H. R. 3448—23
(A) Such government submits to the President a plan
for the stockpiling of potassium iodide tablets, and for
the distribution and utilization of potassium iodide tablets
in the event of a nuclear incident.
(B) The plan is accompanied by certifications by such
government that the government has not already received
sufficient quantities of potassium iodide tablets from the
Federal Government.
(2) LOCAL
GOVERNMENTS.—Subsection (a) applies with
respect to a local government only if, in addition to the condi-
tions described in paragraph (1), the following conditions are
met:
(A) The State in which the locality involved is located—
(i) does not have a plan described in paragraph
(1)(A); or
(ii) has a plan described in such paragraph, but
the plan does not address populations at a distance
greater than 10 miles from the nuclear power plant
involved.
(B) The local government has petitioned the State to
modify the State plan to address such populations, not
exceeding 20 miles from such plant, and 60 days have
elapsed without the State modifying the State plan to
address populations at the full distance sought by the
local government through the petition.
(C) The local government has submitted its local plan
under paragraph (1)(A) to the State, and the State has
approved the plan and certified that the plan is not incon-
sistent with the State emergency plan.
(c) GUIDELINES.—Not later than one year after the date of
the enactment of this Act, the President, in consultation with
individuals representing appropriate Federal, State, and local agen-
cies, shall establish guidelines for the stockpiling of potassium
iodide tablets, and for the distribution and utilization of potassium
iodide tablets in the event of a nuclear incident. Such tablets
may not be made available under subsection (a) until such guide-
lines have been established.
(d) INFORMATION.—The President shall carry out activities to
inform State and local governments of the program under this
section.
(e) REPORTS.—
(1) PRESIDENT.—Not later than six months after the date
on which the guidelines under subsection (c) are issued, the
President shall submit to the Congress a report—
(A) on whether potassium iodide tablets have been
made available under subsection (a) or other Federal, State,
or local programs, and the extent to which State and local
governments have established stockpiles of such tablets;
and
(B) the measures taken by the President to implement
this section.
(2) NATIONAL ACADEMY OF SCIENCES.—
(A) IN
GENERAL.—The President shall request the
National Academy of Sciences to enter into an agreement
with the President under which the Academy conducts
a study to determine what is the most effective and safe
way to distribute and administer potassium iodide tablets
H. R. 3448—24
on a mass scale. If the Academy declines to conduct the
study, the President shall enter into an agreement with
another appropriate public or nonprofit private entity to
conduct the study.
(B) REPORT.—The President shall ensure that, not later
than six months after the date of the enactment of this
Act, the study required in subparagraph (A) is completed
and a report describing the findings made in the study
is submitted to the Congress.
(f) APPLICABILITY.—Subsections (a) and (d) cease to apply as
requirements if the President determines that there is an alter-
native and more effective prophylaxis or preventive measures for
adverse thyroid conditions that may result from the release of
radionuclides from nuclear power plants.
Subtitle C—Improving State, Local, and
Hospital Preparedness for and Response
to Bioterrorism and Other Public Health
Emergencies
SEC. 131. GRANTS TO IMPROVE STATE, LOCAL, AND HOSPITAL
PREPAREDNESS FOR AND RESPONSE TO BIOTERRORISM
AND OTHER PUBLIC HEALTH EMERGENCIES.
(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 the following sections:
‘‘SEC. 319C–1. GRANTS TO IMPROVE STATE, LOCAL, AND HOSPITAL
PREPAREDNESS FOR AND RESPONSE TO BIOTERRORISM
AND OTHER PUBLIC HEALTH EMERGENCIES.
‘‘(a) IN GENERAL.—To enhance the security of the United States
with respect to bioterrorism and other public health emergencies,
the Secretary shall make awards of grants or cooperative agree-
ments to eligible entities to enable such entities to conduct the
activities described in subsection (d).
