1 and 319C–2’’; 
and 
(C) in paragraph (3)— 
(i) by striking ‘‘2009’’ and inserting 
‘‘2022’’;
(ii) by inserting ‘‘(including gaps in 
the environmental health and animal 
health workforces, as applicable), describ-
ing the status of such workforce’’ after 
‘‘gaps in such workforce’’; 
(iii) by striking ‘‘and identifying strat-
egies’’ and inserting ‘‘identifying strate-
gies’’; and 
(iv) by inserting before the period at 
the end ‘‘, and identifying current capabili-
ties to meet the requirements of section 
2803’’; and 
(2) in subsection (b)— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘and investigation’’ and inserting ‘‘inves-
tigation, and related information tech-
nology activities’’; 
(ii) in subparagraph (B), by striking 
‘‘and decontamination’’ and inserting ‘‘de-
contamination, relevant health care serv-
ices and supplies, and transportation and 
disposal of medical waste’’; and 
(iii) by adding at the end the fol-
lowing:
‘‘(E) Response to environmental hazards.’’; 
(B) in paragraph (3)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘including mental 
health’’ and inserting ‘‘including phar-
macies, mental health facilities,’’; and 
(ii) in subparagraph (F), by inserting 
‘‘or exposures to agents that could cause a 
public health emergency’’ before the pe-
riod; 
(C) in paragraph (5), by inserting ‘‘and 
other applicable compacts’’ after ‘‘Compact’’; 
and 
(D) by adding at the end the following: 
‘‘(9) ZOONOTIC
DISEASE, FOOD, AND
AGRI-
CULTURE.—Improving coordination among Federal, 
State, local, tribal, and territorial entities (including 
through consultation with the Secretary of Agri-
culture) to prevent, detect, and respond to outbreaks 
of plant or animal disease (including zoonotic dis-
ease) that could compromise national security result-
ing from a deliberate attack, a naturally occurring 
threat, the intentional adulteration of food, or other 
public health threats, taking into account inter-
actions between animal health, human health, and
animals’ and humans’ shared environment as di-
rectly related to public health emergency prepared-
ness and response capabilities, as applicable. 
‘‘(10) GLOBAL HEALTH SECURITY.—Assessing 
current or potential health security threats from 
abroad to inform domestic public health prepared-
ness and response capabilities.’’. 
TITLE II—IMPROVING 
PREPAREDNESS AND RESPONSE 
SEC. 201. IMPROVING BENCHMARKS AND STANDARDS FOR 
PREPAREDNESS AND RESPONSE. 
(a) EVALUATING MEASURABLE EVIDENCE-BASED 
BENCHMARKS
AND
OBJECTIVE
STANDARDS.—Section 
319C–1 of the Public Health Service Act (42 U.S.C. 
247d–3a) is amended by inserting after subsection (j) the 
following: 
‘‘(k) EVALUATION.— 
‘‘(1) IN
GENERAL.—Not later than 2 years 
after the date of enactment of the Pandemic and 
All-Hazards Preparedness and Advancing Innovation 
Act of 2018 and every 2 years thereafter, the Sec-
retary shall conduct an evaluation of the evidence- 
based benchmarks and objective standards required 
under subsection (g). Such evaluation shall be sub-
mitted to the congressional committees of jurisdic-
tion together with the National Health Security 
Strategy under section 2802, at such time as such 
strategy is submitted. 
‘‘(2) CONTENT.—The evaluation under this 
paragraph shall include— 
‘‘(A) a review of evidence-based bench-
marks and objective standards, and associated 
metrics and targets; 
‘‘(B) a discussion of changes to any evi-
dence-based benchmarks and objective stand-
ards, and the effect of such changes on the abil-
ity to track whether entities are meeting or 
making progress toward the goals under this 
section and, to the extent practicable, the appli-
cable goals of the National Health Security 
Strategy under section 2802; 
‘‘(C) a description of amounts received by 
eligible entities described in subsection (b) and 
section 319C–2(b), and amounts received by 
subrecipients and the effect of such funding on 
meeting evidence-based benchmarks and objec-
tive standards; and 
‘‘(D) recommendations, as applicable and 
appropriate, to improve evidence-based bench-
marks and objective standards to more accu-
rately assess the ability of entities receiving 
awards under this section to better achieve the 
goals under this section and section 2802.’’. 
(b) EVALUATING THE PARTNERSHIP FOR STATE AND 
REGIONAL HOSPITAL PREPAREDNESS.—Section 319C– 
2(i)(1) of the Public Health Service Act (42 U.S.C. 247– 
3b(i)(1)) is amended by striking ‘‘section 319C–1(g), (i), 
and (j)’’ and inserting ‘‘section 319C–1(g), (i), (j), and 
(k)’’. 
SEC. 202. AMENDMENTS TO PREPAREDNESS AND RE-
SPONSE PROGRAMS. 
(a) COOPERATIVE AGREEMENT APPLICATIONS FOR 
IMPROVING STATE AND LOCAL PUBLIC HEALTH SECU-
RITY.—Section 319C–1 of the Public Health Service Act 
(42 U.S.C. 247d–3a) is amended— 
(1) in subsection (a), by inserting ‘‘, acting 
through the Director of the Centers for Disease 
Control and Prevention,’’ after ‘‘the Secretary’’; and 
(2) in subsection (b)(2)(A)— 
(A) in clause (vi), by inserting ‘‘, including 
public health agencies with specific expertise 
that may be relevant to public health security, 
such as environmental health agencies,’’ after 
‘‘stakeholders’’;
(B) by redesignating clauses (vii) through 
(ix) as clauses (viii) through (x); 
(C) by inserting after clause (vi) the fol-
lowing: 
‘‘(vii) a description of how, as applica-
ble, such entity may integrate information 
to account for individuals with behavioral 
health needs following a public health 
emergency;’’; 
(D) in clause (ix), as so redesignated, by 
striking ‘‘; and’’ and inserting a semicolon; 
(E) in clause (x), as so redesignated, by in-
serting ‘‘and’’ after the semicolon; and 
(F) by adding at the end the following: 
‘‘(xi) a description of how the entity 
will partner with health care facilities, in-
cluding hospitals and nursing homes and 
other long-term care facilities, to promote 
and improve public health preparedness 
and response; and 
‘‘(xii) a description of how, as appro-
priate and practicable, the entity will in-
clude critical infrastructure partners, such 
as utility companies within the entity’s ju-
risdiction, in planning pursuant to this
subparagraph to help ensure that critical 
infrastructure will remain functioning dur-
ing, or return to function as soon as prac-
ticable after, a public health emergency.’’. 
(b) EXCEPTION RELATING TO APPLICATION OF CER-
TAIN REQUIREMENTS.— 
(1) IN
GENERAL.—Section 319C–1(g) of the 
Public Health Service Act (42 U.S.C. 247d–3a(g)) is 
amended— 
(A) in paragraph (5)— 
(i) by striking ‘‘Beginning with fiscal 
year 2009’’ and inserting ‘‘Beginning with 
fiscal year 2019’’; 
(ii) by striking ‘‘for the immediately 
preceding fiscal year’’ and inserting ‘‘for 
either of the two immediately preceding 
fiscal years’’; and 
(iii) by striking ‘‘2008’’ and inserting 
‘‘2018’’; and 
(B) by amending subparagraph (A) of 
paragraph (6) to read as follows: 
‘‘(A) IN
GENERAL.—The amounts de-
scribed in this paragraph are the following 
amounts that are payable to an entity for ac-
tivities described in section 319C–1 or 319C–2:
‘‘(i) For one (but not both) of the 
first two fiscal years 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 the re-
spective fiscal year. 
‘‘(ii) For one (but not both) of the 
first two fiscal years immediately following 
the third consecutive fiscal year in which 
an entity experienced such a failure, in lieu 
of applying clause (i), an amount equal to 
15 percent of the amount the entity was el-
igible to receive for the respective fiscal 
year.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to cooper-
ative agreements awarded on or after the date of en-
actment of this Act. 
(c) PARTNERSHIP FOR STATE AND REGIONAL HOS-
PITAL PREPAREDNESS TO IMPROVE SURGE CAPACITY.— 
Section 319C–2 of the Public Health Service Act (42 
U.S.C. 247d–3b) is amended— 
(1) in subsection (a)—
(A) by inserting ‘‘, acting through the As-
sistant Secretary for Preparedness and Re-
sponse,’’ after ‘‘The Secretary’’; and 
(B) by striking ‘‘preparedness for public 
health emergencies’’ and inserting ‘‘prepared-
ness for, and response to, public health emer-
gencies in accordance with subsection (c)’’; 
(2) in subsection (b)(1)(A)— 
(A) by striking ‘‘partnership consisting of’’ 
and inserting ‘‘coalition that includes’’; 
(B) in clause (ii), by striking ‘‘; and’’ and 
inserting a semicolon; and 
(C) by adding at the end the following: 
‘‘(iv) one or more emergency medical serv-
ice organizations or emergency management or-
ganizations; and’’; 
(3) in subsection (d)— 
(A) in paragraph (1)(B), by striking ‘‘part-
nership’’ each place it appears and inserting 
‘‘coalition’’; and 
(B) in paragraph (2)(C), by striking ‘‘med-
ical preparedness’’ and inserting ‘‘preparedness 
and response’’; 
(4) in subsection (f), by striking ‘‘partnership’’ 
and inserting ‘‘coalition’’;
(5) in subsection (g)(2)— 
(A) by striking ‘‘Partnerships’’ and insert-
ing ‘‘Coalitions’’; 
(B) by striking ‘‘partnerships’’ and insert-
ing ‘‘coalitions’’; and 
(C) by inserting ‘‘and response’’ after 
‘‘preparedness’’; and 
(6) in subsection (i)(1)— 
(A) by striking ‘‘An entity’’ and inserting 
‘‘A coalition’’; and 
(B) by striking ‘‘such partnership’’ and in-
serting ‘‘such coalition’’. 
(d) PUBLIC HEALTH SECURITY GRANTS AUTHORIZA-
TION OF APPROPRIATIONS.—Section 319C–1(h)(1)(A) of 
the Public Health Service Act (42 U.S.C. 247d– 
3a(h)(1)(A)) is amended by striking ‘‘$641,900,000 for 
fiscal year 2014’’ and all that follows through the period 
at the end and inserting ‘‘$685,000,000 for each of fiscal 
years 2019 through 2023 for awards pursuant to para-
graph (3) (subject to the authority of the Secretary to 
make awards pursuant to paragraphs (4) and (5)).’’. 
