Order Code RL33589
CRS Report for Congress
Received through the CRS Web
The Pandemic and All-Hazards Preparedness Act
(S. 3678): Provisions and Comparison with
Current Law and Related Proposals
Updated October 10, 2006
Sarah A. Lister
Specialist in Public Health and Epidemiology
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

The Pandemic and All-Hazards Preparedness Act
(S. 3678): Provisions and Comparison
with Current Law and Related Proposals
Summary
Authorities to direct federal preparedness for and response to public health
emergencies are found principally in the Public Health Service Act (PHS Act). Two
recent laws provided the core of these authorities: P.L. 106-505, the Public Health
Threats and Emergencies Act of 2000 (Title I of the Public Health Improvement Act),
and P.L. 107-188, the Public Health Security and Bioterrorism Preparedness and
Response Act of 2002, which reauthorized several existing authorities and created
new ones in the aftermath of the 2001 terror attacks.
The laws above built upon existing broad authorities allowing or requiring the
Secretary of Health and Human Services (HHS) to prepare for or respond to
outbreaks of infectious disease and other unanticipated health threats. Other laws —
such as those creating a new Department of Homeland Security (DHS) and a program
(Project BioShield) to encourage the development of specific countermeasures that
would not otherwise have a commercial market — have added to the federal
government’s slate of preparedness and response authorities as well. Further, the
Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act,
administered by DHS), which authorizes federal assistance and other activities in
response to presidentially declared emergencies and major disasters, is also, to some
extent, a source of federal authority for the response to public health threats.
Authority for a number of preparedness and response programs in the PHS Act
expires at the end of FY2006, and the 109th Congress is considering reauthorization.
Expiring authorities include the position of the Assistant Secretary for Public Health
Emergency Preparedness, grants to states to build public health and hospital capacity,
and the National Disaster Medical System (NDMS), a national system of medical
response teams. The response to Hurricane Katrina in 2005, and the threat of a
possible influenza pandemic, each color the policy landscape as Congress assesses
the adequacy of existing federal preparedness and response activities.
Several bills pending in the 109th Congress would address federal leadership for
public health and medical preparedness and response, extend authority for certain
expiring programs in the PHS Act, or both. These include S. 3678 and S. 3721, both
reported in the Senate, and H.R. 5438, reported by the House Energy and Commerce
Committee and pending before the House Homeland Security Committee. S. 3678
would extend a number of expiring provisions in the PHS Act. S. 3721, while
focused on amending provisions in the Homeland Security Act of 2002, also contains
provisions regarding authority and coordination for public health and medical
response, as does H.R. 5438. In addition, P.L. 109-295, DHS appropriations for
FY2077, signed on October 4, 2006, transferred NDMS from DHS to HHS, effective
January 1, 2007.
A comparison of S. 3678 with current law and related bills, including S. 3721
and H.R. 5438, is provided in Table 1, later in this report. The report will be updated
as circumstances warrant.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Legislative History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
The 109th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Major Legislation in the 107th and 108th Congresses . . . . . . . . . . . . . . . . . . . 4
Major Legislation Prior to the 2001 Terrorist Attacks . . . . . . . . . . . . . . . . . . 6
Additional Congressional Research Service (CRS) Reports . . . . . . . . . . . . . . . . . 7
List of Tables
Table 1. Comparison of Current Law with S. 3678 and Related Bills . . . . . . . . . 8

The Pandemic and All-Hazards
Preparedness Act (S. 3678):
Provisions and Comparison with
Current Law and Related Proposals
Introduction
Authorities to direct federal preparedness for and response to public health
emergencies are found principally in the Public Health Service Act (PHS Act). Two
recent laws provided the core of these authorities: P.L. 106-505, the Public Health
Threats and Emergencies Act of 2000
(Title I of the Public Health Improvement
Act), passed in response to the bombing of the Murrah federal building in Oklahoma
City, the Tokyo sarin attack, and other incidents that raised concern about the threat
of bioterrorism or other public health emergencies; and P.L. 107-188, the Public
Health Security and Bioterrorism Preparedness and Response Act of 2002,
passed following the September 11 and anthrax attacks in 2001.
The laws above built upon existing broad authorities allowing or requiring the
Secretary of Health and Human Services (HHS) to prepare for or respond to
bioterrorism, outbreaks of infectious diseases, and other unanticipated health threats.
Other laws — such as those creating a new Department of Homeland Security (DHS)
and a program (Project BioShield) to encourage the development of specific
biological, chemical, and radiological defense countermeasures (e.g., vaccines and
antidotes) that would not otherwise have a commercial market — have added to the
federal government’s slate of preparedness and response authorities as well. Further,
the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford
Act, administered by DHS), which authorizes federal assistance and other activities
in response to presidentially declared emergencies and major disasters, is also, to
some extent, a source of federal authority for the response to public health threats.
Authority for a number of preparedness and response programs in the PHS Act
expires at the end of FY2006, and the 109th Congress is considering reauthorization.
Expiring authorities include the position of the Assistant Secretary for Public Health
Emergency Preparedness, grants to states to build public health and hospital capacity,
and the National Disaster Medical System (NDMS), a national system of medical
response teams. The response to Hurricane Katrina in 2005, and the threat of a
possible influenza pandemic, each color the policy landscape as Congress assesses
the adequacy of existing federal preparedness and response activities.
In October 2006, the President signed P.L. 109-295, DHS appropriations for
FY2007. In addition to funding the department, the law reauthorized and reorganized
programs in the Federal Emergency Management Agency (FEMA), and transferred

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NDMS from DHS to HHS, effective January 1, 2007. The law also codified the
position of DHS Chief Medical Officer (requiring Senate confirmation), and the
Metropolitan Medical Response System in DHS, a program of contracts with major
cities to coordinate multiple local government agencies in emergency planning.
In August 2006, the Senate Committee on Health, Education, Labor and
Pensions reported S. 3678 (Burr), the Pandemic and All-Hazards Preparedness Act,
which would extend a number of expiring programs in the PHS Act, and would
establish a leadership role for the Secretary of HHS in preparedness and response for
public health threats. The bill is ready for floor consideration in the Senate.
Also in August 2006, the Senate Committee on Homeland Security and
Governmental Affairs reported S. 3721 (Collins), the Post Katrina Emergency
Management Reform Act of 2006. Some sections of the bill, which would amend
the Homeland Security Act of 2002 to retain FEMA within DHS, have been
superseded by P.L. 109-295. Other provisions that affect public health and medical
preparedness and response include a requirement for clearer joint operational
planning between HHS and DHS. The bill is ready for floor consideration in the
Senate.
In May 2006, the House Energy and Commerce Committee reported H.R. 5438
(Barton), the Public Health and Medical Emergency Coordination Act of 2006, which
would establish HHS as the lead federal agency for public health and medical
preparedness and response activities. Another provision to transfer NDMS from
DHS to HHS has been superseded by P.L. 109-295. The bill is pending before the
House Homeland Security Committee.
The 109th Congress is also considering the expansion of authorities in the PHS
Act to encourage the development of biodefense countermeasures, first established
in P.L. 108-276, the Project BioShield Act of 2004; legislation (S. 1873 and H.R.
5533
) has progressed in both chambers.1 Thus far, congressional action in this area
has progressed independently of action to reauthorize public health and medical
preparedness and response programs.
A comparison of S. 3678 with current law and related bills, including S. 3721
and H.R. 5438, is provided in Table 1, later in this report. The report will be updated
as circumstances warrant.
Legislative History
The 109th Congress
One of the most difficult challenges faced by Congress and other policymakers
following the 2001 terror attacks was that of envisioning those catastrophic threats
for which the nation must be prepared, defining the capabilities needed to assure
1 For more information, see CRS Report RS21507, Project BioShield, by Frank Gottron.