‘‘(b) ELIGIBLE ENTITIES.—
‘‘(1) IN GENERAL.—To be eligible to receive an award under
subsection (a), an entity shall—
‘‘(A)(i) be a State; and
‘‘(ii) prepare and submit to the Secretary an application
at such time, and in such manner, and containing such
information as the Secretary may require, including an
assurance that the State—
‘‘(I) has completed an evaluation under section
319B(a), or an evaluation that is substantially equiva-
lent to an evaluation described in such section (as
determined by the Secretary);
‘‘(II) has prepared, or will (within 60 days of
receiving an award under this section) prepare, a Bio-
terrorism 
and 
Other 
Public 
Health 
Emergency
Preparedness and Response Plan in accordance with
subsection (c);
‘‘(III) has established a means by which to obtain
public comment and input on the plan prepared under
subclause (II), and on the implementation of such plan,
H. R. 3448—25
that shall include an advisory committee or other
similar mechanism for obtaining comment from the
public at large as well as from other State and local
stakeholders;
‘‘(IV) will use amounts received under the award
in accordance with the plan prepared under subclause
(II), including making expenditures to carry out the
strategy contained in the plan; and
‘‘(V) with respect to the plan prepared under sub-
clause (II), will establish reasonable criteria to evaluate
the effective performance of entities that receive funds
under the award and include relevant benchmarks in
the plan; or
‘‘(B)(i) be a political subdivision of a State or a consor-
tium of 2 or more such subdivisions; and
‘‘(ii) prepare and submit to the Secretary an application
at such time, and in such manner, and containing such
information as the Secretary may require.
‘‘(2) COORDINATION
WITH
STATEWIDE
PLANS.—An award
under subsection (a) to an eligible entity described in paragraph
(1)(B) may not be made unless the application of such entity
is in coordination with, and consistent with, applicable State-
wide plans described in subsection (d)(1).
‘‘(c) BIOTERRORISM
AND OTHER PUBLIC HEALTH EMERGENCY
PREPAREDNESS AND RESPONSE PLAN.—Not later than 60 days after
receiving amounts under an award under subsection (a), an eligible
entity described in subsection (b)(1)(A) shall prepare and submit
to the Secretary a Bioterrorism and Other Public Health Emergency
Preparedness and Response Plan. Recognizing the assessment of
public health needs conducted under section 319B, such plan shall
include a description of activities to be carried out by the entity
to address the needs identified in such assessment (or an equivalent
assessment).
‘‘(d) USE OF FUNDS.—An award under subsection (a) may be
expended for activities that may include the following and similar
activities:
‘‘(1) To develop Statewide plans (including the development
of the Bioterrorism and Other Public Health Emergency
Preparedness and Response Plan required under subsection
(c)), and community-wide plans for responding to bioterrorism
and other public health emergencies that are coordinated with
the capacities of applicable national, State, and local health
agencies and health care providers, including poison control
centers.
‘‘(2) To address deficiencies identified in the assessment
conducted under section 319B.
‘‘(3) To purchase or upgrade equipment (including sta-
tionary or mobile communications equipment), supplies,
pharmaceuticals or other priority countermeasures to enhance
preparedness for and response to bioterrorism or other public
health emergencies, consistent with the plan described in sub-
section (c).
‘‘(4) To conduct exercises to test the capability and timeli-
ness of public health emergency response activities.
‘‘(5) To develop and implement the trauma care and burn
center care components of the State plans for the provision
of emergency medical services.
H. R. 3448—26
‘‘(6) To improve training or workforce development to
enhance public health laboratories.
‘‘(7) To train public health and health care personnel to
enhance the ability of such personnel—
‘‘(A) to detect, provide accurate identification of, and
recognize the symptoms and epidemiological characteristics
of exposure to a biological agent that may cause a public
health emergency; and
‘‘(B) to provide treatment to individuals who are
exposed to such an agent.
‘‘(8) To develop, enhance, coordinate, or improve participa-
tion in systems by which disease detection and information
about biological attacks and other public health emergencies
can be rapidly communicated among national, State, and local
health agencies, emergency response personnel, and health care
providers and facilities to detect and respond to a bioterrorist
attack or other public health emergency, including activities
to improve information technology and communications equip-
ment available to health care and public health officials for
use in responding to a biological threat or attack or other
public health emergency.
‘‘(9) To enhance communication to the public of information
on bioterrorism and other public health emergencies, including
through the use of 2–1–1 call centers.
‘‘(10) To address the health security needs of children and
other vulnerable populations with respect to bioterrorism and
other public health emergencies.
‘‘(11) To provide training and develop, enhance, coordinate,
or improve methods to enhance the safety of workers and
workplaces in the event of bioterrorism.
‘‘(12) To prepare and plan for contamination prevention
efforts related to public health that may be implemented in
the event of a bioterrorist attack, including training and plan-
ning to protect the health and safety of workers conducting
the activities described in this paragraph.
‘‘(13) To prepare a plan for triage and transport manage-
ment in the event of bioterrorism or other public health emer-
gencies.
‘‘(14) To enhance the training of health care professionals
to recognize and treat the mental health consequences of bioter-
rorism or other public health emergencies.
‘‘(15) To enhance the training of health care professionals
to assist in providing appropriate health care for large numbers
of individuals exposed to a bioweapon.