(e) PARTNERSHIP FOR STATE AND REGIONAL HOS-
PITAL PREPAREDNESS AUTHORIZATION OF APPROPRIA-
TIONS.—Section 319C–2(j) of the Public Health Service 
Act (42 U.S.C. 247d–3b(j)) is amended—
(1) by amending paragraph (1) to read as fol-
lows: 
‘‘(1) IN GENERAL.— 
‘‘(A) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this sec-
tion and section 319C–3, in accordance with 
subparagraph (B), there is authorized to be ap-
propriated $385,000,000 for each of fiscal years 
2019 through 2023. 
‘‘(B) RESERVATION OF AMOUNTS FOR RE-
GIONAL SYSTEMS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), of the amount appropriated under sub-
paragraph (A) for a fiscal year, the Sec-
retary may reserve up to 5 percent for the 
purpose of carrying out section 319C–3. 
‘‘(ii) RESERVATION
CONTINGENT
ON 
CONTINUED
APPROPRIATIONS
FOR
THIS 
SECTION.—If for fiscal year 2019 or a sub-
sequent fiscal year, the amount appro-
priated under subparagraph (A) is such 
that, after application of clause (i), the 
amount remaining for the purpose of car-
rying out this section would be less than 
the amount available for such purpose for
the previous fiscal year, the amount that 
may be reserved under clause (i) shall be 
reduced such that the amount remaining 
for the purpose of carrying out this section 
is not less than the amount available for 
such purpose for the previous fiscal year. 
‘‘(iii) SUNSET.—The authority to re-
serve amounts under clause (i) shall expire 
on September 30, 2023.’’; 
(2) in paragraph (2), by striking ‘‘paragraph 
(1) for a fiscal year’’ and inserting ‘‘paragraph 
(1)(A) for a fiscal year and not reserved for the pur-
pose described in paragraph (1)(B)(i)’’; and 
(3) in paragraph (3)(A), by striking ‘‘paragraph 
(1) and not reserved under paragraph (2)’’ and in-
serting ‘‘paragraph (1)(A) and not reserved under 
paragraph (1)(B)(i) or (2)’’. 
SEC. 203. REGIONAL HEALTH CARE EMERGENCY PRE-
PAREDNESS AND RESPONSE SYSTEMS. 
(a) IN GENERAL.—Part B of title III of the Public 
Health Service Act (42 U.S.C. 243 et seq.) is amended 
by inserting after section 319C–2 the following:
‘‘SEC. 319C–3. GUIDELINES FOR REGIONAL HEALTH CARE 
EMERGENCY PREPAREDNESS AND RESPONSE 
SYSTEMS. 
‘‘(a) PURPOSE.—It is the purpose of this section to 
identify and provide guidelines for regional systems of hos-
pitals, health care facilities, and other public and private 
sector entities, with varying levels of capability to treat 
patients and increase medical surge capacity during, in ad-
vance of, and immediately following a public health emer-
gency, including threats posed by one or more chemical, 
biological, radiological, or nuclear agents, including emerg-
ing infectious diseases. 
‘‘(b) GUIDELINES.—The Assistant Secretary for Pre-
paredness and Response, in consultation with the Director 
of the Centers for Disease Control and Prevention, the Ad-
ministrator of the Centers for Medicare & Medicaid Serv-
ices, the Administrator of the Health Resources and Serv-
ices Administration, the Commissioner of Food and 
Drugs, the Assistant Secretary for Mental Health and 
Substance Use, the Assistant Secretary of Labor for Occu-
pational Safety and Health, the Secretary of Veterans Af-
fairs, the heads of such other Federal agencies as the Sec-
retary determines to be appropriate, and State, local, trib-
al, and territorial public health officials, shall, not later 
than 2 years after the date of enactment of this section—
‘‘(1) identify and develop a set of guidelines re-
lating to practices and protocols for all-hazards pub-
lic health emergency preparedness and response for 
hospitals and health care facilities to provide appro-
priate patient care during, in advance of, or imme-
diately following, a public health emergency, result-
ing from one or more chemical, biological, radio-
logical, or nuclear agents, including emerging infec-
tious diseases (which may include existing practices, 
such as trauma care and medical surge capacity and 
capabilities), with respect to— 
‘‘(A) a regional approach to identifying 
hospitals and health care facilities based on 
varying capabilities and capacity to treat pa-
tients affected by such emergency, including— 
‘‘(i) the manner in which the system 
will coordinate with and integrate the part-
nerships and health care coalitions estab-
lished under section 319C–2(b); and 
‘‘(ii) informing and educating appro-
priate first responders and health care sup-
ply chain partners of the regional emer-
gency preparedness and response capabili-
ties and medical surge capacity of such
hospitals and health care facilities in the 
community; 
‘‘(B) physical and technological infrastruc-
ture, laboratory capacity, staffing, blood supply, 
and other supply chain needs, taking into ac-
count resiliency, geographic considerations, and 
rural considerations; 
‘‘(C) protocols or best practices for the 
safety and personal protection of workers who 
handle human remains and health care workers 
(including with respect to protective equipment 
and supplies, waste management processes, and 
decontamination), sharing of specialized experi-
ence among the health care workforce, behav-
ioral health, psychological resilience, and train-
ing of the workforce, as applicable; 
‘‘(D) in a manner that allows for disease 
containment (within the meaning of section 
2802(b)(2)(B)), coordinated medical triage, 
treatment, and transportation of patients, based 
on patient medical need (including patients in 
rural areas), to the appropriate hospitals or 
health care facilities within the regional system 
or, as applicable and appropriate, between sys-
tems in different States or regions; and
‘‘(E) the needs of children and other at- 
risk individuals; 
‘‘(2) make such guidelines available on the 
internet website of the Department of Health and 
Human Services in a manner that does not com-
promise national security; and 
‘‘(3) update such guidelines as appropriate, in-
cluding based on input received pursuant to sub-
sections (c) and (e) and information resulting from 
applicable reports required under the Pandemic and 
All-Hazards Preparedness and Advancing Innovation 
Act of 2018 (including any amendments made by 
such Act), to address new and emerging public 
health threats. 
‘‘(c) CONSIDERATIONS.—In identifying, developing, 
and updating guidelines under subsection (b), the Assist-
ant Secretary for Preparedness and Response shall— 
‘‘(1) include input from hospitals and health 
care facilities (including health care coalitions under 
section 319C–2), State, local, tribal, and territorial 
public health departments, and health care or sub-
ject matter experts (including experts with relevant 
expertise in chemical, biological, radiological, or nu-
clear threats, including emerging infectious dis-
eases), as the Assistant Secretary determines appro-
priate, to meet the goals under section 2802(b)(3); 
‘‘(2) consult and engage with appropriate 
health care providers and professionals, including 
physicians, nurses, first responders, health care fa-
cilities (including hospitals, primary care clinics, 
community health centers, mental health facilities, 
ambulatory care facilities, and dental health facili-
ties), pharmacies, emergency medical providers, 
trauma care providers, environmental health agen-
cies, public health laboratories, poison control cen-
ters, blood banks, tissue banks, and other experts 
that the Assistant Secretary determines appropriate, 
to meet the goals under section 2802(b)(3); 
‘‘(3) consider feedback related to financial im-
plications for hospitals, health care facilities, public 
health agencies, laboratories, blood banks, tissue 
banks, and other entities engaged in regional pre-
paredness planning to implement and follow such 
guidelines, as applicable; and 
‘‘(4) consider financial requirements and poten-
tial incentives for entities to prepare for, and re-
spond to, public health emergencies as part of the 
regional health care emergency preparedness and re-
sponse system.
‘‘(d) TECHNICAL ASSISTANCE.—The Assistant Sec-
retary for Preparedness and Response, in consultation 
with the Director of the Centers for Disease Control and 
Prevention and the Assistant Secretary of Labor for Occu-
pational Safety and Health, may provide technical assist-
ance and consultation toward meeting the guidelines de-
scribed in subsection (b). 
‘‘(e) DEMONSTRATION
PROJECT
FOR
REGIONAL 
HEALTH CARE PREPAREDNESS
AND RESPONSE SYS-
TEMS.— 
‘‘(1) IN GENERAL.—The Assistant Secretary for 
Preparedness and Response may establish a dem-
onstration project pursuant to the development and 
implementation of guidelines under subsection (b) to 
award grants to improve medical surge capacity for 
all hazards, build and integrate regional medical re-
sponse capabilities, improve specialty care expertise 
for all-hazards response, and coordinate medical pre-
paredness and response across State, local, tribal, 
territorial, and regional jurisdictions. 
‘‘(2) SUNSET.—The authority under this sub-
section shall expire on September 30, 2023.’’. 
(b) GAO REPORT TO CONGRESS.— 
(1) REPORT.—Not later than 3 years after the 
date of enactment of this Act, the Comptroller Gen-
eral of the United States (referred to in this sub-
section as the ‘‘Comptroller General’’) shall submit 
to the Committee on Health, Education, Labor, and 
Pensions and the Committee on Finance of the Sen-
ate and the Committee on Energy and Commerce 
and the Committee on Ways and Means of the 
House of Representatives, a report on the extent to 
which hospitals and health care facilities have imple-
mented the recommended guidelines under section 
319C–3(b) of the Public Health Service Act (as 
added by subsection (a)), including an analysis and 
evaluation of any challenges hospitals or health care 
facilities experienced in implementing such guide-
lines. 
(2) CONTENT.—The Comptroller General shall 
include in the report under paragraph (1)— 
(A) data on the preparedness and response 
capabilities that have been informed by the 
guidelines under section 319C–3(b) of the Pub-
lic Health Service Act to improve regional emer-
gency health care preparedness and response 
capability, including hospital and health care 
facility capacity and medical surge capabilities 
to prepare for, and respond to, public health 
emergencies; and
(B) recommendations to reduce gaps in in-
centives for regional health partners, including 
hospitals and health care facilities, to improve 
capacity and medical surge capabilities to pre-
pare for, and respond to, public health emer-
gencies, consistent with subsection (a), which 
may include consideration of facilities partici-
pating in programs under section 319C–2 of 
the Public Health Service Act (42 U.S.C. 
247d–3b) or in programs under the Centers for 
Medicare & Medicaid Services (including inno-
vative health care delivery and payment mod-
els), and input from private sector financial in-
stitutions. 
