Public Health Infrastructure Saves Lives Act

II 117TH CONGRESS 1ST SESSION S. 674 To support public health infrastructure. IN THE SENATE OF THE UNITED STATES MARCH 10, 2021 Mrs. MURRAY (for herself, Mr. BENNET, Mr. BROWN, Ms. WARREN, Mr. REED, Mr. MERKLEY, Mr. BLUMENTHAL, Mr. MARKEY, Mr. SCHATZ, Ms. BALDWIN, Mr. MENENDEZ, Ms. SMITH, Ms. DUCKWORTH, Mr. CASEY, Mr. VAN HOLLEN, Ms. KLOBUCHAR, Ms. ROSEN, Ms. HIRONO, Mr. DURBIN, and Mrs. GILLIBRAND) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To support public health infrastructure. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Public Health Infra- 4 structure Saves Lives Act’’. 5 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 2 •S 674 IS SEC. 2. CORE PUBLIC HEALTH INFRASTRUCTURE FOR 1 STATE, TERRITORIAL, LOCAL, AND TRIBAL 2 HEALTH DEPARTMENTS. 3 (a) PROGRAM.—The Secretary of Health and Human 4 Services (referred to in this Act as the ‘‘Secretary’’), act- 5 ing through the Director of the Centers for Disease Con- 6 trol and Prevention, shall establish a core public health 7 infrastructure program to strengthen the public health 8 system of the United States, including the Nation’s ability 9 to respond to the COVID–19 pandemic, consisting of 10 awarding grants under subsection (b). 11 (b) GRANTS.— 12 (1) AWARD.—For the purpose of addressing 13 core public health infrastructure needs, the Sec- 14 retary— 15 (A) shall award a grant to each State or 16 territorial health department, and to local 17 health departments that serve 500,000 people 18 or more; and 19 (B) shall award grants on a competitive 20 basis to State, territorial, or local health depart- 21 ments. 22 (2) ALLOCATION.—Of the total amount of 23 funds awarded as grants under this subsection for a 24 fiscal year— 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 3 •S 674 IS (A) not less than 50 percent shall be for 1 grants to health departments under paragraph 2 (1)(A); and 3 (B) not less than 30 percent shall be for 4 grants to State, territorial, or local health de- 5 partments under paragraph (1)(B). 6 (c) USE OF FUNDS.—The Secretary may award a 7 grant to an entity under subsection (b)(1) only if the enti- 8 ty agrees to use the full amount of the grant to address 9 core public health infrastructure needs, including those 10 identified in the accreditation process under subsection 11 (h). 12 (d) FORMULA GRANTS TO HEALTH DEPART- 13 MENTS.—In making grants under subsection (b)(1)(A), 14 the Secretary shall award funds to each health department 15 in accordance with— 16 (1) a formula— 17 (A) based on population size, burden of 18 preventable disease and disability, and poverty 19 rate, with special consideration given to terri- 20 tories; and 21 (B) which, in the event of an award made 22 during the public health emergency declared 23 under section 319 of the Public Health Service 24 Act (42 U.S.C. 247d) in response to COVID– 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 4 •S 674 IS 19, shall consider the COVID–19 burden of 1 each jurisdiction; and 2 (2) application requirements established by the 3 Secretary, including a requirement that the health 4 department submit a plan by the end of year 1 of 5 the grant that demonstrates to the satisfaction of 6 the Secretary that the health department will— 7 (A) address its highest priority core public 8 health infrastructure needs; 9 (B) in the case of such a plan submitted 10 during the public health emergency described in 11 paragraph (1)(B), identify the core public 12 health infrastructure needs that are the highest 13 priority for strengthening the response to 14 COVID–19 and similar public health threats 15 and other public health emergencies; and 16 (C) for State health departments, allocate 17 at least 25 percent of the grant funds to local 18 health departments within the State to support 19 the local jurisdiction’s contribution to core pub- 20 lic health infrastructure. 21 (e) COMPETITIVE GRANTS TO STATE, TERRITORIAL, 22 AND LOCAL HEALTH DEPARTMENTS.