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national preparedness, and determining the appropriate federal activities and effective
incentives needed to achieve national preparedness among federal, state, and local
governments, and the private sector. Both P.L. 106-505 and P.L. 107-188 called on
the Secretary of HHS, in collaboration with other stakeholders, to define core
national capacities for preparedness and response for public health and medical
emergencies. The process has been a challenge, though recent efforts at DHS to
develop national Target Capabilities have helped to define certain large-scale
capabilities — such as rapid disease detection, mass prophylaxis, and medical surge
— that would be required for an effective response to mass casualty incidents, and
that would require a substantial federal coordinating effort.2 S. 3678, reported in the
Senate, would amend existing authority to require the Secretary of HHS to prepare
a quadrennial National Health Security Strategy and implementation plan, to include
preparedness goals for federal, state, and local governments in harmony with national
preparedness and response efforts carried out by DHS.
In light of the response to Hurricane Katrina and efforts to prepare for a flu
pandemic, Congress has debated whether federal responsibilities to address public
health threats are clearly defined, particularly with regard to the respective roles of
the Secretaries of HHS and DHS. Efforts are under way in the 109th Congress to
review federal emergency and disaster response authorities in DHS, including the
structure and organization of the Federal Emergency Management Agency (FEMA).3
S. 3678 and S. 3721, reported in the Senate, and H.R. 5438, reported in the House,4
propose to establish or clarify the role of the Secretary of HHS in the federal response
to public health emergencies. P.L. 109-295, the Department of Homeland Security
Appropriations Act of 2007, signed on October 4, 2006, would delegate certain of
these authorities and responsibilities to DHS, through its Chief Medical Officer.
Since FY2002, Congress has provided approximately $7 billion in grants to
states to build public health and hospital preparedness for public health threats.
Presumably due to national security concerns and other sensitivities, HHS has not
published comprehensive or state-specific information regarding states’ performance
toward meeting the objectives for these grant programs. Congress has been keenly
interested in the management of these grants, on topics ranging from the relevance
of broad program goals in achieving national preparedness, to the rigor of fiscal
accounting mechanisms, to the balance of federal vs. state funding shares, to issues
of program transparency. Several bills (e.g., S. 3678, reported in the Senate, and S.
2792
, introduced in the Senate) propose modifications to these grant programs, for
which authority expires at the end of FY2006. S. 3678 would extend the programs
while adding certain new program elements, including federal authority to withhold
funds for failure to meet program requirements, and a state matching requirement.
S. 2792 would also authorize a matching requirement, and would require the
2 For more information, see CRS Report RL32803, The National Preparedness System:
Issues in the 109th Congress
, by Keith Bea.
3 See CRS Report RL33369, Federal Emergency Management and Homeland Security
Organization: Historical Developments and Legislative Options
, by Henry B. Hogue and
Keith Bea.
4 H.R. 5438 has been reported by the House Committee on Energy and Commerce and has
been referred to the House Committee on Homeland Security for further action.

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Secretaries of HHS and DHS to develop a single Internet-based point of access from
which states could apply for public health and hospital preparedness grants.
There has been considerable discussion in the 109th Congress regarding whether
a public health disaster response could function effectively when NDMS, a key
federal medical response asset, is based at DHS rather than at HHS.5 Congressional
and White House investigators each found that NDMS deployments in response to
Hurricane Katrina were made by FEMA without the involvement of personnel at
HHS.6 In P.L. 109-295, FY2007 appropriations for DHS, Congress transferred
NDMS to HHS, effective January 1, 2007. The transfer was supported by the
Administration.7 (NDMS was originally transferred from HHS to DHS in P.L. 107-
296, the Homeland Security Act, effective in 2003.)
Authority for health professions programs in Title VII of the Public Health
Service Act expired in 2002, and may be considered for extension by the 109th
Congress. These programs, administered by the Health Resources and Services
Administration (HRSA), are primarily intended to alleviate shortages and
maldistributions of healthcare workers. The public health workforce has, in contrast,
received little federal attention over the years. Congress may consider Title VII
programs in the context of preparedness in both the public health and healthcare
sectors.8 S. 506, introduced in the Senate, would provide scholarship and loan
repayment programs for health professionals who work in government public health
agencies. S. 3678, reported in the Senate, would authorize a loan repayment
demonstration project for individuals who serve in health professional shortage areas
or areas at high risk of a public health emergency.
Major Legislation in the 107th and 108th Congresses
Following the terror attacks of 2001, the 107th Congress passed the Public
Health Security and Bioterrorism Preparedness and Response Act (P.L. 107-
188,
signed in June 2002, often called “the Bioterrorism Act”) to improve the
5 NDMS consists of a number of medical response teams that can deploy to a scene rapidly
and set up field operations that are self-sustaining for up to 72 hours, until additional federal
support arrives. Additional information about NDMS is available in CRS Report RL33096,
2005 Gulf Coast Hurricanes: The Public Health and Medical Response, by Sarah A. Lister.
6 See the U.S. House of Representatives, A Failure of Initiative: The Final Report of the
Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane
Katrina,
p. 297, Feb. 2006, at [http://katrina.house.gov/]; U.S. Senate, Committee on
Homeland Security and Governmental Affairs, Hurricane Katrina: A Nation Still
Unprepared,
chapter 24, p. 29, May 2006, at [http://hsgac.senate.gov/]; and the White
House, The Federal Response to Hurricane Katrina: Lessons Learned, p. 47, Feb. 2006, at
[http://www.whitehouse.gov/reports/katrina-lessons-learned/].
7 Office of Management and Budget, “Statement of Administration Policy: H.R. 5441 —
Department of Homeland Security Appropriations Bill, FY2007,” Senate version, July 12,
2006, p. 2, at [http://www.whitehouse.gov/omb/legislative/sap/109-2/hr5441sap-s.pdf].
8 For more information, see the section “Trends Affecting the Health Workforce: Emergency
Preparedness,” in CRS Report RL32546, Title VII Health Professions Education and
Training: Issues in Reauthorization
, by Bernice Reyes-Akinbileje.

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nation’s readiness for bioterrorism, emerging infectious diseases, and other public
health threats and emergencies. The program of grants for state and local public
health capacity, administered by the Centers for Disease Control and Prevention
(CDC), was reauthorized at $1.08 billion for FY2003, and such sums as may be
necessary through FY2006.9 (The program had previously been authorized at $50
million for FY2001, prior to the terror attacks.) The law stipulated a funding
formula, including a base amount plus an amount determined by population, with the
intent that every state and territory receive funding for a variety of core public health
preparedness activities. Under prior statutory authority (see below), the grants had
been competitive.
The Bioterrorism Act also established, for the first time, a program of grants to
states to prepare hospitals, clinics and other healthcare facilities for bioterrorism and
other mass-casualty events, to be administered by HRSA. Congress authorized $520
million for this program in FY2003, and such sums as may be necessary through
FY2006.
The Bioterrorism Act contained a number of other provisions for public health
preparedness. Title I of the act included numerous additional provisions for building
federal public health capacity, including creation of the position of Assistant
Secretary for Public Health Emergency Preparedness (ASPHEP) at HHS, and
expansion of security and preparedness activities at CDC. Title I also expanded the
program for the national stockpile of drugs to treat potential victims of terrorism or
other public health emergencies, and changed its name from the National
Pharmaceutical Stockpile to the Strategic National Stockpile (SNS). Title II of the
act called on the Secretary of HHS to register facilities (e.g., laboratories) and
individuals in possession of Select Agents, those biological agents and toxins that
pose a severe threat to public health and safety, and to promulgate new safety and
security requirements for such facilities and individuals. Title III contained several
provisions to protect the nation’s food and drug supply and enhance agricultural
security. Finally, Title IV of the act included provisions aimed at protecting the
nation’s drinking water supply, including authorizing $160 million to provide
financial assistance to community water systems to conduct vulnerability assessments
and prepare response plans.10
In creating the new Department of Homeland Security, the 107th Congress
considered a variety of public health preparedness programs and where they would
best be located. In the end, the Homeland Security Act (P.L. 107-296, signed in
November 2002) transferred to the new department only the Metropolitan Medical
Response System (a municipal grant program), NDMS, and budget authority for the
9 The authorization for FY2002 funds was signed in June 2002, after the actual emergency
supplemental appropriation for FY2002 was passed in January 2002 and distribution of
awards to states was imminent. Conferees reported (in H.Rept. 107-481, accompanying P.L.
107-188) that they did not intend to delay or disrupt the ongoing awards process, and
directed the Administration to continue its current approach to the awards.
10 For a summary of P.L. 107-188, see CRS Report RL31263, Public Health Security and
Bioterrorism Preparedness and Response Act (P.L. 107-188): Provisions and Changes to
Preexisting Law
, by C. Stephen Redhead, Donna U. Vogt, and Mary E. Tiemann.

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SNS, leaving most public health preparedness and response activities in HHS. P.L.
107-296 directed the Secretary of HHS to collaborate with the Secretary of DHS in
setting priorities for human health-related countermeasures research and
development, and for all public health-related activities to improve state, local, and
hospital preparedness and response, though these programmatic activities remained
at HHS.
The Project BioShield Act of 2004 (P.L. 108-276, signed in July 2004) created
market incentives for the development of drugs, vaccines, biologics, other treatments
and tests for biological and chemical agents — collectively called countermeasures
— that would not otherwise be attractive to entrepreneurs.11 In addition, budget
authority for the SNS was transferred from DHS back to HHS in the act, though both
the Secretaries of HHS and of DHS retain authority to deploy SNS assets in an
emergency. CDC continues to provide administrative management of the SNS, as
it always has.
Major Legislation Prior to the 2001 Terrorist Attacks
Prior to the terrorist attacks of 2001, Congress passed the Public Health
Threats and Emergencies Act of 2000 (Title I of the Public Health Improvement
Act, P.L. 106-505
, signed in November 2000) to address growing concerns about
bioterrorism and emerging infectious diseases, and about the ability of the public
health system to respond. Among other provisions, the law authorized $50 million
for FY2001 (and such sums as may be necessary through FY2006) for competitive
grants to build capacity in state and local health departments. This and other
provisions would augment several public health infrastructure programs begun by
CDC in the 1990s, including grants to states for epidemiology and laboratory
capacity, and the creation of the Laboratory Response Network to assure nationwide
capability for testing of biological agents during an actual or suspected bioterrorism
incident.
In the Antiterrorism and Effective Death Penalty Act of 1996 (P.L. 104-132,
signed in April 1996), Congress called on the Secretary of HHS to establish a
program to identify and list specific infectious agents that could be used for
bioterrorism, and to require the registration of facilities (typically laboratories)
shipping those agents. The resultant Select Agent program is overseen by CDC and
the U.S. Department of Agriculture (USDA). Program authority was expended and
extended through FY2007 in P.L. 107-188, in the aftermath of the anthrax attack.
11 For more information on Project BioShield, see CRS Report RS21507, Project BioShield,
by Frank Gottron.

