69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–873 

COMPREHENSIVE TUBERCULOSIS ELIMINATION ACT OF 

2008 

SEPTEMBER 23, 2008.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. DINGELL, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 1532] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1532) to amend the Public Health Service Act with 

respect to making progress toward the goal of eliminating tuberculosis, and for other purposes, having considered the same, report 

favorably thereon with an amendment and recommend that the bill 

as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 2 

Purpose and Summary ............................................................................................ 6 

Background and Need for Legislation .................................................................... 6 

Hearings ................................................................................................................... 7 

Committee Consideration ........................................................................................ 7 

Committee Votes ...................................................................................................... 7 

Committee Oversight Findings ............................................................................... 7 

Statement of General Performance Goals and Objectives .................................... 7 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 8 

Earmarks and Tax and Tariff Benefits .................................................................. 8 

Committee Cost Estimate ....................................................................................... 8 

Congressional Budget Office Estimate ................................................................... 8 

Federal Mandates Statement ................................................................................. 9 

Advisory Committee Statement .............................................................................. 9 

Constitutional Authority Statement ...................................................................... 9 

Applicability to Legislative Branch ........................................................................ 9 

Section-by-Section Analysis of the Legislation ...................................................... 9 

Changes in Existing Law Made by the Bill, as Reported ..................................... 12 


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AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Comprehensive Tuberculosis 

Elimination Act of 2008’’. 

(b) TABLE OF CONTENTS.—The table of contents for this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH THE CENTERS 

FOR DISEASE CONTROL AND PREVENTION AND OTHER APPROPRIATE AGENCIES 

Subtitle A—National Strategy for Combating and Eliminating Tuberculosis 

Sec. 101. National strategy. 

Subtitle B—Interagency Collaboration 

Sec. 111. Advisory Council for Elimination of Tuberculosis and the Federal Tuberculosis Task Force . 

Subtitle C—Evaluation of Public Health Authorities 

Sec. 121. Evaluation of public health authorities. 

Subtitle D—Authorization of Appropriations 

Sec. 131. Authorizations of appropriations. 

TITLE II—NATIONAL INSTITUTES OF HEALTH 

Sec. 201. Research and development concerning tuberculosis. 

TITLE I—DEPARTMENT OF HEALTH AND 

HUMAN SERVICES IN COORDINATION WITH 

THE CENTERS FOR DISEASE CONTROL AND 

PREVENTION AND OTHER APPROPRIATE 

AGENCIES 

Subtitle A—National Strategy for Combating and 

Eliminating Tuberculosis 

SEC. 101. NATIONAL STRATEGY. 

Section 317E of the Public Health Service Act (42 U.S.C. 247b–6) is amended— 

(1) by striking the heading for the section and inserting the following: ‘‘NATIONAL STRATEGY FOR COMBATING AND ELIMINATING TUBERCULOSIS’’; 

(2) by amending subsection (b) to read as follows: 

‘‘(b) RESEARCH AND DEVELOPMENT; DEMONSTRATION PROJECTS; EDUCATION AND

TRAINING.—With respect to the prevention, treatment, control, and elimination of 

tuberculosis, the Secretary may, directly or through grants to public or nonprofit 

private entities, carry out the following: 

‘‘(1) Research, with priority given to research and development concerning latent tuberculosis infection, strains of tuberculosis resistant to drugs, and research concerning cases of tuberculosis that affect certain populations at risk 

for tuberculosis. 

‘‘(2) Research and development and related activities to develop new tools for 

the elimination of tuberculosis, including drugs, diagnostics, vaccines, and public health interventions, such as directly observed therapy and non-pharmaceutical intervention, and methods to enhance detection and response to outbreaks of tuberculosis, including multidrug resistant tuberculosis. The Secretary 

is encouraged to give priority to programmatically relevant research so that new 

tools can be utilized in public health practice. 

‘‘(3) Demonstration projects for— 

‘‘(A) the development of regional capabilities to prevent, control, and 

eliminate tuberculosis and prevent multidrug resistant and extensively 

drug resistant strains of tuberculosis; 

‘‘(B) the intensification of efforts to reduce health disparities in the incidence of tuberculosis; 

‘‘(C) the intensification of efforts to control tuberculosis along the United 

States-Mexico border and among United States-Mexico binational popuVerDate Aug 31 2005 02:16 Sep 29, 2008 Jkt 069006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6621 E:\HR\OC\HR873.XXX HR873

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lations, including through expansion of the scope and number of programs 

that— 

‘‘(i) detect and treat binational cases of tuberculosis; and 

‘‘(ii) treat high-risk cases of tuberculosis referred from Mexican 

health departments; 

‘‘(D) the intensification of efforts to prevent, detect, and treat tuberculosis 

among foreign-born persons who are in the United States; 

‘‘(E) the intensification of efforts to prevent, detect, and treat tuberculosis 

among populations and settings documented as having a high risk for tuberculosis; and 

‘‘(F) tuberculosis detection, control, and prevention. 

‘‘(4) Public information and education activities. 

‘‘(5) Education, training, clinical skills improvement activities, and workplace 

exposure prevention for health professionals, including allied health personnel 

and emergency response employees. 

‘‘(6) Support of Centers to carry out activities under paragraphs (1) through 

(4). 

‘‘(7) Collaboration with international organizations and foreign countries in 

carrying out such activities. 