—In making grants 23 under subsection (b)(1)(B), the Secretary shall give pri- 24 ority to applicants demonstrating core public health infra- 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 5 •S 674 IS structure needs for all public health agencies in the appli- 1 cant’s jurisdiction to be certified by the accreditation proc- 2 ess under subsection (h), or for an entity for which a waiv- 3 er has been received under subparagraph (A) or (B) of 4 subsection (h)(2), that has otherwise demonstrated the ap- 5 plicant has core public health infrastructure needs for all 6 public health agencies. 7 (f) PERMITTED USE.—The Secretary may make 8 available a subset of the funds available for grants under 9 subsection (b)(1) for purposes of awarding planning 10 grants to health departments eligible to receive a grant 11 under subsection (b)(1)(B). Recipients of such a planning 12 grant may use such award to assess core public health 13 infrastructure needs. 14 (g) MAINTENANCE OF EFFORT.—The Secretary may 15 award a grant to an entity under subsection (b) only if 16 the entity demonstrates to the satisfaction of the Sec- 17 retary that— 18 (1) funds received through the grant will be ex- 19 pended only to supplement, and not supplant, non- 20 Federal and Federal funds otherwise available to the 21 entity for the purpose of addressing core public 22 health infrastructure needs; and 23 (2) with respect to activities for which the grant 24 is awarded, the entity will maintain expenditures of 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 6 •S 674 IS non-Federal amounts for such activities at a level 1 not less than the level of such expenditures main- 2 tained by the entity for the fiscal year preceding the 3 fiscal year for which the entity receives the grant. 4 (h) SUPPORT OF A NATIONAL PUBLIC HEALTH AC- 5 CREDITATION PROGRAM.— 6 (1) IN GENERAL.—The Secretary, acting 7 through the Director of the Centers for Disease 8 Control and Prevention, shall— 9 (A) support continued development, and 10 periodic review and updating of standards for 11 accreditation of State, territorial, local, or tribal 12 health departments for the purpose of advanc- 13 ing the quality and performance of such depart- 14 ments with an emphasis on core public health 15 infrastructure; 16 (B) implement a program to accredit such 17 health departments in accordance with such 18 standards; and 19 (C) beginning in fiscal year 2025, ensure 20 that any entity receiving a grant under sub- 21 section (b) is accredited as described in sub- 22 paragraph (A) or meets another standard of ac- 23 countability specific to public health infrastruc- 24 ture, subject to paragraph (2). 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 7 •S 674 IS (2) WAIVERS.—The Secretary may waive the 1 requirement under paragraph (1)(C) with respect 2 to— 3 (A) any individual entity until fiscal year 4 2027; or 5 (B) after fiscal year 2027, any individual 6 entity that demonstrates that it would be a sig- 7 nificant hardship to comply with such require- 8 ment. 9 (3) COOPERATIVE AGREEMENT.—The Secretary 10 may enter into a cooperative agreement with a pri- 11 vate nonprofit entity to carry out this subsection. 12 (i) REPORT.—The Secretary shall submit to the Com- 13 mittee on Health, Education, Labor, and Pensions of the 14 Senate and the Committee on Energy and Commerce of 15 the House of Representatives an annual report on 16 progress being made to accredit entities under subsection 17 (h). Such report shall include— 18 (1) a strategy, including goals and objectives, 19 for accrediting entities under subsection (h) and 20 achieving the purpose described in subsection (h)(1); 21 (2) a list of funding recipients and the amounts 22 received, including directly funded entities under 23 subsection (b)(1), as well as local health depart- 24 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 8 •S 674 IS ments that receive funding in accordance with sub- 1 section (d)(2)(C); 2 (3) data reported by grantees funded under this 3 section pursuant to a minimum data set required by 4 the Secretary, which shall include each grantee’s ac- 5 tivities, standardized financial reporting, and re- 6 source allocation data; and 7 (4) identification of gaps in research related to 8 core public health infrastructure and recommenda- 9 tions of priority areas for such research. 10 (j) TRIBAL SET-ASIDE.