II 

116TH CONGRESS 

2D SESSION S. 4562 

To amend the Public Health Service Act with respect to the collection and 

availability of health data with respect to Indian Tribes and Tribal 

organizations, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 10, 2020 

Ms. SMITH (for herself, Ms. MURKOWSKI, Mr. TESTER, Mr. DAINES, Ms. 

WARREN, and Mr. CRAMER) introduced the following bill; which was read 

twice and referred to the Committee on Indian Affairs 

A BILL 

To amend the Public Health Service Act with respect to 

the collection and availability of health data with respect 

to Indian Tribes and Tribal organizations, and for other 

purposes. 

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 ‘‘Tribal Health Data 

5 Improvement Act of 2020’’. 


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1 SEC. 2. COLLECTION AND AVAILABILITY OF HEALTH DATA 

2 WITH RESPECT TO INDIAN TRIBES. 

3 (a) DATA COLLECTION.—Section 3101(a)(1) of the 

4 Public Health Service Act (42 U.S.C. 300kk(a)(1)) is 

5 amended— 

6 (1) by striking ‘‘, by not later than 2 years 

7 after the date of enactment of this title,’’; and 

8 (2) in subparagraph (B), by inserting ‘‘Tribal,’’ 

9 after ‘‘State,’’. 

10 (b) DATA REPORTING AND DISSEMINATION.—Sec11 tion 3101(c) of the Public Health Service Act (42 U.S.C. 

12 300kk(c)) is amended— 

13 (1) by amending subparagraph (F) of para14 graph (1) to read as follows: 

15 ‘‘(F) the Indian Health Service, Indian 

16 Tribes, Tribal organizations, and epidemiology 

17 centers;’’; and 

18 (2) in paragraph (3), by inserting ‘‘Indian 

19 Tribes, Tribal organizations, epidemiology centers,’’ 

20 after ‘‘Federal agencies,’’. 

21 (c) PROTECTION AND SHARING OF DATA.—Section 

22 3101(e) of the Public Health Service Act (42 U.S.C. 

23 300kk(e)) is amended— 

24 (1) in paragraph (2)— 

25 (A) by striking ‘‘..’’ and inserting ‘‘.’’; 


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1 (B) by striking ‘‘The Secretary shall’’ and 

2 inserting the following: 

3 ‘‘(A) IN GENERAL.—The Secretary shall’’; 

4 and 

5 (C) by adding at the end the following: 

6 ‘‘(B) EPIDEMIOLOGY CENTERS AND IN7 DIAN TRIBES.—With respect to data access for 

8 epidemiology centers and Indian Tribes, the 

9 Secretary shall establish a data sharing strat10 egy, in consultation with the Secretary’s Tribal 

11 Advisory Committee, for purposes of providing 

12 access to data to the epidemiology centers and 

13 Indian Tribes that protect data privacy and se14 curity and data governance while ensuring that 

15 epidemiology centers and Indian Tribes have 

16 access to data sources necessary to accomplish 

17 their public health responsibilities and plans for 

18 use.’’; and 

19 (2) by adding at the end the following new 

20 paragraph: 

21 ‘‘(3) TRIBAL PUBLIC HEALTH AUTHORITY.— 

22 Beginning not later than 180 days after the date of 

23 the enactment of the Tribal Health Data Improve24 ment Act of 2020, the Secretary shall make avail25 able all requested data collected pursuant to this 


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1 title with respect to health care and public health 

2 surveillance programs and activities, including such 

3 programs and activities that are federally supported 

4 or conducted, to— 

5 ‘‘(A) the Indian Health Service; 

6 ‘‘(B) Indian Tribes and Tribal organiza7 tions; and 

8 ‘‘(C) epidemiology centers.’’. 

9 (d) TECHNICAL UPDATES.—Section 3101 of the 

10 Public Health Service Act (42 U.S.C. 300kk) is amend11 ed— 

12 (1) by striking subsections (g) and (h); and 

13 (2) by redesignating subsection (i) as subsection 

14 (h). 

15 (e) DEFINITIONS.—After executing the amendments 

16 made by subsection (d), section 3101 of the Public Health 

17 Service Act (42 U.S.C. 300kk) is amended by inserting 

18 after subsection (f) the following new subsection: 

19 ‘‘(g) DEFINITIONS.—In this section: 

20 ‘‘(1) The term ‘epidemiology center’ means an 

21 epidemiology center established under section 214 of 

22 the Indian Health Care Improvement Act, including 

23 any epidemiology center serving Indian Tribes re24 gionally or serving urban Indian organizations naVerDate Sep 11 2014 18:12 Sep 11, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4562.IS S4562

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1 tionally that is receiving funding from the Indian 

2 Health Service. 

3 ‘‘(2) The terms ‘Indian Tribe’ and ‘Tribal orga4 nization’ have the meanings given to the terms ‘In5 dian tribe’ and ‘tribal organization’, respectively, in 

6 section 4 of the Indian Self-Determination and Edu7 cation Assistance Act.’’. 