(3) CONSULTATION.—In carrying out para-
graphs (1) and (2), the Comptroller General shall 
consult with the heads of appropriate Federal agen-
cies, including— 
(A) the Assistant Secretary for Prepared-
ness and Response; 
(B) the Director of the Centers for Disease 
Control and Prevention; 
(C) the Administrator of the Centers for 
Medicare & Medicaid Services;
(D) the Assistant Secretary for Mental 
Health and Substance Use; 
(E) the Assistant Secretary of Labor for 
Occupational Safety and Health; and 
(F) the Secretary of Veterans Affairs. 
(c) ANNUAL REPORTS.—Section 319C–2(i)(1) of the 
Public Health Service Act (42 U.S.C. 247d–3b(i)(1)) is 
amended by inserting after the first sentence the following 
‘‘In submitting reports under this paragraph an entity 
shall include information on the progress that the entity 
has made toward the implementation of section 319C–3 
(or barriers to progress, if any).’’. 
(d) NATIONAL HEALTH SECURITY STRATEGY INCOR-
PORATION OF REGIONALIZED EMERGENCY PREPARED-
NESS
AND RESPONSE.—Subparagraph (G) of section 
2802(b)(3) of the Public Health Service Act (42 U.S.C. 
300hh–1(b)(3)) is amended to read as follows: 
‘‘(G) Optimizing a coordinated and flexible 
approach to the emergency response and med-
ical surge capacity of hospitals, other health 
care facilities, critical care, trauma care (which 
may include trauma centers), and emergency 
medical systems.’’. 
(e) IMPROVING STATE AND LOCAL PUBLIC HEALTH 
SECURITY.—
(1) STATE
AND
LOCAL
SECURITY.—Section 
319C–1(e) of the Public Health Service Act (42 
U.S.C. 247d–3a(e)) is amended by striking ‘‘, and 
local emergency plans.’’ and inserting ‘‘, local emer-
gency plans, and any regional health care emergency 
preparedness and response system established pursu-
ant to the applicable guidelines under section 319C– 
3.’’. 
(2) PARTNERSHIPS.—Section 319C–2(d)(1)(A) 
of the Public Health Service Act (42 U.S.C. 247d- 
3b(d)(1)(A)) is amended— 
(A) in clause (i), by striking ‘‘; and’’ and 
inserting ‘‘;’’; 
(B) by redesignating clause (ii) as clause 
(iii); and 
(C) inserting after clause (i), the following: 
‘‘(ii) among one or more facilities in a 
regional health care emergency system 
under section 319C–3; and’’. 
SEC. 204. MILITARY AND CIVILIAN PARTNERSHIP FOR 
TRAUMA READINESS. 
Title XII of the Public Health Service Act (42 U.S.C. 
300d et seq.) is amended by adding at the end the fol-
lowing new part:
‘‘PART I—MILITARY AND CIVILIAN PARTNERSHIP 
FOR TRAUMA READINESS GRANT PROGRAM 
‘‘SEC. 1291. MILITARY AND CIVILIAN PARTNERSHIP FOR 
TRAUMA READINESS GRANT PROGRAM. 
‘‘(a) MILITARY TRAUMA TEAM PLACEMENT PRO-
GRAM.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Assistant Secretary for Preparedness 
and Response and in consultation with the Secretary 
of Defense, shall award grants to not more than 20 
eligible high acuity trauma centers to enable military 
trauma teams to provide, on a full-time basis, trau-
ma care and related acute care at such trauma cen-
ters. 
‘‘(2) LIMITATIONS.—In the case of a grant 
awarded under paragraph (1) to an eligible high 
acuity trauma center, such grant— 
‘‘(A) shall be for a period of at least 3 
years and not more than 5 years (and may be 
renewed at the end of such period); and 
‘‘(B) shall be in an amount that does not 
exceed $1,000,000 per year. 
‘‘(3) 
AVAILABILITY
OF
FUNDS.—Notwith-
standing section 1552 of title 31, United States 
Code, or any other provision of law, funds available 
to the Secretary for obligation for a grant under this
subsection shall remain available for expenditure for 
100 days after the last day of the performance pe-
riod of such grant. 
‘‘(b) MILITARY TRAUMA CARE PROVIDER PLACE-
MENT PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Assistant Secretary for Preparedness 
and Response and in consultation with the Secretary 
of Defense, shall award grants to eligible trauma 
centers to enable military trauma care providers to 
provide trauma care and related acute care at such 
trauma centers. 
‘‘(2) LIMITATIONS.—In the case of a grant 
awarded under paragraph (1) to an eligible trauma 
center, such grant— 
‘‘(A) shall be for a period of at least 1 year 
and not more than 3 years (and may be re-
newed at the end of such period); and 
‘‘(B) shall be in an amount that does not 
exceed, in a year— 
‘‘(i) $100,000 for each military trau-
ma care provider that is a physician at 
such eligible trauma center; and
‘‘(ii) $50,000 for each other military 
trauma care provider at such eligible trau-
ma center. 
‘‘(c) GRANT REQUIREMENTS.— 
‘‘(1) DEPLOYMENT AND PUBLIC HEALTH EMER-
GENCIES.—As a condition of receipt of a grant 
under this section, a grant recipient shall agree to 
allow military trauma care providers providing care 
pursuant to such grant to— 
‘‘(A) be deployed by the Secretary of De-
fense for military operations, for training, or 
for response to a mass casualty incident; and 
‘‘(B) be deployed by the Secretary of De-
fense, in consultation with the Secretary of 
Health and Human Services, for response to a 
public health emergency pursuant to section 
319. 
‘‘(2) USE OF FUNDS.—Grants awarded under 
this section to an eligible trauma center may be used 
to train and incorporate military trauma care pro-
viders into such trauma center, including incorpora-
tion into operational exercises and training drills re-
lated to public health emergencies, expenditures for 
malpractice insurance, office space, information 
technology, specialty education and supervision,
trauma programs, research, and applicable license 
fees for such military trauma care providers. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to affect any other provision of law 
that preempts State licensing requirements for health care 
professionals, including with respect to military trauma 
care providers. 
‘‘(e) REPORTING REQUIREMENTS.— 
‘‘(1) REPORT
TO
THE
SECRETARY
AND
THE 
SECRETARY
OF
DEFENSE.—Each eligible trauma 
center or eligible high acuity trauma center awarded 
a grant under subsection (a) or (b) for a year shall 
submit to the Secretary and the Secretary of De-
fense a report for such year that includes informa-
tion on— 
‘‘(A) the number and types of trauma 
cases managed by military trauma teams or 
military trauma care providers pursuant to such 
grant during such year; 
‘‘(B) the ability to maintain the integration 
of the military trauma providers or teams of 
providers as part of the trauma center, includ-
ing the financial effect of such grant on the 
trauma center;
‘‘(C) the educational effect on resident 
trainees in centers where military trauma teams 
are assigned; 
‘‘(D) any research conducted during such 
year supported by such grant; and 
‘‘(E) any other information required by the 
Secretaries for the purpose of evaluating the ef-
fect of such grant. 
‘‘(2) REPORT
TO
CONGRESS.—Not less than 
once every 2 years, the Secretary, in consultation 
with the Secretary of Defense, shall submit a report 
to the congressional committees of jurisdiction that 
includes information on the effect of placing military 
trauma care providers in trauma centers awarded 
grants under this section on— 
‘‘(A) maintaining military trauma care 
providers’ readiness and ability to respond to 
and treat battlefield injuries; 
‘‘(B) providing health care to civilian trau-
ma patients in urban and rural settings; 
‘‘(C) the capability of trauma centers and 
military trauma care providers to increase med-
ical surge capacity, including as a result of a 
large scale event;
‘‘(D) the ability of grant recipients to 
maintain the integration of the military trauma 
providers or teams of providers as part of the 
trauma center; 
‘‘(E) efforts to incorporate military trauma 
care providers into operational exercises and 
training and drills for public health emer-
gencies; and 
‘‘(F) the capability of military trauma care 
providers to participate as part of a medical re-
sponse during or in advance of a public health 
emergency, as determined by the Secretary, or 
a mass casualty incident. 
‘‘(f) DEFINITIONS.—For purposes of this part: 
‘‘(1) ELIGIBLE
TRAUMA
CENTER.—The term 
‘eligible trauma center’ means a Level I, II, or III 
trauma center that satisfies each of the following: 
‘‘(A) Such trauma center has an agree-
ment with the Secretary of Defense to enable 
military trauma care providers to provide trau-
ma care and related acute care at such trauma 
center. 
‘‘(B) Such trauma center utilizes a risk-ad-
justed benchmarking system and metrics to
‘‘(i) affiliated with a medical school; 
‘‘(ii) that maintains residency pro-
grams and fellowships in critical trauma 
specialties and subspecialties, and provides 
education and supervision of military trau-
ma team members according to those spe-
cialties and subspecialties; and 
‘‘(iii) that undertakes research in the 
prevention and treatment of traumatic in-
jury. 
‘‘(E) Such trauma center serves as a med-
ical and public health preparedness and re-
sponse leader for its community, such as by 
participating in a partnership for State and re-
gional hospital preparedness established under 
section 319C–2 or 319C–3. 
‘‘(3) MAJOR TRAUMA.—The term ‘major trau-
ma’ means an injury that is greater than or equal 
to 15 on the injury severity score. 
‘‘(4) MILITARY
TRAUMA
TEAM.—The term 
‘military trauma team’ means a complete military 
trauma team consisting of military trauma care pro-
viders. 
‘‘(5) MILITARY TRAUMA CARE PROVIDER.—The 
term ‘military trauma care provider’ means a mem-
ber of the Armed Forces who furnishes emergency, 
critical care, and other trauma acute care services 
(including a physician, surgeon, physician assistant, 
nurse, nurse practitioner, respiratory therapist, 
flight paramedic, combat medic, or enlisted medical 
technician), or other military trauma care provider 
as the Secretary determines appropriate. 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated $15,000,000 for each of fiscal years 2019 through 
2023, of which— 
‘‘(1) 2⁄3 of the amount made available each fis-
cal year shall be made available for grants under 
subsection (a); and 
‘‘(2) 1⁄3 of the amount made available each fis-
cal year shall be made available for grants under 
subsection (b).’’. 
SEC. 205. PUBLIC HEALTH AND HEALTH CARE SYSTEM SIT-
UATIONAL 
AWARENESS 
AND 
BIOSURVEIL-
LANCE CAPABILITIES. 