—Of the amount appropriated 11 under subsection (a) for a fiscal year, the Secretary shall 12 reserve 3 percent for purposes of, acting through the Di- 13 rector of the Centers for Disease Control and Prevention 14 and in consultation with the Director of the Indian Health 15 Service, awarding grants under this section to Tribal 16 health departments and to epidemiology centers estab- 17 lished under section 214 of the Indian Health Care Im- 18 provement Act (25 U.S.C. 1621m). 19 SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND AC- 20 TIVITIES FOR CDC. 21 (a) IN GENERAL.—The Secretary, acting through the 22 Director of the Centers for Disease Control and Preven- 23 tion, shall expand and improve the core public health in- 24 frastructure and activities of the Centers for Disease Con- 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 9 •S 674 IS trol and Prevention to address unmet and emerging public 1 health needs and provide technical assistance to grantees 2 funded under this provision, including the administration 3 of the grants under section 2(b)(1). 4 (b) REPORT.—The Secretary shall submit to the Con- 5 gress an annual report on the activities funded through 6 this section. 7 SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED. 8 For purposes of this Act, the term ‘‘core public health 9 infrastructure’’ means all of the following elements, and 10 the workforce needed to establish and maintain such ele- 11 ments: 12 (1) ASSESSMENT (INCLUDING SURVEILLANCE, 13 EPIDEMIOLOGY, AND LABORATORY CAPACITY).—The 14 ability to track the health of a community through 15 data, case finding, and laboratory tests with par- 16 ticular attention to those most at risk. 17 (2) ALL HAZARDS PREPAREDNESS AND RE- 18 SPONSE.—The capacity to respond to emergencies of 19 all kinds. 20 (3) POLICY DEVELOPMENT AND SUPPORT.— 21 The ability to translate public health science into ap- 22 propriate policy and regulation. 23 (4) COMMUNICATIONS.—The ability to reach 24 the public effectively with timely, science-based in- 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 10 •S 674 IS formation to mitigate the impact of public health 1 threats, with particular attention to hard-to-reach 2 populations. 3 (5) COMMUNITY PARTNERSHIP DEVELOP- 4 MENT.—The capacity to harness and align commu- 5 nity resources and organizations to advance the 6 health of all members of the community. 7 (6) ORGANIZATIONAL COMPETENCIES (LEADER- 8 SHIP AND GOVERNANCE).—The ability to lead inter- 9 nal and external stakeholders to consensus and ac- 10 tion. 11 (7) ACCOUNTABILITY AND PERFORMANCE MAN- 12 AGEMENT (INCLUDING QUALITY IMPROVEMENT, IN- 13 FORMATION TECHNOLOGY, HUMAN RESOURCES, FI- 14 NANCIAL MANAGEMENT, AND LAW).—The ability to 15 apply business practices, including a standardized 16 approach to financial reporting, that ensure efficient 17 use of resources, achieve desired outcomes, and fos- 18 ter a continuous learning environment. 19 (8) EQUITY.—Utilizing all of the preceding ele- 20 ments, the capacity to address and correct health 21 disparities (including disparities related to race, eth- 22 nicity, national origin, socioeconomic status, primary 23 language, sex (including sexual orientation and gen- 24 der identity), disability status, and other factors), 25 VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS 11 •S 674 IS advance health equity in all communities, and imple- 1 ment culturally and linguistically appropriate pro- 2 grams and interventions. 3 SEC. 5. FUNDING. 4 (a) IN GENERAL.—To carry out this Act, there are 5 hereby appropriated, out of amounts in the Treasury not 6 otherwise appropriated, the following to be made available 7 until expended: 8 (1) For fiscal year 2022, $750,000,000. 9 (2) For fiscal year 2023, $1,000,000,000. 10 (3) For fiscal year 2024, $2,000,000,000. 11 (4) For fiscal year 2025, $3,000,000,000. 12 (5) For fiscal year 2026 and each subsequent 13 fiscal year, $4,500,000,000. 14 (b) CORE PUBLIC HEALTH INFRASTRUCTURE AND 15 ACTIVITIES.—Of the amounts made available under this 16 section for a fiscal year, not more than $350,000,000 shall 17 be used to carry out section 3. 18 (c) SUPPLEMENT.—Amounts made available under 19 this section shall be used to supplement, and not supplant, 20 amounts otherwise made available for the purposes de- 21 scribed in this Act. 22 Æ VerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S674.IS S674 kjohnson on DSK79L0C42PROD with BILLS