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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Public Health Infra5 structure Saves Lives Act’’. 


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1 SEC. 2. CORE PUBLIC HEALTH INFRASTRUCTURE FOR 

2 STATE, TERRITORIAL, LOCAL, AND TRIBAL 

3 HEALTH DEPARTMENTS. 

4 (a) PROGRAM.—The Secretary of Health and Human 

5 Services (referred to in this Act as the ‘‘Secretary’’), act6 ing through the Director of the Centers for Disease Con7 trol and Prevention, shall establish a core public health 

8 infrastructure program to strengthen the public health 

9 system of the United States, including the Nation’s ability 

10 to respond to the COVID–19 pandemic, consisting of 

11 awarding grants under subsection (b). 

12 (b) GRANTS.— 

13 (1) AWARD.—For the purpose of addressing 

14 core public health infrastructure needs, the Sec15 retary— 

16 (A) shall award a grant to each State or 

17 territorial health department, and to local 

18 health departments that serve 500,000 people 

19 or more; and 

20 (B) shall award grants on a competitive 

21 basis to State, territorial, or local health depart22 ments. 

23 (2) ALLOCATION.—Of the total amount of 

24 funds awarded as grants under this subsection for a 

25 fiscal year— 


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1 (A) not less than 50 percent shall be for 

2 grants to health departments under paragraph 

3 (1)(A); and 

4 (B) not less than 30 percent shall be for 

5 grants to State, territorial, or local health de6 partments under paragraph (1)(B). 

7 (c) USE OF FUNDS.—The Secretary may award a 

8 grant to an entity under subsection (b)(1) only if the enti9 ty agrees to use the full amount of the grant to address 

10 core public health infrastructure needs, including those 

11 identified in the accreditation process under subsection 

12 (h). 

13 (d) FORMULA GRANTS TO HEALTH DEPART14 MENTS.—In making grants under subsection (b)(1)(A), 

15 the Secretary shall award funds to each health department 

16 in accordance with— 

17 (1) a formula— 

18 (A) based on population size, burden of 

19 preventable disease and disability, and poverty 

20 rate, with special consideration given to terri21 tories; and 

22 (B) which, in the event of an award made 

23 during the public health emergency declared 

24 under section 319 of the Public Health Service 

25 Act (42 U.S.C. 247d) in response to COVID– 


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1 19, shall consider the COVID–19 burden of 

2 each jurisdiction; and 

3 (2) application requirements established by the 

4 Secretary, including a requirement that the health 

5 department submit a plan by the end of year 1 of 

6 the grant that demonstrates to the satisfaction of 

7 the Secretary that the health department will— 

8 (A) address its highest priority core public 

9 health infrastructure needs; 

10 (B) in the case of such a plan submitted 

11 during the public health emergency described in 

12 paragraph (1)(B), identify the core public 

13 health infrastructure needs that are the highest 

14 priority for strengthening the response to 

15 COVID–19 and similar public health threats 

16 and other public health emergencies; and 

17 (C) for State health departments, allocate 

18 at least 25 percent of the grant funds to local 

19 health departments within the State to support 

20 the local jurisdiction’s contribution to core pub21 lic health infrastructure. 

22 (e) COMPETITIVE GRANTS TO STATE, TERRITORIAL, 

23 AND LOCAL HEALTH DEPARTMENTS.—In making grants 

24 under subsection (b)(1)(B), the Secretary shall give pri25 ority to applicants demonstrating core public health infraVerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

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1 structure needs for all public health agencies in the appli2 cant’s jurisdiction to be certified by the accreditation proc3 ess under subsection (h), or for an entity for which a waiv4 er has been received under subparagraph (A) or (B) of 

5 subsection (h)(2), that has otherwise demonstrated the ap6 plicant has core public health infrastructure needs for all 

7 public health agencies. 

