Public Health Infrastructure Saves Lives Act

II 116TH CONGRESS 2D SESSION S. 4740 To support public health infrastructure. IN THE SENATE OF THE UNITED STATES SEPTEMBER 29, 2020 Mrs. MURRAY (for herself, Mr. CASEY, Mr. MENENDEZ, Mr. VAN HOLLEN, Ms. DUCKWORTH, Mr. BROWN, Mr. MERKLEY, Mr. BENNET, Ms. WAR- REN, Mr. MARKEY, Ms. HIRONO, Ms. BALDWIN, Ms. ROSEN, Mr. SCHATZ, Ms. KLOBUCHAR, Mr. REED, Ms. SMITH, Mr. BLUMENTHAL, and Mr. DURBIN) 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 SEC. 2. CORE PUBLIC HEALTH INFRASTRUCTURE FOR 6 STATE, TERRITORIAL, LOCAL, AND TRIBAL 7 HEALTH DEPARTMENTS. 8 (a) PROGRAM.—The Secretary of Health and Human 9 Services (referred to in this Act as the ‘‘Secretary’’), act- 10 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4740 IS ing through the Director of the Centers for Disease Con- 1 trol and Prevention, shall establish a core public health 2 infrastructure program to strengthen the public health 3 system of the United States, including the Nation’s ability 4 to respond to the COVID–19 pandemic, consisting of 5 awarding grants under subsection (b). 6 (b) GRANTS.— 7 (1) AWARD.—For the purpose of addressing 8 core public health infrastructure needs, the Sec- 9 retary— 10 (A) shall award a grant to each State or 11 territorial health department, and to local 12 health departments that serve 500,000 people 13 or more; and 14 (B) shall award grants on a competitive 15 basis to State, territorial, local, or tribal health 16 departments. 17 (2) ALLOCATION.—Of the total amount of 18 funds awarded as grants under this subsection for a 19 fiscal year— 20 (A) not less than 50 percent shall be for 21 grants to health departments under paragraph 22 (1)(A); and 23 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4740 IS (B) not less than 30 percent shall be for 1 grants to State, territorial, local, or tribal 2 health departments under paragraph (1)(B). 3 (c) USE OF FUNDS.—The Secretary may award a 4 grant to an entity under subsection (b)(1) only if the enti- 5 ty agrees to use the full amount of the grant to address 6 core public health infrastructure needs, including those 7 identified in the accreditation process under subsection 8 (h). 9 (d) FORMULA GRANTS TO HEALTH DEPART- 10 MENTS.—In making grants under subsection (b)(1)(A), 11 the Secretary shall award funds to each health department 12 in accordance with— 13 (1) a formula— 14 (A) based on population size, burden of 15 preventable disease and disability, and poverty 16 rate, with special consideration given to terri- 17 tories; and 18 (B) which, in the event of an award made 19 during the public health emergency declared 20 under section 319 of the Public Health Service 21 Act (42 U.S.C. 247d) in response to COVID– 22 19, shall consider the COVID–19 burden of 23 each jurisdiction; and 24 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4740 IS (2) application requirements established by the 1 Secretary, including a requirement that the health 2 department submit a plan by the end of year 1 of 3 the grant that demonstrates to the satisfaction of 4 the Secretary that the health department will— 5 (A) address its highest priority core public 6 health infrastructure needs; 7 (B) in the case of such a plan submitted 8 during the public health emergency described in 9 paragraph (1)(B), identify the core public 10 health infrastructure needs that are the highest 11 priority for strengthening the response to 12 COVID–19 and similar public health threats 13 and other public health emergencies; and 14 (C) for State health departments, allocate 15 at least 25 percent of the grant funds to local 16 health departments within the State to support 17 the local jurisdiction’s contribution to core pub- 18 lic health infrastructure. 19 (e) COMPETITIVE GRANTS TO STATE, TERRITORIAL, 20 LOCAL, AND TRIBAL HEALTH DEPARTMENTS.—In mak- 21 ing grants under subsection (b)(1)(B), the Secretary shall 22 give priority to applicants demonstrating core public 23 health infrastructure needs for all public health agencies 24 in the applicant’s jurisdiction to be certified by the accred- 25 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4740 IS itation process under subsection (h), or for an entity for 1 which a waiver has been received under subparagraph (A) 2 or (B) of subsection (h)(2), that has otherwise dem- 3 onstrated the applicant has core public health infrastruc- 4 ture needs for all public health agencies. 5 (f) PERMITTED USE.—The Secretary may make 6 available a subset of the funds available for grants under 7 subsection (b)(1) for purposes of awarding planning 8 grants to health departments eligible to receive a grant 9 under subsection (b)(1)(B). Recipients of such a planning 10 grant may use such award to assess core public health 11 infrastructure needs. 12 (g) MAINTENANCE OF EFFORT.—The Secretary may 13 award a grant to an entity under subsection (b) only if 14 the entity demonstrates to the satisfaction of the Sec- 15 retary that— 16 (1) funds received through the grant will be ex- 17 pended only to supplement, and not supplant, non- 18 Federal and Federal funds otherwise available to the 19 entity for the purpose of addressing core public 20 health infrastructure needs; and 21 (2) with respect to activities for which the grant 22 is awarded, the entity will maintain expenditures of 23 non-Federal amounts for such activities at a level 24 not less than the level of such expenditures main- 25 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4740 IS tained by the entity for the fiscal year preceding the 1 fiscal year for which the entity receives the grant. 