II 

116TH CONGRESS 

2D SESSION S. 4740 

To support public health infrastructure. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 29, 2020 

Mrs. MURRAY (for herself, Mr. CASEY, Mr. MENENDEZ, Mr. VAN HOLLEN, 

Ms. DUCKWORTH, Mr. BROWN, Mr. MERKLEY, Mr. BENNET, Ms. WARREN, Mr. MARKEY, Ms. HIRONO, Ms. BALDWIN, Ms. ROSEN, Mr. 

SCHATZ, Ms. KLOBUCHAR, Mr. REED, Ms. SMITH, Mr. BLUMENTHAL, 

and Mr. DURBIN) introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To support public health infrastructure. 

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’’. 

6 SEC. 2. CORE PUBLIC HEALTH INFRASTRUCTURE FOR 

7 STATE, TERRITORIAL, LOCAL, AND TRIBAL 

8 HEALTH DEPARTMENTS. 

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

10 Services (referred to in this Act as the ‘‘Secretary’’), actVerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740

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1 ing through the Director of the Centers for Disease Con2 trol and Prevention, shall establish a core public health 

3 infrastructure program to strengthen the public health 

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

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

6 awarding grants under subsection (b). 

7 (b) GRANTS.— 

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

9 core public health infrastructure needs, the Sec10 retary— 

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

12 territorial health department, and to local 

13 health departments that serve 500,000 people 

14 or more; and 

15 (B) shall award grants on a competitive 

16 basis to State, territorial, local, or tribal health 

17 departments. 

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

19 funds awarded as grants under this subsection for a 

20 fiscal year— 

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

22 grants to health departments under paragraph 

23 (1)(A); and 


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

2 grants to State, territorial, local, or tribal 

3 health departments under paragraph (1)(B). 

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

5 grant to an entity under subsection (b)(1) only if the enti6 ty agrees to use the full amount of the grant to address 

7 core public health infrastructure needs, including those 

8 identified in the accreditation process under subsection 

9 (h). 

10 (d) FORMULA GRANTS TO HEALTH DEPART11 MENTS.—In making grants under subsection (b)(1)(A), 

12 the Secretary shall award funds to each health department 

13 in accordance with— 

14 (1) a formula— 

15 (A) based on population size, burden of 

16 preventable disease and disability, and poverty 

17 rate, with special consideration given to terri18 tories; and 

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

20 during the public health emergency declared 

21 under section 319 of the Public Health Service 

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

23 19, shall consider the COVID–19 burden of 

24 each jurisdiction; and 


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1 (2) application requirements established by the 

2 Secretary, including a requirement that the health 

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

4 the grant that demonstrates to the satisfaction of 

5 the Secretary that the health department will— 

6 (A) address its highest priority core public 

7 health infrastructure needs; 

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

9 during the public health emergency described in 

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

11 health infrastructure needs that are the highest 

12 priority for strengthening the response to 

13 COVID–19 and similar public health threats 

14 and other public health emergencies; and 

15 (C) for State health departments, allocate 

16 at least 25 percent of the grant funds to local 

17 health departments within the State to support 

18 the local jurisdiction’s contribution to core pub19 lic health infrastructure. 

20 (e) COMPETITIVE GRANTS TO STATE, TERRITORIAL, 

21 LOCAL, AND TRIBAL HEALTH DEPARTMENTS.—In mak22 ing grants under subsection (b)(1)(B), the Secretary shall 

23 give priority to applicants demonstrating core public 

24 health infrastructure needs for all public health agencies 

25 in the applicant’s jurisdiction to be certified by the accredVerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740

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1 itation process under subsection (h), or for an entity for 

2 which a waiver has been received under subparagraph (A) 

3 or (B) of subsection (h)(2), that has otherwise dem4 onstrated the applicant has core public health infrastruc5 ture needs for all public health agencies. 

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

7 available a subset of the funds available for grants under 

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

9 grants to health departments eligible to receive a grant 

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

11 grant may use such award to assess core public health 

12 infrastructure needs. 

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

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

15 the entity demonstrates to the satisfaction of the Sec16 retary that— 

17 (1) funds received through the grant will be ex18 pended only to supplement, and not supplant, non19 Federal and Federal funds otherwise available to the 

20 entity for the purpose of addressing core public 

21 health infrastructure needs; and 

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

23 is awarded, the entity will maintain expenditures of 

24 non-Federal amounts for such activities at a level 

25 not less than the level of such expenditures mainVerDate Sep 11 2014 02:36 Oct 17, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4740.IS S4740

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1 tained by the entity for the fiscal year preceding the 

2 fiscal year for which the entity receives the grant. 

