S.Amdt. 1336

SA 1336. Mr. MORAN submitted an amendment intended to be proposed to
amendment SA 891 proposed by Mr. Schumer (for himself, Mr. Wyden, Mrs.
Murray, Mr. Brown, Mr. Peters, Mr. Cardin, Ms. Cantwell, Ms. Stabenow,
Mr. Tester, Mr. Menendez, Mr. Schatz, Mr. Carper, Mr. Leahy, and Mr.
Sanders) to the bill H.R. 1319, to provide for reconciliation pursuant
to title II of S. Con. Res. 5; which was ordered to lie on the table;
as follows:

Strike section 2 and all that follows and insert the
following:

SEC. 2. TABLE OF CONTENTS.

The table of contents for this Act is as follows:

Sec. 2. Table of contents.

TITLE I--COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

Subtitle A--Public Health

Sec. 101. Funding for COVID-19 vaccine activities at the Centers for
Disease Control and Prevention.
Sec. 102. Funding for vaccine confidence activities.
Sec. 103. Funding for supply chain for COVID-19 vaccines, therapeutics,
and medical supplies.
Sec. 104. Funding for COVID-19 vaccine, therapeutic, and device
activities at the Food and Drug Administration.
Sec. 105. Reduced cost-sharing.

Subtitle B--Testing

Sec. 111. Funding for COVID-19 testing, contact tracing, and mitigation
activities.
Sec. 112. Funding for SARS-CoV-2 genomic sequencing and surveillance.
Sec. 113. Funding for global health.
Sec. 114. Funding for data modernization and forecasting center.

TITLE II--COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS

Sec. 201. COVID-19 emergency medical supplies enhancement.

TITLE III--COMMITTEE ON FINANCE

Sec. 301. Funding for providers relating to COVID-19.

TITLE I--COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

Subtitle A--Public Health

SEC. 101. FUNDING FOR COVID-19 VACCINE ACTIVITIES AT THE
CENTERS FOR DISEASE CONTROL AND PREVENTION.

(a) In General.--In addition to amounts otherwise
available, there is appropriated to the Secretary of Health
and Human Services (in this subtitle referred to as the
``Secretary'') for fiscal year 2021, out of any money in the
Treasury not otherwise appropriated, $7,500,000,000, to
remain available until expended, to carry out activities to
plan, prepare for, promote, distribute, administer, monitor,
and track COVID-19 vaccines.
(b) Use of Funds.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
and in consultation with other agencies, as applicable,
shall, in conducting activities referred to in subsection
(a)--
(1) conduct activities to enhance, expand, and improve
nationwide COVID-19 vaccine distribution and administration,
including activities related to distribution of ancillary
medical products and supplies related to vaccines; and
(2) provide technical assistance, guidance, and support to,
and award grants or cooperative agreements to, State, local,
Tribal, and territorial public health departments for
enhancement of COVID-19 vaccine distribution and
administration capabilities, including--
(A) the distribution and administration of vaccines
licensed under section 351 of the Public Health Service Act
(42 U.S.C. 262) or authorized under section 564 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3) and
ancillary medical products and supplies related to vaccines;
(B) the establishment and expansion, including staffing
support, of community vaccination centers, particularly in
underserved areas;
(C) the deployment of mobile vaccination units,
particularly in underserved areas;
(D) information technology, standards-based data, and
reporting enhancements, including improvements necessary to
support standards-based sharing of data related to vaccine
distribution and vaccinations and systems that enhance
vaccine safety, effectiveness, and uptake, particularly among
underserved populations;
(E) facilities enhancements;
(F) communication with the public regarding when, where,
and how to receive COVID-19 vaccines; and
(G) transportation of individuals to facilitate
vaccinations, including at community vaccination centers and
mobile vaccination units, particularly for underserved
populations.
(c) Supplemental Funding for State Vaccination Grants.--
(1) Definitions.--In this subsection:
(A) Base formula.--The term ``base formula'' means the
allocation formula that applied to the Public Health
Emergency Preparedness cooperative agreement in fiscal year
2020.
(B) Alternative allocation.--The term ``alternative
allocation'' means an allocation to each State, territory, or
locality calculated using the percentage derived from the
allocation received by such State, territory, or locality of
the aggregate amount of fiscal year 2020 Public Health
Emergency Preparedness cooperative agreement awards under
section 319C-1 of the Public Health Service Act (42 U.S.C.
247d-3a).
(2) Supplemental funding.--
(A) In general.--Not later than 21 days after the date of
enactment of this Act, the Secretary shall use amounts
described in subsection (a) to provide supplemental funding
to any State, locality, or territory that received less of
the amounts that were appropriated under title III of
division M of Public Law 116-260 for vaccination grants to be
issued by the Centers for Disease Control and Prevention than
such State, locality, or territory would have received had
such amounts been allocated using the alternative allocation.
(B) Amount.--The amount of supplemental funding provided
under this subsection shall be equal to the difference
between--
(i) the amount the State, locality, or territory received,
or would receive, under the base formula; and
(ii) the amount the State, locality, or territory would
receive under the alternative allocation.