‘‘(8) Develop, enhance, and expand information technologies that support tuberculosis control including surveillance and database management systems 

with cross-jurisdictional capabilities, which shall conform to the standards and 

implementation specifications for such information technologies as recommended by the Secretary.’’; and 

(3) in subsection (d), by adding at the end the following: 

‘‘(3) DETERMINATION OF AMOUNT OF NONFEDERAL CONTRIBUTIONS.— 

‘‘(A) PRIORITY.—In awarding grants under subsection (a) or (b), the Secretary shall give highest priority to an applicant that provides assurances 

that the applicant will contribute non-Federal funds to carry out activities 

under this section, which may be provided directly or through donations 

from public or private entities and may be in cash or in kind, including 

equipment or services. 

‘‘(B) FEDERAL AMOUNTS NOT TO BE INCLUDED AS CONTRIBUTIONS.— 

Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be 

included in determining the amount of non-Federal contributions as described in subparagraph (A).’’. 

Subtitle B—Interagency Collaboration 

SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TUBERCULOSIS AND THE FEDERAL TUBERCULOSIS TASK FORCE. 

(a) IN GENERAL.—Section 317E(f) of the Public Health Service Act (42 U.S.C. 

247b–6(f)) is amended— 

(1) by redesignating paragraph (5) as paragraph (6); and 

(2) by striking paragraphs (2) through (4), and inserting the following: 

‘‘(2) DUTIES.—The Council shall provide advice and recommendations regarding the elimination of tuberculosis to the Secretary. In addition, the Council 

shall, with respect to eliminating such disease, provide to the Secretary and 

other appropriate Federal officials advice on— 

‘‘(A) coordinating the activities of the Department of Health and Human 

Services and other Federal agencies that relate to the disease, including activities under subsection (b); 

‘‘(B) responding rapidly and effectively to emerging issues in tuberculosis; 

and 

‘‘(C) efficiently utilizing the Federal resources involved. 

‘‘(3) COMPREHENSIVE PLAN.— 

‘‘(A) IN GENERAL.—In carrying out paragraph (2), the Council shall make 

or update recommendations on the development, revision, and implementation of a comprehensive plan to eliminate tuberculosis in the United States. 

‘‘(B) CONSULTATION.—In carrying out subparagraph (A), the Council may 

consult with appropriate public and private entities, which may, subject to 

the direction or discretion of the Secretary, include— 

‘‘(i) individuals who are scientists, physicians, laboratorians, and 

other health professionals, who are not officers or employees of the Federal Government and who represent the disciplines relevant to tuberculosis elimination; 


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‘‘(ii) members of public-private partnerships or private entities established to address the elimination of tuberculosis; 

‘‘(iii) members of national and international nongovernmental organizations whose purpose is to eliminate tuberculosis; 

‘‘(iv) members from the general public who are knowledgeable with 

respect to tuberculosis elimination including individuals who have or 

have had tuberculosis; and 

‘‘(v) scientists, physicians, laboratorians, and other health professionals who reside in a foreign country with a substantial incidence or 

prevalence of tuberculosis, and who represent the specialties and disciplines relevant to the research under consideration. 

‘‘(C) CERTAIN COMPONENTS OF PLAN.—In carrying out subparagraph (A), 

the Council shall, subject to the direction or discretion of the Secretary— 

‘‘(i) consider recommendations for the involvement of the United 

States in continuing global and cross-border tuberculosis control activities in countries where a high incidence of tuberculosis directly affects 

the United States; and 

‘‘(ii) review the extent to which progress has been made toward eliminating tuberculosis. 

‘‘(4) BIENNIAL REPORT.— 

‘‘(A) IN GENERAL.—The Council shall submit a biennial report to the Secretary, as determined necessary by the Secretary, on the activities carried 

under this section. Each such report shall include the opinion of the Council 

on the extent to which its recommendations regarding the elimination of tuberculosis have been implemented, including with respect to— 

‘‘(i) activities under subsection (b); and 

‘‘(ii) the national plan referred to in paragraph (3). 

‘‘(B) PUBLIC.—The Secretary shall make a report submitted under subparagraph (A) public. 

‘‘(5) COMPOSITION.—The Council shall be composed of— 

‘‘(A) ex officio representatives from the Centers for Disease Control and 

Prevention, the National Institutes of Health, the United States Agency for 

International Development, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the United StatesMexico Border Health Commission, and other Federal departments and 

agencies that carry out significant activities related to tuberculosis; 

‘‘(B) State and local tuberculosis control and public health officials; 

‘‘(C) individuals who are scientists, physicians, laboratorians, and other 

health professionals who represent disciplines relevant to tuberculosis 

elimination; and 

‘‘(D) members of national and international nongovernmental organizations established to address the elimination of tuberculosis.’’. 

(b) RULE OF CONSTRUCTION REGARDING CURRENT MEMBERSHIP.—With respect to 

the advisory council under section 317E(f) of the Public Health Service Act, the 

amendments made by subsection (a) may not be construed as terminating the membership on such council of any individual serving as such a member as of the day 

before the date of the enactment of this Act. 

(c) FEDERAL TUBERCULOSIS TASK FORCE.—Section 317E of the Public Health Service Act (42 U.S.C. 247b–6) is amended— 

(1) by redesignating subsection (g) as subsection (h); and 

(2) by inserting after subsection (f) the following subsection: 

‘‘(g) FEDERAL TUBERCULOSIS TASK FORCE.— 

‘‘(1) DUTIES.—The Federal Tuberculosis Task Force (in this subsection referred to as the ‘Task Force’) shall provide to the Secretary and other appropriate Federal officials advice on research into new tools under subsection (b)(2), 

including advice regarding the efficient utilization of the Federal resources involved. 