‘‘(16) To enhance training and planning to protect the
health and safety of personnel, including health care profes-
sionals, involved in responding to a biological attack.
‘‘(17) To improve surveillance, detection, and response
activities to prepare for emergency response activities including
biological threats or attacks, including training personnel in
these and other necessary functions and including early
warning and surveillance networks that use advanced informa-
tion technology to provide early detection of biological threats
or attacks.
‘‘(18) To develop, enhance, and coordinate or improve the
ability of existing telemedicine programs to provide health care
H. R. 3448—27
information and advice as part of the emergency public health
response to bioterrorism or other public health emergencies.
Nothing in this subsection may be construed as establishing new
regulatory authority or as modifying any existing regulatory
authority.
‘‘(e) PRIORITIES IN USE OF GRANTS.—
‘‘(1) IN GENERAL.—
‘‘(A) PRIORITIES.—Except as provided in subparagraph
(B), the Secretary shall, in carrying out the activities
described in this section, address the following hazards
in the following priority:
‘‘(i) Bioterrorism or acute outbreaks of infectious
diseases.
‘‘(ii) Other public health threats and emergencies.
‘‘(B) DETERMINATION OF THE SECRETARY.—In the case
of the hazard involved, the degree of priority that would
apply to the hazard based on the categories specified in
clauses (i) and (ii) of subparagraph (A) may be modified
by the Secretary if the following conditions are met:
‘‘(i) The Secretary determines that the modification
is appropriate on the basis of the following factors:
‘‘(I) The extent to which eligible entities are
adequately prepared for responding to hazards
within the category specified in clause (i) of
subparagraph (A).
‘‘(II) There has been a significant change in
the assessment of risks to the public health posed
by hazards within the category specified in clause
(ii) of such subparagraph.
‘‘(ii) Prior to modifying the priority, the Secretary
notifies the appropriate committees of the Congress
of the determination of the Secretary under clause
(i) of this subparagraph.
‘‘(2) AREAS
OF
EMPHASIS
WITHIN
CATEGORIES.—The Sec-
retary shall determine areas of emphasis within the category
of hazards specified in clause (i) of paragraph (1)(A), and shall
determine areas of emphasis within the category of hazards
specified in clause (ii) of such paragraph, based on an assess-
ment of the risk and likely consequences of such hazards and
on an evaluation of Federal, State, and local needs, and may
also take into account the extent to which receiving an award
under subsection (a) will develop capacities that can be used
for public health emergencies of varying types.
‘‘(f) CERTAIN ACTIVITIES.—In administering activities under sec-
tion 319C(c)(4) or similar activities, the Secretary shall, where
appropriate, give priority to activities that include State or local
government financial commitments, that seek to incorporate mul-
tiple public health and safety services or diagnostic databases into
an integrated public health entity, and that cover geographic areas
lacking advanced diagnostic and laboratory capabilities.
‘‘(g) COORDINATION WITH LOCAL MEDICAL RESPONSE SYSTEM.—
An eligible entity and local Metropolitan Medical Response Systems
shall, to the extent practicable, ensure that activities carried out
under an award under subsection (a) are coordinated with activities
that are carried out by local Metropolitan Medical Response Sys-
tems.
H. R. 3448—28
‘‘(h) COORDINATION OF FEDERAL ACTIVITIES.—In making awards
under subsection (a), the Secretary shall—
‘‘(1) annually notify the Director of the Federal Emergency
Management Agency, the Director of the Office of Justice Pro-
grams, and the Director of the National Domestic Preparedness
Office, as to the amount, activities covered under, and status
of such awards; and
‘‘(2) coordinate such awards with other activities conducted
or supported by the Secretary to enhance preparedness for
bioterrorism and other public health emergencies.
‘‘(i) DEFINITION.—For purposes of this section, the term ‘eligible
entity’ means an entity that meets the conditions described in
subparagraph (A) or (B) of subsection (b)(1).
‘‘(j) FUNDING.—
‘‘(1) AUTHORIZATIONS OF APPROPRIATIONS.—
‘‘(A) FISCAL YEAR 2003.—
‘‘(i) AUTHORIZATIONS.—For the purpose of carrying
out this section, there is authorized to be appropriated
$1,600,000,000 for fiscal year 2003, of which—
‘‘(I) $1,080,000,000 is authorized to be appro-
priated for awards pursuant to paragraph (3) (sub-
ject to the authority of the Secretary to make
awards pursuant to paragraphs (4) and (5)); and
‘‘(II) 
$520,000,000 
is 
authorized 
to 
be
appropriated—
‘‘(aa) for awards under subsection (a) to
States, notwitstanding the eligibility condi-
tions under subsection (b), for the purpose of
enhancing the preparedness of hospitals
(including children’s hospitals), clinics, health
centers, and primary care facilities for bioter-
rorism and other public health emergencies;
and
‘‘(bb) for Federal, State, and local planning
and administrative activities related to such
purpose.
