Public Health Infrastructure Saves Lives Act

II 118TH CONGRESS 1ST SESSION S. 1995 To support public health infrastructure. IN THE SENATE OF THE UNITED STATES JUNE 14, 2023 Mrs. MURRAY (for herself, Mr. MERKLEY, Mr. SCHATZ, Mr. CASEY, Mr. BLUMENTHAL, Ms. KLOBUCHAR, Ms. SMITH, Ms. BALDWIN, Ms. WAR- REN, Mr. REED, Mr. MENENDEZ, Mr. VAN HOLLEN, Ms. DUCKWORTH, and Mr. BROWN) 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 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1995 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, consisting of awarding grants 4 under subsection (b). 5 (b) GRANTS.— 6 (1) AWARD.—For the purpose of addressing 7 core public health infrastructure needs, the Sec- 8 retary— 9 (A) shall award a grant to each State or 10 territorial health department, and to local 11 health departments that serve 500,000 people 12 or more; and 13 (B) shall award grants on a competitive 14 basis to State, territorial, or local health depart- 15 ments. 16 (2) ALLOCATION.—Of the total amount of 17 funds awarded as grants under this subsection for a 18 fiscal year— 19 (A) not less than 50 percent shall be for 20 grants to health departments under paragraph 21 (1)(A); and 22 (B) not less than 30 percent shall be for 23 grants to State, territorial, or local health de- 24 partments under paragraph (1)(B). 25 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1995 IS (c) USE OF FUNDS.—The Secretary may award a 1 grant to an entity under subsection (b)(1) only if the enti- 2 ty agrees to use the full amount of the grant to address 3 core public health infrastructure needs, including those 4 identified in the accreditation process under subsection 5 (h). 6 (d) FORMULA GRANTS TO HEALTH DEPART- 7 MENTS.—In making grants under subsection (b)(1)(A), 8 the Secretary shall award funds to each health department 9 in accordance with— 10 (1) a formula based on population size, burden 11 of preventable disease and disability, and poverty 12 rate, with special consideration given to territories; 13 and 14 (2) application requirements established by the 15 Secretary, including a requirement that the health 16 department submit a plan by the end of year 1 of 17 the grant that demonstrates to the satisfaction of 18 the Secretary that the health department will— 19 (A) address its highest priority core public 20 health infrastructure needs; and 21 (B) for State health departments, allocate 22 at least 25 percent of the grant funds to local 23 health departments within the State to support 24 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1995 IS the local jurisdiction’s contribution to core pub- 1 lic health infrastructure. 2 (e) COMPETITIVE GRANTS TO STATE, TERRITORIAL, 3 AND LOCAL HEALTH DEPARTMENTS.—In making grants 4 under subsection (b)(1)(B), the Secretary shall give pri- 5 ority to applicants demonstrating core public health infra- 6 structure needs for all public health agencies in the appli- 7 cant’s jurisdiction to be certified by the accreditation proc- 8 ess under subsection (h), or for an entity for which a waiv- 9 er has been received under subparagraph (A) or (B) of 10 subsection (h)(2), that has otherwise demonstrated the ap- 11 plicant has core public health infrastructure needs for all 12 public health agencies. 13 (f) PERMITTED USE.—The Secretary may make 14 available a subset of the funds available for grants under 15 subsection (b)(1) for purposes of awarding planning 16 grants to health departments eligible to receive a grant 17 under subsection (b)(1)(B). Recipients of such a planning 18 grant may use such award to assess core public health 19 infrastructure needs. 20 (g) MAINTENANCE OF EFFORT.—The Secretary may 21 award a grant to an entity under subsection (b) only if 22 the entity demonstrates to the satisfaction of the Sec- 23 retary that— 24 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1995 IS (1) funds received through the grant will be ex- 1 pended only to supplement, and not supplant, non- 2 Federal and Federal funds otherwise available to the 3 entity for the purpose of addressing core public 4 health infrastructure needs; and 5 (2) with respect to activities for which the grant 6 is awarded, the entity will maintain expenditures of 7 non-Federal amounts for such activities at a level 8 not less than the level of such expenditures main- 9 tained by the entity for the fiscal year preceding the 10 fiscal year for which the entity receives the grant. 11 (h) SUPPORT OF A NATIONAL PUBLIC HEALTH AC- 12 CREDITATION PROGRAM.— 13 (1) IN GENERAL.—The Secretary, acting 14 through the Director of the Centers for Disease 15 Control and Prevention, shall— 16 (A) support continued development, and 17 periodic review and updating of standards for 18 accreditation of State, territorial, local, or Trib- 19 al health departments for the purpose of ad- 20 vancing the quality and performance of such de- 21 partments with an emphasis on core public 22 health infrastructure; 23 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1995 IS (B) implement a program to accredit such 1 health departments in accordance with such 2 standards; and 3 (C) beginning in fiscal year 2027, ensure 4 that any entity receiving a grant under sub- 5 section (b) is accredited as described in sub- 6 paragraph (A) or meets another standard of ac- 7 countability specific to public health infrastruc- 8 ture, subject to paragraph (2). 9 (2) WAIVERS.—The Secretary may waive the 10 requirement under paragraph (1)(C) with respect 11 to— 12 (A) any individual entity until fiscal year 13 2029; or 14 (B) after fiscal year 2029, any individual 15 entity that demonstrates that it would be a sig- 16 nificant hardship to comply with such require- 17 ment. 18 (3) COOPERATIVE AGREEMENT.