‘‘(2) COMPREHENSIVE PLAN FOR NEW TOOLS DEVELOPMENT.—In carrying out 

paragraph (1), the Task Force shall make recommendations on the development 

of a comprehensive plan for the creation of new tools for the elimination of tuberculosis, including drugs, diagnostics, and vaccines. 

‘‘(3) CONSULTATION.—In developing the comprehensive plan under paragraph 

(1), the Task Force shall consult with external parties including representatives 

from groups such as— 

‘‘(A) scientists, physicians, laboratorians, and other health professionals 

who represent the specialties and disciplines relevant to the research under 

consideration; 


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‘‘(B) members from public-private partnerships, private entities, or foundations (or both) engaged in activities relevant to research under consideration; 

‘‘(C) members of national and international nongovernmental organizations established to address tuberculosis elimination; 

‘‘(D) members from the general public who are knowledgeable with respect to tuberculosis including individuals who have or have had tuberculosis; and 

‘‘(E) scientists, physicians, laboratorians, and other health professionals 

who reside in a foreign country with a substantial incidence or prevalence 

of tuberculosis, and who represent the specialties and disciplines relevant 

to the research under consideration.’’. 

Subtitle C—Evaluation of Public Health 

Authorities 

SEC. 121. EVALUATION OF PUBLIC HEALTH AUTHORITIES. 

(a) IN GENERAL.—Not later than 180 days after the date of enactment of the Comprehensive Tuberculosis Elimination Act of 2008, the Secretary of Health and 

Human Services shall prepare and submit to the appropriate committees of Congress a report that evaluates and provides recommendations on changes needed to 

Federal and State public health authorities to address current disease containment 

challenges such as isolation and quarantine. 

(b) CONTENTS OF EVALUATION.—The report described in subsection (a) shall include— 

(1) an evaluation of the effectiveness of current policies to detain patients 

with active tuberculosis; 

(2) an evaluation of whether Federal laws should be strengthened to expressly 

address the movement of individuals with active tuberculosis; and 

(3) specific legislative recommendations for changes to Federal laws, if any. 

(c) UPDATE OF QUARANTINE REGULATIONS.—Not later than 240 days after the date 

of enactment of this Act, the Secretary of Health and Human Services shall promulgate regulations to update the current interstate and foreign quarantine regulations 

found in parts 70 and 71 of title 42, Code of Federal Regulations. 

Subtitle D—Authorization of Appropriations 

SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS. 

Section 317E of the Public Health Service Act, as amended by section 111(c) of 

this Act, is amended by striking subsection (h) and inserting the following: 

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(1) GENERAL PROGRAM.— ‘‘(A) IN GENERAL.—For the purpose of carrying out this section, there are authorized to be appropriated $300,000,000 for fiscal year 2009, 

$315,000,000 for fiscal year 2010, $330,750,000 for fiscal year 2011, 

$347,287,500 for fiscal year 2012, and $364,651,900 for fiscal year 2013. 

‘‘(B) RESERVATION FOR EMERGENCY GRANTS.—Of the amounts appropriated under subparagraph (A) for a fiscal year, the Secretary may reserve 

not more than 25 percent for emergency grants under subsection (a) for any 

geographic area, State, political subdivision of a State, or other public entity in which there is, relative to other areas, a substantial number of cases 

of tuberculosis, multidrug resistant tuberculosis, or extensively drug resistant tuberculosis or a substantial rate of increase in such cases. 

‘‘(C) PRIORITY.—In allocating amounts appropriated under subparagraph 

(A), the Secretary shall give priority to allocating such amounts for grants 

under subsection (a). 

‘‘(D) ALLOCATION OF FUNDS.— ‘‘(i) REQUIREMENT OF FORMULA.—Of the amounts appropriated under 

subparagraph (A), not reserved under subparagraph (B), and allocated 

by the Secretary for grants under subsection (a), the Secretary shall 

distribute a portion of such amounts to grantees under subsection (a) 

on the basis of a formula. 

‘‘(ii) RELEVANT FACTORS.—The formula developed by the Secretary 

under clause (i) shall take into account the level of tuberculosis morbidity and case complexity in the respective geographic area and may 

consider other factors relevant to tuberculosis in such area. 


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‘‘(iii) NO CHANGE TO FORMULA REQUIRED.—This subparagraph does 

not require the Secretary to modify the formula that was used by the 

Secretary to distribute funds to grantees under subsection (a) for fiscal 

year 2009. 

‘‘(2) LIMITATION.—The authorization of appropriations established in paragraph (1) for a fiscal year is effective only if the amount appropriated under 

such paragraph for such year equals or exceeds the amount appropriated to 

carry out this section for fiscal year 2009.’’. 

TITLE II—NATIONAL INSTITUTES OF HEALTH 

SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TUBERCULOSIS. 

Subpart 2 of part C of title IV of the Public Health Service Act (42 U.S.C. 285b 

et seq.) is amended by inserting after section 424B the following section: 

‘‘SEC. 424C. TUBERCULOSIS. 

‘‘(a) IN GENERAL.—The Director of the National Institutes of Health may expand, 

intensify, and coordinate research and development and related activities of the Institutes with respect to tuberculosis including activities toward the goal of eliminating such disease. 

‘‘(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may include— 

‘‘(1) enhancing basic and clinical research on tuberculosis, including drug resistant tuberculosis; 

‘‘(2) expanding research on the relationship between such disease and the 

human immunodeficiency virus; and 

‘‘(3) developing new tools for the elimination of tuberculosis, including public 

health interventions and methods to enhance detection and response to outbreaks of tuberculosis, including multidrug resistant tuberculosis.’’. 