SEC. 102. FUNDING FOR VACCINE CONFIDENCE ACTIVITIES.

In addition to amounts otherwise available, there is
appropriated to the Secretary for fiscal year 2021, out of
any money in the Treasury not otherwise appropriated,
$1,000,000,000, to remain available until expended, to carry
out activities, acting through the Director of the Centers
for Disease Control and Prevention--
(1) to strengthen vaccine confidence in the United States,
including its territories and possessions;
(2) to provide further information and education with
respect to vaccines licensed under section 351 of the Public
Health Service Act (42 U.S.C. 262) or authorized under
section 564 of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 360bbb-3); and
(3) to improve rates of vaccination throughout the United
States, including its territories and possessions, including
through activities described in section 313 of the Public
Health Service Act, as amended by section 311 of division BB
of the Consolidated Appropriations Act, 2021 (Public Law 116-
260).

SEC. 103. FUNDING FOR SUPPLY CHAIN FOR COVID-19 VACCINES,
THERAPEUTICS, AND MEDICAL SUPPLIES.

In addition to amounts otherwise available, there is
appropriated to the Secretary for fiscal year 2021, out of
any money in the Treasury not otherwise appropriated,
$6,050,000,000, to remain available until expended, for
necessary expenses with respect to research, development,
manufacturing, production, and the purchase of vaccines,
therapeutics, and ancillary medical products and supplies to
prevent, prepare, or respond to--
(1) SARS-CoV-2 or any viral variant mutating therefrom with
pandemic potential; and
(2) COVID-19 or any disease with potential for creating a
pandemic.

SEC. 104. FUNDING FOR COVID-19 VACCINE, THERAPEUTIC, AND
DEVICE ACTIVITIES AT THE FOOD AND DRUG
ADMINISTRATION.

In addition to amounts otherwise available, there is
appropriated to the Secretary for fiscal year 2021, out of
any money in the Treasury not otherwise appropriated,
$500,000,000, to remain available until expended, to be used
for the evaluation of the continued performance, safety, and
effectiveness, including with respect to emerging COVID-19
variants, of vaccines, therapeutics, and diagnostics
approved, cleared, licensed, or authorized for use for the
treatment, prevention, or diagnosis of COVID-19; facilitation
of advanced continuous manufacturing activities related to
production of vaccines and related materials; facilitation
and conduct of inspections related to the manufacturing of
vaccines, therapeutics, and devices delayed or cancelled for
reasons related to COVID-19; review of devices authorized for
use for the treatment, prevention, or diagnosis of COVID-19;
and oversight of the supply chain and mitigation of shortages
of vaccines, therapeutics, and devices approved, cleared,
licensed, or authorized for use for the treatment,
prevention, or diagnosis of COVID-19 by the Food and Drug
Administration.

SEC. 105. REDUCED COST-SHARING.

(a) In General.--Section 1402 of the Patient Protection and
Affordable Care Act is amended by redesignating subsection
(f) as subsection (g) and by inserting after subsection (e)
the following new subsection:
``(f) Special Rule for Individuals Who Receive Unemployment
Compensation During 2021.--For purposes of this section, in
the case of an individual who has received, or has been
approved to receive, unemployment

[[Page S1371]]

compensation for any week beginning during 2021, for the plan
year in which such week begins--
``(1) such individual shall be treated as meeting the
requirements of subsection (b)(2), and
``(2) for purposes of subsections (c) and (d), there shall
not be taken into account any household income of the
individual in excess of 133 percent of the poverty line for a
family of the size involved.''.
(b) Effective Date.--The amendment made by this section
shall apply to plan years beginning after December 31, 2020.

Subtitle B--Testing

SEC. 111. FUNDING FOR COVID-19 TESTING, CONTACT TRACING, AND
MITIGATION ACTIVITIES.

(a) In General.--In addition to amounts otherwise
available, there is appropriated to the Secretary of Health
and Human Services (in this subtitle referred to as the
``Secretary'') for fiscal year 2021, out of any money in the
Treasury not otherwise appropriated, $47,800,000,000, to
remain available until expended, to carry out activities to
detect, diagnose, trace, and monitor SARS-CoV-2 and COVID-19
infections and related strategies to mitigate the spread of
COVID-19.
(b) Use of Funds.--From amounts appropriated by subsection
(a), the Secretary shall--
(1) implement a national, evidence-based strategy for
testing, contact tracing, surveillance, and mitigation with
respect to SARS-CoV-2 and COVID-19, including through
activities authorized under section 319(a) of the Public
Health Service Act;
(2) provide technical assistance, guidance, and support,
and award grants or cooperative agreements to State, local,
and territorial public health departments for activities to
detect, diagnose, trace, and monitor SARS-CoV-2 and COVID-19
infections and related strategies and activities to mitigate
the spread of COVID-19;
(3) support the development, manufacturing, procurement,
distribution, and administration of tests to detect or
diagnose SARS-CoV-2 and COVID-19, including through--
(A) support for the development, manufacture, procurement,
and distribution of supplies necessary for administering
tests, such as personal protective equipment; and
(B) support for the acquisition, construction, alteration,
or renovation of non-federally owned facilities for the
production of diagnostics and ancillary medical products and
supplies where the Secretary determines that such an
investment is necessary to ensure the production of
sufficient amounts of such supplies;
(4) establish and expand Federal, State, local, and
territorial testing and contact tracing capabilities,
including--
(A) through investments in laboratory capacity, such as--
(i) academic and research laboratories, or other
laboratories that could be used for processing of COVID-19
testing;
(ii) community-based testing sites and community-based
organizations; or
(iii) mobile health units, particularly in medically
underserved areas; and
(B) with respect to quarantine and isolation of contacts;
(5) enhance information technology, data modernization, and
reporting, including improvements necessary to support
sharing of data related to public health capabilities;
(6) award grants to, or enter into cooperative agreements
or contracts with, State, local, and territorial public
health departments to establish, expand, and sustain a public
health workforce; and
(7) to cover administrative and program support costs
necessary to conduct activities related to subparagraph (a).

SEC. 112. FUNDING FOR SARS-COV-2 GENOMIC SEQUENCING AND
SURVEILLANCE.

(a) In General.--In addition to amounts otherwise
available, there is appropriated to the Secretary for fiscal
year 2021 out of any money in the Treasury not otherwise
appropriated, $1,750,000,000, to remain available until
expended, to strengthen and expand activities and workforce
related to genomic sequencing, analytics, and disease
surveillance.
(b) Use of Funds.--From amounts appropriated by subsection
(a), the Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall--
(1) conduct, expand, and improve activities to sequence
genomes, identify mutations, and survey the circulation and
transmission of viruses and other organisms, including
strains of SARS-CoV-2;
(2) award grants or cooperative agreements to State, local,
Tribal, or territorial public health departments or public
health laboratories--
(A) to increase their capacity to sequence genomes of
circulating strains of viruses and other organisms, including
SARS-CoV-2;
(B) to identify mutations in viruses and other organisms,
including SARS-CoV-2;
(C) to use genomic sequencing to identify outbreaks and
clusters of diseases or infections, including COVID-19; and
(D) to develop effective disease response strategies based
on genomic sequencing and surveillance data;
(3) enhance and expand the informatics capabilities of the
public health workforce; and
(4) award grants for the construction, alteration, or
renovation of facilities to improve genomic sequencing and
surveillance capabilities at the State and local level.

SEC. 113. FUNDING FOR GLOBAL HEALTH.

In addition to amounts otherwise available, there is
appropriated to the Secretary for fiscal year 2021, out of
any amounts in the Treasury not otherwise appropriated,
$750,000,000, to remain available until expended, for
activities to be conducted acting through the Director of the
Centers for Disease Control and Prevention to combat SARS-
CoV- 2, COVID-19, and other emerging infectious disease
threats globally, including efforts related to global health
security, global disease detection and response, global
health protection, global immunization, and global
coordination on public health.

SEC. 114. FUNDING FOR DATA MODERNIZATION AND FORECASTING
CENTER.

In addition to amounts otherwise available, there is
appropriated to the Secretary for fiscal year 2021, out of
any money in the Treasury not otherwise appropriated,
$500,000,000, to remain available until expended, for
activities to be conducted acting through the Director of the
Centers for Disease Control and Prevention to support public
health data surveillance and analytics infrastructure
modernization initiatives at the Centers for Disease Control
and Prevention, and establish, expand, and maintain efforts
to modernize the United States disease warning system to
forecast and track hotspots for COVID-19, its variants, and
emerging biological threats, including academic and workforce
support for analytics and informatics infrastructure and data
collection systems.

TITLE II--COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS

SEC. 201. COVID-19 EMERGENCY MEDICAL SUPPLIES ENHANCEMENT.

(a) Supporting Enhanced Use of the Defense Production Act
of 1950.--In addition to funds otherwise available, there is
appropriated, for fiscal year 2021, out of any money in the
Treasury not otherwise appropriated, $10,000,000,000,
notwithstanding section 304(e) of the Defense Production Act
of 1950 (50 U.S.C. 4534(e)), to remain available until
September 30, 2025, to carry out titles I, III, and VII of
such Act in accordance with subsection (b).
(b) Medical Supplies and Equipment.--
(1) Testing, ppe, vaccines, and other materials.--Except as
provided in paragraph (2), amounts appropriated in subsection
(a) shall be used for the purchase, production (including the
construction, repair, and retrofitting of government-owned or
private facilities as necessary), or distribution of medical
supplies and equipment (including durable medical equipment)
related to combating the COVID-19 pandemic, including--
(A) in vitro diagnostic products for the detection of SARS-
CoV-2 or the diagnosis of the virus that causes COVID-19, and
the reagents and other materials necessary for producing,
conducting, or administering such products, and the
machinery, equipment, laboratory capacity, or other
technology necessary to produce such products;
(B) face masks and personal protective equipment, including
face shields, nitrile gloves, N-95 filtering facepiece
respirators, and any other masks or equipment (including
durable medical equipment) needed to respond to the COVID-19
pandemic, and the materials, machinery, additional
manufacturing lines or facilities, or other technology
necessary to produce such equipment; and
(C) drugs, devices, and biological products that are
approved, cleared, licensed, or authorized for use in
treating or preventing COVID-19 and symptoms related to
COVID-19, and any materials, manufacturing machinery,
additional manufacturing or fill-finish lines or facilities,
technology, or equipment (including durable medical
equipment) necessary to produce or use such drugs, biological
products, or devices (including syringes, vials, or other
supplies or equipment related to delivery, distribution, or
administration).
(2) Responding to public health emergencies.--After
September 30, 2022, amounts appropriated in subsection (a)
may be used for any activity authorized by paragraph (1), or
any other activity necessary to meet critical public health
needs of the United States, with respect to any pathogen that
the President has determined has the potential for creating a
public health emergency.

TITLE III--COMMITTEE ON FINANCE

SEC. 301. FUNDING FOR PROVIDERS RELATING TO COVID-19.

Part A of title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by adding at the end the following:

``SEC. 1150C. FUNDING FOR PROVIDERS RELATING TO COVID-19.

``(a) Funding.--In addition to amounts otherwise available,
there is appropriated to the Secretary, for fiscal year 2021,
out of any monies in the Treasury not otherwise appropriated,
$8,500,000,000 for purposes of making payments to eligible
health care providers for health care related expenses and
lost revenues that are attributable to COVID-19. Amounts
appropriated under the preceding sentence shall remain
available until expended.
``(b) Special Rule Regarding Parent Organizations.--In the
case of any payment made under this section to an eligible
health care provider, but which is received by a parent
organization of such provider, such parent organization shall
allocate all of such payment to such provider.
``(c) Application Requirement.--To be eligible for a
payment under this section, an eligible health care provider
shall submit to

[[Page S1372]]

the Secretary an application in such form and manner as the
Secretary shall prescribe. Such application shall contain the
following:
``(1) A statement justifying the need of the provider for
the payment, including documentation of the health care
related expenses attributable to COVID-19 and lost revenues
attributable to COVID-19.
``(2) The tax identification number of the provider.
``(3) Such assurances as the Secretary determines
appropriate that the eligible health care provider will
maintain and make available such documentation and submit
such reports (at such time, in such form, and containing such
information as the Secretary shall prescribe) as the
Secretary determines is necessary to ensure compliance with
any conditions imposed by the Secretary under this section.
``(4) Any other information determined appropriate by the
Secretary.
``(d) Limitation.--Payments made to an eligible health care
provider under this section may not be used to reimburse any
expense or loss that--
``(1) has been reimbursed from another source; or
``(2) another source is obligated to reimburse.
``(e) Application of Requirements, Rules, and Procedures.--
The Secretary shall apply any requirements, rules, or
procedures as the Secretary deems appropriate for the
efficient execution of this section.
``(f) Definitions.--In this section:
``(1) Eligible health care provider.--The term `eligible
health care provider' means--
``(A) a provider of services (as defined in section
1861(u)) or a supplier (as defined in section 1861(d)) that--
``(i) is enrolled in the Medicare program under title XVIII
under section 1866(j), including temporarily enrolled during
the emergency period described in section 1135(g)(1)(B) for
such period;
``(ii) provides diagnoses, testing, or care for individuals
with possible or actual cases of COVID-19; and
``(iii) is located in a rural area or treated as located in
a rural area pursuant to section 1886(d)(8)(E); or
``(B) a provider or supplier that--
``(i) is enrolled with a State Medicaid plan under title
XIX (or a waiver of such plan) in accordance with subsections
(a)(77) and (kk) of section 1902 (including enrolled pursuant
to section 1902(a)(78) or section 1932(d)(6)) or enrolled
with a State child health plan under title XXI (or a waiver
of such plan) in accordance with subparagraph (G) of section
2107(e)(1) (including enrolled pursuant to subparagraph (D)
or (Q) of such section);
``(ii) provides diagnoses, testing, or care for individuals
with possible or actual cases of COVID-19; and
``(iii) is located in a rural area.
``(2) Health care related expenses attributable to covid-
19.--The term `health care related expenses attributable to
COVID-19' means health care related expenses to prevent,
prepare for, and respond to COVID-19, including the building
or construction of a temporary structure, the leasing of a
property, the purchase of medical supplies and equipment,
including personal protective equipment and testing supplies,
providing for increased workforce and training, including
maintaining staff, obtaining additional staff, or both, the
operation of an emergency operation center, retrofitting a
facility, providing for surge capacity, and other expenses
determined appropriate by the Secretary.
``(3) Lost revenue attributable to covid-19.--The term
`lost revenue attributable to COVID-19' has the meaning given
that term in the Frequently Asked Questions guidance released
by the Department of Health and Human Services in June 2020,
including the difference between such provider's budgeted and
actual revenue if such budget had been established and
approved prior to March 27, 2020.
``(4) Payment.-- The term `payment' includes, as determined
appropriate by the Secretary, a pre-payment, a prospective
payment, a retrospective payment, or a payment through a
grant or other mechanism.
``(5) Rural area.--The term `rural area' means--
``(A) a rural area (as defined in section 1886(d)(2)(D));
or
``(B) any other rural area (as defined by the
Secretary).''.
______