‘‘(ii) CONTINGENT ADDITIONAL AUTHORIZATION.—If
a significant change in circumstances warrants an
increase in the amount authorized to be appropriated
under clause (i) for fiscal year 2003, there are author-
ized to be appropriated such sums as may be necessary
for such year for carrying out this section, in addition
to the amount authorized in clause (i).
‘‘(B) OTHER FISCAL YEARS.—For the purpose of carrying
out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal
years 2004 through 2006.
‘‘(2) SUPPLEMENT NOT SUPPLANT.—Amounts appropriated
under paragraph (1) shall be used to supplement and not sup-
plant other State and local public funds provided for activities
under this section.
‘‘(3) STATE BIOTERRORISM AND OTHER PUBLIC HEALTH EMER-
GENCY PREPAREDNESS AND RESPONSE BLOCK GRANT FOR FISCAL
YEAR 2003.—
H. R. 3448—29
‘‘(A) IN GENERAL.—For fiscal year 2003, the Secretary
shall, in an amount determined in accordance with sub-
paragraphs (B) through (D), make an award under sub-
section (a) to each State, notwithstanding the eligibility
conditions described in subsection (b), that submits to the
Secretary an application for the award that meets the
criteria of the Secretary for the receipt of such an award
and that meets other implementation conditions estab-
lished by the Secretary for such awards. No other awards
may be made under subsection (a) for such fiscal year,
except as provided in paragraph (1)(A)(i)(II) and paragraphs
(4) and (5).
‘‘(B) BASE AMOUNT.—In determining the amount of an
award pursuant to subparagraph (A) for a State, the Sec-
retary shall first determine an amount the Secretary con-
siders appropriate for the State (referred to in this para-
graph as the ‘base amount’), except that such amount may
not be greater than the minimum amount determined
under subparagraph (D).
‘‘(C) INCREASE ON BASIS OF POPULATION.—After deter-
mining the base amount for a State under subparagraph
(B), the Secretary shall increase the base amount by an
amount equal to the product of—
‘‘(i) the amount appropriated under paragraph
(1)(A)(i)(I) for the fiscal year, less an amount equal
to the sum of all base amounts determined for the
States under subparagraph (B), and less the amount,
if any, reserved by the Secretary under paragraphs
(4) and (5); and
‘‘(ii) subject to paragraph (4)(C), the percentage
constituted by the ratio of an amount equal to the
population of the State over an amount equal to the
total population of the States (as indicated by the
most recent data collected by the Bureau of the
Census).
‘‘(D) MINIMUM AMOUNT.—Subject to the amount appro-
priated under paragraph (1)(A)(i)(I), an award pursuant
to subparagraph (A) for a State shall be the greater of
the base amount as increased under subparagraph (C),
or the minimum amount under this subparagraph. The
minimum amount under this subparagraph is—
‘‘(i) in the case of each of the several States, the
District of Columbia, and the Commonwealth of Puerto
Rico, an amount equal to the lesser of—
‘‘(I) $5,000,000; or
‘‘(II) if the amount appropriated under para-
graph (1)(A)(i)(I) is less than $667,000,000, an
amount equal to 0.75 percent of the amount appro-
priated under such paragraph, less the amount,
if any, reserved by the Secretary under paragraphs
(4) and (5); or
‘‘(ii) in the case of each of American Samoa, Guam,
the Commonwealth of the Northern Mariana Islands,
and the Virgin Islands, an amount determined by the
Secretary to be appropriate, except that such amount
may not exceed the amount determined under clause
(i).
H. R. 3448—30
‘‘(4) CERTAIN POLITICAL SUBDIVISIONS.—
‘‘(A) IN GENERAL.—For fiscal year 2003, the Secretary
may, before making awards pursuant to paragraph (3)
for such year, reserve from the amount appropriated under
paragraph (1)(A)(i)(I) for the year an amount determined
necessary by the Secretary to make awards under sub-
section (a) to political subdivisions that have a substantial
number of residents, have a substantial local infrastructure
for responding to public health emergencies, and face a
high degree of risk from bioterrorist attacks or other public
health emergencies. Not more than three political subdivi-
sions may receive awards pursuant to this subparagraph.
‘‘(B) COORDINATION WITH STATEWIDE PLANS.—An award
pursuant to subparagraph (A) may not be made unless
the application of the political subdivision involved is in
coordination with, and consistent with, applicable State-
wide plans described in subsection (c).