8 (f) TECHNICAL CORRECTION.—Section 3101(b) of 

9 the Public Health Service Act (42 U.S.C. 300kk(b)) is 

10 amended by striking ‘‘DATA ANALYSIS.—’’ and all that 

11 follows through ‘‘For each federally’’ and inserting ‘‘DATA

12 ANALYSIS.—For each federally’’. 

13 SEC. 3. IMPROVING HEALTH STATISTICS REPORTING WITH 

14 RESPECT TO INDIAN TRIBES. 

15 (a) TECHNICAL AID TO STATES AND LOCALITIES.— 

16 Section 306(d) of the Public Health Service Act (42 

17 U.S.C. 242k(d)) is amended by inserting ‘‘, Indian Tribes, 

18 Tribal organizations, and epidemiology centers’’ after ‘‘ju19 risdictions’’. 

20 (b) COOPERATIVE HEALTH STATISTICS SYSTEM.— 

21 Section 306(e)(3) of the Public Health Service Act (42 

22 U.S.C. 242k(e)(3)) is amended by inserting ‘‘, Indian 

23 Tribes, Tribal organizations, and epidemiology centers’’ 

24 after ‘‘health agencies’’. 


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1 (c) FEDERAL-STATE-TRIBAL COOPERATION.—Sec2 tion 306(f) of the Public Health Service Act (42 U.S.C. 

3 242k(f)) is amended— 

4 (1) by inserting ‘‘, the Indian Health Service,’’ 

5 after ‘‘Commerce and Labor’’; 

6 (2) by inserting a comma after ‘‘the Depart7 ments of Commerce and Labor’’; 

8 (3) by inserting ‘‘, Indian Tribes, Tribal organi9 zations, and epidemiology centers’’ after ‘‘State and 

10 local health departments and agencies’’; and 

11 (4) by striking ‘‘he shall’’ and inserting ‘‘the 

12 Secretary shall’’. 

13 (d) REGISTRATION AREA RECORDS.—Section 

14 306(h)(1) of the Public Health Service Act (42 U.S.C. 

15 242k(h)(1)) is amended— 

16 (1) by striking ‘‘in his discretion’’ and inserting 

17 ‘‘in the discretion of the Secretary’’; and 

18 (2) by striking ‘‘Hispanics, Asian Americans, 

19 and Pacific Islanders’’ and inserting ‘‘American In20 dians and Alaska Natives, Hispanics, Asians, and 

21 Native Hawaiian and other Pacific Islanders’’. 

22 (e) NATIONAL COMMITTEE ON VITAL AND HEALTH

23 STATISTICS.—Section 306(k) of the Public Health Service 

24 Act (42 U.S.C. 242k(k)) is amended— 


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1 (1) in paragraph (3), by striking ‘‘, not later 

2 than 60 days after the date of the enactment of the 

3 Health Insurance Portability and Accountability Act 

4 of 1996,’’ each place it appears; and 

5 (2) in paragraph (7), by striking ‘‘Not later 

6 than 1 year after the date of the enactment of the 

7 Health Insurance Portability and Accountability Act 

8 of 1996, and annually thereafter, the Committee 

9 shall’’ and inserting ‘‘The Committee shall, on a bi10 ennial basis,’’. 

11 (f) GRANTS FOR ASSEMBLY AND ANALYSIS OF DATA

12 ON ETHNIC AND RACIAL POPULATIONS.—Section 

13 306(m)(4) of the Public Health Service Act (42 U.S.C. 

14 242k(m)(4)) is amended— 

15 (1) in subparagraph (A)— 

16 (A) by striking ‘‘Subject to subparagraph 

17 (B), the’’ and inserting ‘‘The’’; and 

18 (B) by striking ‘‘and major Hispanic sub19 population groups and American Indians’’ and 

20 inserting ‘‘, major Hispanic subgroups, and 

21 American Indians and Alaska Natives’’; and 

22 (2) by amending subparagraph (B) to read as 

23 follows: 


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1 ‘‘(B) In carrying out subparagraph (A), with respect 