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Additional Congressional Research Service
(CRS) Reports
For more information regarding provisions in P.L. 107-188, see
! CRS Report RL31263, Public Health Security and Bioterrorism
Preparedness and Response Act (P.L. 107-188): Provisions and
Changes to Preexisting Law
, by C. Stephen Redhead, Donna U.
Vogt, and Mary E. Tieman.
For more information regarding public health preparedness and response
authorities and programs in general, and in the context of specific threats, see:
! CRS Report RL33579, The Public Health and Medical Response to
Disasters: Federal Authority and Funding, by Sarah A. Lister;
! CRS Report RL31719, An Overview of the U.S. Public Health
System in the Context of Emergency Preparedness, by Sarah A.
Lister;
! CRS Report RL33096, 2005 Gulf Coast Hurricanes: The Public
Health and Medical Response, by Sarah A. Lister; and
! CRS Report RL33145, Pandemic Influenza: Domestic Preparedness
Efforts, by Sarah A. Lister.
For more information regarding the Stafford Act and related preparedness and
response planning activities in DHS, see
! CRS Report RL33053, Federal Stafford Act Disaster Assistance:
Presidential Declarations, Eligible Activities, and Funding, by Keith
Bea; and
! CRS Report RL32803, The National Preparedness System: Issues
in the 109th Congress, by Keith Bea.
For more information regarding Project BioShield, see
! CRS Report RS21507, Project BioShield, by Frank Gottron.

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Table 1. Comparison of Current Law with S. 3678 and Related Bills
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
National Preparedness and Response for Public Health Emergencies: Federal Authority, Leadership and Organization
National Health
Section 2801 of the Public Health Service (PHS)
Repeals existing Sections 319A and 2801 of the
Security Strategy,
Act requires the Secretary of Health and Human
PHS Act. Establishes a new Section 2802(a) of
plan and capacities
Services (HHS), pursuant to PHS Act Section
the PHSA, requiring the Secretary, beginning in
319A, to develop and implement a national plan
2009 and every 4 years thereafter, to prepare and
to prepare for and respond to bioterrorism and
submit to Congress a coordinated National Health
other public health emergencies. Establishes five
Security Strategy and implementation plan for
national preparedness goals: (I) assist state and
public health emergency preparedness and
local governments in the event of bioterrorism or
response. The strategy shall identify the process
other public health emergencies; (ii) ensure that
for achieving the preparedness goals described in
state and local governments have the capacity to
subsection (b) and be consistent with the National
detect and respond to such emergencies; (iii)
Preparedness Goal, the National Incident
develop and maintain countermeasures; (iv)
Management System and the National Response
ensure coordination and minimize duplication of
Plan (NRP), developed by the Department of
federal, state, and local planning, preparedness,
Homeland Security (DHS), or any successor plan.
and response activities; and (v) enhance hospital
The strategy and plan shall include an evaluation
and other healthcare facility readiness. Requires
of progress made by federal, state, local, and
the Secretary to coordinate with state and local
tribal entities toward preparedness, and a strategy
governments and develop outcome measures to
to establish a prepared public health workforce.
evaluate progress in implementing the national
plan and achieving its five goals. Requires the
Establishes a new Section 2802(b) of the PHS Act
Secretary to report to Congress within 1 year, and
requiring that the National Health Security
biennially thereafter, on progress made towards
Strategy include preparedness goals for: (1)
meeting the national preparedness goals,
integration of response capabilities and systems;
including recommendations for new legislative
(2) capabilities for public health preparedness and

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Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
authority to protect public health. [42 U.S.C. §
response; (3) capabilities for medical
300hh]
preparedness and response; (4) provisions for the
needs of “at risk” individuals (defined as children,
Section 319A of the PHS Act requires the
pregnant women, senior citizens and other
Secretary, together with state and local health
individuals who have special needs in the event of
officials, to establish those capacities needed for
a public health emergency, as determined by the
national, state, and local public health systems to
Secretary); (5) coordination of federal, state,
be able to detect, diagnose, and contain outbreaks
local, and tribal planning, preparedness, and
of infectious disease, drug-resistant pathogens, or
response activities; and (6) continuity of federal,
acts of bioterrorism. Authorizes $4 million for
state, local, and tribal operations in the event of a
FY2001, and such sums as may be necessary for
public health emergency. [Section 103]
FY2002 — FY2006. [42 U.S.C. § 247d-1]
Federal leadership
No applicable provision.
Repeals the existing Section 2801 of the PHS Act
S. 3721 (reported in the Senate) requires the
for public health
and establishes a new Section 2801 requiring the
Secretaries of DHS and HHS to establish a
and medical
Secretary to lead all federal public health and
memorandum of understanding defining the roles
preparedness and
medical response to public health emergencies
and responsibilities of their respective
response
and incidents covered by the NRP or any
departments in providing for public health and
successor plan. The Secretary shall, in
medical care under the NRP, or in the event that
collaboration with the Secretaries of Veterans
the Secretary of HHS declares a public health
Affairs (VA), Defense (DOD), Transportation,
emergency under section 319 of the PHS Act.
Homeland Security, and the head of any other
Requires the Secretary of DHS, in conjunction
relevant federal agency, and consistent with the
with other federal departments and agencies, to
NRP or successor plan, establish an interagency
develop strategic and operational plans to respond
agreement under which the Secretary shall assume
effectively to natural or man-made disasters, in
operational control of emergency public health
support of the NRP. Among other requirements,
and medical response assets, as necessary, in the
the DHS Secretary’s planning shall address
event of a public health emergency. [Section 101]
preparedness and deployment of health and
medical resources, including clearly defining the

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Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
responsibility for logistics, security, and other
support assets, and the ability to track these
resources. [Section 404]
H.R. 5438 (reported by the House Cmte. on
Energy and Commerce, referred to the House
Cmte. on Homeland Security) amends Section
2811 of the PHS Act to state that HHS shall be
the primary agency for the coordination of federal
assistance to supplement state, local, and tribal
resources for preparing for or responding to a
bioterrorist attack or other public health or
medical emergency. [Section 3]
Assistant Secretary
Section 2811(a) of the PHS Act authorizes the
Redesignates the existing PHS Act Section 2811
S. 3042 creates in HHS a new position of
appointment of an Assistant Secretary for Public
as Section 2812 and creates a new Section 2811 to
Assistant Secretary for Public Health,
Health Emergency Preparedness (ASPHEP) in
establish within HHS the position of Assistant
encompassing the existing authorities and
HHS to: coordinate all HHS preparedness and
Secretary for Preparedness and Response (ASPR),
responsibilities of the ASPHEP, who is
response activities related to bioterrorism and
to be appointed by the President and confirmed by
responsible in general for HHS preparedness and
other public health emergencies; coordinate HHS
the Senate. Upon enactment, transfers to the
response activities, and the Assistant Secretary for
efforts to bolster state and local emergency
ASPR all functions, personnel, assets and
Health, who, among other duties, oversees the
preparedness for a bioterrorist attack or other
liabilities of the ASPHEP. The ASPR shall: (1)
Surgeon General and the Commissioned Corps of
public health emergency, and evaluate the
advise the Secretary on matters relating to public
the U.S. Public Health Service. [Section 105]
progress of such entities in meeting the
health and medical preparedness and response; (2)
benchmarks and other outcome measures
manage and have the authority to deploy federal
contained in the national plan and in meeting the
public health and medical personnel including the
core public health capabilities established
National Disaster Medical System (NDMS); (3)
pursuant to 319A; and interface with other federal
oversee the advanced research, development and
agencies and state and local entities. This position
procurement of countermeasures pursuant to

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Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
does not require Senate confirmation. Authorizes
Sections 319F-1 and 319F-3, and maintain the
such sums as may be necessary for FY2002 —
Strategic National Stockpile (SNS); (4) coordinate
FY2006. [42 U.S.C. § 300hh-11]
with relevant federal, state, local and tribal health
officials to ensure integration of preparedness and
response activities, and to promote improved
emergency medical services with respect to public
health emergencies; (5) provide logistical support
for medical and public health aspects of federal
response to public health emergencies, in
coordination with the Secretaries of VA and
Homeland Security, the General Services
Administration and other public and private
entities; and (6) provide leadership in
international programs, initiatives and policies
dealing with public health and medical emergency
preparedness and response. The ASPR shall have
authority over and responsibility for the functions,
personnel, assets and liabilities of NDMS, the
Hospital Preparedness Cooperative Agreement
(pursuant to Section 319C-2, as designated in this
act), and the Public Health Preparedness
Cooperative Agreement (pursuant to Section
319C-1); and shall coordinate the Medical
Reserve Corps (pursuant to Section 2813, as
designated in this act), the Emergency System for
the Advance Registration of Volunteer Health
Professionals (pursuant to Section 319I); the SNS;
and the Cities Readiness Initiative. [Section 102]