(a) FACILITIES, CAPACITIES, AND BIOSURVEILLANCE 
CAPABILITIES.—Section 319D of the Public Health Serv-
ice Act (42 U.S.C. 247d–4) is amended—
(1) in the section heading, by striking ‘‘REVI-
TALIZING’’ and inserting ‘‘FACILITIES AND CA-
PACITIES OF’’; 
(2) in subsection (a)— 
(A) in the subsection heading, by striking 
‘‘FACILITIES; CAPACITIES’’ and inserting ‘‘IN 
GENERAL’’; 
(B) in paragraph (1), by striking ‘‘and im-
proved’’ and inserting ‘‘, improved, and appro-
priately maintained’’; 
(C) in paragraph (3), in the matter pre-
ceding subparagraph (A), by striking ‘‘expand, 
enhance, and improve’’ and inserting ‘‘expand, 
improve, enhance, and appropriately maintain’’; 
and 
(D) by adding at the end the following: 
‘‘(4) STUDY
OF
RESOURCES
FOR
FACILITIES 
AND CAPACITIES.—Not later than June 1, 2022, the 
Comptroller General of the United States shall con-
duct a study on Federal spending in fiscal years 
2013 through 2018 for activities authorized under 
this subsection. Such study shall include a review 
and assessment of obligations and expenditures di-
rectly related to each activity under paragraphs (2) 
and (3), including a specific accounting of, and de-
lineation between, obligations and expenditures in-
curred for the construction, renovation, equipping, 
and security upgrades of facilities and associated 
contracts under this subsection, and the obligations 
and expenditures incurred to establish and improve 
the situational awareness and biosurveillance net-
work under subsection (b), and shall identify the 
agency or agencies incurring such obligations and 
expenditures.’’; 
(3) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘NATIONAL’’ and inserting ‘‘ESTABLISHMENT 
OF SYSTEMS OF PUBLIC HEALTH’’; 
(B) in paragraph (1)(B), by inserting ‘‘im-
munization information systems,’’ after ‘‘cen-
ters,’’; and 
(C) in paragraph (2)— 
(i) by inserting ‘‘develop a plan to, 
and’’ after ‘‘The Secretary shall’’; and 
(ii) by inserting ‘‘and in a form read-
ily usable for analytical approaches’’ after 
‘‘in a secure manner’’; and 
(D) by amending paragraph (3) to read as 
follows: 
‘‘(3) STANDARDS.—
‘‘(A) IN GENERAL.—Not later than 1 year 
after the date of the enactment of the Pan-
demic and All-Hazards Preparedness and Ad-
vancing Innovation Act of 2018, the Secretary, 
in cooperation with health care providers, State, 
local, tribal, and territorial public health offi-
cials, and relevant Federal agencies (including 
the Office of the National Coordinator for 
Health Information Technology and the Na-
tional Institute of Standards and Technology), 
shall, as necessary, adopt technical and report-
ing standards, including standards for inter-
operability as defined by section 3000, for net-
works under paragraph (1) and update such 
standards as necessary. Such standards shall be 
made available on the internet website of the 
Department of Health and Human Services, in 
a manner that does not compromise national se-
curity. 
‘‘(B) DEFERENCE TO STANDARDS DEVEL-
OPMENT ORGANIZATIONS.—In adopting and im-
plementing standards under this subsection and 
subsection (c), the Secretary shall give def-
erence to standards published by standards de-
velopment organizations and voluntary con-
sensus-based standards entities.’’; 
(4) in subsection (c)— 
(A) in paragraph (1)— 
(i) by striking ‘‘Not later than 2 years 
after the date of enactment of the Pan-
demic and All-Hazards Preparedness Re-
authorization Act of 2013, the Secretary’’ 
and inserting ‘‘The Secretary’’; 
(ii) by inserting ‘‘, and improve as ap-
plicable and appropriate,’’ after ‘‘shall es-
tablish’’; 
(iii) by striking ‘‘of rapid’’ and insert-
ing ‘‘of, rapid’’; and 
(iv) by striking ‘‘such connectivity’’ 
and inserting ‘‘such interoperability’’; 
(B) by amending paragraph (2) to read as 
follows: 
‘‘(2) COORDINATION AND CONSULTATION.—In 
establishing and improving the network under para-
graph (1) the Secretary shall— 
‘‘(A) facilitate coordination among agencies 
within the Department of Health and Human 
Services that provide, or have the potential to 
provide, information and data to, and analyses
for, the situational awareness and biosurveil-
lance network under paragraph (1), including 
coordination among relevant agencies related to 
health care services, the facilitation of health 
information exchange (including the Office of 
the National Coordinator for Health Informa-
tion Technology), and public health emergency 
preparedness and response; and 
‘‘(B) consult with the Secretary of Agri-
culture, the Secretary of Commerce (and the 
Director of the National Institute of Standards 
and Technology), the Secretary of Defense, the 
Secretary of Homeland Security, the Secretary 
of Veterans Affairs, and the heads of other 
Federal agencies, as the Secretary determines 
appropriate.’’; 
(C) in paragraph (3)— 
(i) by redesignating subparagraphs 
(A) through (E) as clauses (i) through (v), 
respectively, and adjusting the margins ac-
cordingly; 
(ii) in clause (iv), as so redesig-
nated—
(I) by inserting ‘‘immunization 
information systems,’’ after ‘‘poison 
control,’’; and 
(II) by striking ‘‘and clinical lab-
oratories’’ and inserting ‘‘, clinical 
laboratories, and public environmental 
health agencies’’; 
(iii) by striking ‘‘The network’’ and 
inserting the following: 
‘‘(A) IN GENERAL.—The network’’; and 
(iv) by adding at the end the fol-
lowing: 
‘‘(B) REVIEW.—Not later than 2 years 
after the date of the enactment of the Pan-
demic and All-Hazards Preparedness and Ad-
vancing Innovation Act of 2018 and every 6 
years thereafter, the Secretary shall conduct a 
review of the elements described in subpara-
graph (A). Such review shall include a discus-
sion of the addition of any elements pursuant to 
clause (v), including elements added to advanc-
ing new technologies, and identify any chal-
lenges in the incorporation of elements under 
subparagraph (A). The Secretary shall provide
such review to the congressional committees of 
jurisdiction.’’; 
(D) in paragraph (5)— 
(i) by redesignating subparagraphs 
(A) through (D) as clauses (i) through 
(iv), respectively, and adjusting the mar-
gins accordingly; 
(ii) by striking ‘‘In establishing’’ and 
inserting the following: 
‘‘(A) IN GENERAL.—In establishing’’; 
(iii) by adding at the end the fol-
lowing: 
‘‘(B) PUBLIC MEETING.— 
‘‘(i) IN
GENERAL.—Not later than 
180 days after the date of enactment of 
the Pandemic and All-Hazards Prepared-
ness and Advancing Innovation Act of 
2018, the Secretary shall convene a public 
meeting for purposes of discussing and 
providing input on the potential goals, 
functions, and uses of the network de-
scribed in paragraph (1) and incorporating 
the 
elements 
described 
in 
paragraph 
(3)(A).
‘‘(ii) EXPERTS.—The public meeting 
shall include representatives of relevant 
Federal agencies (including representatives 
from the Office of the National Coordi-
nator for Health Information Technology 
and the National Institute of Standards 
and Technology); State, local, tribal, and 
territorial public health officials; stake-
holders with expertise in biosurveillance 
and situational awareness; stakeholders 
with expertise in capabilities relevant to 
biosurveillance and situational awareness, 
such as experts in informatics and data 
analytics (including experts in prediction, 
modeling, or forecasting); and other rep-
resentatives as the Secretary determines 
appropriate. 
‘‘(iii) TOPICS.—Such public meeting 
shall include a discussion of— 
‘‘(I) data elements, including 
minimal or essential data elements, 
that are voluntarily provided for such 
network, which may include elements 
from public health and public and pri-
vate health care entities, to the extent 
practicable; 
‘‘(II) standards and implementa-
tion specifications that may improve 
the collection, analysis, and interpre-
tation of data during a public health 
emergency; 
‘‘(III) strategies to encourage the 
access, exchange, and use of informa-
tion; 
‘‘(IV) considerations for State, 
local, tribal, and territorial capabilities 
and infrastructure related to data ex-
change and interoperability; 
‘‘(V) privacy and security protec-
tions provided at the Federal, State, 
local, tribal, and territorial levels, and 
by nongovernmental stakeholders; and 
‘‘(VI) opportunities for the incor-
poration of innovative technologies to 
improve the network.’’; and 
(iv) in subparagraph (A), as so des-
ignated by clause (ii)— 
(I) in clause (i), as so redesig-
nated—
(aa) by striking ‘‘as deter-
mined’’ and inserting ‘‘as adopt-
ed’’; and 
(bb) by inserting ‘‘and the 
National Institute of Standards 
and Technology’’ after ‘‘Office of 
the National Coordinator for 
Health Information Technology’’; 
(II) in clause (iii), as so redesig-
nated, by striking ‘‘; and’’ and insert-
ing a semicolon; 
(III) in clause (iv), as so redesig-
nated, by striking the period and in-
serting ‘‘; and’’; and 
(IV) by adding at the end the fol-
lowing: 
‘‘(v) pilot test standards and imple-
mentation specifications, consistent with 
the 
process 
described 
in 
section 
3002(b)(3)(C), which State, local, tribal, 
and territorial public health entities may 
utilize, on a voluntary basis, as a part of 
the network.’’; 
(E) by redesignating paragraph (6) as 
paragraph (7);
(F) by inserting after paragraph (5) the 
following: 
‘‘(6) 
STRATEGY
AND
IMPLEMENTATION 
PLAN.— 
‘‘(A) IN
GENERAL.—Not later than 18 
months after the date of enactment of the Pan-
demic and All-Hazards Preparedness and Ad-
vancing Innovation Act of 2018, the Secretary 
shall submit to the congressional committees of 
jurisdiction a coordinated strategy and an ac-
companying implementation plan that— 
‘‘(i) is informed by the public meeting 
under paragraph (5)(B); 
‘‘(ii) includes a review and assessment 
of existing capabilities of the network and 
related infrastructure, including input pro-
vided by the public meeting under para-
graph (5)(B); 
‘‘(iii) identifies and demonstrates the 
measurable steps the Secretary will carry 
out to— 
‘‘(I) develop, implement, and 
evaluate the network described in 
paragraph (1), utilizing elements de-
scribed in paragraph (3)(A);
‘‘(II) modernize and enhance bio-
surveillance activities, including strat-
egies to include innovative tech-
nologies and analytical approaches 
(including prediction and forecasting 
for pandemics and all-hazards) from 
public and private entities; 
‘‘(III) improve information shar-
ing, coordination, and communication 
among disparate biosurveillance sys-
tems supported by the Department of 
Health and Human Services, includ-
ing the identification of methods to 
improve accountability, better utilize 
resources and workforce capabilities, 
and 
incorporate 
innovative 
tech-
nologies within and across agencies; 
and 
‘‘(IV) test and evaluate capabili-
ties of the interoperable network of 
systems to improve situational aware-
ness and biosurveillance capabilities; 
‘‘(iv) includes performance measures 
and the metrics by which performance 
measures will be assessed with respect to
the measurable steps under clause (iii); 
and 
‘‘(v) establishes dates by which each 
measurable step under clause (iii) will be 
implemented. 