8 (f) PERMITTED USE.—The Secretary may make 

9 available a subset of the funds available for grants under 

10 subsection (b)(1) for purposes of awarding planning 

11 grants to health departments eligible to receive a grant 

12 under subsection (b)(1)(B). Recipients of such a planning 

13 grant may use such award to assess core public health 

14 infrastructure needs. 

15 (g) MAINTENANCE OF EFFORT.—The Secretary may 

16 award a grant to an entity under subsection (b) only if 

17 the entity demonstrates to the satisfaction of the Sec18 retary that— 

19 (1) funds received through the grant will be ex20 pended only to supplement, and not supplant, non21 Federal and Federal funds otherwise available to the 

22 entity for the purpose of addressing core public 

23 health infrastructure needs; and 

24 (2) with respect to activities for which the grant 

25 is awarded, the entity will maintain expenditures of 


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1 non-Federal amounts for such activities at a level 

2 not less than the level of such expenditures main3 tained by the entity for the fiscal year preceding the 

4 fiscal year for which the entity receives the grant. 

5 (h) SUPPORT OF A NATIONAL PUBLIC HEALTH AC6 CREDITATION PROGRAM.— 

7 (1) IN GENERAL.—The Secretary, acting 

8 through the Director of the Centers for Disease 

9 Control and Prevention, shall— 

10 (A) support continued development, and 

11 periodic review and updating of standards for 

12 accreditation of State, territorial, local, or tribal 

13 health departments for the purpose of advanc14 ing the quality and performance of such depart15 ments with an emphasis on core public health 

16 infrastructure; 

17 (B) implement a program to accredit such 

18 health departments in accordance with such 

19 standards; and 

20 (C) beginning in fiscal year 2025, ensure 

21 that any entity receiving a grant under sub22 section (b) is accredited as described in sub23 paragraph (A) or meets another standard of ac24 countability specific to public health infrastruc25 ture, subject to paragraph (2). 


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1 (2) WAIVERS.—The Secretary may waive the 

2 requirement under paragraph (1)(C) with respect 

3 to— 

4 (A) any individual entity until fiscal year 

5 2027; or 

6 (B) after fiscal year 2027, any individual 

7 entity that demonstrates that it would be a sig8 nificant hardship to comply with such require9 ment. 

10 (3) COOPERATIVE AGREEMENT.—The Secretary 

11 may enter into a cooperative agreement with a pri12 vate nonprofit entity to carry out this subsection. 

13 (i) REPORT.—The Secretary shall submit to the Com14 mittee on Health, Education, Labor, and Pensions of the 

15 Senate and the Committee on Energy and Commerce of 

16 the House of Representatives an annual report on 

17 progress being made to accredit entities under subsection 

18 (h). Such report shall include— 

19 (1) a strategy, including goals and objectives, 

20 for accrediting entities under subsection (h) and 

21 achieving the purpose described in subsection (h)(1); 

22 (2) a list of funding recipients and the amounts 

23 received, including directly funded entities under 

24 subsection (b)(1), as well as local health departVerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

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1 ments that receive funding in accordance with sub2 section (d)(2)(C); 

3 (3) data reported by grantees funded under this 

4 section pursuant to a minimum data set required by 

5 the Secretary, which shall include each grantee’s ac6 tivities, standardized financial reporting, and re7 source allocation data; and 

8 (4) identification of gaps in research related to 

9 core public health infrastructure and recommenda10 tions of priority areas for such research. 

11 (j) TRIBAL SET-ASIDE.—Of the amount appropriated 

12 under subsection (a) for a fiscal year, the Secretary shall 

13 reserve 3 percent for purposes of, acting through the Di14 rector of the Centers for Disease Control and Prevention 

15 and in consultation with the Director of the Indian Health 

16 Service, awarding grants under this section to Tribal 

17 health departments and to epidemiology centers estab18 lished under section 214 of the Indian Health Care Im19 provement Act (25 U.S.C. 1621m). 