CRS-12
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S. 3678 (as reported)
Selected Provisions in Related Bills
Assessing public
PHS Act Section 319B authorizes grants to states
Repeals Section 319A of the PHS Act. Does not
S. 3042 amends Section 319B of the PHS Act to
health needs
and local public health departments to evaluate
modify Section 319B.
require the Secretary, not later than 180 days after
the extent to which they can achieve the capacities
enactment, to establish and review annually,
identified pursuant to Section 319A. Requires the
guidelines for grantees to assess their
Secretary to develop a national framework for the
preparedness, and to evaluate performance. Such
evaluations. Authorizes $45 million for FY2001,
guidelines shall define the responsibilities of the
and such sums as may be necessary for FY2002 -
public health entities involved, and describe the
FY2003. [42 U.S.C. § 247d-2]
activities that are the responsibility of the federal
government, the state and local public health
authorities, healthcare providers, and other
organizations, respectively, consistent with the
NRP. Authorizes $75 million for FY2007 and
such sums as may be necessary for subsequent
fiscal years.
Public health
PHS Act Section 319 authorizes the Secretary to
(EMTALA provision: see below)
S. 1769 amends PHS Act Section 319 to state that
emergency
determine that a public health emergency exists,
determinations of a public health emergency shall
authorities and
establishes the Public Health Emergency Fund,
specify the geographic area to which such
emergency fund
and authorizes such sums as may be necessary.
determinations apply. Authorizes the Secretary,
Requires an annual report to Congress on
upon such a determination and in the area to
expenditures from the Fund. Requires the
which it applies, to waive certain statutory
Secretary to notify Congress within 48 hours of
requirements, and to apply such waivers
declaring a public health emergency. Provides
retroactively, including extensions of certain
that public health emergencies expire by
administrative, reporting and budget deadlines;
announcement of the Secretary or after 90 days,
requirements regarding the eligibility of adults
whichever comes first, and permits the Secretary
and children for participation in vaccine access
to renew emergency declarations, subject to the
programs authorized in Section 317 of the PHS
same 90-day limitation. Allows the Secretary
Act and Section 1928 of the Social Security Act;
during a public health emergency to waive
federal matching requirements for programs in the
deadlines for the submission of data and reports
PHS Act; provisions related to the designation of

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Selected Provisions in Related Bills
by individuals or public or private entities
health workforce shortage areas; certain licensing
pursuant to any law administered by the
requirements for physicians and other health
Secretary. Requires the Secretary to notify
professionals who volunteer to provide medical
Congress of such an action and publish a notice in
services; and certain provisions in the federal
the Federal Register. [42 U.S.C. § 247d]
Food, Drug, and Cosmetic Act related to the
administrative detention of foods. The Secretary
Authorizes the Secretary to modify or waive
shall notify Congress of any such waivers within
certain statutory or regulatory requirements
2 days, and shall publish in the Federal Register
following a determination of a public health
a notice of such waivers in a timely manner.
emergency pursuant to PHS Act Section 319
[Section 101] Authorizes the Secretary, when a
AND an emergency or disaster declaration by the
determination of a public health emergency has
President pursuant to the National Emergencies
been made, to extend the maximum period of
Act [50 U.S.C. § 1601] or the Stafford Act [42
assistance to states in Section 311 of the PHS Act
U.S.C. § 5121 et seq.]. Requirements that may be
from six months to 18 months, with respect to
waived or modified include (1) conditions of
assistance to geographic areas that are the subject
participation and certain other requirements in the
of such a determination. [Section 201] Requires
Medicare, Medicaid and SCHIP programs; (2)
the Secretary, within 120 days of enactment, to
federal requirements for state licensure of health
submit to Congress a report on specific regulatory
professionals; (3) certain provisions of the
requirements and funding formulas under the PHS
Emergency Medical Treatment and Active Labor
Act that would assist the Secretary in responding
Act of 1985 (EMTALA: see additional
to a public health emergency, as declared under
information below); (4) certain sanctions
Section 319. [Section 302]
prohibiting physician self-referral (so-called
“Stark” provisions); (5) modification, but not
S. 3042 establishes a Bioterrorism and Public
waiver, of deadlines and timetables for
Health Response Emergency Fund to provide
performance of required activities; (6) limitations
short-term assistance to hospitals, federally
on certain payments for health care items and
qualified health centers, rural health clinics,
services furnished to individuals enrolled in a
public health laboratories, and other healthcare
Medicare + Choice plan; and (7) sanctions and
providers and other members of the public health
penalties that arise from noncompliance with
workforce, as determined appropriate by the

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Current Law
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Selected Provisions in Related Bills
certain patient privacy requirements of the Health
Secretary, in the event of bioterrorism or other
Insurance Portability and Accountability Act of
public health emergency. Authorizes such sums
1996. [42 U.S.C. § 1320b-5]
as may be necessary for FY2007 and each
subsequent fiscal year. [Section 2813]
Public health
EMTALA: When there is a concurrent public
Amends Section 1135(b) of the Social Security
emergency
health emergency determination pursuant to PHS
Act [42 U.S.C. § 1320b-5(b)] regarding the
authorities —
Act Section 319 [42 U.S.C. § 247d] AND an
waiver of EMTALA requirements when there is
EMTALAa
emergency or disaster declaration by the President
a concurrent public health emergency
pursuant to either the National Emergencies Act
determination pursuant to PHS Act Section 319
[50 U.S.C. § 1601] or the Stafford Act [42 U.S.C.
AND an emergency or disaster declaration by the
§ 5121 et seq.], the Secretary may waive certain
President pursuant to the National Emergencies
EMTALA requirements [42 U.S.C. § 1395dd] as
Act [50 U.S.C. § 1601] or the Stafford Act [42
follows: if a hospital within such a declared
U.S.C. § 5121 et seq.], as follows: If the public
emergency area implements its disaster protocol
health emergency declared pursuant to Section
as a consequence of the emergency, the hospital
319 of the PHS Act involves a pandemic
may be exempt, for 72 hours, from the
infectious disease: (1) the Secretary’s waiver or
prohibitions against the transfer of a
modification of EMTALA requirements regarding
non-stabilized individual, and the direction or
direction of individuals to alternate locations for
relocation of individuals to an alternate location
medical screening shall be pursuant to the
for medical screening pursuant to an appropriate
appropriate state emergency preparedness or
state emergency preparedness plan. [42 U.S.C. §
pandemic plan; and (2) if a hospital within such a
1320b-5]
declared emergency area implements its disaster
protocol as a consequence of the emergency, the
hospital may be exempt, for 60 days or until the
termination of the Secretary’s declaration,
whichever is sooner, from the prohibitions against
the transfer of an individual who has not been
stabilized and the direction of individuals to an
alternate location for medical screening. This

CRS-15
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
provision is effective upon enactment. [Section
302]
Federal assistance
Section 311(c)(2) of the PHS Act authorizes the
No applicable provision.
S. 1769 amends Section 311 of the PHS Act to
to states
Secretary of HHS, at the request of the
provide that if the Secretary declares a public
appropriate state or local authority, to extend
health emergency pursuant to section 319 of the
temporary (not in excess of six months) assistance
PHS Act, the six-month limitation for assistance
to states or localities in meeting health
to states may be extended for a period not to
emergencies of such a nature as to warrant federal
exceed 18 months, with respect to assistance to
assistance. The Secretary may, for such
geographic areas that are the subject of such
assistance provided, require reimbursement as he
declaration. [Section 201]
determines reasonable under the circumstances.
Any reimbursement so paid shall be credited to
the applicable appropriation for the U.S. Public
Health Service for the year in which such
reimbursement is received. [42 U.S.C. §
243(c)(2)]
Federal working
PHS Act Section 319F, subsections (a) through
Repeals existing PHS Act Section 319F,
groups and
(d) creates a single interagency working group on
subsections (a) through (d).
advisory
the prevention, preparedness, and response to
committees
bioterrorism and other public health emergencies,
to be established by the Secretary in coordination
with other federal officials. Requires the working
group or its subcommittees to meet periodically to
consult on, assist in and make recommendations
on topics related to preparedness and response for
bioterrorism and other public health emergencies
(including research and development for
countermeasures to treat, prevent, and identify

