IIB 

116TH CONGRESS 

2D SESSION H. R. 7948 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 

Received; read twice and referred to the Committee on Indian Affairs 

AN ACT 

To amend the Public Health Service Act with respect to 

the collection and availability of health data with respect 

to Indian Tribes, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Tribal Health Data 

3 Improvement Act of 2020’’. 

4 SEC. 2. COLLECTION AND AVAILABILITY OF HEALTH DATA 

5 WITH RESPECT TO INDIAN TRIBES. 

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

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

8 amended— 

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

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

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

12 after ‘‘State,’’. 

13 (b) DATA REPORTING AND DISSEMINATION.—Sec14 tion 3101(c) of the Public Health Service Act (42 U.S.C. 

15 300kk(c)) is amended— 

16 (1) by amending subparagraph (F) of para17 graph (1) to read as follows: 

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

19 Tribes, Tribal organizations, and epidemiology 

20 centers authorized under the Indian Health 

21 Care Improvement Act;’’; and 

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

23 Tribes, Tribal organizations, and epidemiology cen24 ters,’’ after ‘‘Federal agencies,’’. 

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

26 3101(e) of the Public Health Service Act (42 U.S.C. 


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1 300kk(e)) is amended by adding at the end the following 

2 new paragraphs: 

3 ‘‘(3) DATA SHARING STRATEGY.—With respect 

4 to data access for Tribal epidemiology centers and 

5 Tribes, the Secretary shall create a data sharing 

6 strategy that takes into consideration recommenda7 tions by the Secretary’s Tribal Advisory Committee 

8 for— 

9 ‘‘(A) ensuring that Tribal epidemiology 

10 centers and Indian Tribes have access to the 

11 data sources necessary to accomplish their pub12 lic health responsibilities; and 

13 ‘‘(B) protecting the privacy and security of 

14 such data. 

15 ‘‘(4) TRIBAL PUBLIC HEALTH AUTHORITY.— 

16 ‘‘(A) AVAILABILITY.—Beginning not later 

17 than 180 days after the date of the enactment 

18 of the Tribal Health Data Improvement Act of 

19 2020, the Secretary shall make available to the 

20 entities listed in subparagraph (B) all data that 

21 is collected pursuant to this title with respect to 

22 health care and public health surveillance pro23 grams and activities, including such programs 

24 and activities that are federally supported or 

25 conducted, so long as— 


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1 ‘‘(i) such entities request the data 

2 pursuant to statute; and 

3 ‘‘(ii) the data is requested for use— 

4 ‘‘(I) consistent with Federal law 

5 and obligations; and 

6 ‘‘(II) to satisfy a particular pur7 pose or carry out a specific function 

8 consistent with the purpose for which 

9 the data was collected. 

10 ‘‘(B) ENTITIES.—The entities listed in this 

11 subparagraph are— 

12 ‘‘(i) the Indian Health Service; 

13 ‘‘(ii) Indian Tribes and Tribal organi14 zations; and 

15 ‘‘(iii) epidemiology centers.’’. 

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

17 Public Health Service Act (42 U.S.C. 300kk) is amend18 ed— 

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

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

21 (h). 

22 (e) DEFINITIONS.—After executing the amendments 

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

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

25 after subsection (f) the following new subsection: 


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

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

3 epidemiology center established under section 214 of 

4 the Indian Health Care Improvement Act, including 

5 such Tribal epidemiology centers serving Indian 

6 Tribes regionally and any Tribal epidemiology center 

7 serving Urban Indian organizations nationally. 

8 ‘‘(2) The term ‘Indian Tribe’ has the meaning 

9 given to the term ‘Indian tribe’ in section 4 of the 

10 Indian Self-Determination and Education Assistance 

11 Act. 

12 ‘‘(3) The term ‘Tribal organization’ has the 

13 meaning given to the term ‘tribal organization’ in 

14 section 4 of the of the Indian Self-Determination 

15 and Education Assistance Act. 

16 ‘‘(4) 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 (f) TECHNICAL CORRECTION.—Section 3101(b) of 

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

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

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

23 ANALYSIS.—For each federally’’. 


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1 SEC. 3. IMPROVING HEALTH STATISTICS REPORTING WITH 

2 RESPECT TO INDIAN TRIBES. 

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

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

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

6 Tribal organizations, and epidemiology centers’’ after ‘‘ju7 risdictions’’. 

8 (b) COOPERATIVE HEALTH STATISTICS SYSTEM.— 

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

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

11 Tribes, Tribal organizations, and epidemiology centers’’ 

12 after ‘‘health agencies’’. 

13 (c) FEDERAL-STATE-TRIBAL COOPERATION.—Sec14 tion 306(f) of the Public Health Service Act (42 U.S.C. 

15 242k(f)) is amended— 

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

17 before ‘‘the Departments of Commerce’’; 

18 (2) by inserting a comma after ‘‘the Depart19 ments of Commerce and Labor’’; 

20 (3) by inserting ‘‘, Indian Tribes, Tribal organi21 zations, and epidemiology centers’’ after ‘‘State and 

22 local health departments and agencies’’; and 

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

24 Secretary shall’’. 


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1 (d) REGISTRATION AREA RECORDS.—Section 

2 306(h)(1) of the Public Health Service Act (42 U.S.C. 

3 242k(h)(1)) is amended— 

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

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

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

7 and Pacific Islanders’’ and inserting ‘‘American In8 dians and Alaska Natives, Hispanics, Asian Ameri9 cans, and Native Hawaiian and other Pacific Island10 ers’’. 