20 SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND AC21 TIVITIES FOR CDC. 

22 (a) IN GENERAL.—The Secretary, acting through the 

23 Director of the Centers for Disease Control and Preven24 tion, shall expand and improve the core public health in25 frastructure and activities of the Centers for Disease ConVerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

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1 trol and Prevention to address unmet and emerging public 

2 health needs and provide technical assistance to grantees 

3 funded under this provision, including the administration 

4 of the grants under section 2(b)(1). 

5 (b) REPORT.—The Secretary shall submit to the Con6 gress an annual report on the activities funded through 

7 this section. 

8 SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED. 

9 For purposes of this Act, the term ‘‘core public health 

10 infrastructure’’ means all of the following elements, and 

11 the workforce needed to establish and maintain such ele12 ments: 

13 (1) ASSESSMENT (INCLUDING SURVEILLANCE, 

14 EPIDEMIOLOGY, AND LABORATORY CAPACITY).—The 

15 ability to track the health of a community through 

16 data, case finding, and laboratory tests with par17 ticular attention to those most at risk. 

18 (2) ALL HAZARDS PREPAREDNESS AND RE19 SPONSE.—The capacity to respond to emergencies of 

20 all kinds. 

21 (3) POLICY DEVELOPMENT AND SUPPORT.— 

22 The ability to translate public health science into ap23 propriate policy and regulation. 

24 (4) COMMUNICATIONS.—The ability to reach 

25 the public effectively with timely, science-based inVerDate Sep 11 2014 00:09 Apr 05, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

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1 formation to mitigate the impact of public health 

2 threats, with particular attention to hard-to-reach 

3 populations. 

4 (5) COMMUNITY PARTNERSHIP DEVELOP5 MENT.—The capacity to harness and align commu6 nity resources and organizations to advance the 

7 health of all members of the community. 

8 (6) ORGANIZATIONAL COMPETENCIES (LEADER9 SHIP AND GOVERNANCE).—The ability to lead inter10 nal and external stakeholders to consensus and ac11 tion. 

12 (7) ACCOUNTABILITY AND PERFORMANCE MAN13 AGEMENT (INCLUDING QUALITY IMPROVEMENT, IN14 FORMATION TECHNOLOGY, HUMAN RESOURCES, FI15 NANCIAL MANAGEMENT, AND LAW).—The ability to 

16 apply business practices, including a standardized 

17 approach to financial reporting, that ensure efficient 

18 use of resources, achieve desired outcomes, and fos19 ter a continuous learning environment. 

20 (8) EQUITY.—Utilizing all of the preceding ele21 ments, the capacity to address and correct health 

22 disparities (including disparities related to race, eth23 nicity, national origin, socioeconomic status, primary 

24 language, sex (including sexual orientation and gen25 der identity), disability status, and other factors), 


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1 advance health equity in all communities, and imple2 ment culturally and linguistically appropriate pro3 grams and interventions. 

4 SEC. 5. FUNDING. 

5 (a) IN GENERAL.—To carry out this Act, there are 

6 hereby appropriated, out of amounts in the Treasury not 

7 otherwise appropriated, the following to be made available 

8 until expended: 

9 (1) For fiscal year 2022, $750,000,000. 

10 (2) For fiscal year 2023, $1,000,000,000. 

11 (3) For fiscal year 2024, $2,000,000,000. 

12 (4) For fiscal year 2025, $3,000,000,000. 

13 (5) For fiscal year 2026 and each subsequent 

14 fiscal year, $4,500,000,000. 

15 (b) CORE PUBLIC HEALTH INFRASTRUCTURE AND

16 ACTIVITIES.—Of the amounts made available under this 

17 section for a fiscal year, not more than $350,000,000 shall 

18 be used to carry out section 3. 

19 (c) SUPPLEMENT.—Amounts made available under 

20 this section shall be used to supplement, and not supplant, 

21 amounts otherwise made available for the purposes de22 scribed in this Act. 

Æ 


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