CRS-16
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
exposure to biological agents). Establishes the
National Advisory Committee on Children and
Terrorism and the Emergency Public Information
and Communications (EPIC) Advisory
Committee, both of which sunset after one year.
Requires the Secretary to develop a strategy to
communicate information on bioterrorism and
other public health emergencies, and recommends
establishing a federal website on bioterrorism.
[42 U.S.C. § 247d-6]
Grants for Public Health and Hospital Preparedness
Grants to states for
Section 319C-1 of the PHS Act requires the
Repeals and replaces PHS Act Sections 319C-1(a)
S. 2792 amends PHS Act Section 319C-1 to,
public health
Secretary to make awards to eligible entities to
through (I) and amends remaining subsections.
among other provisions, require the Secretary to
preparedness
improve public health preparedness and response
Defines eligible entities as states, consortia of
develop and apply measurable critical
to bioterrorism and other public health
states, or certain political subdivisions of states.
benchmarks and performance standards to
emergencies. Eligible entities are states, political
Grantees shall prepare and submit to the
grantees. Extends program authority through
subdivisions of states, or consortia of
Secretary, as required, an All-Hazards Public
FY2010. [Section 2]
subdivisions. Eligible entities must have
Health Emergency Preparedness and Response
completed a Section 319B evaluation of core
Plan, to contain information including pandemic
S. 3042 amends PHS Act Section 319C-1, to
public health capacity needs and must, within 60
influenza planning and certain additional criteria.
require: the concurrence of the governor or chief
days of receiving an award, submit an emergency
Grantees shall submit to the Secretary, as
elected official of the eligible entity, and of local
preparedness and response plan describing the
required, reports regarding the annual conduct of
jurisdictions, with the annual application; and
activities to be carried out. Use of funds for
drills, grantees’ performance according to
additional planning requirements, including the
preparedness and response to bioterrorism and
standards defined by the Secretary, and other
conduct of drills. Requires the Secretary to
outbreaks of infectious disease takes priority over
information. Eligible entities shall, by FY2009,
establish performance standards for grantees, to
other public health emergencies, subject to any
participate in the Emergency System for Advance
conduct biennial evaluations of grantee
modification in the assessment of risk by the
Registration of Volunteer Health Professionals.
performance, and to report on such evaluations
Secretary. Authorizes $1.08 billion for FY2003
Awards shall be used to achieve the preparedness
publicly, to the extent that the Secretary
for block grants to states and territories, and such
goals described under the following subsections
determines such availability does not threaten
sums as may be necessary for FY2004 —
of Section 2802(b) (as established in this act)
national security. Establishes criteria for
FY2006. Note: The requirement that public
regarding: (1) integration; (2) public health
withholding of funds and designates a maximum

CRS-17
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
health preparedness funding be awarded as block
capability; (4) the needs of at-risk individuals; (5)
carryover amount. Extends program authority
grants applies only to FY2003; greater flexibility
coordination; and (6) continuity of operations.
through FY2010. [Section 103]
in awarding funding is provided to the Secretary
(Note: Goal #3, medical capability, is not a
beyond FY2003. [42 U.S.C. § 247d-3a]
required activity for these grants.) The Secretary
shall consult with the Secretary of DHS to assure
Note: The funding formula and certain other
the coordination of relevant activities. Authorizes
administrative requirements are established jointly
$824 million for awards for FY2007 and such
for both the public health and hospital
sums as may be necessary for FY2008 —
preparedness grants, and are described in later
FY2011, and $10 million for FY2007 for a study
sections.
of best practices for required drills. [Section 201]
Note: The funding formula and certain other
administrative and fiscal requirements are
established jointly for both the public health
preparedness grants described here and the
hospital preparedness grants described below.
These administrative and fiscal requirements, in
Sections 319C-1(g) and (I), as established in this
act, are described in later sections.
Grants for hospital
Section 319C-1 of the PHS Act requires the
Repeals the existing PHS Act Section 319C-2 and
and health system
Secretary to make awards to eligible entities to
substitutes a new Section 319C-2, which requires
preparedness
enhance the preparedness of hospitals (including
the Secretary to award competitive grants to
children’s hospitals), clinics, health centers, and
eligible entities to improve surge capacity and
primary care facilities, for bioterrorism and other
enhance community and hospital preparedness for
public health emergencies, and for related
public health emergencies. Eligible entities shall
planning and administrative activities. Eligible
be: (1) “partnerships” of: (I) one or more
entities are states, political subdivisions of states,
hospitals, at least one of which shall be a
or consortia of subdivisions. Authorizes $520
designated trauma center; AND (ii) one or more
million for FY2003 and such sums as may be
other local health care facilities, including clinics,
necessary for FY2004 — FY2006. [42 U.S.C. §
health centers, primary care facilities, mental
247d-3a]
health centers, mobile medical assets, or nursing
homes; AND (iii) one or more states, one or more
Note: The funding formula and certain other
political subdivisions of states, or consortia of the
administrative requirements are established jointly
two; or (2) states, political subdivisions of states,
for both the public health and hospital
or consortia of the two, that are eligible for public

CRS-18
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
preparedness grants, and are described in later
health preparedness grants pursuant to Section
sections.
319C-1(b)(1) (as designated in this act), provided
that such entities assure the Secretary that they
Section 319C-2 of the PHS Act authorizes grants
will retain not more than 25% of the award for
to improve community and hospital preparedness
administrative and other support functions.
for bioterrorism and other public health
emergencies. Eligible entities are partnerships
Eligible entities shall submit applications for
between one or more hospitals (or other
awards to include such information as the
healthcare facilities) and one or more states and/or
Secretary may require, and consistent with the
local governments. Grant proposals must be
states’ All-Hazards Public Health Emergency
coordinated and consistent with the state’s
Preparedness and Response Plan and other
emergency preparedness and response plan. Use
relevant state and local activities. Awards shall be
of funds for preparedness and response to
used to achieve the preparedness goals described
bioterrorism and outbreaks of infectious disease
under the following subsections of Section
takes priority over other public health
2802(b), as established in this act: (1) integration;
emergencies, subject to any modification in the
(3) medical capability; (4) the needs of at-risk
assessment of risk by the Secretary. Authorizes
individuals; (5) coordination; and (6) continuity
such sums as may be necessary for FY2004 —
of operations. (Note: Goal #2, public health
FY2006. [42 U.S.C. § 247d-3b]
capability, is not a required activity for these
grants.) In making awards the Secretary shall
consider whether proposals: would enhance
coordination among the variety of health system
partners in the area; would include one or more
NDMS-participating hospitals; and are for areas
that, as determined by the Secretary in
consultation with the Secretary of DHS, face a
high degree of risk or have a significant need for
funds to achieve the required preparedness goals.
Authorizes $474 million for FY2007 and such
sums as may be necessary for FY2008 —
FY2011. The Secretary may reserve a portion of
this amount to make awards for “partnership”
entities as described in subsection (b)(1)(A), as
established in this act. Remaining amounts for
award to states and political subdivisions shall be

CRS-19
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
allocated according to the formula and other
requirements in Section 319C-1(h), as established
in this act. [Section 305]
Note: The funding formula and certain other
administrative and fiscal requirements are
established jointly for both the hospital
preparedness grants described here, and the public
health preparedness grants. These administrative
and fiscal requirements, in Sections 319C-1(g)
and (I), as established in this act, are described
below.
Grants for public
Note: Provisions described here apply to both the
Note: Provisions described here apply to both the
health and hospital
public health and hospital preparedness grants
public health preparedness grants established in
preparedness —
established in PHA Act Section 319C-1.
Section 319C-1 of this act, and the hospital
funding formula,
preparedness partnership grants established in
risk-based funding,
PHS Act Section 319C-1(j) requires the Secretary,
Section 319C-2 of this act.
and pass-through
for FY2003, to award block grants to states and
requirement
territories for public health and hospital
Amends PHS Act Section 319C-1, redesignating
preparedness, with each state/territory guaranteed
subsection (j) as subsection (h), and requiring that
a minimum level of funding, plus an additional
the Secretary maintain the funding formula, as it
amount based on population. Establishes different
applies in current law to FY2003, through
minimum amounts for states and for territories,
FY2011.
based upon the available appropriation. The
District of Columbia and the Commonwealth of
Authorizes the Secretary, for FY2007, to make
Puerto Rico are considered states for the purposes
awards for certain political subdivisions, as such
of this section.
authority applies in current law to FY2003.
Authorizes the Secretary, for FY2003, to make
Authorizes the Secretary, for FY2007, to make
awards for certain political subdivisions, as
awards for additional unmet need, as such
follows: the Secretary may reserve a portion of
authority applies in current law to FY2003.
appropriations to make awards to not more than 3
political subdivisions that have a substantial

CRS-20
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
number of residents, have a substantial local
Requires the Secretary to ensure that awardees
infrastructure for responding to public health
make available appropriate portions of awards to
emergencies, and face a high degree of risk from
political subdivisions and local departments of
bioterrorist attacks or other public health
public health through a process involving the
emergencies.
consensus, approval or concurrence with such
local entities. [Section 201]
Authorizes the Secretary, for FY2003, to reserve
a portion of appropriations for awards to eligible
entities that have an additional unmet need to
build capacity to identify, detect, monitor, and
respond to public health threats, and that face a
particularly high degree of risk of such threats.
The Secretary shall consider the District of
Columbia to have a significant unmet need, 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
District.
Requires the Secretary, for FY2003, to ensure that
appropriate portions of such awards are made
available to political subdivisions, local health
departments, hospitals (including children’s
hospitals), clinics, health centers, or primary care
facilities, or consortia of such entities. [42 U.S.C.
§ 247d-3a]