‘‘(B) ANNUAL BUDGET PLAN.—Not later 
than 2 years after the date of enactment of the 
Pandemic and All-Hazards Preparedness and 
Advancing Innovation Act of 2018 and on an 
annual basis thereafter, in accordance with the 
strategy and implementation plan under this 
paragraph, the Secretary shall, taking into ac-
count recommendations provided by the Na-
tional Biodefense Science Board, develop a 
budget plan based on the strategy and imple-
mentation plan under this section. Such budget 
plan shall include— 
‘‘(i) a summary of resources pre-
viously expended to establish, improve, and 
utilize the nationwide public health situa-
tional awareness and biosurveillance net-
work under paragraph (1); 
‘‘(ii) estimates of costs and resources 
needed to establish and improve the net-
work under paragraph (1) according to the
strategy and implementation plan under 
subparagraph (A); 
‘‘(iii) the identification of gaps and in-
efficiencies in nationwide public health sit-
uational awareness and biosurveillance ca-
pabilities, resources, and authorities need-
ed to address such gaps; and 
‘‘(iv) a strategy to minimize and ad-
dress such gaps and improve inefficien-
cies.’’; 
(G) in paragraph (7), as so redesignated— 
(i) in subparagraph (A), by inserting 
‘‘(taking into account zoonotic disease, in-
cluding gaps in scientific understanding of 
the interactions between human, animal, 
and environmental health)’’ after ‘‘human 
health’’; 
(ii) in subparagraph (B)— 
(I) by inserting ‘‘and gaps in sur-
veillance programs’’ after ‘‘surveil-
lance programs’’; and 
(II) by striking ‘‘; and’’ and in-
serting a semicolon; 
(iii) in subparagraph (C)—
(I) by inserting ‘‘, animal health 
organizations related to zoonotic dis-
ease,’’ after ‘‘health care entities’’; 
and 
(II) by striking the period and 
inserting ‘‘; and’’; and 
(iv) by adding at the end the fol-
lowing: 
‘‘(D) provide recommendations to the Sec-
retary on policies and procedures to complete 
the steps described in this paragraph in a man-
ner that is consistent with section 2802.’’; and 
(H) by adding at the end the following: 
‘‘(8) 
SITUATIONAL
AWARENESS
AND
BIO-
SURVEILLANCE
AS
A
NATIONAL
SECURITY
PRI-
ORITY.—The Secretary, on a periodic basis as appli-
cable and appropriate, shall meet with the Director 
of National Intelligence to inform the development 
and capabilities of the nationwide public health situ-
ational awareness and biosurveillance network.’’; 
(5) in subsection (d)— 
(A) in paragraph (1)— 
(i) by inserting ‘‘environmental health 
agencies,’’ after ‘‘public health agencies,’’; 
and
(ii) by inserting ‘‘immunization pro-
grams,’’ after ‘‘poison control centers,’’; 
and 
(B) in paragraph (2)— 
(i) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (C), by striking 
the period and inserting ‘‘; and’’; and 
(iii) by adding after subparagraph (C) 
the following: 
‘‘(D) an implementation plan that may in-
clude measurable steps to achieve the purposes 
described in paragraph (1).’’; and 
(C) by striking paragraph (5) and insert-
ing the following: 
‘‘(5) TECHNICAL ASSISTANCE.—The Secretary 
may provide technical assistance to States, localities, 
tribes, and territories or a consortium of States, lo-
calities, tribes, and territories receiving an award 
under this subsection regarding interoperability and 
the technical standards set forth by the Secretary.’’; 
(6) by redesignating subsections (f) and (g) as 
subsections (i) and (j), respectively; and 
(7) by inserting after subsection (e) the fol-
lowing:
‘‘(f) PERSONNEL AUTHORITIES.— 
‘‘(1) SPECIALLY
QUALIFIED
PERSONNEL.—In 
addition to any other personnel authorities, to carry 
out subsections (b) and (c), the Secretary may— 
‘‘(A) appoint highly qualified individuals to 
scientific or professional positions at the Cen-
ters for Disease Control and Prevention, not to 
exceed 30 such employees at any time (specific 
to positions authorized by this subsection), with 
expertise in capabilities relevant to biosurveil-
lance and situational awareness, such as experts 
in informatics and data analytics (including ex-
perts in prediction, modeling, or forecasting), 
and other related scientific or technical fields; 
and 
‘‘(B) compensate individuals appointed 
under subparagraph (A) in the same manner 
and subject to the same terms and conditions in 
which individuals appointed under 9903 of title 
5, United States Code, are compensated, with-
out regard to the provisions of chapter 51 and 
subchapter III of chapter 53 of such title relat-
ing to classification and General Schedule pay 
rates.
‘‘(2) LIMITATIONS.—The Secretary shall exer-
cise the authority under paragraph (1) in a manner 
that is consistent with the limitations described in 
section 319F–1(e)(2). 
‘‘(g) TIMELINE.—The Secretary shall accomplish the 
purposes under subsections (b) and (c) no later than Sep-
tember 30, 2023, and shall provide a justification to the 
congressional committees of jurisdiction for any missed or 
delayed implementation of measurable steps identified 
under subsection (c)(6)(A)(iii). 
‘‘(h) INDEPENDENT EVALUATION.—Not later than 3 
years after the date of enactment of the Pandemic and 
All-Hazards Preparedness and Advancing Innovation Act 
of 2018, the Comptroller General of the United States 
shall conduct an independent evaluation, and submit to 
the Secretary and the congressional committees of juris-
diction a report concerning the activities conducted under 
subsections (b) and (c), and provide recommendations, as 
applicable and appropriate, on necessary improvements to 
the biosurveillance and situational awareness network.’’. 
(b) AUTHORIZATION
OF
APPROPRIATIONS.—Sub-
section (i) of section 319D of the Public Health Service 
Act (42 U.S.C. 247d–4), as redesignated by subsection 
(a)(6), is amended by striking ‘‘$138,300,000 for each of 
fiscal 
years 
2014 
through 
2018’’ 
and 
inserting
‘‘$161,800,000 for each of fiscal years 2019 through 
2023’’. 
(c) BIOLOGICAL THREAT DETECTION REPORT.—The 
Secretary of Health and Human Services shall, in coordi-
nation with the Secretary of Defense and the Secretary 
of Homeland Security, not later than 180 days after the 
date of enactment of this Act, report to the Committee 
on Energy and Commerce, the Committee on Armed Serv-
ices, and the Committee on Homeland Security of the 
House of Representatives and the Committee on Health, 
Education, Labor, and Pensions, the Committee on Armed 
Services, and the Committee on Homeland Security and 
Governmental Affairs of the Senate on the state of Fed-
eral biological threat detection efforts, including the fol-
lowing— 
(1) an identification of technological, oper-
ational, and programmatic successes and failures of 
domestic detection programs supported by Federal 
departments and agencies for intentionally-intro-
duced or accidentally-released biological threat 
agents and naturally occurring infectious diseases; 
(2) a description of Federal efforts to facilitate 
the exchange of information related to the informa-
tion described in paragraph (1) among Federal de-
partments and agencies that utilize biological threat 
detection technology; 
(3) a description of the capabilities of detection 
systems in use by Federal departments and agencies 
including the capability to— 
(A) rapidly detect, identify, characterize, 
and confirm the presence of biological threat 
agents; 
(B) recover live biological agents from col-
lection devices; 
(C) determine the geographical distribution 
of biological agents; 
(D) determine the extent of environmental 
contamination and persistence of biological 
agents; and 
(E) provide advanced molecular diagnostics 
to State, local, tribal, and territorial public 
health and other laboratories that support bio-
logical threat detection activities; 
(4) a description of Federal interagency coordi-
nation related to biological threat detection; 
(5) a description of efforts by Federal depart-
ments and agencies that utilize biological threat de-
tection technology to collaborate with State, local, 
tribal, and territorial public health laboratories and
other users of biological threat detection systems, in-
cluding collaboration regarding the development of— 
(A) biological threat detection require-
ments or standards; 
(B) a standardized integration strategy; 
(C) training requirements or guidelines; 
(D) guidelines for a coordinated public 
health response, including preparedness capa-
bilities, and, as applicable, for coordination with 
public health surveillance systems; and 
(E) a coordinated environmental remedi-
ation plan, as applicable; and 
(6) recommendations related to research, ad-
vanced research, development, and procurement for 
Federal departments and agencies to improve and 
enhance biological threat detection systems, includ-
ing recommendations on the transfer of biological 
threat detection technology among Federal depart-
ments and agencies, as necessary and appropriate. 
SEC. 206. STRENGTHENING AND SUPPORTING THE PUBLIC 
HEALTH 
EMERGENCY 
RAPID 
RESPONSE 
FUND. 
