‘‘(B) At least 20 percent of patients treat-
ed at such trauma center in the most recent 3- 
month period for which data are available are 
treated for a major trauma at such trauma cen-
ter. 
‘‘(C) Such trauma center utilizes a risk-ad-
justed benchmarking system and metrics to 
measure performance, quality, and patient out-
comes. 
‘‘(D) Such trauma center is an academic 
training center— 
‘‘(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-
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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 $11,500,000 for each of fiscal years 2019 through 
2023.’’. 
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SEC. 205. PUBLIC HEALTH AND HEALTH CARE SYSTEM SIT-
UATIONAL 
AWARENESS 
AND 
BIOSURVEIL-
LANCE CAPABILITIES. 
(a) FACILITIES, CAPACITIES, AND BIOSURVEILLANCE 
CAPABILITIES.—Section 319D (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 
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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 
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(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. 
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‘‘(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: 
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‘‘(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)— 
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(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-
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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, 
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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, 
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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 
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(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 
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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— 
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‘‘(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 
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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-
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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)— 
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(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 
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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-
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