PURPOSE AND SUMMARY

The purpose of H.R. 1532, the Comprehensive Tuberculosis 

Elimination Act of 2008, is to amend the Public Health Service Act 

with respect to making progress toward the goal of eliminating tuberculosis, and for other purposes. 

BACKGROUND AND NEED FOR LEGISLATION

Tuberculosis (TB), a chronic bacterial infection, continues to be 

a worldwide problem. Tuberculosis is spread through the air when 

an infected person coughs, sneezes, or speaks. It usually infects the 

lungs; however, it can also damage other parts of the body. Nearly 

2 billion people, including 10 to 15 million in the United States, are 

infected and approximately 8 million new cases and 1.6 million tuberculosis deaths are reported globally each year. Tuberculosis 

causes more deaths than any other infectious disease caused by a 

single microorganism. Tuberculosis is the leading cause of death 

among the 40 million people living with human immunodeficiency 

virus (HIV), approximately one-third of whom are co-infected with 

TB. 

An emerging public health concern is the increase in the number 

of cases of multidrug-resistant tuberculosis, a form of the disease 

that is resistant to several of the standard therapeutic drugs. Recently, there has also been an increase in the number of cases of 

extensively drug-resistant tuberculosis, which is resistant to four or 

more standard drugs. 

A May 2000 Institute for Medicine (IOM) report entitled ‘‘Ending 

Neglect: The Elimination of Tuberculosis in the U.S.’’ found that 

the resurgence of tuberculosis in the late 1980s and early 1990s 

was largely due to Federal funding reductions. According to the 

Centers for Disease Control and Prevention (CDC), however, intenVerDate Aug 31 2005 02:16 Sep 29, 2008 Jkt 069006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR873.XXX HR873

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sive efforts brought the disease under control again and the Nation 

is back on track toward its goal of eliminating tuberculosis. In 

2006, the lowest number of U.S. cases (13,779) was reported. Since 

the 1992 TB resurgence peak in the United States, the number of 

TB cases reported annually has decreased by 48 percent. In addition, the case rate is the lowest ever, at 4.6 cases per 100,000 people. Yet, the high global burden of disease, coupled with continued 

problems of drug-resistant strains and a failure to develop better 

tools for TB control, threaten our ability to eliminate TB in the 

U.S. and hamper efforts to control TB globally as the decreasing 

trend in the annual case rate has slowed from an annual average 

decline of 6.6 percent for 1993 through 2002 to an annual average 

decline of 3.1 percent for 2003 through 2006. 

The IOM report also stated that proper funding, the organization 

of prevention and control activities, and the research and development of new tools could eliminate tuberculosis as a public health 

problem in the U.S. As a result, research aimed at the diagnosis, 

treatment, and prevention of all forms of tuberculosis and the care 

of infected individuals continues to be of interest to Congress. 

HEARINGS

No hearings were held in connection with H.R. 1532. 

COMMITTEE CONSIDERATION

On Wednesday, September 17, 2008, the full Committee met in 

open markup session and ordered H.R. 1532 favorably reported to 

the House, amended, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. No record votes were 

taken on amendments or in connection with ordering H.R. 1532 reported to the House. A motion by Mr. Dingell to order H.R. 1532 

favorably reported to the House, amended, was agreed to by a voice 

vote. 

COMMITTEE OVERSIGHT FINDINGS

Regarding clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings of the Committee regarding H.R. 1532 are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The objective of H.R. 1532 is to amend the Public Health Service 

Act to (1) reauthorize and modify a grant program for the prevention, treatment, control, and elimination of tuberculosis; (2) create 

a new Federal Tuberculosis Task Force; and (3) encourage the Director of the National Institutes of Health (NIH) to expand, intensify, and coordinate research and development and related activities with respect to tuberculosis, including activities related to the 

goal of eliminating the disease. 


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NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

Regarding compliance with clause 3(c)(2) of rule XIII of the Rules 

of the House of Representatives, the Committee finds that H.R. 

1532 would result in no new or increased budget authority, entitlement authority, or tax expenditures or revenues. 

EARMARKS AND TAX AND TARIFF BENEFITS

Regarding compliance with clause 9 of rule XXI of the Rules of 

the House of Representatives, H.R. 1532 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits 

as defined in clause 9(d), 9(e), or 9(f) of rule XXI. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 1532 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate on H.R. 1532 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 22, 2008. 

Hon. JOHN D. DINGELL, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1532, the Comprehensive 

Tuberculosis Elimination Act of 2008. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Jamease Kowalczyk. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

Enclosure. 

H.R. 1532—Comprehensive Tuberculosis Elimination Act of 2008 

H.R. 1532 would authorize the Secretary of Health and Human 

Services to conduct planning, research, and development activities 

to detect, treat, and eliminate tuberculosis, and to provide grants 

to public or nonprofit entities to carry out related research and development activities. The bill also would direct the Secretary to 

issue updated regulations regarding quarantine for communicable 

diseases. 

The bill would authorize the appropriation of $300 million for fiscal year 2009 and about $1.7 billion for the 2009–2013 period. 

Based on past spending for similar activities, CBO estimates that 

implementing H.R. 1532 would cost $111 million in 2009 and about 

$1.3 billion over the 2009–2013 period, assuming the appropriation 


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of authorized amounts. Enacting H.R. 1532 would have no effect on 

direct spending or receipts. Costs of the legislation fall within 

budget function 550 (health). 

