```

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2657 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  1st Session
                                S. 2657

To provide for green and resilient health care infrastructure, and for 
                            other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 27, 2023

  Mr. Markey introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To provide for green and resilient health care infrastructure, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Granting Resources for Eliminating 
Emissions Now in Hospitals Act'' or the ``GREEN Hospitals Act''.

SEC. 2. GREEN HILL-BURTON FUNDS FOR CLIMATE-READY MEDICAL FACILITIES.

    (a) Grants for Construction or Modernization Projects.--
            (1) In general.--Section 1610(a) of the Public Health 
        Service Act (42 U.S.C. 300r(a)) is amended--
                    (A) in paragraph (1)(A)--
                            (i) in clause (i), by striking ``, or'' and 
                        inserting a semicolon;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``; or''; and
                            (iii) by adding at the end the following:
                            ``(iii) increase capacity to provide 
                        essential health care and update medical 
                        facilities to become more resilient to climate 
                        disasters and public health crises to ensure 
                        access and availability of quality health care 
                        for communities in need.''; and
                    (B) by striking paragraph (3) and inserting the 
                following:
            ``(3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to applicants whose projects 
        will include, by design, resilience against natural disasters, 
        climate change mitigation, or other necessary predisaster 
        adaptations to ensure continuous health care access and combat 
        health risks due to climate change, such as--
                    ``(A) installation of onsite distributed generation 
                that combines energy-efficient devices, energy storage, 
                and renewable energy in accordance with modern 
                electrical safety standards for medical facilities to 
                allow the medical facility to access essential energy 
                during power outages and optimize use of onsite and 
                offsite energy sources for emissions reductions;
                    ``(B) improving air conditioning, monitoring, and 
                purifying through installation of high-efficiency heat 
                pumps that provide both cooling and heating, air 
                purifiers, air filtration systems, and air quality 
                monitoring systems integrated with energy systems and 
                energy efficiency considerations in preparation for 
                future natural hazards and public health crises, such 
                as wildfire, smog, extreme heat events, and pandemics;
                    ``(C) installation and maintenance of wetlands, 
                drainage ponds, stormwater drainage, and any other 
                green infrastructure to protect the medical facility 
                from projected severe effects with respect to extreme 
                weather, natural disasters, or climate change-related 
                events, including sea-level rise, flooding, and 
                increased risk of wildfire;
                    ``(D) green rooftops, walls, and indoor plantings, 
                particularly those that can provide publicly accessible 
                temperature management and air quality improvements;
                    ``(E) tree planting and other green infrastructure 
                to create publicly accessible cool space to address 
                urban heat islands;
                    ``(F) infrastructure upgrades that protect access 
                routes to the medical facility, such as long-term 
                flood, wildfire, and other disaster mitigation for the 
                roads, sidewalks, and public transit infrastructure 
                that service the medical facility;
                    ``(G) the long-term maintenance of decarbonization 
                and zero-emissions infrastructure (regardless of the 
                source of original funding for such infrastructure); 
                and
                    ``(H) any other type of plan or project the 
                Secretary determines will increase the sustainability 
                and resiliency of a medical facility, protect patient 
                health and community access during extreme weather, and 
                advance environmental justice.
            ``(4) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection 
        $100,000,000,000 for fiscal year 2024, to remain available 
        until expended.''.
            (2) Technical amendment.--Section 1610(b) of the Public 
        Health Service Act (42 U.S.C. 300r(b)) is amended by striking 
        paragraph (3).
    (b) Medical Facility Project Applications.--
            (1) In general.--Section 1621(b)(1) of the Public Health 
        Service Act (42 U.S.C. 300s-1(b)(1)) is amended--
                    (A) in subparagraph (J), by striking ``and'' at the 
                end;
                    (B) in subparagraph (K), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(L) reasonable assurance that the facility will 
                have adequate staffing to fulfill the community service 
                obligation; and
                    ``(M) reasonable assurance that the facility--
                            ``(i) has a collective bargaining agreement 
                        with 1 or more labor organizations representing 
                        employees at the facility; or
                            ``(ii) has an explicit policy not to 
                        interfere with the rights of employees of the 
                        facility under section 7 of the National Labor 
                        Relations Act.''.
            (2) Application for planning grants.--Section 1621 of the 
        Public Health Service Act (42 U.S.C. 300s-1) is amended by 
        adding at the end the following:
    ``(c) Application for Planning Grants.--An application for a 
project submitted under part A or B shall be deemed to be complete for 
purposes of section 3(d)(2) of the Granting Resources for Eliminating 
Emissions Now in Hospitals Act, and the application shall be deemed to 
have been submitted for purposes of consideration for a planning grant 
under that section.''.

SEC. 3. PLANNING AND EVALUATION GRANT PROGRAM.

