II 

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. 

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 ‘‘Granting Resources 

5 for Eliminating Emissions Now in Hospitals Act’’ or the 

6 ‘‘GREEN Hospitals Act’’. 

7 SEC. 2. GREEN HILL-BURTON FUNDS FOR CLIMATE-READY 

8 MEDICAL FACILITIES. 

9 (a) GRANTS FOR CONSTRUCTION OR MODERNIZA10 TION PROJECTS.— 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 2657 IS

1 (1) IN GENERAL.—Section 1610(a) of the Pub2 lic Health Service Act (42 U.S.C. 300r(a)) is 

3 amended— 

4 (A) in paragraph (1)(A)— 

5 (i) in clause (i), by striking ‘‘, or’’ and 

6 inserting a semicolon; 

7 (ii) in clause (ii), by striking the pe8 riod at the end and inserting ‘‘; or’’; and 

9 (iii) by adding at the end the fol10 lowing: 

11 ‘‘(iii) increase capacity to provide es12 sential health care and update medical fa13 cilities to become more resilient to climate 

14 disasters and public health crises to ensure 

15 access and availability of quality health 

16 care for communities in need.’’; and 

17 (B) by striking paragraph (3) and insert18 ing the following: 

19 ‘‘(3) PRIORITY.—In awarding grants under this 

20 subsection, the Secretary shall give priority to appli21 cants whose projects will include, by design, resil22 ience against natural disasters, climate change miti23 gation, or other necessary predisaster adaptations to 

24 ensure continuous health care access and combat 

25 health risks due to climate change, such as— 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 2657 IS

1 ‘‘(A) installation of onsite distributed gen2 eration that combines energy-efficient devices, 

3 energy storage, and renewable energy in accord4 ance with modern electrical safety standards for 

5 medical facilities to allow the medical facility to 

6 access essential energy during power outages 

7 and optimize use of onsite and offsite energy 

8 sources for emissions reductions; 

9 ‘‘(B) improving air conditioning, moni10 toring, and purifying through installation of 

11 high-efficiency heat pumps that provide both 

12 cooling and heating, air purifiers, air filtration 

13 systems, and air quality monitoring systems in14 tegrated with energy systems and energy effi15 ciency considerations in preparation for future 

16 natural hazards and public health crises, such 

17 as wildfire, smog, extreme heat events, and 

18 pandemics; 

19 ‘‘(C) installation and maintenance of wet20 lands, drainage ponds, stormwater drainage, 

21 and any other green infrastructure to protect 

22 the medical facility from projected severe effects 

23 with respect to extreme weather, natural disas24 ters, or climate change-related events, including 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 2657 IS

1 sea-level rise, flooding, and increased risk of 

2 wildfire; 

3 ‘‘(D) green rooftops, walls, and indoor 

4 plantings, particularly those that can provide 

5 publicly accessible temperature management 

6 and air quality improvements; 

7 ‘‘(E) tree planting and other green infra8 structure to create publicly accessible cool space 

9 to address urban heat islands; 

10 ‘‘(F) infrastructure upgrades that protect 

11 access routes to the medical facility, such as 

12 long-term flood, wildfire, and other disaster 

13 mitigation for the roads, sidewalks, and public 

14 transit infrastructure that service the medical 

15 facility; 

16 ‘‘(G) the long-term maintenance of 

17 decarbonization and zero-emissions infrastruc18 ture (regardless of the source of original fund19 ing for such infrastructure); and 

20 ‘‘(H) any other type of plan or project the 

21 Secretary determines will increase the sustain22 ability and resiliency of a medical facility, pro23 tect patient health and community access dur24 ing extreme weather, and advance environ25 mental justice. 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 2657 IS

1 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this subsection $100,000,000,000 for fiscal year 

4 2024, to remain available until expended.’’. 

5 (2) TECHNICAL AMENDMENT.—Section 1610(b) 

6 of the Public Health Service Act (42 U.S.C. 

7 300r(b)) is amended by striking paragraph (3). 