By fiscal year, in millions of dollars— 

2009 2010 2011 2012 2013 2009– 

2013 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ............................................................................... 300 315 331 347 365 1,658 

Estimated Outlays ................................................................................ 111 253 302 327 347 1,340 

H.R. 1532 contains no intergovernmental or private-sector mandates as defined in Unfunded Mandates Reform Act. 

The CBO staff contact for this estimate is Jamease Kowalczyk, 

who can be reached at 226–9010. This estimate was approved by 

Keith J. Fontenot, Deputy Assistant Director for Health and 

Human Resources, Budget Analysis Division. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 1532 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 1532. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 1532 is provided in the provisions of Article I, section 8, clause 1, that relate to expending funds to provide for the 

general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 1532 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act of 1995. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title; table of contents 

Section establishes the short title of the bill as the ‘‘Comprehensive Tuberculosis Elimination Act of 2008’’, and also provides the 

table of contents. 


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Title I—Department of Health and Human Services in Coordination with the Centers for Disease Control and Prevention and 

Other Appropriate Agencies 

Subtitle A—National Strategy for Combating and Eliminating 

Tuberculosis 

Section 101. National strategy 

Section 101 amends Section 317E of the Public Health Service 

Act (42 U.S.C. 247b–6) to strike the existing title and replace it 

with, ‘‘National Strategy for Combating and Eliminating Tuberculosis.’’ 

In addition, section 101 states that, with respect to the prevention, treatment, control, and elimination of tuberculosis, the Secretary may, directly or through grants to public or nonprofit private entities, carry out additional activities including (1) research 

and development, with priority given to projects concerning latent 

tuberculosis infection, strains of tuberculosis resistant to drugs, 

and cases of tuberculosis that affect certain at-risk populations and 

(2) research and development and related activities concerning the 

development of new tools for the elimination of tuberculosis, such 

as directly observed therapy and non-pharmaceutical intervention 

and methods to enhance detection and response to outbreaks of tuberculosis. In doing so, the Secretary is encouraged to give priority 

to programmatically relevant research. 

Section 101 states that demonstration projects shall be for the 

development of regional capabilities to prevent, control, and eliminate tuberculosis and prevent multidrug-resistant and extensively 

drug-resistant strains of tuberculosis. In addition, demonstration 

projects shall be for the intensification of efforts to reduce disparities in the incidence of tuberculosis among United States-Mexico 

bi-national populations and to control tuberculosis along the United 

States-Mexico border. Demonstration projects shall also be for the 

intensification of efforts to prevent, detect, and treat tuberculosis 

among foreign-born persons who are living in the United States 

and among other high-risk populations and settings. 

Section 101 also requires that, with respect to the prevention, 

treatment, control, and elimination of tuberculosis, the Secretary 

may carry out activities relating to workplace exposure prevention 

for health professionals. The Secretary may also develop, enhance, 

and expand information technologies that support tuberculosis control such as surveillance and database management systems with 

cross-jurisdictional capabilities. 

In awarding grants in this section, the Secretary shall give highest priority to an applicant that provides assurances that they will 

contribute non-Federal funds to carry out the activities. These nonFederal funds may be provided directly or through donations from 

public or private entities and may be in cash or in kind, including 

equipment and services. Finally, section 101 clarifies that amounts 

provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may 

not be included in determining the amount of non-Federal contributions. 


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Subtitle B—Interagency Collaboration 

Section 111. Advisory Council for Elimination of Tuberculosis and 

the Federal Tuberculosis Task Force 

Section 111 amends section 317E(f) of the Public Health Service 

Act (42 U.S.C. 247b–6(f)) by modifying the structure and duties of 

the Advisory Council for the Elimination of Tuberculosis. Section 

111 establishes both the composition of the Advisory Council and 

the specific duties for the Advisory Council, which include providing advice and recommendations regarding the elimination of 

tuberculosis to the Secretary. In addition, the Advisory Council 

shall provide advice on coordinating the activities of Federal agencies that relate to tuberculosis, respond rapidly and effectively to 

emerging issues relating to tuberculosis, and efficiently utilize the 

Federal resources involved. 

Section 111 establishes a Comprehensive Plan which requires the 

Advisory Council to make or update recommendations on the development, revision, and implementation of a strategy to eliminate tuberculosis in the United States. In carrying out this task, the Advisory Council may consult with appropriate public and private entities, subject to the direction or discretion of the Secretary. In addition, the Advisory Council shall, subject to the discretion of the 

Secretary, consider recommendations for continuing the involvement of the United States in global and cross-border tuberculosis 

control activities in countries where a high incidence of tuberculosis directly affects the United States. The Advisory Council 

shall review the extent to which progress has been made toward 

eliminating tuberculosis with regard to these cross-border control 

activities. 

Section 111 requires the Advisory Council to submit a biennial 

report to the Secretary, if the Secretary determines it necessary, on 

the activities carried out under this section. The report shall include the opinion of the Advisory Council on the extent to which 

its recommendations regarding the elimination of tuberculosis have 

been implemented. The Secretary shall make this report public. 

Section 111 creates a Federal Tuberculosis Task Force. The Task 

Force is required to provide the Secretary, and other appropriate 

Federal officials, advice on research into new tools for the elimination of tuberculosis, including advice regarding the efficient utilization of the Federal resources involved. In carrying out these activities, the Task Force shall make recommendations on the development of a comprehensive plan for the creation of new tools for 

the elimination of tuberculosis, including drugs, diagnostics, and 

vaccines. In developing this comprehensive plan, the Task Force 

shall consult with external parties. 