    (a) Definitions.--In this section:
            (1) Medical facility.--The term ``medical facility'' means 
        a hospital, public health center, outpatient medical facility, 
        rehabilitation facility, facility for long-term care, or other 
        facility (as may be designated by the Secretary) for the 
        provision of health care to ambulatory patients.
            (2) Proposed project.--The term ``proposed project'' means 
        a construction or modernization project proposed by an eligible 
        entity in a sustainability and resiliency plan.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) Sustainability and resiliency plan.--The term 
        ``sustainability and resiliency plan'' means a plan, including 
        comprehensive preproject evaluation, for a construction or 
        modernization project that would, in order to protect patient 
        health and community access, enhance--
                    (A) the sustainability of a medical facility and 
                infrastructure surrounding the medical facility; and
                    (B) the resiliency of that medical facility and 
                infrastructure surrounding the medical facility to 
                climate change and public health crises.
    (b) Establishment.--The Secretary shall establish a grant program, 
to be known as the ``Planning and Evaluation Grant Program'', under 
which the Secretary shall make planning grants to eligible entities to 
develop sustainability and resiliency plans for medical facilities 
owned or operated by the eligible entity and infrastructure surrounding 
the medical facilities.
    (c) Eligible Entities.--To be eligible to receive a planning grant 
under subsection (b), an applicant shall be--
            (1) a State, Tribal government, or political subdivision of 
        a State or Tribal government, including any city, town, county, 
        borough, hospital district authority, or public or quasi-public 
        corporation; or
            (2) a nonprofit private entity.
    (d) Applications.--
            (1) In general.--Except as provided in paragraph (2), an 
        eligible entity seeking a planning grant under subsection (b) 
        shall submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may by regulation prescribe, including--
                    (A) a description of the proposed project;
                    (B) a summary and breakdown of the demographics of 
                the patient population served or potentially served by 
                the medical facility under the proposed project, 
                including information on--
                            (i) whether the medical facility is a 
                        facility for which a majority of the revenue 
                        the facility receives for patient care is from 
                        reimbursements for medical care furnished to 
                        Medicare and Medicaid beneficiaries under 
                        titles XVIII and XIX of the Social Security Act 
                        (42 U.S.C. 1395 et seq. and 1396 et seq.); and
                            (ii) other indications that individuals 
                        vulnerable to climate change are served or 
                        potentially served by the medical facility;
                    (C) a description of the ways in which the proposed 
                project--
                            (i) will carry out 1 or more activities 
                        described in subsection (g);
                            (ii) meet the needs of the community the 
                        medical facility serves, especially the needs 
                        of vulnerable populations; and
                            (iii) meet the sustainability and 
                        resiliency needs of the medical facility due to 
                        climate risks and hazards;
                    (D) a description of whether the community served 
                by the medical facility is an environmental justice 
                community;
                    (E) a description of the ways in which the planning 
                grant would be used to carry out 1 or more planning and 
                evaluation activities described in subsection (f);
                    (F) reasonable assurance that all laborers and 
                mechanics employed by contractors or subcontractors in 
                the performance of work on a project will be paid wages 
                at rates not less than those prevailing on similar work 
                in the locality as determined by the Secretary of Labor 
                in accordance with subchapter IV of chapter 31 of part 
                A of subtitle II of title 40, United States Code 
                (commonly referred to as the ``Davis-Bacon Act'') and 
                the Secretary of Labor shall have with respect to such 
                labor standards the authority and functions set forth 
                in Reorganization Plan Numbered 14 of 1950 (64 Stat. 
                1267; 5 U.S.C. App.) and section 3145 of title 40, 
                United States Code; and
                    (G) reasonable assurance that the facility--
                            (i) has a collective bargaining agreement 
                        with 1 or more labor organizations representing 
                        employees at the facility; or
                            (ii) has an explicit policy not to 
                        interfere with the rights of employees at the 
                        facility under section 7 of the National Labor 
                        Relations Act (29 U.S.C. 157).
            (2) Additional applications.--An application submitted 
        under part A or B of title XVI of the Public Health Service Act 
        (42 U.S.C. 300q et seq. and 42 U.S.C. 300r) shall be deemed to 
        be a complete application submitted for purposes of 
        consideration for a planning grant under subsection (b).
    (e) Selection.--The Secretary shall--
            (1) in coordination with the Secretary of Energy and the 
        Administrator of the Environmental Protection Agency, if 
        necessary, develop metrics to evaluate applications for 
        planning grants under subsection (b); and
            (2) give priority to applications that focus on improving a 
        medical facility--
                    (A) for which--
                            (i) a majority of the revenue the facility 
                        receives for patient care is from 
                        reimbursements for medical care furnished to 
                        Medicare and Medicaid beneficiaries under 
                        titles XVIII and XIX of the Social Security Act 
                        (42 U.S.C. 1395 et seq. and 1396 et seq.); or
                            (ii) a high proportion of patients is 
                        uninsured, as determined by the Secretary; and
                    (B) that is located in a neighborhood or serves a 
                patient population that--
                            (i) experiences low-air quality;
                            (ii) lacks green space;
                            (iii) bears higher cumulative pollution 
                        burdens; or
                            (iv) is at disproportionate risk of 
                        experiencing the adverse effects of climate 
                        change.