CRS-21
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Grants for public
Note: Provisions described here apply to both the
Note: Provisions described here apply to both the
S. 2792 amends PHS Act Section 319C-1
health and hospital
public health and hospital preparedness grants
public health preparedness grants established in
(applying to both public health and hospital
preparedness —
established in PHA Act Section 319C-1.
Section 319C-1 of this act, and the hospital
preparedness grants) to require the Secretary to
performance
preparedness partnership grants established in
develop and apply measurable critical
measurement and
Section 319A of the PHS Act requires the
Section 319C-2 of this act.
benchmarks and performance standards to the
withholding of
Secretary to establish, by June 2003, and revise
grant programs, including requirements for annual
funds
every five years, capacities for national, state and
Establishes a new PHS Act Section 319C-1(g)
drills and submission of annual expenditure
local public health systems to combat public
requiring the Secretary, within 180 days of
reports. Requires the Secretary to give preference
health threats. Section 319B requires the
enactment, to: (1) develop and apply measurable
in making awards to entities that demonstrate in
Secretary to award grants to states to conduct
evidence-based benchmarks and objective
their applications approaches that would enhance
assessments of their status with respect to these
standards to measure grantees’ preparedness; and,
coordination among the variety of healthcare
capacities. [42 U.S.C. §§ 247d-1, d-2]
(2) develop criteria for state pandemic influenza
facilities in the area. [Section 2]
plans. The Secretary shall provide appropriate
technical assistance to grantees, and develop and
implement a process to notify grantees of their
failure to meet requirements established in (1) and
(2). Establishes formulas by which the Secretary
shall withhold portions of awards from grantees
that fail to meet requirements. Requires the
Secretary to reallocate any such amounts to
hospital and health system “partnership” entities
described in Section 319C-2(b)(1) (as established
in this act), giving preference to entities in states
from which amounts are withheld. Amounts
withheld are increased for consecutive failures.
Authorizes the Secretary to waive or reduce
withholding for one or more grantees if there are
mitigating factors. [Section 201]

CRS-22
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Grants for public
No applicable provision.
Note: Provisions described here apply to both the
S. 1769 authorizes the Secretary to waive federal
health and hospital
public health preparedness grants established in
matching requirements under any provision of the
preparedness —
Section 319C-1 of this act, and the hospital
PHS Act, when the Secretary has declared a
matching
preparedness partnership grants established in
public health emergency pursuant to Section 319
requirement
Section 319C-2 of this act.
of the act and determines that an entity in an
affected area is unable to provide funds. The
Amends PHS Act Section 319C-1, adding a new
Secretary may grant such a waiver for the fiscal
requirement, beginning in FY2009, that awardees
years covered by such emergency declaration.
make available non-federal funds to support the
[Section 101]
cooperative agreements, in the amount of 5% of
the total amount for the first fiscal year, and 10%
S. 2792 prohibits the Secretary from making a
of the total amount for the second and subsequent
grant to a state under Section 319C-1 unless the
fiscal years. Non-federal amounts may be
state agrees to make available, directly or through
provided directly or through public or private
public or private donations, non-federal
donations, and may be in cash or in kind. [Section
contributions toward such costs in an amount
201]
equal to: with respect to a state with a population
of more than 2 million, not less than $1 for each
$1 of federal funds; and, with respect to a state
with a population of 2 million or less, not less
than $1 for each $4 of federal funds provided in
the grant. [Section 2]
Grants for public
Note: Provisions described here apply to both the
Note: Provisions described here apply to both the
health and hospital
public health and hospital preparedness grants
public health preparedness grants established in
preparedness —
established in PHS Act Section 319C-1.
Section 319C-1 of this act, and the hospital
maintenance of
preparedness partnership grants established in
state funding
PHS Act Section 319C-1, subsection (j), requires
Section 319C-2 of this act.
that amounts appropriated to states for public
health and hospital preparedness be used to
For awards for public health and hospital
supplement and not supplant other state and local
preparedness made pursuant to PHS Act Sections
public funds provided for activities under this
319C-1 and 319C-2, as established in this act,
section. [42 U.S.C. § 247d-3a(j)]
grantees shall maintain expenditures for public

CRS-23
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
health or health care preparedness, respectively, at
a level not less than the average level of such
expenditures maintained by the grantee for the
preceding two-year period. Clarifies that awards
may be used to pay salary and related expenses of
public health and other professionals employed by
state, local, or tribal agencies, who are carrying
out activities supported by such awards,
regardless of whether the primary assignment of
such personnel is to carry out such activities.
[Sections 201 and 305]
Grants for public
No applicable provisions.
Note: Provisions described here apply to both the
health and hospital
public health preparedness grants established in
preparedness —
Section 319C-1 of this act, and the hospital
additional fiscal and
preparedness grants established in Section 319C-2
administrative
of this act.
provisions
Establishes a new PHS Act Section 319C-1(I),
requiring grantees to submit to the Secretary
annual reports describing funded activities,
performance with respect to program goals and
objectives, appropriate budget information, and
other requirements. Grantees shall, not less than
every two years, conduct an independent audit of
program expenditures. For activities not in
accordance with program requirements, and after
notice and opportunity for a hearing, grantees
shall repay to the United States such amounts as
determined by the Secretary; and the Secretary
may withhold payment of funds for such
activities. Requires the Secretary, in consultation

CRS-24
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
with states and political subdivisions, to
determine maximum annual percentages of
awards that may be carried over into the next
fiscal year. Amounts exceeding this percentage
shall be returned to the Secretary for reallocation
to hospital and health system “partnership”
entities described in Section 319C-2(b)(1) (as
established in this act), giving preference to
entities in states from which amounts are
withheld. Provides for grantees to appeal such
withholdings, and for the Secretary to grant
waivers.
Other Public Health Capacities
Public health
PHS Act Section 319D(a) recognizes CDC’s
Amends PHS Act Section 319D(a) to recognize
S. 2792 would create a new Section 311A of the
surveillance and
essential role in defending against and combating
CDC’s role in defending against and combating
PHS Act authorizing the Secretary to develop a
information
bioterrorism and other public health emergencies.
public health threats both domestically and
national real-time surveillance program for
technology
Section 319D(b) provides for the establishment of
abroad. Creates a new PHS Act Section 319D(d)
notifiable diseases and conditions. Within 180
networks
public health alert communications and
to require that the Secretary: within two years of
days of enactment, the Secretary, in consultation
surveillance networks and requires the Secretary,
enactment, establish a nationwide interoperable
with state and local health authorities and others,
within one year and in cooperation with health
near real-time electronic public health “situational
shall certify a list of infectious diseases,
care providers and state and local public health
awareness” (surveillance) network; within 180
environmental exposures or poisons, and other
officials, to establish technical and reporting
days of enactment, submit to Congress a strategic
conditions for which real-time surveillance and
standards for such networks. Section 319D(c)
plan outlining steps to develop, implement, and
control constitute a critical public health need.
authorizes such sums as may be necessary for
evaluate the network; and develop program
Requires the CDC Director to establish and
FY2002 — FY2006 to national communications
elements and required activities. Creates a new
maintain a national electronic surveillance
and surveillance networks. [42 U.S.C. § 247d-
Section 319D(e) authorizing the Secretary to
program in compliance with certain regulations
4(b)]
award grants to states to enhance surveillance
promulgated under the Health Insurance
capability, for activities consistent with
Portability and Accountability Act of 1996, and
interoperability and other technological standards,
certain other requirements. The CDC Director
and other requirements determined by the
shall analyze and report on information obtained

CRS-25
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Secretary. Requires, within four years of
through this program. The Secretary shall provide
enactment, that the Government Accountability
technical assistance (which may include financial
Office conduct an independent evaluation, and
assistance) to government and private program
submit to the Secretary and the Congress a report
participants. Requires healthcare providers
concerning the activities conducted under
receiving reimbursements through the Medicare
subsections (d) and (e). Creates a new Section
and Medicaid programs to register with the
319D(f) authorizing the Secretary to make awards
Secretary to receive health alerts in the case of a
to hospitals, clinical laboratories, universities,
public health emergency or other circumstance
poison control centers or professional
requiring active surveillance. Requires the
organizations in the field of poison control, and to
Secretary to make awards to states to conduct
other situational awareness network participants
notifiable disease surveillance, and to withhold,
to enhance medical detection and reporting
from states determined not to be reporting in a
capability. Authorizes $102 million for FY2007
timely manner, funding through the Preventive
for subsections (d), (e), and (f), of which $35
Health and Health Services Block Grant (Part A
million is to carry out subsection (f); and such
of Title XIX of the PHS Act). In addition,
sums as may be necessary to carry out subsections
healthcare providers or facilities shall not be
(d), (e), and (f) for FY2008 — FY2011. [Section
eligible to receive Medicare or Medicaid
202]
reimbursement if the Secretary determines, based
on a state notification, that such provider or
facility has consistently failed to report to the
state, in a timely manner, instances of notifiable
diseases. Authorizes such sums as may be
necessary to carry out this section. [Section 3]
Strategic National
PHS Act Section 319F-2 provides statutory
No applicable provision.
Stockpile
authority for a Strategic National Stockpile (SNS)
of drugs, vaccines, medical devices, and other
supplies to meet the nation’s health security needs
in the event of a bioterrorist attack or other public
health emergency. Requires the Secretary to
manage the SNS, in coordination with the
Secretaries of DHS and VA, and ensure its