—The Secretary 19 may enter into a cooperative agreement with a pri- 20 vate nonprofit entity to carry out this subsection. 21 (i) REPORT.—The Secretary shall submit to the Com- 22 mittee on Health, Education, Labor, and Pensions of the 23 Senate and the Committee on Energy and Commerce of 24 the House of Representatives an annual report on 25 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1995 IS progress being made to accredit entities under subsection 1 (h). Such report shall include— 2 (1) a strategy, including goals and objectives, 3 for accrediting entities under subsection (h) and 4 achieving the purpose described in subsection (h)(1); 5 (2) a list of funding recipients and the amounts 6 received, including directly funded entities under 7 subsection (b)(1), as well as local health depart- 8 ments that receive funding in accordance with sub- 9 section (d)(2)(B); 10 (3) data reported by grantees funded under this 11 section pursuant to a minimum data set required by 12 the Secretary, which shall include each grantee’s ac- 13 tivities, standardized financial reporting, and re- 14 source allocation data; and 15 (4) identification of gaps in research related to 16 core public health infrastructure and recommenda- 17 tions of priority areas for such research. 18 (j) TRIBAL SET-ASIDE.—Of the amount appropriated 19 under subsection (a) for a fiscal year, the Secretary shall 20 reserve 3 percent for purposes of, acting through the Di- 21 rector of the Centers for Disease Control and Prevention 22 and in consultation with the Director of the Indian Health 23 Service, awarding grants under this section to Tribal 24 health departments and to epidemiology centers estab- 25 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1995 IS lished under section 214 of the Indian Health Care Im- 1 provement Act (25 U.S.C. 1621m). 2 SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND AC- 3 TIVITIES FOR CDC. 4 (a) IN GENERAL.—The Secretary, acting through the 5 Director of the Centers for Disease Control and Preven- 6 tion, shall expand and improve the core public health in- 7 frastructure and activities of the Centers for Disease Con- 8 trol and Prevention to address unmet and emerging public 9 health needs and provide technical assistance to grantees 10 funded under this provision, including the administration 11 of the grants under section 2(b)(1). 12 (b) REPORT.—The Secretary shall submit to Con- 13 gress an annual report on the activities funded through 14 this section. 15 SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED. 16 For purposes of this Act, the term ‘‘core public health 17 infrastructure’’ means all of the following elements, and 18 the workforce needed to establish and maintain such ele- 19 ments: 20 (1) ASSESSMENT (INCLUDING SURVEILLANCE, 21 EPIDEMIOLOGY, AND LABORATORY CAPACITY).—The 22 ability to track the health of a community through 23 data, case finding, and laboratory tests with par- 24 ticular attention to those most at risk. 25 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1995 IS (2) ALL HAZARDS PREPAREDNESS AND RE- 1 SPONSE.—The capacity to respond to emergencies of 2 all kinds. 3 (3) POLICY DEVELOPMENT AND SUPPORT.— 4 The ability to translate public health science into ap- 5 propriate policy and regulation. 6 (4) COMMUNICATIONS.—The ability to reach 7 the public effectively with timely, science-based in- 8 formation to mitigate the impact of public health 9 threats, with particular attention to hard-to-reach 10 populations. 11 (5) COMMUNITY PARTNERSHIP DEVELOP- 12 MENT.—The capacity to harness and align commu- 13 nity resources and organizations to advance the 14 health of all members of the community. 15 (6) ORGANIZATIONAL COMPETENCIES (LEADER- 16 SHIP AND GOVERNANCE).—The ability to lead inter- 17 nal and external stakeholders to consensus and ac- 18 tion. 19 (7) ACCOUNTABILITY AND PERFORMANCE MAN- 20 AGEMENT (INCLUDING QUALITY IMPROVEMENT, IN- 21 FORMATION TECHNOLOGY, HUMAN RESOURCES, FI- 22 NANCIAL MANAGEMENT, AND LAW).—The ability to 23 apply business practices, including a standardized 24 approach to financial reporting, that ensure efficient 25 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1995 IS use of resources, achieve desired outcomes, and fos- 1 ter a continuous learning environment. 2 (8) EQUITY.—Utilizing all of the preceding ele- 3 ments, the capacity to address and correct health 4 disparities (including disparities related to race, eth- 5 nicity, national origin, socioeconomic status, primary 6 language, sex (including sexual orientation and gen- 7 der identity), disability status, and other factors), 8 advance health equity in all communities, and imple- 9 ment culturally and linguistically appropriate pro- 10 grams and interventions. 11 SEC. 5. FUNDING. 12 (a) IN GENERAL.—To carry out this Act, there are 13 hereby appropriated, out of amounts in the Treasury not 14 otherwise appropriated, the following to be made available 15 until expended: 16 (1) For fiscal year 2024, $750,000,000. 17 (2) For fiscal year 2025, $1,000,000,000. 18 (3) For fiscal year 2026, $2,000,000,000. 19 (4) For fiscal year 2027, $3,000,000,000. 20 (5) For fiscal year 2028 and each subsequent 21 fiscal year, $4,500,000,000. 22 (b) CORE PUBLIC HEALTH INFRASTRUCTURE AND 23 ACTIVITIES.—Of the amounts made available under this 24 VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1995 IS section for a fiscal year, not more than $350,000,000 shall 1 be used to carry out section 3. 2 (c) SUPPLEMENT.—Amounts made available under 3 this section shall be used to supplement, and not supplant, 4 amounts otherwise made available for the purposes de- 5 scribed in this Act. 6 Æ VerDate Sep 11 2014 19:38 Jul 07, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S1995.IS S1995 kjohnson on DSK79L0C42PROD with BILLS