8 (b) MEDICAL FACILITY PROJECT APPLICATIONS.— 

9 (1) IN GENERAL.—Section 1621(b)(1) of the 

10 Public Health Service Act (42 U.S.C. 300s–1(b)(1)) 

11 is amended— 

12 (A) in subparagraph (J), by striking ‘‘and’’ 

13 at the end; 

14 (B) in subparagraph (K), by striking the 

15 period at the end and inserting a semicolon; 

16 and 

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

18 ‘‘(L) reasonable assurance that the facility 

19 will have adequate staffing to fulfill the commu20 nity service obligation; and 

21 ‘‘(M) reasonable assurance that the facil22 ity— 

23 ‘‘(i) has a collective bargaining agree24 ment with 1 or more labor organizations 

25 representing employees at the facility; or 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 2657 IS

1 ‘‘(ii) has an explicit policy not to 

2 interfere with the rights of employees of 

3 the facility under section 7 of the National 

4 Labor Relations Act.’’. 

5 (2) APPLICATION FOR PLANNING GRANTS.— 

6 Section 1621 of the Public Health Service Act (42 

7 U.S.C. 300s–1) is amended by adding at the end the 

8 following: 

9 ‘‘(c) APPLICATION FOR PLANNING GRANTS.—An ap10 plication for a project submitted under part A or B shall 

11 be deemed to be complete for purposes of section 3(d)(2) 

12 of the Granting Resources for Eliminating Emissions Now 

13 in Hospitals Act, and the application shall be deemed to 

14 have been submitted for purposes of consideration for a 

15 planning grant under that section.’’. 

16 SEC. 3. PLANNING AND EVALUATION GRANT PROGRAM. 

17 (a) DEFINITIONS.—In this section: 

18 (1) MEDICAL FACILITY.—The term ‘‘medical 

19 facility’’ means a hospital, public health center, out20 patient medical facility, rehabilitation facility, facil21 ity for long-term care, or other facility (as may be 

22 designated by the Secretary) for the provision of 

23 health care to ambulatory patients. 

24 (2) PROPOSED PROJECT.—The term ‘‘proposed 

25 project’’ means a construction or modernization 


kjohnson on DSK79L0C42PROD with BILLS
7 

•S 2657 IS

1 project proposed by an eligible entity in a sustain2 ability and resiliency plan. 

3 (3) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (4) SUSTAINABILITY AND RESILIENCY PLAN.— 

6 The term ‘‘sustainability and resiliency plan’’ means 

7 a plan, including comprehensive preproject evalua8 tion, for a construction or modernization project 

9 that would, in order to protect patient health and 

10 community access, enhance— 

11 (A) the sustainability of a medical facility 

12 and infrastructure surrounding the medical fa13 cility; and 

14 (B) the resiliency of that medical facility 

15 and infrastructure surrounding the medical fa16 cility to climate change and public health crises. 

17 (b) ESTABLISHMENT.—The Secretary shall establish 

18 a grant program, to be known as the ‘‘Planning and Eval19 uation Grant Program’’, under which the Secretary shall 

20 make planning grants to eligible entities to develop sus21 tainability and resiliency plans for medical facilities owned 

22 or operated by the eligible entity and infrastructure sur23 rounding the medical facilities. 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 2657 IS

1 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

2 planning grant under subsection (b), an applicant shall 

3 be— 

4 (1) a State, Tribal government, or political sub5 division of a State or Tribal government, including 

6 any city, town, county, borough, hospital district au7 thority, or public or quasi-public corporation; or 

8 (2) a nonprofit private entity. 

9 (d) APPLICATIONS.— 

10 (1) IN GENERAL.—Except as provided in para11 graph (2), an eligible entity seeking a planning 

12 grant under subsection (b) shall submit to the Sec13 retary an application at such time, in such manner, 

14 and containing such information as the Secretary 

15 may by regulation prescribe, including— 

16 (A) a description of the proposed project; 

17 (B) a summary and breakdown of the de18 mographics of the patient population served or 

19 potentially served by the medical facility under 

20 the proposed project, including information 

21 on— 

22 (i) whether the medical facility is a fa23 cility for which a majority of the revenue 

24 the facility receives for patient care is from 

25 reimbursements for medical care furnished 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 2657 IS

1 to Medicare and Medicaid beneficiaries 

2 under titles XVIII and XIX of the Social 

3 Security Act (42 U.S.C. 1395 et seq. and 

4 1396 et seq.); and 

5 (ii) other indications that individuals 

6 vulnerable to climate change are served or 

7 potentially served by the medical facility; 

8 (C) a description of the ways in which the 

9 proposed project— 

10 (i) will carry out 1 or more activities 

11 described in subsection (g); 