CRS-26
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
physical security. Protects information on
stockpile locations from disclosure under the
Freedom of Information Act.
Both the Secretary of HHS [42 U.S.C. §
247d-6b(a)(2)(G)] and the Secretary of DHS [6
U.S.C. § 312] have authority to deploy the SNS.
Authorizes $640 million for FY2002 and such
sums as may be necessary for FY2003 —
FY2006, in addition to amounts in a special
reserve fund, and authorizes, for smallpox vaccine
development, $509 million for FY2002 and such
sums as may be necessary for FY2003 —
FY2006. [42 U.S.C. § 247d-6b]
Programs to
Section 319H of the PHS Act authorizes a grant
Amends Section 338L of the PHS Act to require
S. 506 and S. 3042 amend Title VII, Part E of the
address national
program to provide financial assistance for the
the Secretary, depending upon an appropriation,
PHS Act, requiring the Secretary to establish a
shortages of health
education and training of individuals in any
to establish a demonstration project for the
Public Health Workforce Scholarship Program to
professionals
category of the health professions where there is
participation of individuals who are eligible for
assure an adequate supply of public health
a shortage that the Secretary determines should be
the NHSC loan repayment program described in
professionals, and to eliminate public health
alleviated to improve public health emergency
PHS Act Section 338B et seq. [42 U.S.C. § 254l-1
preparedness workforce shortages in federal,
readiness. Authorizes such sums as may be
et seq.] and who agree to serve in a state health
state, local, and tribal public health agencies, by
necessary for FY2002 — FY2006. [42 U.S.C. §
department that serves a significant number of
offering four-year scholarships in return for
247d-7a]
health professional shortage areas or areas at risk
employment at such agencies. Authorizes $35
of a public health emergency, as determined by
million for FY2006 and such sums as may be
Section 338L of the PHS Act authorizes
the Secretary, or in a local health department that
necessary for FY2007 — FY2011. Requires the
demonstration projects for loan repayment
serves a health professional shortage area or an
Secretary to establish a Public Health Workforce
programs for chiropractic doctors and
area at risk of a public health emergency. Eligible
Loan Repayment Program to provide for the
pharmacists, subject to the eligibility criteria,
individuals must have a degree, or be enrolled in
repayment of loans incurred by persons in pursuit
service obligations and breach of contract
an approved course of study, in medicine,
of relevant public health preparedness workforce
provisions of the National Health Service Corps
osteopathic medicine, dentistry, an appropriate
educational degrees or certificates, in exchange
(NHSC) program. [42 U.S.C. § 254t]
program of behavioral and mental health, or
for work at such agencies for at least three years.
another health profession, or be certified as a

CRS-27
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
nurse midwife, nurse practitioner, or physician
Requires the Secretary to award grants to public
assistant. Health professionals receiving such
health agencies that receive public health
assistance shall comply with the service
preparedness cooperative agreements from HHS
obligations, breach of contract, and other relevant
to operate state, local, and tribal public health
provisions of the NHSC program, and shall agree
workforce loan repayment programs.
to serve for a period of not less than two years.
Individuals placed pursuant to this demonstration
Authorizes, for the loan repayment and state
project shall not be considered by the Secretary in
grants programs, $195 million for FY2006, and
making shortage designations during FY2007 —
such sums as may be necessary for FY2007 —
FY2010. The Secretary shall report to Congress
FY2011.
not later than three years after enactment
regarding participation in the project and the
Requires the Director of the Office of Personnel
impact of such participation on state, local and
Management (OPM), in cooperation with the
tribal health departments. Authorizes such sums
Secretary, to ensure that there is an online
as may be necessary for FY2007 — FY2010.
catalogue, within the OPM website, of public
health workforce employment opportunities
Authorizes the Secretary to make awards to states
within the federal government. [S. 506, Section
to assist them in operating loan repayment
3, and S. 3042, Section 201]
programs for individuals who agree to serve in
state, local, or tribal health departments that serve
health professional shortage areas or other areas
at risk of a public health emergency, as designated
by the Secretary. Establishes loan eligibility
criteria. Authorizes such sums as may be
necessary for FY2007 — 2010. [Section 203]

CRS-28
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Vaccine tracking
No applicable provision.
Repeals existing Section 319A of the PHS Act
S. 1828 amends Section 319B of the PHS Act to
and distribution
and creates a new Section 319A, which authorizes
require that the Director of the CDC establish an
the Secretary of HHS, with the voluntary
electronic tracking system for influenza vaccine.
cooperation of manufacturers, wholesalers, and
Such system shall collect estimates of the size of
distributors, to track the initial distribution of
high-priority populations in each county in the
federally purchased influenza vaccine during an
United States. The Secretary of HHS shall
influenza pandemic. Requires the Secretary to
develop guidelines for the creation of an
promote communication between state, local, and
appropriate database and protections for the
tribal public health officials and such
confidentiality of information collected. [Section
manufacturers, wholesalers, and distributors as
401]
agree to participate in the tracking program,
regarding the effective distribution of seasonal
influenza vaccine.
Vaccine distribution information submitted to the
Secretary or his contractors, if any, under this act,
shall remain confidential in accordance with the
exception to the Freedom of Information Act
(FOIA) governing trade secrets and commercial
or financial information obtained from a person
and privileged or confidential [5 U.S.C. §
552(b)(4)]. Any public disclosure by the agency
of vaccine distribution information is subject to
the criminal penalties for theft of trade secrets
under 18 U.S.C. § 1832 and the exception to the
prohibition on economic espionage and theft of
trade secrets under 18 U.S.C. § 1833 (any
otherwise lawful activity conducted by a federal
or state governmental entity, or the reporting of a
suspected violation of law to any federal or state
governmental entity).b Information submitted
shall also be subject to privacy protections
consistent with the regulations promulgated under
Section 264(c) of the Health Insurance Portability
and Accountability Act of 1996 (P.L. 104-191).

CRS-29
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Requires the Secretary to develop guidelines to
ensure the confidentiality of information obtained
for tracking purposes.
Requires the Secretary to provide updates on
implementation of this section in its quadrennial
reports to the Congress, according to provisions
for the National Health Security Strategy
established in Section 103 of this act. Authorizes
such sums as may be necessary for FY2007 —
FY2011. [Section 204]
National Science
No applicable provision. (The National Science
The National Science Advisory Board for
Advisory Board for
Advisory Board for Biosecurity, which does not
Biosecurity shall, when requested by the
Biosecurity
have an explicit authority in statute, is
Secretary of HHS, provide to relevant federal
administered by the Office of Biotechnology
departments and agencies, advice, guidance, or
Activities in the National Institutes of Health.
recommendations concerning: a core curriculum
The Board advises all federal departments and
and training requirements for workers in
agencies on ways to minimize the possibility that
maximum containment biological laboratories;
knowledge and technologies stemming from
and, periodic evaluations of maximum
vitally important biological research will be
containment biological laboratory capacity
misused to threaten public health or national
nationwide and assessments of the future need for
security. See [http://www.biosecurityboard.gov/]
increased laboratory capacity. [Section 205]
for more information.)

CRS-30
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Medical Surge Capacity
National Disaster
Section 2811(b) of the PHS Act authorizes
Transfers the functions, personnel, assets, and
P.L. 109-295, the Department of Homeland
Medical System
NDMS, to be coordinated by HHS, DOD, VA and
liabilities of NDMS to HHS, under the
Security Appropriations Act, 2007, signed Oct. 4,
(NDMS)
the Federal Emergency Management Agency
responsibility of the ASPR, effective Jan. 1, 2007.
2006, transferred NDMS from DHS to HHS,
(FEMA) in collaboration with states and other
Requires the Secretary of HHS, within 180 days
effective Jan. 1, 2007, but did not reauthorize the
appropriate public or private entities. Requires
of enactment, to conduct a joint review of NDMS,
program.
the Secretary of HHS within one year, and
in coordination with DHS, VA, and DOD, and
periodically thereafter, to conduct exercises to test
submit a report to Congress describing the roles,
H.R. 5438 (reported by the House Cmte. on
the capability and timeliness of the NDMS to
missions, appropriate size and structure of NDMS
Energy and Commerce, referred to the House
mobilize and respond effectively to a bioterrorist
in the future. Authorizes such sums as may be
Cmte. on Homeland Security) amends Section
attack or other public health emergency.
necessary for FY2007 — FY2011. [Section 301]
2811 of the PHS Act to transfer the functions,
Appoints activated NDMS volunteers as
personnel, assets, and liabilities of NDMS to
temporary federal employees. Establishes liability
(Note: the transfer provision has been superseded
HHS, not later than nine months after enactment.
protections, compensation for work injuries, and
by P.L. 109-295.)
[Section 2]
employment and reemployment rights for NDMS
volunteers. Authorizes such sums as may be
H.R. 5351 creates a new Directorate of
necessary for FY2002 — FY2006 for NDMS
Emergency Management in DHS and requires the
operations and for the HHS ASPHEP. [42 U.S.C.
DHS Under Secretary for Emergency
§ 300hh-11]
Management to have the primary federal
responsibility for preparing for, mitigating
The Homeland Security Act (P.L. 107-296),
against, responding to, and recovering from acts
transferred the functions, personnel, assets, and
of terrorism, natural disasters, and other
liabilities of NDMS to the Secretary of Homeland
emergencies. Such responsibilities shall include
Security effective in March 2003, without other
performing the functions of and coordinating
amendments to program authority. [6 U.S.C. §
NDMS. Requires a report to Congress on various
313]
aspects of NDMS, including whether it should
remain in DHS. Authorizes $85 million for each
Requires the VA Secretary, in consultation with
of the fiscal years 2007 through 2010. [Sections
the Secretaries of HHS and DOD and the FEMA
101, 103]
Director, to establish a training program to
facilitate the participation of VA medical center
S. 3721 (reported in the Senate) retains FEMA in
staff in NDMS. [38 U.S.C. § 8117]
DHS and requires the FEMA Administrator to
direct NDMS with respect to the federal response
to natural and man-made disasters. [Section 513]