Section 319 of the Public Health Service Act (42 
U.S.C. 247d) is amended— 
(1) in subsection (b)—
(A) in paragraph (1)— 
(i) in the first sentence, by inserting 
‘‘or if the Secretary determines there is the 
significant potential for a public health 
emergency, to allow the Secretary to rap-
idly respond to the immediate needs result-
ing from such public health emergency or 
potential public health emergency’’ before 
the period; and 
(ii) by inserting ‘‘The Secretary shall 
plan for the expedited distribution of funds 
to appropriate agencies and entities.’’ after 
the first sentence; 
(B) by redesignating paragraph (2) as 
paragraph (3); 
(C) by inserting after paragraph (1) the 
following: 
‘‘(2) USES.—The Secretary may use amounts 
in the Fund established under paragraph (1), to— 
‘‘(A) facilitate coordination between and 
among Federal, State, local, tribal, and terri-
torial entities and public and private health 
care entities that the Secretary determines may 
be affected by a public health emergency or po-
tential public health emergency referred to in
paragraph (1) (including communication of 
such entities with relevant international enti-
ties, as applicable); 
‘‘(B) make grants, provide for awards, 
enter into contracts, and conduct supportive in-
vestigations pertaining to a public health emer-
gency or potential public health emergency, in-
cluding further supporting programs under sec-
tion 319C–1, 319C–2, or 319C–3; 
‘‘(C) facilitate and accelerate, as applica-
ble, advanced research and development of secu-
rity countermeasures (as defined in section 
319F–2), qualified countermeasures (as defined 
in section 319F–1), or qualified pandemic or 
epidemic products (as defined in section 319F– 
3), that are applicable to the public health 
emergency or potential public health emergency 
under paragraph (1); 
‘‘(D) strengthen biosurveillance capabilities 
and laboratory capacity to identify, collect, and 
analyze information regarding such public 
health emergency or potential public health 
emergency, including the systems under section 
319D;
‘‘(E) support initial emergency operations 
and assets related to preparation and deploy-
ment of intermittent disaster response per-
sonnel under section 2812, and the Medical Re-
serve Corps under section 2813; and 
‘‘(F) carry out other activities, as the Sec-
retary determines applicable and appropriate.’’; 
and 
(D) by inserting after paragraph (3), as so 
redesignated, the following: 
‘‘(4) REVIEW.—Not later than 2 years after the 
date of enactment of the Pandemic and All-Hazards 
Preparedness and Advancing Innovation Act of 
2018, the Secretary, in coordination with the Assist-
ant Secretary for Preparedness and Response, shall 
conduct a review of the Fund under this section, and 
provide recommendations to the Committee on 
Health, Education, Labor, and Pensions and the 
Committee on Appropriations of the Senate and the 
Committee on Energy and Commerce and the Com-
mittee on Appropriations of the House of Represent-
atives on policies to improve such Fund for the uses 
described in paragraph (2). 
‘‘(5) GAO REPORT.—Not later than 4 years 
after the date of enactment of the Pandemic and
All-Hazards Preparedness and Advancing Innovation 
Act of 2018, the Comptroller General of the United 
States shall— 
‘‘(A) conduct a review of the Fund under 
this section, including its uses and the re-
sources available in the Fund; and 
‘‘(B) submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate 
and the Committee on Energy and Commerce 
of the House of Representatives a report on 
such review, including recommendations related 
to such review, as applicable.’’; and 
(2) in subsection (c)— 
(A) by inserting ‘‘rapidly respond to public 
health emergencies or potential public health 
emergencies and’’ after ‘‘used to’’; and 
(B) by striking ‘‘section.’’ and inserting 
‘‘Act or funds otherwise provided for emergency 
response.’’. 
SEC. 207. IMPROVING ALL-HAZARDS PREPAREDNESS AND 
RESPONSE BY PUBLIC HEALTH EMERGENCY 
VOLUNTEERS. 
(a) IN GENERAL.—Section 319I of the Public Health 
Service Act (42 U.S.C. 247d–7b) is amended—
(1) in the section heading, by striking 
‘‘HEALTH PROFESSIONS VOLUNTEERS’’ and in-
serting ‘‘VOLUNTEER HEALTH PROFESSIONAL’’; 
(2) in subsection (a), by adding at the end the 
following: ‘‘Such health care professionals may in-
clude members of the National Disaster Medical 
System, members of the Medical Reserve Corps, and 
individual health care professionals.’’; 
(3) in subsection (i) by adding at the end ‘‘In 
order to inform the development of such mechanisms 
by States, the Secretary shall make available infor-
mation and material provided by States that have 
developed mechanisms to waive the application of li-
censing requirements to applicable health profes-
sionals seeking to provide medical services during a 
public health emergency. Such information shall be 
made publicly available in a manner that does not 
compromise national security.’’; and 
(4) in subsection (k) by striking ‘‘2014 through 
2018’’ and inserting ‘‘2019 through 2023’’. 
(b) ALL-HAZARDS PUBLIC HEALTH EMERGENCY 
PREPAREDNESS AND RESPONSE PLAN.—Section 319C– 
1(b)(2)(A)(iv) of the Public Health Service Act (42 U.S.C. 
247d–3a(b)(2)(A)(iv)) is amended to read as follows:
‘‘(iv) a description of the mechanism the 
entity will implement to utilize the Emergency 
Management Assistance Compact, or other mu-
tual aid agreement, for medical and public 
health mutual aid, and, as appropriate, the ac-
tivities such entity will implement pursuant to 
section 319I to improve enrollment and coordi-
nation of volunteer health care professionals 
seeking to provide medical services during a 
public health emergency, which may include— 
‘‘(I) providing a public method of 
communication for purposes of volunteer 
coordination (such as a phone number); 
‘‘(II) providing for optional registra-
tion to participate in volunteer services 
during processes related to State medical 
licensing, registration, or certification or 
renewal of such licensing, registration or 
certification; or 
‘‘(III) other mechanisms as the State 
determines appropriate;’’.
SEC. 208. CLARIFYING STATE LIABILITY LAW FOR VOLUN-
TEER HEALTH CARE PROFESSIONALS. 
(a) IN GENERAL.—Title II of the Public Health Serv-
ice Act (42 U.S.C. 202 et seq.) is amended by inserting 
after section 224 the following: 
‘‘SEC. 225. HEALTH CARE PROFESSIONALS ASSISTING DUR-
ING A PUBLIC HEALTH EMERGENCY. 
‘‘(a) LIMITATION ON LIABILITY.—Notwithstanding 
any other provision of law, a health care professional who 
is a member of the Medical Reserve Corps under section 
2813 or who is included in the Emergency System for Ad-
vance Registration of Volunteer Health Professionals 
under section 319I and who— 
‘‘(1) is responding— 
‘‘(A) to a public health emergency deter-
mined under section 319(a), during the initial 
period of not more than 90 days (as determined 
by the Secretary) of the public health emer-
gency determination (excluding any period cov-
ered by a renewal of such determination); or 
‘‘(B) to a major disaster or an emergency 
as declared by the President under section 401 
of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5170) or 
under section 201 of the National Emergencies
Act (50 U.S.C.1621) during the initial period of 
such declaration; and 
‘‘(2) is alleged to be liable for an act or omis-
sion— 
‘‘(A) during the initial period of a deter-
mination or declaration described in paragraph 
(1) and related to the treatment of individuals 
in need of health care services due to such pub-
lic health emergency, major disaster, or emer-
gency; 
‘‘(B) in the State or States for which such 
determination or declaration is made; 
‘‘(C) in the health care professional’s ca-
pacity as a member of the Medical Reserve 
Corps or a professional included in the Emer-
gency System for Advance Registration of Vol-
unteer Health Professionals under section 319I; 
and 
‘‘(D) in the course of providing services 
that are within the scope of the license, reg-
istration, or certification of the professional, as 
defined by the State of licensure, registration, 
or certification; and 
‘‘(3) prior to the rendering of such act or omis-
sion, was authorized by the State’s authorization of
deploying such State’s Emergency System for Ad-
vance Registration of Volunteer Health Professionals 
described in section 319I or the Medical Reserve 
Corps established under section 2813, to provide 
health care services, 
shall be subject only to the State liability laws of the State 
in which such act or omission occurred, in the same man-
ner and to the same extent as a similar health care profes-
sional who is a resident of such State would be subject 
to such State laws, except with respect to the licensure, 
registration, and certification of such individual. 
‘‘(b) VOLUNTEER PROTECTION ACT.—Nothing in 
this section shall be construed to affect an individual’s 
right to protections under the Volunteer Protection Act 
of 1997. 
‘‘(c) PREEMPTION.—This section shall supercede the 
laws of any State that would subject a health care profes-
sional described in subsection (a) to the liability laws of 
any State other than the State liability laws to which such 
individual is subject pursuant to such subsection. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘health care professional’ means 
an individual licensed, registered, or certified under 
Federal or State laws or regulations to provide 
health care services.
‘‘(2) The term ‘health care services’ means any 
services provided by a health care professional, or by 
any individual working under the supervision of a 
health care professional, that relate to— 
‘‘(A) the diagnosis, prevention, or treat-
ment of any human disease or impairment; or 
‘‘(B) the assessment or care of the health 
of human beings. 
‘‘(e) EFFECTIVE DATE.— 
‘‘(1) IN GENERAL.—This section shall take ef-
fect 90 days after the date of the enactment of the 
Pandemic and All-Hazards Preparedness and Ad-
vancing Innovation Act of 2018. 
‘‘(2) APPLICATION.—This section shall apply to 
a claim for harm only if the act or omission that 
caused such harm occurred on or after the effective 
date described in paragraph (1).’’. 
(b) GAO STUDY.—Not later than one year after the 
date of enactment of this Act, the Comptroller General 
of the United States shall conduct a review of— 
(1) the number of health care providers who 
register under the Emergency System for Advance 
Registration of Volunteer Health Professionals 
under section 319I of the Public Health Service Act
(42 U.S.C. 247d–7b) in advance to provide services 
during a public health emergency; 
(2) the number of health care providers who are 
credentialed to provide services during the period of 
a public health emergency declaration, including 
those who are credentialed though programs estab-
lished in the Emergency System for Advance Reg-
istration of Volunteer Health Professionals under 
such section 319I and those credentialed by authori-
ties within the State in which the emergency oc-
curred; 
(3) the average time to verify the credentials of 
a health care provider during the period of a public 
health emergency declaration, including the average 
time pursuant to the Emergency System for Ad-
vance Registration of Volunteer Health Professionals 
under such section 319I and for an individual’s cre-
dentials to be verified by an authority within the 
State; and 
(4) the Emergency System for Advance Reg-
istration of Volunteer Health Professionals program 
in States, including whether physician or medical 
groups, associations, or other relevant provider orga-
nizations utilize such program for purposes of volun-
teering during public health emergencies.
SEC. 209. REPORT ON ADEQUATE NATIONAL BLOOD SUP-
PLY. 
Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall submit to Congress a report containing recommenda-
tions related to maintaining an adequate national blood 
supply, including— 
(1) challenges associated with the continuous 
recruitment of blood donors (including those newly 
eligible to donate); 
(2) ensuring the adequacy of the blood supply 
in the case of public health emergencies; 
(3) implementation of the transfusion trans-
mission monitoring system; and 
(4) other measures to promote safety and inno-
vation, such as the development, use, or implementa-
tion of new technologies, processes, and procedures 
to improve the safety and reliability of the blood 
supply. 