12 (ii) meet the needs of the community 

13 the medical facility serves, especially the 

14 needs of vulnerable populations; and 

15 (iii) meet the sustainability and resil16 iency needs of the medical facility due to 

17 climate risks and hazards; 

18 (D) a description of whether the commu19 nity served by the medical facility is an environ20 mental justice community; 

21 (E) a description of the ways in which the 

22 planning grant would be used to carry out 1 or 

23 more planning and evaluation activities de24 scribed in subsection (f); 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 2657 IS

1 (F) reasonable assurance that all laborers 

2 and mechanics employed by contractors or sub3 contractors in the performance of work on a 

4 project will be paid wages at rates not less than 

5 those prevailing on similar work in the locality 

6 as determined by the Secretary of Labor in ac7 cordance with subchapter IV of chapter 31 of 

8 part A of subtitle II of title 40, United States 

9 Code (commonly referred to as the ‘‘Davis10 Bacon Act’’) and the Secretary of Labor shall 

11 have with respect to such labor standards the 

12 authority and functions set forth in Reorganiza13 tion Plan Numbered 14 of 1950 (64 Stat. 

14 1267; 5 U.S.C. App.) and section 3145 of title 

15 40, United States Code; and 

16 (G) reasonable assurance that the facil17 ity— 

18 (i) has a collective bargaining agree19 ment with 1 or more labor organizations 

20 representing employees at the facility; or 

21 (ii) has an explicit policy not to inter22 fere with the rights of employees at the fa23 cility under section 7 of the National 

24 Labor Relations Act (29 U.S.C. 157). 


kjohnson on DSK79L0C42PROD with BILLS
11 

•S 2657 IS

1 (2) ADDITIONAL APPLICATIONS.—An applica2 tion submitted under part A or B of title XVI of the 

3 Public Health Service Act (42 U.S.C. 300q et seq. 

4 and 42 U.S.C. 300r) shall be deemed to be a com5 plete application submitted for purposes of consider6 ation for a planning grant under subsection (b). 

7 (e) SELECTION.—The Secretary shall— 

8 (1) in coordination with the Secretary of En9 ergy and the Administrator of the Environmental 

10 Protection Agency, if necessary, develop metrics to 

11 evaluate applications for planning grants under sub12 section (b); and 

13 (2) give priority to applications that focus on 

14 improving a medical facility— 

15 (A) for which— 

16 (i) a majority of the revenue the facil17 ity receives for patient care is from reim18 bursements for medical care furnished to 

19 Medicare and Medicaid beneficiaries under 

20 titles XVIII and XIX of the Social Secu21 rity Act (42 U.S.C. 1395 et seq. and 1396 

22 et seq.); or 

23 (ii) a high proportion of patients is 

24 uninsured, as determined by the Secretary; 

25 and 


kjohnson on DSK79L0C42PROD with BILLS
12 

•S 2657 IS

1 (B) that is located in a neighborhood or 

2 serves a patient population that— 

3 (i) experiences low-air quality; 

4 (ii) lacks green space; 

5 (iii) bears higher cumulative pollution 

6 burdens; or 

7 (iv) is at disproportionate risk of ex8 periencing the adverse effects of climate 

9 change. 

10 (f) PLANNING ACTIVITIES.—Planning and evaluation 

11 activities carried out by an eligible entity using grant 

12 funds received under subsection (b) shall include 1 or 

13 more of the following: 

14 (1) Performing project planning, community 

15 outreach and engagement, feasibility studies, and 

16 needs assessments of the local community and pa17 tient populations. 

18 (2) Performing engineering and climate-risk as19 sessments of the medical facility infrastructure and 

20 the access routes to the medical facility. 

21 (3) Providing management and operational as22 sistance for developing and receiving funding for the 

23 proposed project. 


kjohnson on DSK79L0C42PROD with BILLS
13 

•S 2657 IS

1 (4) Other planning and evaluation activities and 

2 assessments as the Secretary determines appro3 priate. 