11 (e) NATIONAL COMMITTEE ON VITAL AND HEALTH

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

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

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

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

16 Health Insurance Portability and Accountability Act 

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

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

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

20 Health Insurance Portability and Accountability Act 

21 of 1996, and annually thereafter, the Committee 

22 shall’’ and inserting ‘‘The Committee shall, on an bi23 ennial basis,’’. 

24 (f) GRANTS FOR ASSEMBLY AND ANALYSIS OF DATA

25 ON ETHNIC AND RACIAL POPULATIONS.—Section 


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1 306(m)(4) of the Public Health Service Act (42 U.S.C. 

2 242k(m)(4)) is amended— 

3 (1) in subparagraph (A)— 

4 (A) by striking ‘‘Subject to subparagraph 

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

6 (B) by striking ‘‘and major Hispanic sub7 population groups and American Indians’’ and 

8 inserting ‘‘, major Hispanic subgroups, and 

9 American Indians and Alaska Natives’’; and 

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

11 follows: 

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

13 to American Indians and Alaska Natives, the Secretary 

14 shall— 

15 ‘‘(i) consult with Indian Tribes, Tribal organi16 zations, the Tribal Technical Advisory Group of the 

17 Centers for Medicare & Medicaid Services main18 tained under section 5006(e) of the American Recov19 ery and Reinvestment Act of 2009, and the Tribal 

20 Advisory Committee established by the Centers for 

21 Disease Control and Prevention, in coordination with 

22 epidemiology centers, to develop guidelines for State 

23 and local health agencies to improve the quality and 

24 accuracy of data with respect to the birth and death 

25 records of American Indians and Alaska Natives; 


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1 ‘‘(ii) confer with Urban Indian organizations to 

2 develop guidelines for State and local health agencies 

3 to improve the quality and accuracy of data with re4 spect to the birth and death records of American In5 dians and Alaska Natives; 

6 ‘‘(iii) enter into cooperative agreements with In7 dian Tribes, Tribal organizations, Urban Indian or8 ganizations, and epidemiology centers to address 

9 misclassification and undersampling of American In10 dians and Alaska Natives with respect to— 

11 ‘‘(I) birth and death records; and 

12 ‘‘(II) health care and public health surveil13 lance systems, including, but not limited to, 

14 data with respect to chronic and infectious dis15 eases, unintentional injuries, environmental 

16 health, child and adolescent health, maternal 

17 health and mortality, foodborne and waterborne 

18 illness, reproductive health, and any other 

19 notifiable disease or condition; 

20 ‘‘(iv) encourage States to enter into data shar21 ing agreements with Indian Tribes, Tribal organiza22 tions, and epidemiology centers to improve the qual23 ity and accuracy of public health data; and 

24 ‘‘(v) not later than 180 days after the date of 

25 enactment of the Tribal Health Data Improvement 


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1 Act of 2020, and biennially thereafter, issue a report 

2 on the following: 

3 ‘‘(I) Which States have data sharing agree4 ments with Indian Tribes, Tribal organizations, 

5 Urban Indian organizations, and Tribal epide6 miology centers to improve the quality and ac7 curacy of health data. 

8 ‘‘(II) What the Centers for Disease Control 

9 and Prevention is doing to encourage States to 

10 enter into data sharing agreements with Indian 

11 Tribes, Tribal organizations, Urban Indian or12 ganizations, and Tribal epidemiology centers to 

13 improve the quality and accuracy of health 

14 data. 

15 ‘‘(III) Best practices and guidance for 

16 States, Indian Tribes, Tribal organizations, 

17 Urban Indian organizations, and Tribal epide18 miology centers that wish to enter into data 

19 sharing agreements. 

20 ‘‘(IV) Best practices and guidance for 

21 local, State, Tribal, and Federal uniform stand22 ards for the collection of data on race and eth23 nicity.’’. 

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

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


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1 (1) by redesignating subsection (n) as sub2 section (o); and 

3 (2) by inserting after subsection (m) the fol4 lowing: 

5 ‘‘(n) In this section: 

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

7 epidemiology center established under section 214 of 

8 the Indian Health Care Improvement Act, including 

9 such Tribal epidemiology centers serving Indian 

10 Tribes regionally and any Tribal epidemiology center 

11 serving Urban Indian organizations nationally. 

12 ‘‘(2) The term ‘Indian Tribe’ has the meaning 

13 given to the term ‘Indian tribe’ in section 4 of the 

14 Indian Self-Determination and Education Assistance 

15 Act. 

16 ‘‘(3) The term ‘Tribal organization’ has the 

17 meaning given to the term ‘tribal organization’ in 

18 section 4 of the Indian Self-Determination and Edu19 cation Assistance Act. 

20 ‘‘(4) The term ‘Urban Indian organization’ has 

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

22 Indian Health Care Improvement Act.’’. 

23 (h) AUTHORIZATION OF APPROPRIATIONS.—Section 

24 306(o) of the Public Health Service Act, as redesignated 

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


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1 ‘‘(o)(1) To carry out this section, there is authorized 

2 to be appropriated $185,000,000 for each of the fiscal 

3 years 2021 through 2025. 

4 ‘‘(2) Of the amount authorized to be appropriated to 

5 carry out this section for a fiscal year, the Secretary shall 

6 not use more than 10 percent for the combined costs of— 

7 ‘‘(A) administration of this section; and 

8 ‘‘(B) carrying out subsection (m)(2).’’. 

Passed the House of Representatives September 29, 

2020. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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