    (f) Planning Activities.--Planning and evaluation activities 
carried out by an eligible entity using grant funds received under 
subsection (b) shall include 1 or more of the following:
            (1) Performing project planning, community outreach and 
        engagement, feasibility studies, and needs assessments of the 
        local community and patient populations.
            (2) Performing engineering and climate-risk assessments of 
        the medical facility infrastructure and the access routes to 
        the medical facility.
            (3) Providing management and operational assistance for 
        developing and receiving funding for the proposed project.
            (4) Other planning and evaluation activities and 
        assessments as the Secretary determines appropriate.
    (g) Proposed Projects.--Construction and modernization activities 
carried out by a proposed project under a sustainability and resiliency 
plan developed pursuant to a planning grant received under subsection 
(b) may include--
            (1) improvements to the infrastructure, buildings, and 
        grounds of the medical facility, including--
                    (A) installation of onsite distributed generation 
                that combines energy-efficient devices, energy storage, 
                and renewable energy in accordance with modern 
                electrical safety standards for medical facilities to 
                allow the medical facility to access essential energy 
                during power outages and optimize use of onsite and 
                offsite energy sources for emissions reductions; and
                    (B) improving air conditioning, monitoring, and 
                purifying through installation of high-efficiency heat 
                pumps that provide both cooling and heating, air 
                purifiers, air filtration systems, and air quality 
                monitoring systems integrated with energy systems and 
                energy efficiency considerations in preparation for 
                future natural hazards and public health crises such as 
                wildfire, smog, extreme heat events, and pandemics;
            (2) green infrastructure projects, such as--
                    (A) installation and maintenance of wetlands, 
                drainage ponds, and any other green infrastructure that 
                would protect the medical facility from projected 
                severe effects with respect to extreme weather, natural 
                disasters, or climate change-related events, including 
                sea-level rise, flooding, and increased risk of 
                wildfire; and
                    (B) green rooftops, walls, and indoor plantings, 
                particularly those that can provide publicly accessible 
                temperature management and air quality improvements;
            (3) resiliency projects to secure local accessibility to 
        the medical facility by protecting the access routes to the 
        medical facility, such as--
                    (A) infrastructure upgrades that protect access 
                routes to the medical facility, such as long-term 
                flood, wildfire, and other disaster mitigation for the 
                roads, sidewalks, and public transit infrastructure 
                that service the medical facility; and
                    (B) the long-term maintenance of decarbonization 
                and zero-emissions infrastructure; and
            (4) any other type of activity the Secretary determines 
        will increase the sustainability and resiliency of a medical 
        facility and protect patient health and community access during 
        extreme weather.
    (h) Amount of Grant.--The total amount of a grant under subsection 
(b) shall not exceed $500,000.
    (i) Technical Assistance.--The Secretary, in coordination with the 
Secretary of Energy, the Administrator of the Environmental Protection 
Agency, and the Secretary of Transportation, if necessary, directly or 
through partnerships with States, Tribal governments, and nonprofit 
organizations, shall provide technical assistance to eligible entities 
interested in carrying out proposed projects that--
            (1) serve environmental justice communities or medically 
        underserved communities;
            (2) demonstrate a commitment to provide job training, 
        apprenticeship programs, and contracting opportunities to 
        residents and small businesses owned by residents of the 
        community that the medical facility serves;
            (3) identify and further community priority actions and 
        conduct robust community engagement; and
            (4) employ nature-based solutions that focus on protection, 
        restoration, or management of ecological systems to safeguard 
        public health, provide clean air and water, increase natural 
        hazard resilience, and sequester carbon.
    (j) Prohibition on Training Repayment.--As a condition of receiving 
a grant or technical assistance under this section, an eligible entity 
shall certify that the eligible entity does not use, and if the 
eligible entity contracts with any staffing agency or training 
provider, that such agency or provider does not use, any provision in 
employment agreements, job training agreements, or apprenticeship 
program agreements that would require an employee or training or 
apprenticeship program participant to pay a debt if the employee or 
training or apprenticeship program participant's employment or work 
relationship or training period with a specified employer or business 
entity is terminated.
    (k) Environmental Justice Communities.--The Secretary shall ensure 
that not less than 50 percent of grant funds awarded under subsection 
(b) are used for sustainability and resiliency plans for proposed 
projects located in environmental justice communities.
    (l) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary to carry out this section $5,000,000,000 
for fiscal year 2024, to remain available until expended.
                                 <all>
```