CRS-31
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Establishes within FEMA a Chief Medical
Officer, who shall establish doctrine and priorities
for NDMS (consistent with the NRP), supervise
its medical components, and exercise pre-
deployment operational control. [Section 521]
Requires the Secretary of DHS, with respect to
NDMS, to plan for the provision of resources to
equip, staff, train NDMS teams; transportation,
logistics, and communications capabilities;
training and outreach programs; and patient triage
and tracking capabilities. [Section 404]
S. 2792 extends authority for NDMS under the
Secretary of DHS. Requires federal agency
partners to conduct a joint review of NDMS
operations, and requires the Secretary of DHS to
implement resulting recommendations and
monitor ongoing system performance. Authorizes
such sums as may be necessary for FY2006 —
FY2010. [Section 7]
Education and
PHS Act Section 319F(g) requires the Secretary,
Repeals the existing PHS Act Section 319F(g)
training of health
in collaboration with the interagency working
and creates new Sections 319F(a)-(e), requiring
care personnel
group and professional organizations, to award
the Secretary, in collaboration with DOD, to
grants: (I) to develop education materials to teach
develop core health and medical response
health officials and other emergency personnel to
curricula and trainings, by adapting applicable
identify potential bioweapons and other
existing programs, to improve responses to public
dangerous agents and to care for victims of public
health emergencies, and authorizes $12 million
health emergencies, recognizing the special needs
for FY2007 and such sums as may be necessary
of children and other vulnerable populations; (ii)
for FY2008 and each subsequent fiscal year.
to develop education materials for community-
Authorizes the Secretary to expand the Epidemic
wide planning to respond to bioterrorism or other
Intelligence Service by placing officers in health
public health emergencies; (iii) to develop
shortage areas, and authorizes $3 million for
materials for proficiency testing of lab and other
FY2007 and such sums as may be necessary for
public health personnel for the recognition and
FY2008 and each subsequent fiscal year.

CRS-32
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
identification of potential bioweapons and other
Authorizes the Secretary to establish Centers for
dangerous agents; and (iv) to provide for the
Public Health Preparedness at accredited schools
dissemination and teaching of these materials.
of public health, and authorizes $31 million for
Authorizes the Secretary, in consultation with the
FY2007 and such sums as may be necessary for
Attorney General and the FEMA Director, to
FY2008 and each subsequent fiscal year.
provide technical assistance for emergency
[Section 304]
response personnel training carried out by the
Justice Department and FEMA. [42 U.S.C. §
247d-6(g)]
Federal activities to
No applicable provision.
Creates a new Section 2804 of the PHS Act,
enhance medical
requiring the Secretary to conduct an analysis of:
surge capacity
(1) the benefits and feasibility of improving the
capacity of HHS to provide additional medical
surge capacity to local communities in the event
of a public health emergency, through the
acquisition and operation of mobile medical
assets, and other strategies; and (2) whether there
are federal facilities which, in the event of a
public health emergency, could be used as
healthcare facilities. Authorizes the Secretary to
acquire mobile medical assets. Requires the
Secretary to develop appropriate memoranda of
understanding with respect to any federal facilities
identified by the Secretary’s analysis. [Section
302]
Health professional
Section 319I to the PHS Act requires the
Amends PHS Act Section 319I to require the
S. 1769 requires the Secretary to implement a
volunteers
Secretary to establish an electronic database for
HHS Secretary to link existing state verification
program to disseminate publicly information on
the advance registration of health professionals to
systems to maintain a single national
health professional liability coverage and
verify their credentials, licenses, accreditations,
interoperable network of systems, each system
licensure requirements for intermittent disaster
and hospital privileges when they volunteer to
being maintained by a state or group of states, for
response personnel, as described in Section
respond during public health emergencies.
the purpose of verifying the credentials and
2811(d)(1) of the PHS Act, in areas in which a
Authorizes the Secretary to encourage states to
licenses of health care professionals who
public health emergency has been declared under
permit out-of-state health professionals to provide
volunteer to provide health services during a
section 319, providing information sufficient to
health services during public health emergencies.
public health emergency. The Secretary shall:
enable health professionals to make an informed

CRS-33
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Authorizes $2 million for FY2002, and such sums
establish system requirements; incorporate the
decision about providing volunteer health
as may be necessary for FY2003 — FY2006. [42
memberships of NDMS and MRC; assure state
services. [Section 205]
U.S.C. § 247d-7b]
access to and confidentiality of data; assess the
feasibility of integrating with comparable systems
in the VA and DHS; and encourage states to
establish and implement mechanisms to waive the
application of licensing requirements for
volunteer health professionals. Clarifies that
inclusion of an individual in the database does not
constitute an appointment as a federal employee.
Authorizes such sums as may be necessary
through FY2011.
Creates a new Section 2813 of the PHS Act
requiring the HHS Secretary, within 180 days and
in consultation with state, local, and tribal
officials, to establish and maintain a Medical
Reserve Corps (MRC) of health professions
volunteers, and to develop an identification card
for each member of the MRC that describes
relevant licensure and certification information.
Requires the Secretary to appoint a Director who
shall develop drills and certification requirements,
not to supersede state requirements. Authorizes
the Secretary to appoint selected individuals to
serve as intermittent personnel of the MRC in
accordance with applicable civil service laws and
regulations, and to deploy willing members of the
MRC with the concurrence of the state, local, or
tribal officials from the area where the members
reside and cover appropriate expenses that result
pursuant to an assignment by the Secretary.
Authorizes $22 million for FY2007 and such
sums as may be necessary for FY2008 —
FY2011. [Section 303]

CRS-34
Current Law
S. 3678 (as reported)
Selected Provisions in Related Bills
Department of
Directs the VA Secretary to enhance the readiness
Amends [38 U.S.C. § 8117] to change references
Veterans Affairs
of VA medical centers and research facilities to
to VA readiness for chemical and biological
protect staff and respond to a chemical or
attack to readiness for a public health emergency.
biological attack, based on the results of an
Requires the VA Secretary to enhance the
evaluation of the security needs at these facilities.
readiness of VA medical centers and research
Requires the VA Secretary to develop a
facilities by: organizing, equipping and training
centralized tracking system for pharmaceuticals
staff for the appropriate support of the HHS
and medical supplies and equipment throughout
Secretary in the event of public health
the VA health care system, and train VA health
emergencies and incidents covered by the NRP;
care personnel in emergency medical response.
and, providing medical logistical support to
Requires the VA Secretary, in collaboration with
NDMS and the Secretary of HHS, as necessary,
the Secretaries of Defense and HHS, and the
on a reimbursable basis and in coordination with
Director of FEMA, to establish a training program
other designated federal agencies. Requires the
to facilitate VA participation in NDMS. Requires
VA Secretary, through existing procurement
the VA Secretary, in consultation with the HHS
contracts and on a reimbursable basis, to make
Secretary, the American Red Cross, and the
available, as needed, medical supplies, equipment,
interagency working group, to provide mental
and pharmaceuticals in response to a public health
health counseling to individuals seeking care at a
emergency in support of the Secretary of HHS.
VA medical center following a bioterrorist attack
Authorizes such sums as may be necessary for
or other public health emergency. Authorizes
FY2007 — FY2011. [Section 306]
$133 million for FY2002, and such sums as may
be necessary for FY2003 — FY2006. [38 U.S.C.
§ 8117]
Note: Unless otherwise stated, “the Secretary” refers to the Secretary of HHS, and sections in law refer to sections in the Public Health Service Act.
a. Information provided by Kathleen S. Swendiman, Legislative Attorney, American Law Division of CRS.
b. Information provided by Brian T. Yeh, Legislative Attorney, American Law Division of CRS.