3 (h) SUPPORT OF A NATIONAL PUBLIC HEALTH AC4 CREDITATION PROGRAM.— 

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

6 through the Director of the Centers for Disease 

7 Control and Prevention, shall— 

8 (A) support continued development, and 

9 periodic review and updating of standards for 

10 accreditation of State, territorial, local, or tribal 

11 health departments for the purpose of advanc12 ing the quality and performance of such depart13 ments with an emphasis on core public health 

14 infrastructure; 

15 (B) implement a program to accredit such 

16 health departments in accordance with such 

17 standards; and 

18 (C) beginning in fiscal year 2024, ensure 

19 that any entity receiving a grant under sub20 section (b) is accredited as described in sub21 paragraph (A) or meets another standard of ac22 countability specific to public health infrastruc23 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 2026; or 

6 (B) after fiscal year 2026, 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), including— 

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 and 

23 (2) identification of gaps in research related to 

24 core public health infrastructure and recommenda25 tions of priority areas for such research. 


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1 SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND AC2 TIVITIES FOR CDC. 

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

4 Director of the Centers for Disease Control and Preven5 tion, shall expand and improve the core public health in6 frastructure and activities of the Centers for Disease Con7 trol and Prevention to address unmet and emerging public 

8 health needs and provide technical assistance to grantees 

9 funded under this provision, including the administration 

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

11 (b) REPORT.—The Secretary shall submit to Con12 gress an annual report on the activities funded through 

13 this section. 

14 SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED. 

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

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

17 the workforce needed to establish and maintain such ele18 ments: 

19 (1) ASSESSMENT (INCLUDING SURVEILLANCE, 

20 EPIDEMIOLOGY, AND LABORATORY CAPACITY).—The 

21 ability to track the health of a community through 

22 data, case finding, and laboratory tests with par23 ticular attention to those most at risk. 

24 (2) ALL HAZARDS PREPAREDNESS AND RE25 SPONSE.—The capacity to respond to emergencies of 

26 all kinds. 


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1 (3) POLICY DEVELOPMENT AND SUPPORT.— 

2 The ability to translate public health science into ap3 propriate policy and regulation. 

4 (4) COMMUNICATIONS.—The ability to reach 

5 the public effectively with timely, science-based in6 formation to mitigate the impact of public health 

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

8 populations. 

9 (5) COMMUNITY PARTNERSHIP DEVELOP10 MENT.—The capacity to harness and align commu11 nity resources and organizations to advance the 

12 health of all members of the community. 

13 (6) ORGANIZATIONAL COMPETENCIES (LEADER14 SHIP AND GOVERNANCE, HEALTH EQUITY).—The 

15 ability to lead internal and external stakeholders to 

16 consensus and action. 

17 (7) ACCOUNTABILITY AND PERFORMANCE MAN18 AGEMENT (INCLUDING QUALITY IMPROVEMENT, IN19 FORMATION TECHNOLOGY, HUMAN RESOURCES, FI20 NANCIAL MANAGEMENT, AND LAW).—The ability to 

21 apply business practices that ensure efficient use of 

22 resources, achieve desired outcomes, and foster a 

23 continuous learning environment. 

24 (8) EQUITY.—Utilizing all of the preceding ele25 ments, the capacity to address and correct health 


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1 disparities (including disparities related to race, eth2 nicity, national origin, socioeconomic status, primary 

3 language, sex (including sexual orientation and gen4 der identity), disability status, and other factors), 

5 advance health equity in all communities, and imple6 ment culturally and linguistically appropriate pro7 grams and interventions. 

8 SEC. 5. FUNDING. 

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

10 hereby appropriated, out of amounts in the Treasury not 

11 otherwise appropriated, the following to be made available 

12 until expended: 

13 (1) For fiscal year 2021, $750,000,000. 

14 (2) For fiscal year 2022, $1,000,000,000. 

15 (3) For fiscal year 2023, $2,000,000,000. 

16 (4) For fiscal year 2024, $3,000,000,000. 

17 (5) For fiscal year 2025 and each subsequent 

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

19 (b) CORE PUBLIC HEALTH INFRASTRUCTURE AND

20 ACTIVITIES.—Of the amounts made available under this 

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

22 be used to carry out section 3. 

23 (c) SUPPLEMENT.—Amounts made available under 

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


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1 amounts otherwise made available for the purposes de2 scribed in this Act. 

Æ 


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