Subtitle C—Evaluation of Public Health Authorities 

Section 121. Evaluation of public health authorities 

Section 121 requires the HHS Secretary to prepare and submit 

a report to Congress, which evaluates and provides recommendations on changes needed to Federal and State public health authorities to address current disease containment challenges such as 

isolation and quarantine. The report shall include an evaluation of 

the effectiveness of current policies to detain patients with active 


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12 

tuberculosis, an evaluation of whether Federal laws should be 

strengthened to expressly address the movement of individuals 

with active tuberculosis, and specific legislative recommendations 

for changes to Federal laws, if any. This report shall be submitted 

to Congress no later than 180 days after the date of enactment of 

this Act. 

In addition, Section 121 requires the Secretary of HHS to promulgate regulations to update current interstate and foreign quarantine regulations within 240 days of the date of enactment of this 

Act. 

Subtitle D—Authorization of Appropriations 

Section 131. Authorization of appropriations 

Section 131 amends section 317E of the Public Health Service 

Act to provide updated and modified authorization of appropriations. Section 131 authorizes to be appropriated $300,000,000 for 

fiscal year 2009 with 5 percent increases per year for each of fiscal 

years 2010 through 2013. Of amounts appropriated for a fiscal 

year, the Secretary may reserve not more than 25 percent for emergency grants. 

Title II—National Institutes of Health 

Section 201. Research and development concerning tuberculosis 

Section 201 amends Subpart 2 of part C of title IV of the Public 

Health Service Act (42 U.S.C. 285b et seq.) to include a new section 

which states that the Director of the National Institutes of Health 

(NIH) may expand, intensify, and coordinate research and development and related activities of the Institutes with respect to tuberculosis, including activities related to the goal of eliminating the 

disease. Such activities may include enhancing basic and clinical 

research on tuberculosis, expanding research on the relationship 

between tuberculosis and the human immunodeficiency virus, and 

developing new tools for the elimination of tuberculosis, including 

public health interventions and methods to enhance detection and 

response to outbreaks of tuberculosis. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART B—FEDERAL-STATE COOPERATION

* * * * * * * 


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øPREVENTIVE HEALTH SERVICES REGARDING TUBERCULOSIS¿ 

NATIONAL STRATEGY FOR COMBATING AND ELIMINATING

TUBERCULOSIS

SEC. 317E. (a) * * * 

ø(b) RESEARCH, DEMONSTRATION PROJECTS, EDUCATION, AND

TRAINING.—With respect to the prevention, control, and elimination 

of tuberculosis, the Secretary may, directly or through grants to 

public or nonprofit private entities, carry out the following: 

ø(1) Research, with priority given to research concerning 

strains of tuberculosis resistant to drugs and research concerning cases of tuberculosis that affect certain populations. 

ø(2) Demonstration projects. 

ø(3) Public information and education programs. 

ø(4) Education, training, and clinical skills improvement activities for health professionals, including allied health personnel and emergency response employees. 

ø(5) Support of centers to carry out activities under paragraphs (1) through (4). 

ø(6) Collaboration with international organizations and foreign countries in carrying out such activities.¿ 

(b) RESEARCH AND DEVELOPMENT; DEMONSTRATION PROJECTS; 

EDUCATION AND TRAINING.—With respect to the prevention, treatment, control, and elimination of tuberculosis, the Secretary may, 

directly or through grants to public or nonprofit private entities, 

carry out the following: 

(1) Research, with priority given to research and development 

concerning latent tuberculosis infection, strains of tuberculosis 

resistant to drugs, and research concerning cases of tuberculosis 

that affect certain populations at risk for tuberculosis. 

(2) Research and development and related activities to develop new tools for the elimination of tuberculosis, including 

drugs, diagnostics, vaccines, and public health interventions, 

such as directly observed therapy and non-pharmaceutical 

intervention, and methods to enhance detection and response to 

outbreaks of tuberculosis, including multidrug resistant tuberculosis. The Secretary is encouraged to give priority to programmatically relevant research so that new tools can be utilized in 

public health practice. 

(3) Demonstration projects for— 

(A) the development of regional capabilities to prevent, 

control, and eliminate tuberculosis and prevent multidrug 

resistant and extensively drug resistant strains of tuberculosis; 

(B) the intensification of efforts to reduce health disparities in the incidence of tuberculosis; 

(C) the intensification of efforts to control tuberculosis 

along the United States-Mexico border and among United 

States-Mexico binational populations, including through 

expansion of the scope and number of programs that— 

(i) detect and treat binational cases of tuberculosis; 

and 

(ii) treat high-risk cases of tuberculosis referred from 

Mexican health departments; 


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14 

(D) the intensification of efforts to prevent, detect, and 

treat tuberculosis among foreign-born persons who are in 

the United States; 

(E) the intensification of efforts to prevent, detect, and 

treat tuberculosis among populations and settings documented as having a high risk for tuberculosis; and 

(F) tuberculosis detection, control, and prevention. 

(4) Public information and education activities. 

(5) Education, training, clinical skills improvement activities, 

and workplace exposure prevention for health professionals, including allied health personnel and emergency response employees. 

(6) Support of Centers to carry out activities under paragraphs (1) through (4). 

(7) Collaboration with international organizations and foreign countries in carrying out such activities. 