SEC. 210. REPORT ON THE PUBLIC HEALTH PREPARED-
NESS AND RESPONSE CAPABILITIES AND CA-
PACITIES OF HOSPITALS, LONG-TERM CARE 
FACILITIES, AND OTHER HEALTH CARE FA-
CILITIES. 
(a) STUDY.—
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services shall enter 
into an agreement with an appropriate entity to con-
duct a study regarding the public health prepared-
ness and response capabilities and medical surge ca-
pacities of hospitals, long-term care facilities, and 
other health care facilities to prepare for, and re-
spond to, public health emergencies, including nat-
ural disasters. 
(2) CONSULTATION.—In conducting the study 
under paragraph (1), the entity shall consult with 
Federal, State, local, tribal, and territorial public 
health officials (as appropriate), and health care 
providers and facilities with experience in public 
health preparedness and response activities. 
(3) EVALUATION.—The study under paragraph 
(1) shall include— 
(A) an evaluation of the current bench-
marks and objective standards, as applicable, 
related to programs that support hospitals, 
long-term care facilities, and other health care 
facilities, and their effect on improving public 
health preparedness and response capabilities 
and medical surge capacities, including the
environmental health agencies with expertise in 
emergency preparedness and response planning 
for hospitals, long-term care facilities and other 
health care facilities; and 
(E) an evaluation of current public health 
preparedness and response capabilities and 
medical surge capacities related to at-risk indi-
viduals during public health emergencies, in-
cluding an identification of gaps in such pre-
paredness as they relate to such individuals. 
(b) REPORT.— 
(1) IN GENERAL.—The agreement under sub-
section (a) shall require the entity to submit to the 
Secretary of Health and Human Services and the 
congressional committees of jurisdiction, not later 
than 3 years after the date of enactment of this Act, 
a report on the results of the study conducted pur-
suant to this section. 
(2) CONTENTS.—The report under paragraph 
(1) shall— 
(A) describe the findings and conclusions 
of the evaluation conducted pursuant to sub-
section (a); and 
(B) provide recommendations for improv-
ing public health preparedness and response ca-
pability and medical surge capacity for hos-
pitals, long-term care facilities, and other health 
care facilities, including— 
(i) improving the existing benchmarks 
and objective standards for the Federal 
grant programs described in subsection 
(a)(3)(A) or developing new benchmarks 
and standards for such programs; and 
(ii) identifying best practices for im-
proving public health preparedness and re-
sponse programs and medical surge capac-
ity at hospitals, long-term care facilities, 
and other health care facilities, including 
recommendations for the evaluation under 
subparagraphs (C) and (D) of subsection 
(a)(3). 
TITLE III—REACHING ALL 
COMMUNITIES 
SEC. 301. STRENGTHENING AND ASSESSING THE EMER-
GENCY RESPONSE WORKFORCE. 
(a) NATIONAL DISASTER MEDICAL SYSTEM.— 
(1) STRENGTHENING THE NATIONAL DISASTER 
MEDICAL
SYSTEM.—Clause 
(ii) 
of 
section 
2812(a)(3)(A) of the Public Health Service Act (42
U.S.C. 300hh–11(a)(3)(A)) is amended to read as 
follows: 
‘‘(ii) be present at locations, and for 
limited periods of time, specified by the 
Secretary on the basis that the Secretary 
has determined that a location is at risk of 
a public health emergency during the time 
specified, or there is a significant potential 
for a public health emergency.’’. 
(2) REVIEW OF THE NATIONAL DISASTER MED-
ICAL
SYSTEM.—Section 2812(b)(2) of the Public 
Health Service Act (42 U.S.C. 300hh–11(b)(2)) is 
amended to read as follows: 
‘‘(2) JOINT REVIEW AND MEDICAL SURGE CA-
PACITY STRATEGIC PLAN.— 
‘‘(A) REVIEW.—Not later than 180 days 
after the date of enactment of the Pandemic 
and All-Hazards Preparedness and Advancing 
Innovation Act of 2018, the Secretary, in co-
ordination with the Secretary of Homeland Se-
curity, the Secretary of Defense, and the Sec-
retary of Veterans Affairs, shall conduct a joint 
review of the National Disaster Medical System. 
Such review shall include—
‘‘(i) an evaluation of medical surge ca-
pacity, as described in section 2803(a); 
‘‘(ii) an assessment of the available 
workforce of the intermittent disaster re-
sponse personnel described in subsection 
(c); 
‘‘(iii) the capacity of the workforce de-
scribed in clause (ii) to respond to all haz-
ards, including capacity to simultaneously 
respond to multiple public health emer-
gencies and the capacity to respond to a 
nationwide public health emergency; 
‘‘(iv) the effectiveness of efforts to re-
cruit, retain, and train such workforce; and 
‘‘(v) gaps that may exist in such 
workforce and recommendations for ad-
dressing such gaps. 
‘‘(B) UPDATES.—As part of the National 
Health Security Strategy under section 2802, 
the Secretary shall update the findings from the 
review under subparagraph (A) and provide rec-
ommendations to modify the policies of the Na-
tional Disaster Medical System as necessary.’’. 
(3) NOTIFICATION
OF
SHORTAGE.—Section 
2812(c) of the Public Health Service Act (42 U.S.C.
300hh–11(c)) is amended by adding at the end the 
following: 
‘‘(3) NOTIFICATION.—Not later than 30 days 
after the date on which the Secretary determines the 
number of intermittent disaster-response personnel 
of the National Disaster Medical System is insuffi-
cient to address a public health emergency or poten-
tial public health emergency, the Secretary shall sub-
mit to the congressional committees of jurisdiction a 
notification detailing— 
‘‘(A) the impact such shortage could have 
on meeting public health needs and emergency 
medical personnel needs during a public health 
emergency; and 
‘‘(B) any identified measures to address 
such shortage. 
‘‘(4) CERTAIN APPOINTMENTS.— 
‘‘(A) IN GENERAL.—If the Secretary deter-
mines that the number of intermittent disaster 
response personnel within the National Disaster 
Medical System under this section is insuffi-
cient to address a public health emergency or 
potential public health emergency, the Secretary 
may appoint candidates directly to personnel 
positions for intermittent disaster response
within such system. The Secretary shall provide 
updates on the number of vacant or unfilled po-
sitions within such system to the congressional 
committees of jurisdiction each quarter for 
which this authority is in effect. 
‘‘(B) SUNSET.—The authority under this 
paragraph shall expire on September 30, 
2021.’’. 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
Section 2812(g) of the Public Health Service Act 
(42 U.S.C. 300hh–11(g)) is amended by striking 
‘‘$52,700,000 for each of fiscal years 2014 through 
2018’’ and inserting ‘‘$57,400,000 for each of fiscal 
years 2019 through 2023’’. 
(b) VOLUNTEER MEDICAL RESERVE CORPS.— 
(1) IN GENERAL.—Section 2813(a) of the Pub-
lic Health Service Act (42 U.S.C. 42 U.S.C. 300hh– 
15(a)) is amended by striking the second sentence 
and inserting ‘‘The Secretary may appoint a Direc-
tor to head the Corps and oversee the activities of 
the Corps chapters that exist at the State, local, 
tribal, and territorial levels.’’. 
(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
Section 2813(i) of the Public Health Service Act (42
U.S.C. 300hh–15(i)) is amended by striking ‘‘2014 
through 2018’’ and inserting ‘‘2019 through 2023’’. 
(c) STRENGTHENING THE EPIDEMIC INTELLIGENCE 
SERVICE.—Section 317F of the Public Health Service Act 
(42 U.S.C. Sec. 247b–7) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by inserting ‘‘or preparedness and 
response activities, including rapid re-
sponse to public health emergencies and 
significant public health threats’’ after 
‘‘conduct prevention activities’’; and 
(ii) by striking ‘‘$35,000’’ and insert-
ing ‘‘$50,000’’; and 
(B) in paragraph (2)(B), by striking ‘‘3 
years’’ and inserting ‘‘2 years’’; and 
(2) in subsection (c)— 
(A) by striking ‘‘For the purpose of car-
rying out this section’’ and inserting the fol-
lowing: 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out this section, except as described in para-
graph (2)’’; and 
(B) by adding at the end the following:
‘‘(2) EPIDEMIC
INTELLIGENCE
SERVICE
PRO-
GRAM.—For purposes of carrying out this section 
with respect to qualified health professionals serving 
in the Epidemic Intelligence Service, as authorized 
under section 317G, there are authorized to be ap-
propriated $1,000,000 for each of fiscal years 2019 
through 2023.’’. 
(d) SERVICE BENEFIT
FOR NATIONAL DISASTER 
MEDICAL SYSTEM VOLUNTEERS.— 
(1) IN GENERAL.—Section 2812(c) of the Pub-
lic Health Service Act (42 U.S.C. 300hh–11(c)), as 
amended by subsection (a)(3), is further amended by 
adding at the end the following: 
‘‘(5) SERVICE BENEFIT.—Individuals appointed 
to serve under this subsection shall be considered eli-
gible for benefits under part L of title I of the Om-
nibus Crime Control and Safe Streets Act of 1968. 
The Secretary shall provide notification to eligible 
individuals of any effect such designation may have 
on other benefits for which such individual are eligi-
ble, including benefits from private entities.’’. 
(2) PUBLIC SAFETY OFFICER BENEFITS.—Sec-
tion 1204(9) of title I of the Omnibus Crime Control 
and Safe Streets Act of 1968 (34 U.S.C. 10284(9)) 
is amended—
(A) in subparagraph (C)(ii), by striking 
‘‘or’’ at the end; 
(B) in subparagraph (D), by striking the 
period and inserting ‘‘; or’’; and 
(C) by inserting after subparagraph (D) 
the following: 
‘‘(E) an individual appointed to the Na-
tional Disaster Medical System under section 
2812 of the Public Health Service Act (42 
U.S.C. 300hh–11) who is performing official 
duties of the Department of Health and Human 
Services, if those official duties are— 
‘‘(i) related to responding to a public 
health emergency or potential public health 
emergency, or other activities for which the 
Secretary of Health and Human Services 
has activated such National Disaster Med-
ical System; and 
‘‘(ii) determined by the Secretary of 
Health and Human Services to be haz-
ardous.’’. 
(3) SUNSET.—The amendments made by para-
graphs (1) and (2) shall cease to have force or effect 
on October 1, 2021. 