‘‘(C) RELATIONSHIP TO FORMULA GRANTS.—In the case
of a State that will receive an award pursuant to paragraph
(3), and in which there is located a political subdivision
that will receive an award pursuant to subparagraph (A),
the Secretary shall, in determining the amount under para-
graph (3)(C) for the State, subtract from the population
of the State an amount equal to the population of such
political subdivision.
‘‘(D) 
CONTINUITY
OF
FUNDING.—In 
determining
whether to make an award pursuant to subparagraph (A)
to a political subdivision, the Secretary may consider, as
a factor indicating that the award should be made, that
the political subdivision received public health funding from
the Secretary for fiscal year 2002.
‘‘(5) SIGNIFICANT UNMET NEEDS; DEGREE OF RISK.—
‘‘(A) IN GENERAL.—For fiscal year 2003, the Secretary
may, before making awards pursuant to paragraph (3)
for such year, reserve from the amount appropriated under
paragraph (1)(A)(i)(I) for the year an amount determined
necessary by the Secretary to make awards under sub-
section (a) to eligible entities that—
‘‘(i) have a significant need for funds to build
capacity to identify, detect, monitor, and respond to
a bioterrorist or other threat to the public health,
which need will not be met by awards pursuant to
paragraph (3); and
‘‘(ii) face a particularly high degree of risk of such
a threat.
‘‘(B) RECIPIENTS
OF
GRANTS.—Awards pursuant to
subparagraph (A) may be supplemental awards to States
that receive awards pursuant to paragraph (3), or may
be awards to eligible entities described in subsection
(b)(1)(B) within such States.
‘‘(C) 
FINDING
WITH
RESPECT
TO
DISTRICT
OF
COLUMBIA.—The Secretary shall consider the District of
Columbia to have a significant unmet need for purposes
of subparagraph (A), and to face a particularly high degree
of risk for such purposes, on the basis of the concentration
of entities of national significance located within the Dis-
trict.
H. R. 3448—31
‘‘(6) FUNDING OF LOCAL ENTITIES.—For fiscal year 2003,
the Secretary shall in making awards under this section ensure
that appropriate portions of such awards are made available
to political subdivisions, local departments of public health,
hospitals (including children’s hospitals), clinics, health centers,
or primary care facilities, or consortia of such entities.
‘‘SEC. 319C–2. PARTNERSHIPS FOR COMMUNITY AND HOSPITAL
PREPAREDNESS.
‘‘(a) GRANTS.—The Secretary shall make awards of grants or
cooperative agreements to eligible entities to enable such entities
to improve community and hospital preparedness for bioterrorism
and other public health emergencies.
‘‘(b) ELIGIBILITY.—To be eligible for an award under subsection
(a), an entity shall—
‘‘(1) be a partnership consisting of—
‘‘(A) one or more hospitals (including children’s hos-
pitals), clinics, health centers, or primary care facilities;
and
‘‘(B)(i) one or more political subdivisions of States;
‘‘(ii) one or more States; or
‘‘(iii) one or more States and one or more political
subdivisions of States; and
‘‘(2) prepare, in consultation with the Chief Executive
Officer of the State, District, or territory in which the hospital,
clinic, health center, or primary care facility described in para-
graph (1)(A) is located, and submit to the Secretary, an applica-
tion at such time, in such manner, and containing such informa-
tion as the Secretary may require.
‘‘(c) REGIONAL COORDINATION.—In making awards under sub-
section (a), the Secretary shall give preference to eligible entities
that submit applications that, in the determination of the Secretary,
will—
‘‘(1) enhance coordination—
‘‘(A) among the entities described in subsection
(b)(1)(A); and
‘‘(B) between such entities and the entities described
in subsection (b)(1)(B); and
‘‘(2) serve the needs of a defined geographic area.
‘‘(d) CONSISTENCY OF PLANNED ACTIVITIES.—An entity described
in subsection (b)(1) shall utilize amounts received under an award
under subsection (a) in a manner that is coordinated and consistent,
as determined by the Secretary, with an applicable State Bioter-
rorism and Other Public Health Emergency Preparedness and
Response Plan.
‘‘(e) USE OF FUNDS.—An award under subsection (a) may be
expended for activities that may include the following and similar
activities—
‘‘(1) planning and administration for such award;
‘‘(2) preparing a plan for triage and transport management
in the event of bioterrorism or other public health emergencies;
‘‘(3) enhancing the training of health care professionals
to improve the ability of such professionals to recognize the
symptoms of exposure to a potential bioweapon, to make appro-
priate diagnosis, and to provide treatment to those individuals
so exposed;
H. R. 3448—32
‘‘(4) enhancing the training of health care professionals
to recognize and treat the mental health consequences of bioter-
rorism or other public health emergencies;
‘‘(5) enhancing the training of health care professionals
to assist in providing appropriate health care for large numbers
of individuals exposed to a bioweapon;
‘‘(6) enhancing training and planning to protect the health
and safety of personnel involved in responding to a biological
attack;
‘‘(7) developing and implementing the trauma care and
burn center care components of the State plans for the provision
of emergency medical services; or
‘‘(8) conducting such activities as are described in section
319C–1(d) that are appropriate for hospitals (including chil-
dren’s hospitals), clinics, health centers, or primary care facili-
ties.
‘‘(f) LIMITATION ON AWARDS.—A political subdivision of a State
shall not participate in more than one partnership described in
subsection (b)(1).
‘‘(g) PRIORITIES IN USE OF GRANTS.—
‘‘(1) IN GENERAL.—
‘‘(A) PRIORITIES.—Except as provided in subparagraph
(B), the Secretary shall, in carrying out the activities
described in this section, address the following hazards
in the following priority:
‘‘(i) Bioterrorism or acute outbreaks of infectious
diseases.
‘‘(ii) Other public health threats and emergencies.
‘‘(B) DETERMINATION OF THE SECRETARY.—In the case
of the hazard involved, the degree of priority that would
apply to the hazard based on the categories specified in
clauses (i) and (ii) of subparagraph (A) may be modified
by the Secretary if the following conditions are met:
‘‘(i) The Secretary determines that the modification
is appropriate on the basis of the following factors:
‘‘(I) The extent to which eligible entities are
adequately prepared for responding to hazards
within the category specified in clause (i) of
subparagraph (A).
‘‘(II) There has been a significant change in
the assessment of risks to the public health posed
by hazards within the category specified in clause
(ii) of such subparagraph.
‘‘(ii) Prior to modifying the priority, the Secretary
notifies the appropriate committees of the Congress
of the determination of the Secretary under clause
(i) of this subparagraph.
‘‘(2) AREAS
OF
EMPHASIS
WITHIN
CATEGORIES.—The Sec-
retary shall determine areas of emphasis within the category
of hazards specified in clause (i) of paragraph (1)(A), and shall
determine areas of emphasis within the category of hazards
specified in clause (ii) of such paragraph, based on an assess-
ment of the risk and likely consequences of such hazards and
on an evaluation of Federal, State, and local needs, and may
also take into account the extent to which receiving an award
under subsection (a) will develop capacities that can be used
for public health emergencies of varying types.
H. R. 3448—33
‘‘(h) COORDINATION WITH LOCAL MEDICAL RESPONSE SYSTEM.—
An eligible entity and local Metropolitan Medical Response Systems
shall, to the extent practicable, ensure that activities carried out
under an award under subsection (a) are coordinated with activities
that are carried out by local Metropolitan Medical Response Sys-
tems.
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of fiscal years 2004 through
2006.’’.
(b) CERTAIN GRANTS.—Section 319C of the Public Health
Service Act (42 U.S.C. 247d–3) is amended by striking subsection
(f).
Subtitle D—Emergency Authorities;
Additional Provisions
SEC. 141. REPORTING DEADLINES.
Section 319 of the Public Health Service Act (42 U.S.C. 247d)
is amended by adding at the end the following:
‘‘(d) DATA SUBMITTAL AND REPORTING DEADLINES.—In any case
in which the Secretary determines that, wholly or partially as
a result of a public health emergency that has been determined
pursuant to subsection (a), individuals or public or private entities
are unable to comply with deadlines for the submission to the
Secretary of data or reports required under any law administered
by the Secretary, the Secretary may, notwithstanding any other
provision of law, grant such extensions of such deadlines as the
circumstances reasonably require, and may waive, wholly or par-
tially, any sanctions otherwise applicable to such failure to comply.
Before or promptly after granting such an extension or waiver,
the Secretary shall notify the Congress of such action and publish
in the Federal Register a notice of the extension or waiver.’’.
SEC. 142. STREAMLINING AND CLARIFYING COMMUNICABLE DISEASE
QUARANTINE PROVISIONS.