(8) Develop, enhance, and expand information technologies 

that support tuberculosis control including surveillance and 

database management systems with cross-jurisdictional capabilities, which shall conform to the standards and implementation specifications for such information technologies as recommended by the Secretary. 

* * * * * * * 

(d) APPLICATION FOR GRANT.— 

(1) * * * 

* * * * * * * 

(3) DETERMINATION OF AMOUNT OF NONFEDERAL CONTRIBU- TIONS.— 

(A) PRIORITY.—In awarding grants under subsection (a) 

or (b), the Secretary shall give highest priority to an applicant that provides assurances that the applicant will contribute non-Federal funds to carry out activities under this 

section, which may be provided directly or through donations from public or private entities and may be in cash or 

in kind, including equipment or services. 

(B) FEDERAL AMOUNTS NOT TO BE INCLUDED AS CONTRIBUTIONS.—Amounts provided by the Federal Government, or services assisted or subsidized to any significant 

extent by the Federal Government, may not be included in 

determining the amount of non-Federal contributions as described in subparagraph (A). 

* * * * * * * 

(f) ADVISORY COUNCIL.— 

(1) * * * 

ø(2) GENERAL DUTIES.—The Council shall provide advice and 

recommendations regarding the elimination of tuberculosis to 

the Secretary, the Assistant Secretary for Health, and the Director of the Centers for Disease Control and Prevention. 

ø(3) CERTAIN ACTIVITIES.—With respect to the elimination of 

tuberculosis, the Council shall— 

ø(A) in making recommendations under paragraph (2), 

make recommendations regarding policies, strategies, objectives, and priorities; 


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15 

ø(B) address the development and application of new 

technologies; and 

ø(C) review the extent to which progress has been made 

toward eliminating tuberculosis. 

ø(4) COMPOSITION.—The Secretary shall determine the size 

and composition of the Council, and the frequency and scope 

of official meetings of the Council.¿ 

(2) DUTIES.—The Council shall provide advice and recommendations regarding the elimination of tuberculosis to the 

Secretary. In addition, the Council shall, with respect to eliminating such disease, provide to the Secretary and other appropriate Federal officials advice on— 

(A) coordinating the activities of the Department of 

Health and Human Services and other Federal agencies 

that relate to the disease, including activities under subsection (b); 

(B) responding rapidly and effectively to emerging issues 

in tuberculosis; and 

(C) efficiently utilizing the Federal resources involved. 

(3) COMPREHENSIVE PLAN.— 

(A) IN GENERAL.—In carrying out paragraph (2), the 

Council shall make or update recommendations on the development, revision, and implementation of a comprehensive plan to eliminate tuberculosis in the United States. 

(B) CONSULTATION.—In carrying out subparagraph (A), 

the Council may consult with appropriate public and private entities, which may, subject to the direction or discretion of the Secretary, include— 

(i) individuals who are scientists, physicians, 

laboratorians, and other health professionals, who are 

not officers or employees of the Federal Government 

and who represent the disciplines relevant to tuberculosis elimination; 

(ii) members of public-private partnerships or private 

entities established to address the elimination of tuberculosis; 

(iii) members of national and international nongovernmental organizations whose purpose is to eliminate tuberculosis; 

(iv) members from the general public who are knowledgeable with respect to tuberculosis elimination including individuals who have or have had tuberculosis; and 

(v) scientists, physicians, laboratorians, and other 

health professionals who reside in a foreign country 

with a substantial incidence or prevalence of tuberculosis, and who represent the specialties and disciplines relevant to the research under consideration. 

(C) CERTAIN COMPONENTS OF PLAN.—In carrying out subparagraph (A), the Council shall, subject to the direction or 

discretion of the Secretary— 

(i) consider recommendations for the involvement of 

the United States in continuing global and cross-border tuberculosis control activities in countries where a 


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16 

high incidence of tuberculosis directly affects the 

United States; and 

(ii) review the extent to which progress has been 

made toward eliminating tuberculosis. 

(4) BIENNIAL REPORT.— 

(A) IN GENERAL.—The Council shall submit a biennial 

report to the Secretary, as determined necessary by the Secretary, on the activities carried under this section. Each 

such report shall include the opinion of the Council on the 

extent to which its recommendations regarding the elimination of tuberculosis have been implemented, including 

with respect to— 

(i) activities under subsection (b); and 

(ii) the national plan referred to in paragraph (3). 

(B) PUBLIC.—The Secretary shall make a report submitted under subparagraph (A) public. 

(5) COMPOSITION.—The Council shall be composed of— 

(A) ex officio representatives from the Centers for Disease 

Control and Prevention, the National Institutes of Health, 

the United States Agency for International Development, 

the Agency for Healthcare Research and Quality, the 

Health Resources and Services Administration, the United 

States-Mexico Border Health Commission, and other Federal departments and agencies that carry out significant 

activities related to tuberculosis; 

(B) State and local tuberculosis control and public health 

officials; 

(C) individuals who are scientists, physicians, 

laboratorians, and other health professionals who represent 

disciplines relevant to tuberculosis elimination; and 

(D) members of national and international nongovernmental organizations established to address the elimination 

of tuberculosis. 

ø(5)¿ (6) STAFF, INFORMATION, AND OTHER ASSISTANCE.—The 

Secretary shall provide to the Council such staff, information, 

and other assistance as may be necessary to carry out the duties of the Council. 

ø(g) FUNDING.— 

ø(1) IN GENERAL; ALLOCATION FOR EMERGENCY GRANTS.— 

ø(A) For the purpose of making grants under subsection 

(a), there are authorized to be appropriated $200,000,000 

for fiscal year 1994, and such sums as may be necessary 

for each of the fiscal years 1995 through 2002. 

