INSIGHTi U S National Health Security Homeland Security Issues in the 116th Congress February 11 2019 In its quadrennial National Health Security Strategy the U S Department of Health and Human Services HHS states U S National Health Security actions protect the nation’s physical and psychological health limit economic losses and preserve confidence in government and the national will to pursue its interests when threatened by incidents that result in serious health consequences whether natural accidental or deliberate The strategy aims to ensure the resilience of the nation’s public health and health care systems against potential threats including natural disasters and human-caused incidents emerging and pandemic infectious diseases acts of terrorism and potentially catastrophic risks posed by nation-state actors By law the HHS Secretary “shall lead all Federal public health and medical response to public health emergencies and incidents covered by the National Response Framework ” and the HHS Assistant Secretary for Preparedness and Response ASPR shall “ s erve as the principal advisor to the Secretary on all matters related to Federal public health and medical preparedness and response for public health emergencies ” However under the nation’s federal system of government state and local agencies and private entities are principally responsible for ensuring health security and responding to threats The federal government’s ability to affect national health security through funding assistance and other policies is relatively limited Congressional Research Service https crsreports congress gov IN11038 CRS INSIGHT Prepared for Members and Committees of Congress Congressional Research Service 2 Figure 1 HHS Secretary’s Operations Center SOC Activated for the Wannacry Ransomware Attack May 2017 Source Office of the HHS Assistant Secretary for Preparedness and Response February 6 2019 Notes The health care sector was a significant target of the cyberattack The image shows a staff briefing on cyber threat information sharing and other efforts to protect health care infrastructure The nation’s public health emergency management laws have expanded considerably following the terrorist attacks in 2001 Since then a number of public health emergencies revealed both improvements in the nation’s readiness and persistent gaps The National Health Security Preparedness Index NHSPI or the Index a public-private partnership begun in 2013 currently assesses preparedness using 140 measures across all 50 states and the District of Columbia In its latest comprehensive report for 2017 NHSPI found overall incremental improvements over earlier years However the report highlighted differing preparedness levels among states stating Large differences in preparedness persisted across states and those in the Deep South and Mountain West regions lagged significantly behind the rest of the nation If current trends continue the average state will require 9 more years to reach health security levels currently found in the bestprepared states In addition measures of health care delivery—for example the number of certain types of health care providers including mental health providers per unit of population access to trauma centers the extent of preparedness planning in long-term care facilities and uptake of electronic health record systems— continued to yield the lowest scores The readiness of individual health care facilities and services to respond to a mass casualty incident or other public health emergency has been a persistent health security challenge Aiming to address this the HHS Centers for Medicare Medicaid Services CMS has implemented a rule that requires 17 different types of health care facilities and service providers to meet a suite of preparedness benchmarks in order to participate in i e receive payments from the Medicare and Medicaid programs The Emergency Preparedness EP Rule became effective in November 2017 Policymakers may be interested to see in NHSPI results and through other studies the extent to which the EP Rule yields meaningful improvements in national health system preparedness in the future Congressional Research Service 3 For incidents declared by the President as major disasters or emergencies under the Robert T Stafford Disaster Relief and Emergency Assistance Act P L 93-288 as amended public assistance is available to help federal state and local agencies with the costs of some public health emergency response activities such as ensuring food and water safety However no federal assistance program is designed specifically to cover the uninsured costs of individual health care services that may be needed as a consequence of a disaster There is no consensus that this should be a federal responsibility Nonetheless during mass casualty incidents hospitals and health care providers may face expectations to deliver care without a clear payment source of reimbursement Also the response to an incident could necessitate activities that begin before Stafford Act reimbursement to HHS has been approved or that are not eligible for reimbursement under the act For example there is no precedent for a major disaster declaration under the Stafford Act for an outbreak of infectious disease and only one declaration of emergency for West Nile virus in 2000 Although the HHS Secretary has authority for a no-year Public Health Emergency Fund PHEF Congress has not appropriated monies to it for many years and no funds are currently available On several occasions Congress has provided supplemental appropriations to address uncompensated disaster-related health care costs and otherwise unreimbursed state and local response costs flowing from a public health emergency These incidents include Hurricane Katrina and Hurricane Sandy the 2009 H1N1 influenza pandemic and the Ebola and Zika virus outbreaks Supplemental appropriations for hurricane relief were provided for costs such as uncompensated care that were not reimbursed under the Stafford Act The act was not invoked for the three infectious disease incidents and supplemental appropriations were therefore needed to fund most aspects of the federal response to those outbreaks Some policymakers concerned about the inherent uncertainty in supplemental appropriations have proposed dedicated funding approaches for public health emergency response Two proposals in the 115th Congress S 196 H R 3579 would have appropriated funds to the PHEF These measures did not advance In appropriations for FY2019 P L 115-245 Congress established and appropriated $50 million to remain available until expended to an Infectious Diseases Rapid Response Reserve Fund to be administered by the Director of the HHS Centers for Disease Control and Prevention CDC “to prevent prepare for or respond to an infectious disease emergency ” The 116th Congress may choose to examine any uses of this new fund by CDC and to consider appropriations to the PHEF as well as other options to improve national health security preparedness Author Information Sarah A Lister Specialist in Public Health and Epidemiology Congressional Research Service 4 Disclaimer This document was prepared by the Congressional Research Service CRS CRS serves as nonpartisan shared staff to congressional committees and Members of Congress It operates solely at the behest of and under the direction of Congress Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role CRS Reports as a work of the United States Government are not subject to copyright protection in the United States Any CRS Report may be reproduced and distributed in its entirety without permission from CRS However as a CRS Report may include copyrighted images or material from a third party you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material IN11038 · VERSION 3 · NEW