(e) MISSION READINESS REPORT TO CONGRESS.—
(1) REPORT.—Not later than one year after the 
date of enactment of this section, the Comptroller 
General of the United States (referred to in this 
subsection as the ‘‘Comptroller General’’) shall sub-
mit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representa-
tives, a report on the medical surge capacity of the 
United States in the event of a public health emer-
gency, including the capacity and capability of the 
current health care workforce to prepare for, and re-
spond to the full range of public health emergencies 
or potential public health emergencies, and rec-
ommendations to address any gaps identified in such 
workforce. 
(2) CONTENTS.—The Comptroller General shall 
include in the report under paragraph (1)— 
(A) the number of health care providers 
who have volunteered to provide health care 
services during a public health emergency, in-
cluding members of the National Disaster Med-
ical System, the Disaster Medical Assistant 
Teams, the Medical Reserve Corps, and other 
volunteer health care professionals in the 
verification network pursuant to section 319I of
the Public Health Service Act (42 U.S.C. 
247d–7b); 
(B) the capacity of the workforce described 
in subparagraph (A) to respond to a public 
health emergency or potential public health 
emergency, including the capacity to respond to 
multiple concurrent public health emergencies 
and the capacity to respond to a nationwide 
public health emergency; 
(C) the preparedness and response capa-
bilities and mission readiness of the workforce 
described in subparagraph (A) taking into ac-
count areas of health care expertise and consid-
erations for at-risk individuals (as defined in 
section 2802(b)(4)(B) of the Public Health 
Service Act (42 U.S.C. 300hh–1(b)(4)(B)); 
(D) an assessment of the effectiveness of 
efforts to recruit, retain, and train such work-
force; and 
(E) identification of gaps that may exist in 
such workforce and recommendations for ad-
dressing such gaps, the extent to which the As-
sistant Secretary for Preparedness and Re-
sponse plans to address such gaps, and any rec-
ommendations from the Comptroller General to 
address such gaps. 
SEC. 302. HEALTH SYSTEM INFRASTRUCTURE TO IMPROVE 
PREPAREDNESS AND RESPONSE. 
(a) COORDINATION
OF
PREPAREDNESS.—Section 
2811(b)(5) of the Public Health Service Act (42 U.S.C. 
300hh–10(b)(5)) is amended by adding at the end the fol-
lowing: ‘‘Such logistical support shall include working with 
other relevant Federal, State, local, tribal, and territorial 
public health officials and private sector entities to identify 
the critical infrastructure assets, systems, and networks 
needed for the proper functioning of the health care and 
public health sectors that need to be maintained through 
any emergency or disaster, including entities capable of 
assisting with, responding to, and mitigating the effect of 
a public health emergency, including a public health emer-
gency determined by the Secretary pursuant to section 
319(a), an emergency or major disaster declared by the 
President under the Robert T. Stafford Disaster Relief 
and Emergency Assistance Act, or the National Emer-
gencies Act, including by establishing methods to exchange 
critical information and deliver products consumed or used 
to preserve, protect, or sustain life, health, or safety, and 
sharing of specialized expertise.’’.
(b) 
MANUFACTURING
CAPACITY.—Section 
2811(d)(2)(C) of the Public Health Service Act (42 
U.S.C. 300hh–10(d)(2)(C)) is amended by inserting ‘‘, 
and ancillary medical supplies to assist with the utilization 
of such countermeasures or products,’’ after ‘‘products’’. 
(c) EVALUATION OF BARRIERS TO RAPID DELIVERY 
OF MEDICAL COUNTERMEASURES.— 
(1) RAPID
DELIVERY
STUDY.—The Assistant 
Secretary for Preparedness and Response may con-
duct a study on issues that have the potential to ad-
versely affect the handling and rapid delivery of 
medical countermeasures to individuals during public 
health emergencies occurring in the United States. 
(2) NOTICE TO CONGRESS.—Not later than 9 
months after the date of the enactment of this Act, 
the Assistant Secretary for Preparedness and Re-
sponse shall notify the Committee on Energy and 
Commerce of the House of Representatives and the 
Committee on Health, Education, Labor, and Pen-
sions of the Senate if the Assistant Secretary for 
Preparedness and Response does not plan to conduct 
the study under paragraph (1) and shall provide 
such committees a summary explanation for such de-
cision.
(3) REPORT TO CONGRESS.—Not later than 1 
year after the Assistant Secretary for Preparedness 
and Response conducts the study under paragraph 
(1), such Assistant Secretary shall submit a report 
to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on 
Health, Education, Labor, and Pensions of the Sen-
ate containing the findings of such study. 
SEC. 303. CONSIDERATIONS FOR AT-RISK INDIVIDUALS. 
(a) AT-RISK
INDIVIDUALS
IN
THE
NATIONAL 
HEALTH SECURITY STRATEGY.—Section 2802(b)(4)(B) 
of the Public Health Service Act (42 U.S.C. 300hh– 
1(b)(4)(B)) is amended— 
(1) by striking ‘‘this section and sections 319C– 
1, 319F, and 319L,’’ and inserting ‘‘this Act,’’; and 
(2) by striking ‘‘special’’ and inserting ‘‘access 
or functional’’. 
(b) COUNTERMEASURE CONSIDERATIONS.—Section 
319L(c)(6) of the Public Health Service Act (42 U.S.C. 
247d–7e(c)(6)) is amended— 
(1) by striking ‘‘elderly’’ and inserting ‘‘senior 
citizens’’; and 
(2) by inserting ‘‘with relevant characteristics 
that warrant consideration during the process of re-
searching and developing such countermeasures and 
products’’ before the period. 
(c) 
BIOSURVEILLANCE
OF
EMERGING
PUBLIC 
HEALTH THREATS.—Section 2814 is amended— 
(1) in paragraph (7), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) in paragraph (8), by striking the period and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(9) facilitate coordination to ensure that, in 
implementing the situational awareness and bio-
surveillance network under section 319D, the Sec-
retary considers incorporating data and information 
from Federal, State, local, tribal, and territorial 
public health officials and entities relevant to detect-
ing emerging public health threats that may affect 
at-risk individuals, such as pregnant and postpartum 
women and infants, including adverse health out-
comes of such populations related to such emerging 
public health threats.’’.
SEC. 304. IMPROVING EMERGENCY PREPAREDNESS AND 
RESPONSE 
CONSIDERATIONS 
FOR 
CHIL-
DREN. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 319D the following: 
‘‘SEC. 319D–1. CHILDREN’S PREPAREDNESS UNIT. 
‘‘(a) ENHANCING EMERGENCY PREPAREDNESS FOR 
CHILDREN.—The Secretary, acting through the Director 
of the Centers for Disease Control and Prevention (re-
ferred to in this subsection as the ‘Director’), shall main-
tain an internal team of experts, to be known as the Chil-
dren’s Preparedness Unit (referred to in this subsection 
as the ‘Unit’), to work collaboratively to provide guidance 
on the considerations for, and the specific needs of, chil-
dren before, during, and after public health emergencies. 
The Unit shall inform the Director regarding emergency 
preparedness and response efforts pertaining to children 
at the Centers for Disease Control and Prevention. 
‘‘(b) EXPERTISE.—The team described in subsection 
(a) shall include one or more pediatricians, which may be 
a developmental-behavioral pediatrician, and may also in-
clude behavioral scientists, child psychologists, epidemiolo-
gists, biostatisticians, health communications staff, and 
individuals with other areas of expertise, as the Secretary 
determines appropriate.
‘‘(c) DUTIES.—The team described in subsection (a) 
may— 
‘‘(1) assist State, local, tribal, and territorial 
emergency planning and response activities related 
to children, which may include developing, identi-
fying, and sharing best practices; 
‘‘(2) provide technical assistance, training, and 
consultation to Federal, State, local, tribal, and ter-
ritorial public health officials to improve prepared-
ness and response capabilities with respect to the 
needs of children, including providing such technical 
assistance, training, and consultation to eligible enti-
ties in order to support the achievement of measur-
able evidence-based benchmarks and objective stand-
ards applicable to sections 319C–1 and 319C–2; 
‘‘(3) improve the utilization of methods to in-
corporate the needs of children in planning for and 
responding to a public health emergency, including 
public awareness of such methods; 
‘‘(4) coordinate with, and improve, public-pri-
vate partnerships, such as health care coalitions pur-
suant to sections 319C–2 and 319C–3, to address 
gaps and inefficiencies in emergency preparedness 
and response efforts for children;
‘‘(5) provide expertise and input during the de-
velopment of guidance and clinical recommendations 
to address the needs of children when preparing for, 
and responding to, public health emergencies, includ-
ing pursuant to section 319C–3; and 
‘‘(6) carry out other duties related to prepared-
ness and response activities for children, as the Sec-
retary determines appropriate.’’. 
SEC. 305. NATIONAL ADVISORY COMMITTEES ON DISAS-
TERS. 
(a) REAUTHORIZING THE NATIONAL ADVISORY COM-
MITTEE ON CHILDREN AND DISASTERS.—Section 2811A 
of the Public Health Service Act (42 U.S.C. 300hh–10a) 
is amended— 
(1) in subsection (b)(2), by inserting ‘‘, mental 
and behavioral,’’ after ‘‘medical’’; 
(2) in subsection (d)— 
(A) in paragraph (1), by striking ‘‘15’’ and 
inserting ‘‘25’’; and 
(B) by striking paragraph (2) and insert-
ing the following: 
‘‘(2) REQUIRED NON-FEDERAL MEMBERS.—The 
Secretary, in consultation with such other heads of 
Federal agencies as may be appropriate, shall ap-
point to the Advisory Committee under paragraph 
(1) at least 13 individuals, including— 
‘‘(A) at least 2 non-Federal professionals 
with expertise in pediatric medical disaster 
planning, preparedness, response, or recovery; 
‘‘(B) at least 2 representatives from State, 
local, tribal, or territorial agencies with exper-
tise in pediatric disaster planning, prepared-
ness, response, or recovery; 
‘‘(C) at least 4 members representing 
health care professionals, which may include 
members with expertise in pediatric emergency 
medicine; pediatric trauma, critical care, or sur-
gery; the treatment of pediatric patients af-
fected by chemical, biological, radiological, or 
nuclear agents, including emerging infectious 
diseases; pediatric mental or behavioral health 
related to children affected by a public health 
emergency; or pediatric primary care; and 
‘‘(D) other members as the Secretary de-
termines appropriate, of whom— 
‘‘(i) at least one such member shall 
represent a children’s hospital;