4 (g) PROPOSED PROJECTS.—Construction and mod5 ernization activities carried out by a proposed project 

6 under a sustainability and resiliency plan developed pursu7 ant to a planning grant received under subsection (b) may 

8 include— 

9 (1) improvements to the infrastructure, build10 ings, and grounds of the medical facility, includ11 ing— 

12 (A) installation of onsite distributed gen13 eration that combines energy-efficient devices, 

14 energy storage, and renewable energy in accord15 ance with modern electrical safety standards for 

16 medical facilities to allow the medical facility to 

17 access essential energy during power outages 

18 and optimize use of onsite and offsite energy 

19 sources for emissions reductions; and 

20 (B) improving air conditioning, monitoring, 

21 and purifying through installation of high-effi22 ciency heat pumps that provide both cooling 

23 and heating, air purifiers, air filtration systems, 

24 and air quality monitoring systems integrated 

25 with energy systems and energy efficiency conVerDate Sep 11 2014 23:14 Aug 16, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2657.IS S2657

kjohnson on DSK79L0C42PROD with BILLS
14 

•S 2657 IS

1 siderations in preparation for future natural 

2 hazards and public health crises such as wild3 fire, smog, extreme heat events, and pandemics; 

4 (2) green infrastructure projects, such as— 

5 (A) installation and maintenance of wet6 lands, drainage ponds, and any other green in7 frastructure that would protect the medical fa8 cility from projected severe effects with respect 

9 to extreme weather, natural disasters, or cli10 mate change-related events, including sea-level 

11 rise, flooding, and increased risk of wildfire; 

12 and 

13 (B) green rooftops, walls, and indoor 

14 plantings, particularly those that can provide 

15 publicly accessible temperature management 

16 and air quality improvements; 

17 (3) resiliency projects to secure local accessi18 bility to the medical facility by protecting the access 

19 routes to the medical facility, such as— 

20 (A) infrastructure upgrades that protect 

21 access routes to the medical facility, such as 

22 long-term flood, wildfire, and other disaster 

23 mitigation for the roads, sidewalks, and public 

24 transit infrastructure that service the medical 

25 facility; and 


kjohnson on DSK79L0C42PROD with BILLS
15 

•S 2657 IS

1 (B) the long-term maintenance of 

2 decarbonization and zero-emissions infrastruc3 ture; and 

4 (4) any other type of activity the Secretary de5 termines will increase the sustainability and resil6 iency of a medical facility and protect patient health 

7 and community access during extreme weather. 

8 (h) AMOUNT OF GRANT.—The total amount of a 

9 grant under subsection (b) shall not exceed $500,000. 

10 (i) TECHNICAL ASSISTANCE.—The Secretary, in co11 ordination with the Secretary of Energy, the Adminis12 trator of the Environmental Protection Agency, and the 

13 Secretary of Transportation, if necessary, directly or 

14 through partnerships with States, Tribal governments, 

15 and nonprofit organizations, shall provide technical assist16 ance to eligible entities interested in carrying out proposed 

17 projects that— 

18 (1) serve environmental justice communities or 

19 medically underserved communities; 

20 (2) demonstrate a commitment to provide job 

21 training, apprenticeship programs, and contracting 

22 opportunities to residents and small businesses 

23 owned by residents of the community that the med24 ical facility serves; 


kjohnson on DSK79L0C42PROD with BILLS
16 

•S 2657 IS

1 (3) identify and further community priority ac2 tions and conduct robust community engagement; 

3 and 

4 (4) employ nature-based solutions that focus on 

5 protection, restoration, or management of ecological 

6 systems to safeguard public health, provide clean air 

7 and water, increase natural hazard resilience, and 

8 sequester carbon. 

9 (j) PROHIBITION ON TRAINING REPAYMENT.—As a 

10 condition of receiving a grant or technical assistance under 

11 this section, an eligible entity shall certify that the eligible 

12 entity does not use, and if the eligible entity contracts with 

13 any staffing agency or training provider, that such agency 

14 or provider does not use, any provision in employment 

15 agreements, job training agreements, or apprenticeship 

16 program agreements that would require an employee or 

17 training or apprenticeship program participant to pay a 

18 debt if the employee or training or apprenticeship program 

19 participant’s employment or work relationship or training 

20 period with a specified employer or business entity is ter21 minated. 

22 (k) ENVIRONMENTAL JUSTICE COMMUNITIES.—The 

23 Secretary shall ensure that not less than 50 percent of 

24 grant funds awarded under subsection (b) are used for 


kjohnson on DSK79L0C42PROD with BILLS
17 

•S 2657 IS

1 sustainability and resiliency plans for proposed projects lo2 cated in environmental justice communities. 

3 (l) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to the Secretary to carry 

5 out this section $5,000,000,000 for fiscal year 2024, to 

6 remain available until expended. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS