II 
108TH CONGRESS 
1ST SESSION H. R. 1770
IN THE SENATE OF THE UNITED STATES 
APRIL 11, 2003
Received 
AN ACT 
To provide benefits and other compensation for certain indi-
viduals with injuries resulting from administration of 
smallpox countermeasures, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Smallpox Emergency 
Personnel Protection Act of 2003’’. 
SEC. 2. SMALLPOX EMERGENCY PERSONNEL PROTECTION. 
Title II of the Public Health Service Act (42 U.S.C. 
202 et seq.) is amended by adding at the end the following 
part: 
‘‘PART C—SMALLPOX EMERGENCY PERSONNEL 
PROTECTION 
‘‘SEC. 261. GENERAL PROVISIONS. 
‘‘(a) DEFINITIONS.—For purposes of this part: 
‘‘(1) COVERED COUNTERMEASURE.—The term 
‘covered countermeasure’ means a covered counter-
measure as specified in a Declaration made pursu-
ant to section 224(p). 
‘‘(2) COVERED
INDIVIDUAL.—The term ‘cov-
ered individual’ means an individual—
‘‘(A) who is a health care worker, law en-
forcement officer, firefighter, security per-
sonnel, emergency medical personnel, other 
public safety personnel, or support personnel 
for such occupational specialities; 
‘‘(B) who is or will be functioning in a role 
identified in a State, local, or Department of 
Health and Human Services smallpox emer-
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gency response plan (as defined in paragraph 
(7)) approved by the Secretary; 
‘‘(C) who has volunteered and been se-
lected to be a member of a smallpox emergency 
response plan described in subparagraph (B) 
prior to the time at which the Secretary pub-
licly announces that an active case of smallpox 
has been identified either within or outside of 
the United States; and 
‘‘(D) to whom a smallpox vaccine is admin-
istered pursuant to such approved plan during 
the effective period of the Declaration (includ-
ing the portion of such period before the enact-
ment of this part). 
‘‘(3) COVERED INJURY.—The term ‘covered in-
jury’ means an injury, disability, illness, condition, 
or death (other than a minor injury such as minor 
scarring or minor local reaction) determined, pursu-
ant to the procedures established under section 262, 
to have been sustained by an individual as the direct 
result of—
‘‘(A) administration to the individual of a 
covered countermeasure during the effective pe-
riod of the Declaration; or
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‘‘(B) accidental vaccinia inoculation of the 
individual in circumstances in which—
‘‘(i) the vaccinia is contracted during 
the effective period of the Declaration or 
within 30 days after the end of such pe-
riod; 
‘‘(ii) smallpox vaccine has not been 
administered to the individual; and 
‘‘(iii) the individual has been in con-
tact with an individual who is (or who was 
accidentally inoculated by) a covered indi-
vidual. 
‘‘(4) DECLARATION.—The term ‘Declaration’ 
means the Declaration Regarding Administration of 
Smallpox Countermeasures issued by the Secretary 
on January 24, 2003, and published in the Federal 
Register on January 28, 2003. 
‘‘(5) EFFECTIVE
PERIOD
OF
THE
DECLARA-
TION.—The term ‘effective period of the Declara-
tion’ means the effective period specified in the Dec-
laration, unless extended by the Secretary. 
‘‘(6) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual who is (as deter-
mined in accordance with section 262)—
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‘‘(A) a covered individual who sustains a 
covered injury in the manner described in para-
graph (3)(A); or 
‘‘(B) an individual who sustains a covered 
injury in the manner described in paragraph 
(3)(B). 
‘‘(7) 
SMALLPOX
EMERGENCY
RESPONSE 
PLAN.—The term ‘smallpox emergency response 
plan’ or ‘plan’ means a response plan detailing ac-
tions to be taken in preparation for a possible small-
pox-related emergency during the period prior to the 
identification of an active case of smallpox either 
within or outside the United States. 
‘‘(b) VOLUNTARY PROGRAM.—The Secretary shall 
ensure that a State, local, or Department of Health and 
Human Services plan to vaccinate individuals that is ap-
proved by the Secretary establishes procedures to ensure, 
consistent with the Declaration and any applicable guide-
lines of the Centers for Disease Control and Prevention, 
that—
‘‘(1) potential participants are educated with 
respect to contraindications, the voluntary nature of 
the program, and the availability of potential bene-
fits and compensation under this part;
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‘‘(2) there is voluntary screening provided to 
potential participants that can identify health condi-
tions relevant to contraindications; and 
‘‘(3) there is appropriate post-inoculation med-
ical surveillance that includes an evaluation of ad-
verse health effects that may reasonably appear to 
be due to such vaccine and prompt referral of, or the 
provision of appropriate information to, any indi-
vidual requiring health care as a result of such ad-
verse health event. 
‘‘SEC. 262. DETERMINATION OF ELIGIBILITY AND BENE-
FITS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
procedures for determining, as applicable with respect to 
an individual—
‘‘(1) whether the individual is an eligible indi-
vidual; 
‘‘(2) whether an eligible individual has sus-
tained a covered injury or injuries for which medical 
benefits or compensation may be available under sec-
tions 264 and 265, and the amount of such benefits 
or compensation; and 
‘‘(3) whether the covered injury or injuries of 
an eligible individual caused the individual’s death 
for purposes of benefits under section 266.
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‘‘(b) COVERED INDIVIDUALS.—The Secretary may 
accept a certification, by a Federal, State, or local govern-
ment entity or private health care entity participating in 
the administration of covered countermeasures under the 
Declaration, that an individual is a covered individual. 
‘‘(c) CRITERIA FOR REIMBURSEMENT.—
‘‘(1) INJURIES SPECIFIED IN INJURY TABLE.—
In any case where an injury or other adverse effect 
specified in the injury table established under section 
263 as a known effect of a vaccine manifests in an 
individual within the time period specified in such 
table, such injury or other effect shall be presumed 
to have resulted from administration of such vaccine. 
‘‘(2) OTHER DETERMINATIONS.—In making de-
terminations other than those described in para-
graph (1) as to the causation or severity of an in-
jury, the Secretary shall employ a preponderance of 
the evidence standard and take into consideration all 
relevant medical and scientific evidence presented for 
consideration, and may obtain and consider the 
views of qualified medical experts. 
‘‘(d) DEADLINE FOR FILING REQUEST.—The Sec-
retary shall not consider any request for a benefit under 
this part with respect to an individual, unless—
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‘‘(1) in the case of a request based on the ad-
ministration of the vaccine to the individual, the in-
dividual files with the Secretary an initial request 
for benefits or compensation under this part not 
later than one year after the date of administration 
of the vaccine; or 
‘‘(2) in the case of a request based on acci-
dental vaccinia inoculation, the individual files with 
the Secretary an initial request for benefits or com-
pensation under this part not later than two years 
after the date of the first symptom or manifestation 
of onset of the adverse effect. 
‘‘(e) STRUCTURED SETTLEMENTS AT SECRETARY’S 
OPTION.—In any case in which there is a reasonable likeli-
hood that compensation or payment under section 264, 
265, or 266(b) will be required for a period in excess of 
one year from the date an individual is determined eligible 
for such compensation or payment, the Secretary shall 
have the discretion to make a lump-sum payment, pur-
chase an annuity or medical insurance policy, or execute 
an appropriate structured settlement agreement, provided 
that such payment, annuity, policy, or agreement is actu-
arially determined to have a value equal to the present 
value of the projected total amount of benefits or com-
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pensation that the individual is eligible to receive under 
such section or sections. 
‘‘(f) REVIEW OF DETERMINATION.—
‘‘(1) SECRETARY’S REVIEW AUTHORITY.—The 
Secretary may review a determination under this 
section at any time on the Secretary’s own motion 
or on application, and may affirm, vacate, or modify 
such determination in any manner the Secretary 
deems appropriate. The Secretary shall develop a 
process by which an individual may file a request for 
reconsideration of any determination made by the 
Secretary under this section. 
‘‘(2) JUDICIAL
AND
ADMINISTRATIVE
RE-
VIEW.—No court of the United States, or of any 
State, District, territory or possession thereof, shall 
have subject matter jurisdiction to review, whether 
by mandamus or otherwise, any action by the Sec-
retary under this section. No officer or employee of 
the United States shall review any action by the Sec-
retary under this section (unless the President spe-
cifically directs otherwise). 
‘‘SEC. 263. SMALLPOX VACCINE INJURY TABLE. 
‘‘(a) SMALLPOX VACCINE INJURY TABLE.—
‘‘(1) ESTABLISHMENT
REQUIRED.—The Sec-
retary shall establish by interim final regulation a
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table identifying adverse effects (including injuries, 
disabilities, illnesses, conditions, and deaths) that 
shall be presumed to result from the administration 
of (or exposure to) a smallpox vaccine, and the time 
period in which the first symptom or manifestation 
of onset of each such adverse effect must manifest 
in order for such presumption to apply. 
‘‘(2) AMENDMENTS.—The Secretary may by 
regulation amend the table established under para-
graph (1). An amendment to the table takes effect 
on the date of the promulgation of the final rule 
that makes the amendment, and applies to all re-
quests for benefits or compensation under this part 
that are filed on or after such date or are pending 
as of such date. In addition, the amendment applies 
retroactively to an individual who was not with re-
spect to the injury involved an eligible individual 
under the table as in effect before the amendment 
but who with respect to such injury is an eligible in-
dividual under the table as amended. With respect to 
a request for benefits or compensation under this 
part by an individual who becomes an eligible indi-
vidual as described in the preceding sentence, the 
Secretary may not provide such benefits or com-
pensation unless the request (or amendment to a re-
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quest, as applicable) is filed before the expiration of 
one year after the effective date of the amendment 
to the table in the case of an individual to whom the 
vaccine was administered and before the expiration 
of two years after such effective date in the case of 
a request based on accidental vaccinia inoculation. 
‘‘SEC. 264. MEDICAL BENEFITS. 
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, the Secretary shall make payment 
or reimbursement for medical items and services as rea-
sonable and necessary to treat a covered injury of an eligi-
ble individual, including the services, appliances, and sup-
plies prescribed or recommended by a qualified physician, 
which the Secretary considers likely to cure, give relief, 
reduce the degree or the period of disability, or aid in less-
ening the amount of monthly compensation. 
‘‘(b) BENEFITS
SECONDARY
TO
OTHER
COV-
ERAGE.—Payment or reimbursement for services or bene-
fits under subsection (a) shall be secondary to any obliga-
tion of the United States or any third party (including 
any State or local governmental entity, private insurance 
carrier, or employer) under any other provision of law or 
contractual agreement, to pay for or provide such services 
or benefits.
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‘‘SEC. 265. COMPENSATION FOR LOST EMPLOYMENT IN-
COME. 
‘‘(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, the Secretary shall provide compensa-
tion to an eligible individual for loss of employment income 
(based on such income at the time of injury) incurred as 
a result of a covered injury, at the rate specified in sub-
section (b). 
‘‘(b) AMOUNT OF COMPENSATION.—
‘‘(1) IN GENERAL.—Compensation under sub-
section (a) shall be at the rate of 66 2/3 percent of 
the relevant pay period (weekly, monthly, or other-
wise), except as provided in paragraph (2). 
‘‘(2) AUGMENTED
COMPENSATION
FOR
DE-
PENDENTS.—If an eligible individual has one or 
more dependents, the basic compensation for loss of 
employment income as described in paragraph (1) 
shall be augmented at the rate of 8 1/3 percent. 
‘‘(3) CONSIDERATION OF OTHER PROGRAMS.—
‘‘(A) IN
GENERAL.—The Secretary may 
consider the provisions of sections 8114, 8115, 
and 8146a of title 5, United States Code, and 
any implementing regulations, in determining 
the amount of payment under subsection (a) 
and the circumstances under which such pay-
ments are reasonable and necessary.