ø(B) Of the amounts appropriated under subparagraph 

(A) for a fiscal year, the Secretary may reserve not more 

than 25 percent for emergency grants under subsection (a) 

for any geographic area in which there is, relative to other 

areas, a substantial number of cases of tuberculosis or a 

substantial rate of increase in such cases. 

ø(2) RESEARCH, DEMONSTRATION PROJECTS, EDUCATION, AND

TRAINING.—For the purpose of carrying out subsection (b), 

there are authorized to be appropriated such sums as may be 

necessary for each of the fiscal years 1994 through 2002.¿ 

(g) FEDERAL TUBERCULOSIS TASK FORCE.— 


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17 

(1) DUTIES.—The Federal Tuberculosis Task Force (in this 

subsection referred to as the ‘‘Task Force’’) shall provide to the 

Secretary and other appropriate Federal officials advice on research into new tools under subsection (b)(2), including advice 

regarding the efficient utilization of the Federal resources involved. 

(2) COMPREHENSIVE PLAN FOR NEW TOOLS DEVELOPMENT.—In 

carrying out paragraph (1), the Task Force shall make recommendations on the development of a comprehensive plan for 

the creation of new tools for the elimination of tuberculosis, including drugs, diagnostics, and vaccines. 

(3) CONSULTATION.—In developing the comprehensive plan 

under paragraph (1), the Task Force shall consult with external 

parties including representatives from groups such as— 

(A) scientists, physicians, laboratorians, and other health 

professionals who represent the specialties and disciplines 

relevant to the research under consideration; 

(B) members from public-private partnerships, private 

entities, or foundations (or both) engaged in activities relevant to research under consideration; 

(C) members of national and international nongovernmental organizations established to address tuberculosis 

elimination; 

(D) members from the general public who are knowledgeable with respect to tuberculosis including individuals who 

have or have had tuberculosis; and 

(E) scientists, physicians, laboratorians, and other health 

professionals who reside in a foreign country with a substantial incidence or prevalence of tuberculosis, and who 

represent the specialties and disciplines relevant to the research under consideration. 

(h) AUTHORIZATION OF APPROPRIATIONS.— 

(1) GENERAL PROGRAM.— (A) IN GENERAL.—For the purpose of carrying out this 

section, there are authorized to be appropriated 

$300,000,000 for fiscal year 2009, $315,000,000 for fiscal 

year 2010, $330,750,000 for fiscal year 2011, $347,287,500 

for fiscal year 2012, and $364,651,900 for fiscal year 2013. 

(B) RESERVATION FOR EMERGENCY GRANTS.—Of the 

amounts appropriated under subparagraph (A) for a fiscal 

year, the Secretary may reserve not more than 25 percent 

for emergency grants under subsection (a) for any geographic area, State, political subdivision of a State, or 

other public entity in which there is, relative to other areas, 

a substantial number of cases of tuberculosis, multidrug resistant tuberculosis, or extensively drug resistant tuberculosis or a substantial rate of increase in such cases. 

(C) PRIORITY.—In allocating amounts appropriated 

under subparagraph (A), the Secretary shall give priority to 

allocating such amounts for grants under subsection (a). 

(D) ALLOCATION OF FUNDS.— (i) REQUIREMENT OF FORMULA.—Of the amounts appropriated under subparagraph (A), not reserved under 

subparagraph (B), and allocated by the Secretary for 

grants under subsection (a), the Secretary shall disVerDate Aug 31 2005 02:16 Sep 29, 2008 Jkt 069006 PO 00000 Frm 00017 Fmt 6659 Sfmt 6603 E:\HR\OC\HR873.XXX HR873

bajohnson on PROD1PC77 with REPORTS
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tribute a portion of such amounts to grantees under 

subsection (a) on the basis of a formula. 

(ii) RELEVANT FACTORS.—The formula developed by 

the Secretary under clause (i) shall take into account 

the level of tuberculosis morbidity and case complexity 

in the respective geographic area and may consider 

other factors relevant to tuberculosis in such area. 

(iii) NO CHANGE TO FORMULA REQUIRED.—This subparagraph does not require the Secretary to modify the 

formula that was used by the Secretary to distribute 

funds to grantees under subsection (a) for fiscal year 

2009. 

(2) LIMITATION.—The authorization of appropriations established in paragraph (1) for a fiscal year is effective only if the 

amount appropriated under such paragraph for such year 

equals or exceeds the amount appropriated to carry out this section for fiscal year 2009. 

* * * * * * * 

TITLE IV—NATIONAL RESEARCH INSTITUTES 

* * * * * * * 

PART C—SPECIFIC PROVISIONS RESPECTING NATIONAL RESEARCH

INSTITUTES

* * * * * * * 

SEC. 424C. TUBERCULOSIS. 

(a) IN GENERAL.—The Director of the National Institutes of 

Health may expand, intensify, and coordinate research and development and related activities of the Institutes with respect to tuberculosis including activities toward the goal of eliminating such disease. 

(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may include— 

(1) enhancing basic and clinical research on tuberculosis, including drug resistant tuberculosis; 

(2) expanding research on the relationship between such disease and the human immunodeficiency virus; and 

(3) developing new tools for the elimination of tuberculosis, 

including public health interventions and methods to enhance 

detection and response to outbreaks of tuberculosis, including 

multidrug resistant tuberculosis. 

* * * * * * * 

Æ 


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