(a) ELIMINATION
OF PREREQUISITE
FOR NATIONAL ADVISORY
HEALTH COUNCIL RECOMMENDATION BEFORE ISSUING QUARANTINE
RULES.—
(1) EXECUTIVE ORDERS SPECIFYING DISEASES SUBJECT TO
INDIVIDUAL DETENTIONS.—Section 361(b) of the Public Health
Act (42 U.S.C. 264(b)) is amended by striking ‘‘Executive orders
of the President upon the recommendation of the National
Advisory Health Council and the Surgeon General’’ and
inserting ‘‘Executive orders of the President upon the rec-
ommendation of the Secretary, in consultation with the Surgeon
General,’’.
(2) REGULATIONS PROVIDING FOR APPREHENSION OF INDIVID-
UALS.—Section 361(d) of the Public Health Act (42 U.S.C.
264(d)) is amended by striking ‘‘On recommendation of the
National Advisory Health Council, regulations’’ and inserting
‘‘Regulations’’.
(3) REGULATIONS PROVIDING FOR APPREHENSION OF INDIVID-
UALS IN WARTIME.—Section 363 of the Public Health Act (42
U.S.C. 266) is amended by striking ‘‘the Surgeon General, on
recommendation of the National Advisory Health Council,’’ and
H. R. 3448—34
inserting ‘‘the Secretary, in consultation with the Surgeon Gen-
eral,’’.
(b) APPREHENSION AUTHORITY TO APPLY IN CASES OF EXPOSURE
TO DISEASE.—
(1) REGULATIONS PROVIDING FOR APPREHENSION OF INDIVID-
UALS.—Section 361(d) of the Public Health Act (42 U.S.C.
264(d)), as amended by subsection (a)(2), is further amended—
(A) by striking ‘‘(1)’’ and ‘‘(2)’’ and inserting ‘‘(A)’’ and
‘‘(B)’’, respectively;
(B) by striking ‘‘(d)’’ and inserting ‘‘(d)(1)’’;
(C) in paragraph (1) (as designated by subparagraph
(B) of this paragraph), in the first sentence, by striking
‘‘in a communicable stage’’ each place such term appears
and inserting ‘‘in a qualifying stage’’; and
(D) by adding at the end the following paragraph:
‘‘(2) For purposes of this subsection, the term ‘qualifying stage’,
with respect to a communicable disease, means that such disease—
‘‘(A) is in a communicable stage; or
‘‘(B) is in a precommunicable stage, if the disease would
be likely to cause a public health emergency if transmitted
to other individuals.’’.
(2) REGULATIONS PROVIDING FOR APPREHENSION OF INDIVID-
UALS IN WARTIME.—Section 363 of the Public Health Act (42
U.S.C. 266), as amended by subsection (a)(3), is further
amended by striking ‘‘in a communicable stage’’.
(c) STATE AUTHORITY.—Section 361 of the Public Health Act
(42 U.S.C. 264) is amended by adding at the end the following:
‘‘(e) Nothing in this section or section 363, or the regulations
promulgated under such sections, may be construed as superseding
any provision under State law (including regulations and including
provisions established by political subdivisions of States), except
to the extent that such a provision conflicts with an exercise of
Federal authority under this section or section 363.’’.
SEC. 143. EMERGENCY WAIVER OF MEDICARE, MEDICAID, AND SCHIP
REQUIREMENTS.
(a) WAIVER AUTHORITY.—Title XI of the Social Security Act
(42 U.S.C. 1301 et seq.) is amended by inserting after section
1134 the following new section:
‘‘AUTHORITY TO WAIVE REQUIREMENTS DURING NATIONAL
EMERGENCIES
‘‘SEC. 1135. (a) PURPOSE.—The purpose of this section is to
enable the Secretary to ensure to the maximum extent feasible,
in any emergency area and during an emergency period (as defined
in subsection (g)(1))—
‘‘(1) that sufficient health care items and services are avail-
able to meet the needs of individuals in such area enrolled
in the programs under titles XVIII, XIX, and XXI; and
‘‘(2) that health care providers (as defined in subsection
(g)(2)) that furnish such items and services in good faith, but
that are unable to comply with one or more requirements
described in subsection (b), may be reimbursed for such items
and services and exempted from sanctions for such noncompli-
ance, absent any determination of fraud or abuse.
‘‘(b) SECRETARIAL AUTHORITY.—To the extent necessary to
accomplish the purpose specified in subsection (a), the Secretary
H. R. 3448—35
is authorized, subject to the provisions of this section, to temporarily
waive or modify the application of, with respect to health care
items and services furnished by a health care provider (or classes
of health care providers) in any emergency area (or portion of
such an area) during any portion of an emergency period, the
requirements of titles XVIII, XIX, or XXI, or any regulation there-
under (and the requirements of this title other than this section,
and regulations thereunder, insofar as they relate to such titles),
pertaining to—
‘‘(1)(A) conditions of participation or other certification
requirements for an individual health care provider or types
of providers,
‘‘(B) program participation and similar requirements for
an individual health care provider or types of providers, and
‘‘(C) pre-approval requirements;
‘‘(2) requirements that physicians and other health care
professionals be licensed in the State in which they provide
such services, if they have equivalent licensing in another State
and are not affirmatively excluded from practice in that State
or in any State a part of which is included in the emergency
area;
‘‘(3) sanctions under section 1867 (relating to examination
and treatment for emergency medical conditions and women
in labor) for a transfer of an individual who has not been
stabilized in violation of subsection (c) of such section if the
transfer arises out of the circumstances of the emergency;
‘‘(4) sanctions under section 1877(g) (relating to limitations
on physician referral);
‘‘(5) deadlines and timetables for performance of required
activities, except that such deadlines and timetables may only
be modified, not waived; and
‘‘(6) limitations on payments under section 1851(i) for
health care items and services furnished to individuals enrolled
in a Medicare+Choice plan by health care professionals or facili-
ties not included under such plan.
Insofar as the Secretary exercises authority under paragraph (6)
with respect to individuals enrolled in a Medicare+Choice plan,
to the extent possible given the circumstances, the Secretary shall
reconcile payments made on behalf of such enrollees to ensure
that the enrollees do not pay more than would be required had
they received services from providers within the network of the
plan and may reconcile payments to the organization offering the
plan to ensure that such organization pays for services for which
payment is included in the capitation payment it receives under
part C of title XVIII.
‘‘(c) AUTHORITY FOR RETROACTIVE WAIVER.—A waiver or modi-
fication of requirements pursuant to this section may, at the Sec-
retary’s discretion, be made retroactive to the beginning of the
emergency period or any subsequent date in such period specified
by the Secretary.
‘‘(d) CERTIFICATION TO CONGRESS.—The Secretary shall provide
a certification and advance written notice to the Congress at least
two days before exercising the authority under this section with
respect to an emergency area. Such a certification and notice shall
include—
‘‘(1) a description of—
H. R. 3448—36
‘‘(A) the specific provisions that will be waived or modi-
fied;
‘‘(B) the health care providers to whom the waiver
or modification will apply;
‘‘(C) the geographic area in which the waiver or modi-
fication will apply; and
‘‘(D) the period of time for which the waiver or modifica-
tion will be in effect; and
‘‘(2) a certification that the waiver or modification is nec-
essary to carry out the purpose specified in subsection (a).
‘‘(e) DURATION OF WAIVER.—
‘‘(1) IN GENERAL.—A waiver or modification of requirements
pursuant to this section terminates upon—
‘‘(A) the termination of the applicable declaration of
emergency or disaster described in subsection (g)(1)(A);
‘‘(B) the termination of the applicable declaration of
public health emergency described in subsection (g)(1)(B);
or
‘‘(C) subject to paragraph (2), the termination of a
period of 60 days from the date the waiver or modification
is first published (or, if applicable, the date of extension
of the waiver or modification under paragraph (2)).
‘‘(2) EXTENSION OF 60-DAY PERIODS.—The Secretary may,
by notice, provide for an extension of a 60-day period described
in paragraph (1)(C) (or an additional period provided under
this paragraph) for additional period or periods (not to exceed,
except as subsequently provided under this paragraph, 60 days
each), but any such extension shall not affect or prevent the
termination of a waiver or modification under subparagraph
(A) or (B) of paragraph (1).
‘‘(f) REPORT TO CONGRESS.—Within one year after the end of
the emergency period in an emergency area in which the Secretary
exercised the authority provided under this section, the Secretary
shall report to the Congress regarding the approaches used to
accomplish the purposes described in subsection (a), including an
evaluation of such approaches and recommendations for improved
approaches should the need for such emergency authority arise
in the future.
‘‘(g) DEFINITIONS.—For purposes of this section:
‘‘(1) EMERGENCY AREA; EMERGENCY PERIOD.—An ‘emergency
area’ is a geographical area in which, and an ‘emergency period’
is the period during which, there exists—
‘‘(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert
T. Stafford Disaster Relief and Emergency Assistance Act;
and
‘‘(B) a public health emergency declared by the Sec-
retary pursuant to section 319 of the Public Health Service
Act.
‘‘(2) HEALTH CARE PROVIDER.—The term ‘health care pro-
vider’ means any entity that furnishes health care items or
services, and includes a hospital or other provider of services,
a physician or other health care practitioner or professional,
a health care facility, or a supplier of health care items or
services.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a)
shall be effective on and after September 11, 2001.