2 to American Indians and Alaska Natives, the Secretary 

3 shall— 

4 ‘‘(i) in consultation with Indian Tribes, Tribal 

5 organizations, the Tribal Technical Advisory Group 

6 of the Centers for Medicare & Medicaid Services 

7 maintained under section 5006(e) of the American 

8 Recovery and Reinvestment Act of 2009, and the 

9 Tribal Advisory Committee established by the Cen10 ters for Disease Control and Prevention, and in co11 ordination with epidemiology centers, develop guid12 ance for State and local health agencies to improve 

13 the quality and accuracy of data with respect to the 

14 birth and death records of American Indians and 

15 Alaska Natives; 

16 ‘‘(ii) confer with urban Indian organizations to 

17 develop guidance for State and local health agencies 

18 to improve the quality and accuracy of data with re19 spect to the birth and death records of American In20 dians and Alaska Natives; 

21 ‘‘(iii) enter into cooperative agreements with In22 dian Tribes, Tribal organizations, Urban Indian or23 ganizations, and epidemiology centers to analyze and 

24 address misclassification and undersampling of 

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1 tems at the Federal, State, and local levels, with re2 spect to— 

3 ‘‘(I) birth and death records; and 

4 ‘‘(II) Federal, State, and local health care 

5 and public health surveillance systems, includ6 ing with respect to chronic and infectious dis7 eases, unintentional injuries, environmental 

8 health, child and adolescent health, maternal 

9 health and mortality, foodborne and waterborne 

10 illness, reproductive health, and any other 

11 notifiable disease or condition; 

12 ‘‘(iv) adopt, based on local, statewide, Tribal, 

13 and national best practices, uniform standards for 

14 the collection of health data on race and ethnicity; 

15 ‘‘(v) encourage States to enter into data shar16 ing agreements with Indian Tribes and epidemiology 

17 centers to improve the quality and accuracy of public 

18 health data regarding American Indians and Alaska 

19 natives, including by addressing misclassification 

20 and undersampling of American Indians and Alaska 

21 Natives in State and local public health data sys22 tems, including with respect to vital statistics, chron23 ic and infectious diseases, unintentional injuries, en24 vironmental health, child and adolescent health, ma25 ternal health and mortality, foodborne and waterVerDate Sep 11 2014 18:12 Sep 11, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4562.IS S4562

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1 borne illness, reproductive health, and any other 

2 notifiable disease or condition; 

3 ‘‘(vi) encourage States to adopt, based on local, 

4 statewide, Tribal, and national best practices, uni5 form standards for the collection of health data on 

6 race and ethnicity; and 

7 ‘‘(vii) 180 days after the date of enactment of 

8 the Tribal Health Data Improvement Act of 2020 

9 and biennially thereafter, issue a report on— 

10 ‘‘(I) which States have data sharing agree11 ments with Indian Tribes, Tribal Organizations, 

12 urban Indian organizations, or epidemiology 

13 centers to improve the quality and accuracy of 

14 health data, listed by data system name; and 

15 ‘‘(II) actions taken by the Director of the 

16 Centers for Disease Control and Prevention to 

17 encourage States to enter into data sharing 

18 agreements with Indian Tribes, Tribal Organi19 zations, urban Indian organizations, and epide20 miology centers to improve the quality and ac21 curacy of health data.’’. 

22 (g) DEFINITIONS.—Section 306 of the Public Health 

23 Service Act (42 U.S.C. 242k) is amended— 

24 (1) by redesignating subsection (n) as sub25 section (o); and 


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1 (2) by inserting after subsection (m) the fol2 lowing: 

3 ‘‘(n) In this section: 

4 ‘‘(1) The term ‘epidemiology center’ means an 

5 epidemiology center established under section 214 of 

6 the Indian Health Care Improvement Act, including 

7 any epidemiology center serving Indian Tribes re8 gionally or serving urban Indian organizations na9 tionally that is receiving funding from the Indian 

10 Health Service. 

11 ‘‘(2) The terms ‘Indian Tribe’ and ‘Tribal orga12 nization’ have the meanings given to the terms ‘In13 dian tribe’ and ‘tribal organization’, respectively, in 

14 section 4 of the Indian Self-Determination and Edu15 cation Assistance Act. 

16 ‘‘(3) The term ‘Urban Indian organization’ has 

17 the meaning given to that term in section 4 of the 

18 Indian Health Care Improvement Act.’’. 

19 (h) AUTHORIZATION OF APPROPRIATIONS.—Section 

20 306(o) of the Public Health Service Act, as redesignated 

21 by subsection (g), is amended to read as follows: 

22 ‘‘(o) To carry out this section, there is authorized to 

23 be appropriated $185,000,000 for each of the fiscal years 

24 2021 through 2025.’’. 

Æ 


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