2 (h) SUPPORT OF A NATIONAL PUBLIC HEALTH AC- 3 CREDITATION PROGRAM.— 4 (1) IN GENERAL.—The Secretary, acting 5 through the Director of the Centers for Disease 6 Control and Prevention, shall— 7 (A) support continued development, and 8 periodic review and updating of standards for 9 accreditation of State, territorial, local, or tribal 10 health departments for the purpose of advanc- 11 ing the quality and performance of such depart- 12 ments with an emphasis on core public health 13 infrastructure; 14 (B) implement a program to accredit such 15 health departments in accordance with such 16 standards; and 17 (C) beginning in fiscal year 2024, ensure 18 that any entity receiving a grant under sub- 19 section (b) is accredited as described in sub- 20 paragraph (A) or meets another standard of ac- 21 countability specific to public health infrastruc- 22 ture, subject to paragraph (2). 23 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4740 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 2026; or 5 (B) after fiscal year 2026, 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), including— 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 and 22 (2) identification of gaps in research related to 23 core public health infrastructure and recommenda- 24 tions of priority areas for such research. 25 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4740 IS SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND AC- 1 TIVITIES FOR CDC. 2 (a) IN GENERAL.—The Secretary, acting through the 3 Director of the Centers for Disease Control and Preven- 4 tion, shall expand and improve the core public health in- 5 frastructure and activities of the Centers for Disease Con- 6 trol and Prevention to address unmet and emerging public 7 health needs and provide technical assistance to grantees 8 funded under this provision, including the administration 9 of the grants under section 2(b)(1). 10 (b) REPORT.—The Secretary shall submit to Con- 11 gress an annual report on the activities funded through 12 this section. 13 SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED. 14 For purposes of this Act, the term ‘‘core public health 15 infrastructure’’ means all of the following elements, and 16 the workforce needed to establish and maintain such ele- 17 ments: 18 (1) ASSESSMENT (INCLUDING SURVEILLANCE, 19 EPIDEMIOLOGY, AND LABORATORY CAPACITY).—The 20 ability to track the health of a community through 21 data, case finding, and laboratory tests with par- 22 ticular attention to those most at risk. 23 (2) ALL HAZARDS PREPAREDNESS AND RE- 24 SPONSE.—The capacity to respond to emergencies of 25 all kinds. 26 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4740 IS (3) POLICY DEVELOPMENT AND SUPPORT.— 1 The ability to translate public health science into ap- 2 propriate policy and regulation. 3 (4) COMMUNICATIONS.—The ability to reach 4 the public effectively with timely, science-based in- 5 formation to mitigate the impact of public health 6 threats, with particular attention to hard-to-reach 7 populations. 8 (5) COMMUNITY PARTNERSHIP DEVELOP- 9 MENT.—The capacity to harness and align commu- 10 nity resources and organizations to advance the 11 health of all members of the community. 12 (6) ORGANIZATIONAL COMPETENCIES (LEADER- 13 SHIP AND GOVERNANCE, HEALTH EQUITY).—The 14 ability to lead internal and external stakeholders to 15 consensus and action. 16 (7) ACCOUNTABILITY AND PERFORMANCE MAN- 17 AGEMENT (INCLUDING QUALITY IMPROVEMENT, IN- 18 FORMATION TECHNOLOGY, HUMAN RESOURCES, FI- 19 NANCIAL MANAGEMENT, AND LAW).—The ability to 20 apply business practices that ensure efficient use of 21 resources, achieve desired outcomes, and foster a 22 continuous learning environment. 23 (8) EQUITY.—Utilizing all of the preceding ele- 24 ments, the capacity to address and correct health 25 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4740 IS disparities (including disparities related to race, eth- 1 nicity, national origin, socioeconomic status, primary 2 language, sex (including sexual orientation and gen- 3 der identity), disability status, and other factors), 4 advance health equity in all communities, and imple- 5 ment culturally and linguistically appropriate pro- 6 grams and interventions. 7 SEC. 5. FUNDING. 8 (a) IN GENERAL.—To carry out this Act, there are 9 hereby appropriated, out of amounts in the Treasury not 10 otherwise appropriated, the following to be made available 11 until expended: 12 (1) For fiscal year 2021, $750,000,000. 13 (2) For fiscal year 2022, $1,000,000,000. 14 (3) For fiscal year 2023, $2,000,000,000. 15 (4) For fiscal year 2024, $3,000,000,000. 16 (5) For fiscal year 2025 and each subsequent 17 fiscal year, $4,500,000,000. 18 (b) CORE PUBLIC HEALTH INFRASTRUCTURE AND 19 ACTIVITIES.—Of the amounts made available under this 20 section for a fiscal year, not more than $350,000,000 shall 21 be used to carry out section 3. 22 (c) SUPPLEMENT.—Amounts made available under 23 this section shall be used to supplement, and not supplant, 24 VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4740 IS amounts otherwise made available for the purposes de- 1 scribed in this Act. 2 Æ VerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S4740.IS S4740 kjohnson on DSK79L0C42PROD with BILLS