II 

118TH CONGRESS 

1ST SESSION S. 1229 

To establish a Green New Deal for Health to prepare and empower the 

health care sector to protect the health and well-being of our workers, 

our communities, and our planet in the face of the climate crisis, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 20, 2023 

Mr. MARKEY (for himself, Mr. MERKLEY, Mr. SANDERS, and Ms. WARREN) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

A BILL 

To establish a Green New Deal for Health to prepare and 

empower the health care sector to protect the health 

and well-being of our workers, our communities, and 

our planet in the face of the climate crisis, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Green New Deal for Health Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

Sec. 3. Findings and sense of Congress on health and climate change. 

TITLE I—WHOLE-OF-GOVERNMENT APPROACH 

Sec. 101. Definitions. 

Sec. 102. Office of Climate Change and Health Equity; national strategic action plan. 

Sec. 103. Advisory board. 

Sec. 104. Climate change health protection and promotion reports. 

Sec. 105. Authorization of appropriations. 

TITLE II—PROTECTING ESSENTIAL HEALTH CARE ACCESS 

Sec. 201. Maintenance of health care access relating to hospital discontinuation 

of services or closure. 

Sec. 202. Empowering community health in environmental justice communities. 

TITLE III—GREEN AND RESILIENT HEALTH CARE 

INFRASTRUCTURE 

Sec. 301. Green Hill-Burton funds for climate-ready medical facilities. 

Sec. 302. Planning and Evaluation Grant Program. 

TITLE IV—HEALTH CARE SECTOR DECARBONIZATION 

Sec. 401. Office of Sustainability and Environmental Impact. 

Sec. 402. Climate risk disclosure for medical supplies. 

Sec. 403. Green health care manufacturing. 

TITLE V—A HEALTH WORKFORCE TO TACKLE THE CLIMATE 

CRISIS 

Sec. 501. Education and training relating to health risks associated with climate change. 

Sec. 502. Building a community health workforce for the climate crisis. 

Sec. 503. Safeguarding essential health care workers. 

TITLE VI—SAFE, STRONG, AND RESILIENT COMMUNITIES 

Subtitle A—Empowering Resilient Community Mental Health 

Sec. 601. Grants for resilient community mental health. 

Subtitle B—Understanding and Preventing Heat Risk 

Sec. 611. Definitions. 

Sec. 612. Study on extreme heat information and response. 

Sec. 613. Financial assistance for research and resilience in addressing extreme 

heat risks. 

Sec. 614. Authorization of appropriations. 

Subtitle C—Home Resiliency for Medical Needs 

Sec. 621. Medicare coverage of medically necessary home resiliency services. 


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TITLE VII—RESEARCH AND INNOVATION FOR CLIMATE AND 

HEALTH 

Sec. 701. Research and innovation for climate and health. 

1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) ENVIRONMENTAL JUSTICE COMMUNITY.— 

4 The term ‘‘environmental justice community’’ means 

5 a community with significant representation of com6 munities of color, low-income communities, or Tribal 

7 and Indigenous communities that experiences, or is 

8 at risk of experiencing, higher or more adverse 

9 human health or environmental effects. 

10 (2) INDIVIDUAL DISPROPORTIONATELY AF11 FECTED BY CLIMATE CHANGE.—The term ‘‘indi12 vidual disproportionately affected by climate change’’ 

13 means an individual that may face elevated mental 

14 and physical health risks due to climate change 

15 based on 2 or more of the following factors: 

16 (A) Age under 5 years old or over 65 years 

17 old. 

18 (B) Race and ethnicity, and experience of 

19 racial bias. 

20 (C) Sex, gender, and gender minority sta21 tus. 

22 (D) Being of reproductive age. 


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1 (E) Exposure to environmental health 

2 risks due to living conditions or location, includ3 ing current or past experience of homelessness. 

4 (F) Occupation or exposure to occupational 

5 hazards. 

6 (G) Household income. 

7 (H) Disability. 

8 (I) Co-morbidities. 

9 (J) Current or past exposure to personal 

10 or systemic trauma, including natural disasters. 

11 (K) Immigration status. 

12 (L) Language isolation. 

13 (3) MEDICALLY UNDERSERVED COMMUNITY.— 

14 The term ‘‘medically underserved community’’ has 

15 the meaning given such term in section 799B of the 

16 Public Health Service Act (42 U.S.C. 295p). 

17 SEC. 3. FINDINGS AND SENSE OF CONGRESS ON HEALTH 

18 AND CLIMATE CHANGE. 

19 (a) FINDINGS.—Congress finds that, according to the 

20 assessment of the United States Global Change Research 

21 Program entitled ‘‘The Impacts of Climate Change on 

22 Human Health in the United States: A Scientific Assess23 ment’’ and dated 2016— 

24 (1) the impacts of human-induced climate 

25 change are increasing nationwide; 


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1 (2) rising greenhouse gas concentrations result 

2 in increases in temperature, changes in precipitation, 

3 increases in the frequency and intensity of some ex4 treme weather events, and rising sea levels; 

5 (3) the climate change impacts described in 

6 paragraph (2) endanger our health by affecting— 

7 (A) our access to care, food, and water 

8 sources; 

9 (B) the air we breathe; 

10 (C) the weather we experience; and 

11 (D) our interactions with the built and 

12 natural environments; and 

13 (4) as the climate continues to change, the risks 

14 to human health continue to grow. 

15 (b) SENSE OF CONGRESS.—It is the sense of Con16 gress that— 

17 (1) climate change poses threats to the United 

18 States and globally through its impacts on society, 

19 the economy, the physical environment, and physical 

20 and mental health; 

21 (2) climate change health threats are growing 

22 in scale and severity; 

23 (3) climate change disproportionately affects in24 dividuals in the United States who are economically 


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1 disadvantaged, belong to communities of color, or 

2 have other social and health vulnerabilities; 

3 (4) the health care sector accounts for 8.5 per4 cent of United States emissions, further worsening 

5 the overall health impacts of climate change; and 

6 (5) the Federal Government, working with 

7 international, State, Tribal, and local governments, 

8 nongovernmental organizations, businesses, and indi9 viduals, should use all practicable means and meas10 ures— 

11 (A) to deploy a whole-of-government and 

12 whole-of-health approach to protect our collec13 tive health from the impacts of climate change 

14 and to mitigate environmental health impacts 

15 from health sector operations; 

16 (B) to build a just health care ecosystem 

17 where all Americans have access to dignified, 

18 high-quality care in their communities; 

19 (C) to ensure the health care system is re20 silient to extreme weather and can continue to 

21 provide care before, during, and after crises; 

22 (D) to lead the health sector to 

23 decarbonize its facilities and operations in an 

24 equitable and just manner; 


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1 (E) to empower a thriving health work2 force with good, high-wage union jobs and to 

3 recognize the value of all of the essential work4 ers that enable high-quality health care; and 

5 (F) to invest in, empower, and build safe, 

6 strong, and resilient communities. 

7 TITLE I—WHOLE-OF8 GOVERNMENT APPROACH 

9 SEC. 101. DEFINITIONS. 

10 In this title: 

11 (1) DIRECTOR.—The term ‘‘Director’’ means 

12 the Director of the Office. 

13 (2) NATIONAL STRATEGIC ACTION PLAN.—The 

14 term ‘‘national strategic action plan’’ means the na15 tional strategic action plan published pursuant to 

16 section 102(b)(1). 

17 (3) OFFICE.—The term ‘‘Office’’ means the Of18 fice of Climate Change and Health Equity estab19 lished by section 102(a)(1). 

20 (4) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 SEC. 102. OFFICE OF CLIMATE CHANGE AND HEALTH EQ23 UITY; NATIONAL STRATEGIC ACTION PLAN. 

24 (a) OFFICE OF CLIMATE CHANGE AND HEALTH EQ25 UITY.— 


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1 (1) ESTABLISHMENT.— 

2 (A) IN GENERAL.—There is established 

3 within the Department of Health and Human 

4 Services the Office of Climate Change and 

5 Health Equity. 

6 (B) PURPOSE.—The purpose of the Office 

7 shall be to facilitate a robust, Federal response 

8 to the impact of climate change on the health 

9 of the American people and the health care sys10 tem. 

11 (C) DIRECTOR.—There is established the 

12 position of Director of the Office, who— 

13 (i) shall be the head of the Office; and 

14 (ii) may report to the Assistant Sec15 retary for Health. 

16 (2) ACTIVITIES.—The duties of the Office shall 

17 be to address priority health actions relating to the 

18 health impacts of climate change, including by doing 

19 each of the following: 

20 (A) Contribute to assessments of how cli21 mate change is affecting the health of individ22 uals living in the United States. 

23 (B) Understand the needs of the popu24 lations most disproportionately affected by cli25 mate-related health threats. 


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1 (C) Serve as a credible source of informa2 tion on the physical, mental, and behavioral 

3 health consequences of climate change. 

4 (D) Align Federal efforts to deploy cli5 mate-conscious human services and direct serv6 ices to support and protect populations com7 posed of individuals disproportionately affected 

8 by climate change. 

9 (E) Create and distribute tools and re10 sources to support climate resilience for the 

11 health sector, community-based organizations, 

12 and individuals. 

13 (F) Create and distribute tools and re14 sources to support health sector efforts to track 

15 and decrease greenhouse gas emissions. 

16 (G) Lead efforts to reduce the carbon foot17 print and environmental impacts of the health 

18 sector. 

19 (H) Carry out other activities determined 

20 appropriate by the Secretary. 

21 (b) NATIONAL STRATEGIC ACTION PLAN.— 

22 (1) IN GENERAL.—Not later than 1 year after 

23 the date of enactment of this Act, the Secretary, on 

24 the basis of the best available science, and in con25 sultation pursuant to paragraph (2), shall publish a 


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1 national strategic action plan to coordinate effective 

2 deployment of Federal efforts to ensure that public 

3 health and health care systems are prepared for and 

4 can respond to the impacts of climate change on 

5 health in the United States. 

6 (2) CONSULTATION.—In developing or making 

7 any revision to the national strategic action plan, the 

8 Secretary shall— 

9 (A) consult with the Director, the Adminis10 trator of the Environmental Protection Agency, 

11 the Under Secretary of Commerce for Oceans 

12 and Atmosphere, the Administrator of the Na13 tional Aeronautics and Space Administration, 

14 the Director of the Indian Health Service, the 

15 Secretary of Labor, the Secretary of Defense, 

16 the Secretary of State, the Secretary of Vet17 erans Affairs, the National Environmental Jus18 tice Advisory Council, the heads of other appro19 priate Federal agencies, Tribal governments, 

20 and State and local government officials; and 

21 (B) provide meaningful opportunity for en22 gagement, comment, and consultation with rel23 evant public stakeholders, particularly rep24 resentatives of populations composed of individ25 uals disproportionately affected by climate 


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1 change, environmental justice communities, 

2 Tribal communities, health care providers, pub3 lic health organizations, and scientists. 

4 (3) NATIONAL STRATEGIC ACTION PLAN COM5 PONENTS.—The national strategic action plan shall 

6 include an assessment of, and strategies to improve, 

7 the health sector capacity of the United States to 

8 address climate change, including— 

9 (A) identifying, prioritizing, and engaging 

10 communities and populations who are dis11 proportionately affected by exposures to climate 

12 hazards; 

13 (B) addressing mental and physical health 

14 disparities exacerbated by climate impacts to 

15 enhance community health resilience; 

16 (C) identifying the link between environ17 mental injustice and vulnerability to the im18 pacts of climate change and prioritizing those 

19 who have been harmed by environmental and 

20 climate injustice; 

21 (D) providing outreach and communication 

22 aimed at public health and health care profes23 sionals and the public to promote preparedness 

24 and response strategies; 


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1 (E) tracking and assessing programs 

2 across Federal agencies to advance research re3 lated to the impacts of climate change on 

4 health; 

5 (F) identifying and assessing existing pre6 paredness and response strategies for the health 

7 impacts of climate change; 

8 (G) prioritizing critical public health and 

9 health care infrastructure projects; 

10 (H) providing modeling and forecasting 

11 tools of climate change health impacts, includ12 ing local impacts, where feasible; 

13 (I) establishing academic and regional cen14 ters of excellence; 

15 (J) recommending models for maintaining 

16 access to health care during extreme weather; 

17 (K) providing technical assistance and sup18 port for preparedness and response plans for 

19 the health threats of climate change in States, 

20 municipalities, territories, Indian Tribes, and 

21 developing countries; 

22 (L) addressing the impacts of fossil fuel 

23 pollution and greenhouse gas emissions on the 

24 health of individuals living in the United States; 


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1 (M) tracking health care sector contribu2 tions to greenhouse gas emissions and identi3 fying actions to reduce those emissions; 

4 (N) recommending new regulations or poli5 cies to address identified gaps in the health sys6 tem capacity to effectively reduce emissions, re7 duce environmental impact, and address climate 

8 change; and 

9 (O) developing, improving, integrating, and 

10 maintaining disease surveillance systems and 

11 monitoring capacity to respond to health-related 

12 impacts of climate change, including on topics 

13 addressing— 

14 (i) water-, food-, and vector-borne in15 fectious diseases and climate change; 

16 (ii) pulmonary effects, including re17 sponses to aeroallergens, infectious agents, 

18 and toxic exposures; 

19 (iii) cardiovascular effects, including 

20 impacts of temperature extremes; 

21 (iv) air pollution health effects, includ22 ing heightened sensitivity to air pollution 

23 such as wildfire smoke; 

24 (v) reproductive health effects, includ25 ing access to reproductive health care; 


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1 (vi) harmful algal blooms; 

2 (vii) mental and behavioral health im3 pacts of climate change; 

4 (viii) the health of migrants, refugees, 

5 displaced persons, and communities com6 posed of individuals disproportionately af7 fected by climate change; 

8 (ix) the implications for communities 

9 and populations vulnerable to the health 

10 effects of climate change, as well as strate11 gies for responding to climate change with12 in such communities; 

13 (x) Tribal, local, and community14 based health interventions for climate-re15 lated health impacts; 

16 (xi) extreme heat and weather events; 

17 (xii) decreased nutritional value of 

18 crops; and 

19 (xiii) disruptions in access to routine 

20 and acute medical care, public health pro21 grams, and other supportive services for 

22 maintaining health. 

23 (c) PERIODIC ASSESSMENT AND REVISION.—Not 

24 later than 1 year after the date of first publication of the 

25 national strategic action plan, and annually thereafter, the 


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1 Secretary shall periodically assess, and revise as necessary, 

2 the national strategic action plan, to reflect new informa3 tion collected, including information on— 

4 (1) the status of and trends in critical environ5 mental health indicators and related human health 

6 impacts; 

7 (2) the trends in and impacts of climate change 

8 on public health; 

9 (3) advances in the development of strategies 

10 for preparing for and responding to the impacts of 

11 climate change on public health; and 

12 (4) the effectiveness of the implementation of 

13 the national strategic action plan in protecting 

14 against climate change health threats. 

15 (d) IMPLEMENTATION.— 

16 (1) IMPLEMENTATION THROUGH HHS.—The 

17 Secretary shall exercise the Secretary’s authority 

18 under this title and other Federal statutes to achieve 

19 the goals and measures of the Office and the na20 tional strategic action plan. 

21 (2) OTHER PUBLIC HEALTH PROGRAMS AND

22 INITIATIVES.—The Secretary and Federal officials of 

23 other relevant Federal agencies shall administer 

24 public health programs and initiatives authorized by 

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1 ments of such laws, in a manner designed to achieve 

2 the goals of the Office and the national strategic ac3 tion plan. 

4 (3) HEALTH IMPACT ASSESSMENT.— 

5 (A) IN GENERAL.—Not later than 180 

6 days after the date of enactment of this Act, 

7 the Secretary shall identify proposed and cur8 rent laws, policies, and programs that are of 

9 particular interest for their impact in contrib10 uting to or alleviating health burdens and the 

11 health impacts of climate change. 

12 (B) ASSESSMENTS.—Not later than 2 

13 years after the date of enactment of this Act, 

14 the head of each relevant Federal agency 

15 shall— 

16 (i) assess the impacts that the pro17 posed and current laws, policies, and pro18 grams identified under subparagraph (A) 

19 under their jurisdiction have or may have 

20 on protection against the health threats of 

21 climate change; and 

22 (ii) assist State, Tribal, local, and ter23 ritorial governments in conducting such as24 sessments. 


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1 SEC. 103. ADVISORY BOARD. 

2 (a) ESTABLISHMENT.—The Secretary shall, pursuant 

3 to chapter 10 of title 5, United States Code, establish a 

4 permanent science advisory board to be composed of not 

5 less than 10 and not more than 20 members. 

6 (b) APPOINTMENT OF MEMBERS.— 

7 (1) IN GENERAL.—The Secretary shall appoint 

8 the members of the science advisory board from 

9 among individuals who— 

10 (A) are recommended by the President of 

11 the National Academy of Sciences or the Presi12 dent of the National Academy of Medicine; and 

13 (B) have expertise in essential public 

14 health and health care services, including with 

15 respect to diverse populations, climate change, 

16 environmental and climate justice, and other 

17 relevant disciplines. 

18 (2) REQUIREMENT.—The Secretary shall en19 sure that the science advisory board includes mem20 bers with practical or lived experience with relevant 

21 issues described in paragraph (1)(B). 

22 (c) FUNCTIONS.—The science advisory board shall— 

23 (1) provide scientific and technical advice and 

24 recommendations to the Secretary on the domestic 

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1 ately affected by climate change, and strategies and 

2 mechanisms to prepare for and respond to the im3 pacts of climate change on public health; 

4 (2) advise the Secretary regarding the best 

5 science available for purposes of issuing the national 

6 strategic action plan and conducting the climate and 

7 health program; and 

8 (3) submit a report to Congress on its activities 

9 and recommendations not later than 1 year after the 

10 date of enactment of this Act and not later than 

11 every year thereafter. 

12 (d) SUPPORT.—The Secretary shall provide financial 

13 and administrative support to the board. 

14 SEC. 104. CLIMATE CHANGE HEALTH PROTECTION AND 

15 PROMOTION REPORTS. 

16 (a) IN GENERAL.—The Secretary shall offer to enter 

17 into an agreement, including the provision of such funding 

18 as may be necessary, with the National Academies of 

19 Sciences, Engineering, and Medicine, under which such 

20 National Academies will prepare periodic reports to aid 

21 public health and health care professionals in preparing 

22 for and responding to the adverse health effects of climate 

23 change that— 

24 (1) review scientific developments on health im25 pacts and health disparities of climate change; 


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1 (2) evaluate the measurable impacts of activi2 ties undertaken at the directive of the national stra3 tegic action plan; and 

4 (3) recommend changes to the national stra5 tegic action plan and climate and health program. 

6 (b) SUBMISSION.—The agreement under subsection 

7 (a) shall require a report to be submitted to Congress and 

8 the Secretary and made publicly available not later than 

9 1 year after the first publication of the national strategic 

10 action plan, and every 4 years thereafter. 

11 SEC. 105. AUTHORIZATION OF APPROPRIATIONS. 

12 (a) OFFICE OF CLIMATE CHANGE AND HEALTH EQ13 UITY.—There is authorized to be appropriated to the Sec14 retary to carry out section 102(a) $10,000,000 for each 

15 of fiscal years 2024 through 2030. 

16 (b) NATIONAL STRATEGIC ACTION PLAN.—There is 

17 authorized to be appropriated to the Secretary to carry 

18 out section 102(b) $2,000,000 for fiscal year 2024, to re19 main available until expended. 

20 (c) ADVISORY BOARD.—There is authorized to be ap21 propriated to the Secretary to carry out section 103(c) 

22 $500,000 for fiscal year 2024, to remain available until 

23 expended. 


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1 TITLE II—PROTECTING ESSEN2 TIAL HEALTH CARE ACCESS 

3 SEC. 201. MAINTENANCE OF HEALTH CARE ACCESS RELAT4 ING TO HOSPITAL DISCONTINUATION OF 

5 SERVICES OR CLOSURE. 

6 Section 1866 of the Social Security Act (42 U.S.C. 

7 1395cc) is amended— 

8 (1) in subsection (a)(1)— 

9 (A) in subparagraph (X), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (Y)(ii)(V), by striking 

12 the period and inserting ‘‘, and’’; and 

13 (C) by inserting after subparagraph (Y) 

14 the following new subparagraph: 

15 ‘‘(Z) beginning 60 days after the date of the en16 actment of this subparagraph, in the case of a hos17 pital, to comply with the requirements of subsection 

18 (l) (relating to discontinuation of services or clo19 sure).’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘(l) REQUIREMENTS FOR HOSPITALS RELATING TO

23 DISCONTINUATION OF SERVICES OR CLOSURE.— 

24 ‘‘(1) REQUIREMENTS.— 


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1 ‘‘(A) IN GENERAL.—For purposes of sub2 section (a)(1)(Z), except as provided in sub3 paragraph (B), the requirements described in 

4 this subsection are that a hospital— 

5 ‘‘(i) notify the Secretary, in accord6 ance with paragraph (2), not less than 90 

7 days prior to the discontinuation of serv8 ices or full hospital closure; 

9 ‘‘(ii) prohibit the discontinuation of 

10 essential services (as defined in paragraph 

11 (6)) during the notification period (as de12 fined in such paragraph) unless there is a 

13 clear harm posed to patient or employee 

14 health or safety in the hospital continuing 

15 to furnish such services; 

16 ‘‘(iii) respond to any inquiries by the 

17 Secretary relating to the implementation of 

18 this subsection, including the determina19 tion of essential services under paragraph 

20 (6)(C); and 

21 ‘‘(iv) if applicable— 

22 ‘‘(I) submit a mitigation plan 

23 and related information as described 

24 in paragraph (3); and 


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1 ‘‘(II) participate in the public 

2 comment and review process (includ3 ing, if applicable, the alternative miti4 gation plan) described in paragraph 

5 (4). 

6 ‘‘(B) APPLICATION IN CASE OF CATA7 STROPHIC EVENTS.—In the case where a dis8 continuation of services or closure of a hospital 

9 is due to an unforeseen catastrophic event (as 

10 defined by the Secretary), the requirements de11 scribed in subparagraph (A) shall apply, ex12 cept— 

13 ‘‘(i) the hospital shall provide the no14 tification under clause (i) of such subpara15 graph not later than 30 days after the cat16 astrophic event or as soon as feasible as 

17 determined by the Secretary; and 

18 ‘‘(ii) clause (ii) of such subparagraph 

19 (relating to prohibiting the discontinuation 

20 of services) shall not apply. 

21 ‘‘(2) NOTIFICATION INFORMATION.—For pur22 poses of paragraph (1)(A)(i), the notification under 

23 such paragraph shall include the following informa24 tion with respect to a hospital: 


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1 ‘‘(A) DISCONTINUATION OF SERVICES.—In 

2 the case where the hospital is discontinuing 

3 services (without full hospital closure): 

4 ‘‘(i) The services that will be discon5 tinued and number of hospital beds im6 pacted. 

7 ‘‘(ii) The number of individuals fur8 nished such services annually and a break9 down of the type of insurance used by such 

10 individuals for such services. 

11 ‘‘(iii) The number of impacted em12 ployees and what labor organization rep13 resents them (and the contact information 

14 for such organization). 

15 ‘‘(iv) The names and addresses of any 

16 organized health care coalitions and com17 munity groups that represent the commu18 nities impacted by the discontinuation of 

19 such services. 

20 ‘‘(v) Alternative providers of such 

21 services, including provider type, contact 

22 information, and distance and transpor23 tation time by car and public transit from 

24 the hospital. 


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1 ‘‘(B) FULL HOSPITAL CLOSURE.—In the 

2 case of full hospital closure: 

3 ‘‘(i) Hospital ownership entities. 

4 ‘‘(ii) The full extent of services that 

5 will no longer be furnished by the hospital. 

6 ‘‘(iii) The number of individuals fur7 nished services annually by the hospital, a 

8 description of the services furnished, and a 

9 breakdown of the type of insurance type 

10 used by such individuals for such services. 

11 ‘‘(iv) The number of impacted employ12 ees and, if applicable, what labor organiza13 tions represent them (and the contact in14 formation for each such organization). 

15 ‘‘(v) The names and addresses of any 

16 organized health care coalitions and com17 munity groups that represent the commu18 nities impacted by the closure. 

19 ‘‘(vi) Alternative providers, including 

20 provider type, contact information, and 

21 distance and transportation time by car 

22 and public transit from the hospital. 

23 ‘‘(vii) Steps taken prior to the deci24 sion to close in order to avoid closure. 


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1 ‘‘(viii) Distribution of liquidation pro2 ceeds (cash or assets) or any payments 

3 (cash or assets) made to employees, own4 ers, or contractors related to the closure. 

5 ‘‘(3) SUBMISSION OF MITIGATION PLAN AND

6 RELATED INFORMATION FOR ESSENTIAL SERV7 ICES.— 

8 ‘‘(A) NOTIFICATION BY SECRETARY.—If 

9 the Secretary determines that the discontinu10 ation of services or closure of an applicable hos11 pital would negatively impact access to essential 

12 services, the Secretary shall notify the applica13 ble hospital of such determination. 

14 ‘‘(B) SUBMISSION OF MITIGATION PLAN

15 AND RELATED INFORMATION.—If an applicable 

16 hospital receives a notification under subpara17 graph (A), the applicable hospital shall, not 

18 later than 15 days after receiving such notifica19 tion, submit to the Secretary— 

20 ‘‘(i) a plan to— 

21 ‘‘(I) preserve access to essential 

22 services for impacted communities 

23 through partnerships, commitments 

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1 tation plan access, and preparation 

2 for surge response; and 

3 ‘‘(II) support employees in 

4 transitioning to new positions within 

5 health care; 

6 ‘‘(ii) information on workforce and 

7 public engagement to ensure awareness of 

8 the discontinuation of services or closure; 

9 and 

10 ‘‘(iii) a description of potential alter11 natives to the discontinuation of services or 

12 closure that the hospital considered and an 

13 explanation of why those alternatives are 

14 not a viable option. 

15 ‘‘(C) PUBLIC AVAILABILITY.—The Sec16 retary shall make a mitigation plan and related 

17 information submitted by an applicable hospital 

18 under this paragraph available to the public on 

19 the internet website of the Centers for Medicare 

20 & Medicaid Services. 

21 ‘‘(4) PUBLIC COMMENT AND REVIEW PROCESS; 

22 ALTERNATIVE MITIGATION PLAN.— 

23 ‘‘(A) PUBLIC COMMENT PERIOD.— 

24 ‘‘(i) IN GENERAL.—The Secretary 

25 shall provide a public comment period of 


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1 not less than 45 days with the opportunity 

2 to submit written comments regarding the 

3 impact of the potential discontinuation of 

4 services or closure of an applicable hos5 pital. 

6 ‘‘(ii) NOTICE.—Notice of the oppor7 tunity to submit comments shall be pub8 lished in the Federal Register and distrib9 uted to— 

10 ‘‘(I) providers of services and 

11 suppliers that may be impacted by the 

12 discontinuation of services or closure 

13 of the applicable hospital; 

14 ‘‘(II) any labor organization that 

15 represents any subdivision of employ16 ees of the applicable hospital; 

17 ‘‘(III) organized health care coa18 litions and community groups that 

19 represent the communities impacted 

20 by the discontinuation of services or 

21 closure; 

22 ‘‘(IV) the State health agency; 

23 and 

24 ‘‘(V) the local department of pub25 lic health. 


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1 ‘‘(B) ALTERNATIVE MITIGATION PLAN.— 

2 ‘‘(i) IN GENERAL.—If, after reviewing 

3 the mitigation plan submitted by an appli4 cable hospital under paragraph (3) and the 

5 comments submitted during the public 

6 comment period under subparagraph (A) 

7 with respect to the discontinuation of serv8 ices or closure of the applicable hospital, 

9 the Secretary finds that the discontinu10 ation of services or closure of the applica11 ble hospital would have a significant im12 pact on access to essential services, the 

13 Secretary shall work with the applicable 

14 hospital or other providers of services and 

15 suppliers in the area, as appropriate, to de16 velop and implement an alternative plan to 

17 the plan submitted by the applicable hos18 pital under paragraph (3) (referred to in 

19 this subsection as the ‘alternative mitiga20 tion plan’) in order to ensure continued ac21 cess to essential services, which may in22 clude an agreement to delay the dis23 continuation of services or closure of the 

24 applicable hospital until the alternative 

25 mitigation plan is complete. 


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1 ‘‘(ii) TECHNICAL ASSISTANCE.—An 

2 alternative mitigation plan under clause (i) 

3 may include technical assistance or infor4 mation on available funding mechanisms to 

5 support the furnishing of essential services. 

6 ‘‘(iii) COLLABORATION.—The Sec7 retary should, to the extent practicable, 

8 collaborate with State and municipal gov9 ernment officials in the development of an 

10 alternative mitigation plan under clause 

11 (i). 

12 ‘‘(iv) PUBLIC AVAILABILITY.—The 

13 Secretary shall make any information sub14 mitted and the alternative mitigation plan 

15 developed under this paragraph available 

16 to the public on the internet website of the 

17 Centers for Medicare & Medicaid Services. 

18 ‘‘(C) IMPLEMENTATION.—The Secretary 

19 shall promulgate regulations to detail the re20 quired response time by an applicable hospital 

21 and the speed of the review process under this 

22 paragraph in order to ensure that such process 

23 can be completed with respect to an applicable 

24 hospital prior to the proposed service disVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 continuation date or closure date of the applica2 ble hospital. 

3 ‘‘(D) PROHIBITION.—In the case where 

4 the Secretary finds that a hospital has violated 

5 the requirements of this subsection, the Sec6 retary may prohibit the hospital and any hos7 pital under the same hospital ownership entity 

8 from being eligible to enroll or reenroll under 

9 the program under this title under section 

10 1866(j) until the earlier of— 

11 ‘‘(i) the date that is 3 years after the 

12 date on which the hospital discontinues 

13 services or closes; 

14 ‘‘(ii) the date on which the Secretary 

15 determines essential health services that 

16 were negatively impacted by the dis17 continuation or closure have been restored; 

18 or 

19 ‘‘(iii) such time as the Secretary is 

20 satisfied with the mitigation plan sub21 mitted by the hospital under paragraph (3) 

22 or the alternative mitigation plan under 

23 paragraph (4). 

24 ‘‘(5) ANNUAL REPORTS.—The Secretary shall 

25 submit an annual report to Congress on the disVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 continuation of services and full closure of hospitals. 

2 Each report submitted under the preceding sentence 

3 shall include— 

4 ‘‘(A) a description of trends in the dis5 continuation of services and closures of hos6 pitals, including hospital ownership type, geo7 graphic location, types of services furnished, de8 mographic served, and insurance type; 

9 ‘‘(B) an analysis of the impact of the dis10 continuation of services and closures on health 

11 care access and ability to meet surge demand 

12 due to emergency (such as a pandemic or cli13 mate disaster); 

14 ‘‘(C) recommendations for such adminis15 trative or legislative changes as the Secretary 

16 determines appropriate to preserve access to es17 sential services nationwide. 

18 ‘‘(6) DEFINITIONS.—In this subsection: 

19 ‘‘(A) APPLICABLE HOSPITAL.—The term 

20 ‘applicable hospital’ means a hospital that sub21 mits a notification under paragraph (1)(A)(i) of 

22 a discontinuation of services or full hospital clo23 sure. 

24 ‘‘(B) DISCONTINUATION.—The term ‘dis25 continuation’ may include any reduction or disVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 continuation of services furnished by an appli2 cable hospital, including those that occur as 

3 part of a merger or acquisition agreement. 

4 ‘‘(C) ESSENTIAL SERVICES.—The term ‘es5 sential services’ means, with respect to an ap6 plicable hospital, services that are necessary for 

7 preserving health care access (as determined by 

8 the Secretary), including services for which the 

9 Secretary determines— 

10 ‘‘(i) there are no equivalent services 

11 available within the same travel time; 

12 ‘‘(ii) that loss of the services would re13 sult in meaningful reductions in surge ca14 pacity that will negatively impact access to 

15 services; 

16 ‘‘(iii) that loss of the services would 

17 limit health care access for specific demo18 graphics of individuals based on sex, sexu19 ality, race, nationality, age, or disability 

20 status; 

21 ‘‘(iv) that loss of the services would 

22 have a meaningful impact on the ability of 

23 health systems to respond to impacts of 

24 climate change; or 


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1 ‘‘(v) there is a health or health care2 related emergency declaration status appli3 cable to the surrounding geographical area 

4 of the hospital on the date on which the 

5 hospital submits notification under para6 graph (1)(A)(i) of a discontinuation of 

7 services or full hospital closure. 

8 ‘‘(D) NOTIFICATION PERIOD.—The term 

9 ‘notification period’ means, with respect to an 

10 applicable hospital, the period beginning on the 

11 date on which the hospital submits notification 

12 under paragraph (1)(A)(i) of a discontinuation 

13 of services or full hospital closure and ending 

14 on the date of such discontinuation of services 

15 or closure. 

16 ‘‘(7) NO PREEMPTION OF STATE LAW.—Noth17 ing in subsection (a)(1)(Z) or this subsection shall 

18 be construed to limit any rights or remedies under 

19 State or local law relating to protecting access to es20 sential services or reviewing proposed hospital clo21 sures or reduction of services.’’. 

22 SEC. 202. EMPOWERING COMMUNITY HEALTH IN ENVIRON23 MENTAL JUSTICE COMMUNITIES. 

24 Section 10503 of the Patient Protection and Afford25 able Care Act (42 U.S.C. 254b–2) is amended— 


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1 (1) in subsection (b)— 

2 (A) in paragraph (1)— 

3 (i) in subparagraph (E), by striking 

4 ‘‘and’’ at the end; and 

5 (ii) by adding at the end the fol6 lowing: 

7 ‘‘(G) $130,000,000,000 for the period of 

8 fiscal years 2024 through 2028; and’’; and 

9 (B) in paragraph (2)— 

10 (i) in subparagraph (G), by striking 

11 ‘‘and’’ at the end; 

12 (ii) in subparagraph (H), by striking 

13 the period and inserting ‘‘; and’’; and 

14 (iii) by adding at the end the fol15 lowing: 

16 ‘‘(I) $2,000,000,000 for each of 

17 fiscals years 2024 through 2028.’’; 

18 and 

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

20 ‘‘(f) ENVIRONMENTAL JUSTICE COMMUNITIES.—The 

21 Secretary shall ensure that not less than 50 percent of 

22 the amounts appropriated under subsection (b) on or after 

23 2024 are awarded to entities for use with respect to 

24 projects or sites located in or serving environmental justice 


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1 communities (as defined in section 2 of the Green New 

2 Deal for Health Act). 

3 ‘‘(g) PROHIBITION.—No amounts made available 

4 under this section may be used for any activity that is 

5 subject to the reporting requirements set forth in section 

6 203(a) of the Labor-Management Reporting and Disclo7 sure Act of 1959 (29 U.S.C. 433(a)).’’. 

8 TITLE III—GREEN AND RESIL9 IENT HEALTH CARE INFRA10 STRUCTURE 

11 SEC. 301. GREEN HILL-BURTON FUNDS FOR CLIMATE12 READY MEDICAL FACILITIES. 

13 (a) GRANTS FOR CONSTRUCTION OR MODERNIZA14 TION PROJECTS.— 

15 (1) IN GENERAL.—Section 1610(a) of the Pub16 lic Health Service Act (42 U.S.C. 300r(a)) is 

17 amended— 

18 (A) in paragraph (1)(A)— 

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

20 inserting a semicolon; 

21 (ii) in clause (ii), by striking the pe22 riod at the end and inserting ‘‘; or’’; and 

23 (iii) by adding at the end the fol24 lowing: 


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1 ‘‘(iii) increase capacity to provide es2 sential health care and update medical fa3 cilities to become more resilient to climate 

4 disasters and public health crises to ensure 

5 access and availability of quality health 

6 care for communities in need.’’; and 

7 (B) by striking paragraph (3) and insert8 ing the following: 

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

10 subsection, the Secretary shall give priority to appli11 cants whose projects will include, by design, resil12 ience against natural disasters, climate change miti13 gation, or other necessary predisaster adaptations to 

14 ensure continuous health care access and combat 

15 health risks due to climate change, such as— 

16 ‘‘(A) installation of onsite distributed gen17 eration that combines energy-efficient devices, 

18 energy storage, and renewable energy in accord19 ance with modern electrical safety standards for 

20 medical facilities to allow the medical facility to 

21 access essential energy during power outages 

22 and optimize use of onsite and offsite energy 

23 sources for emissions reductions; 

24 ‘‘(B) improving air conditioning, moni25 toring, and purifying through installation of 


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1 high-efficiency heat pumps that provide both 

2 cooling and heating, air purifiers, air filtration 

3 systems, and air quality monitoring systems in4 tegrated with energy systems and energy effi5 ciency considerations in preparation for future 

6 natural hazards and public health crises, such 

7 as wildfire, smog, extreme heat events, and 

8 pandemics; 

9 ‘‘(C) installation and maintenance of wet10 lands, drainage ponds, and any other green in11 frastructure to protect the medical facility from 

12 projected severe effects with respect to extreme 

13 weather, natural disasters, or climate-change14 related events, including sea-level rise, flooding, 

15 and increased risk of wildfire; 

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

17 plantings, particularly those that can provide 

18 publicly accessible temperature management 

19 and air quality improvements; 

20 ‘‘(E) tree planting and other green infra21 structure to create publicly accessible cool space 

22 to address urban heat islands; 

23 ‘‘(F) infrastructure upgrades that protect 

24 access routes to the medical facility, such as 

25 long-term flood, wildfire, and other disaster 


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1 mitigation for the roads, sidewalks, and public 

2 transit infrastructure that service the medical 

3 facility; 

4 ‘‘(G) the long-term maintenance of 

5 decarbonization and zero-emissions infrastruc6 ture; and 

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

8 Secretary determines will increase the sustain9 ability and resiliency of a medical facility, pro10 tect patient health and community access dur11 ing extreme weather, and advance environ12 mental justice. 

13 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated to carry out 

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

16 2024, to remain available until expended.’’. 

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

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

19 300r(b)) is amended by striking paragraph (3). 

20 (b) MEDICAL FACILITY PROJECT APPLICATIONS.— 

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

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

23 is amended— 

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

25 at the end; 


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

2 period at the end and inserting a semicolon; 

3 and 

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

5 ‘‘(L) reasonable assurance that the facility 

6 will have adequate staffing to fulfill the commu7 nity service obligation; and 

8 ‘‘(M) reasonable assurance that the facil9 ity— 

10 ‘‘(i) has a collective bargaining agree11 ment with 1 or more labor organizations 

12 representing employees at the facility; or 

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

14 interfere with the rights of employees of 

15 the facility under section 7 of the National 

16 Labor Relations Act.’’. 

17 (2) APPLICATION FOR PLANNING GRANTS.— 

18 Section 1621 of the Public Health Service Act (42 

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

20 following: 

21 ‘‘(c) APPLICATION FOR PLANNING GRANTS.—An ap22 plication for a project submitted under part A or B shall 

23 deemed to be complete for purposes of section 302(d)(2) 

24 of the Green New Deal for Health Act, and the application 


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1 shall be deemed to have been submitted for purposes of 

2 consideration for a planning grant under that section.’’. 

3 SEC. 302. PLANNING AND EVALUATION GRANT PROGRAM. 

4 (a) DEFINITIONS.—In this section: 

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

6 facility’’ means a hospital, public health center, out7 patient medical facility, rehabilitation facility, facil8 ity for long-term care, or other facility (as may be 

9 designated by the Secretary) for the provision of 

10 health care to ambulatory patients. 

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

12 project’’ means a construction or modernization 

13 project proposed by an eligible entity in a sustain14 ability and resiliency plan. 

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

16 the Secretary of Health and Human Services. 

17 (4) SUSTAINABILITY AND RESILIENCY PLAN.— 

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

19 a plan, including comprehensive preproject evalua20 tion, for a construction or modernization project 

21 that would, in order to protect patient health and 

22 community access, enhance— 

23 (A) the sustainability of a medical facility 

24 and infrastructure surrounding the medical fa25 cility; and 


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1 (B) the resiliency of that medical facility 

2 and infrastructure surrounding the medical fa3 cility to climate change and public health crises. 

4 (b) ESTABLISHMENT.—The Secretary shall establish 

5 a grant program, to be known as the ‘‘Planning and Eval6 uation Grant Program’’, under which the Secretary shall 

7 make planning grants to eligible entities to develop sus8 tainability and resiliency plans for medical facilities owned 

9 or operated by the eligible entity and infrastructure sur10 rounding the medical facilities. 

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

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

13 be— 

14 (1) a State, Tribal government, or political sub15 division of a State or Tribal government, including 

16 any city, town, county, borough, hospital district au17 thority, or public or quasi-public corporation; or 

18 (2) a nonprofit private entity. 

19 (d) APPLICATIONS.— 

20 (1) IN GENERAL.—Except as provided in para21 graph (2), an eligible entity seeking a planning 

22 grant under subsection (b) shall submit to the Sec23 retary an application at such time, in such manner, 

24 and containing such information as the Secretary 

25 may by regulation prescribe, including— 


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1 (A) a description of the proposed project; 

2 (B) a summary and breakdown of the de3 mographics of the patient population served or 

4 potentially served by the medical facility under 

5 the proposed project, including information 

6 on— 

7 (i) whether the medical facility is a fa8 cility for which a majority of the revenue 

9 the facility receives for patient care is from 

10 reimbursements for medical care furnished 

11 to Medicare and Medicaid beneficiaries 

12 under titles XVIII and XIX of the Social 

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

14 1396 et seq.); and 

15 (ii) other indications that individuals 

16 vulnerable to climate change are served or 

17 potentially served by the medical facility; 

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

19 proposed project— 

20 (i) will carry out 1 or more activities 

21 described in subsection (g); 

22 (ii) meet the needs of the community 

23 the medical facility serves, especially the 

24 needs of vulnerable populations; and 


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1 (iii) meet the sustainability and resil2 iency needs of the medical facility due to 

3 climate risks and hazards; 

4 (D) a description of whether the commu5 nity served by the medical facility is an environ6 mental justice community; 

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

8 planning grant would be used to carry out 1 or 

9 more planning and evaluation activities de10 scribed in subsection (f); 

11 (F) reasonable assurance that all laborers 

12 and mechanics employed by contractors or sub13 contractors in the performance of work on a 

14 project will be paid wages at rates not less than 

15 those prevailing on similar work in the locality 

16 as determined by the Secretary of Labor in ac17 cordance with subchapter IV of chapter 31 of 

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

19 Code (commonly referred to as the ‘‘Davis20 Bacon Act’’) and the Secretary of Labor shall 

21 have with respect to such labor standards the 

22 authority and functions set forth in Reorganiza23 tion Plan Numbered 14 of 1950 (64 Stat. 

24 1267; 5 U.S.C. App.) and section 3145 of title 

25 40, United States Code; and 


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1 (G) reasonable assurance that the facil2 ity— 

3 (i) has a collective bargaining agree4 ment with 1 or more labor organizations 

5 representing employees at the facility; or 

6 (ii) has an explicit policy not to inter7 fere with the rights of employees at the fa8 cility under section 7 of the National 

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

10 (2) ADDITIONAL APPLICATIONS.—An applica11 tion submitted under part A or B of title XVI of the 

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

13 and 42 U.S.C. 300r) shall be deemed to be a com14 plete application submitted for purposes of consider15 ation for a planning grant under subsection (b). 

16 (e) SELECTION.—The Secretary shall— 

17 (1) in coordination with the Secretary of En18 ergy and the Administrator of the Environmental 

19 Protection Agency, if necessary, develop metrics to 

20 evaluate applications for planning grants under sub21 section (b); and 

22 (2) give priority to applications that focus on 

23 improving a medical facility— 

24 (A) for which— 


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1 (i) a majority of the revenue the facil2 ity receives for patient care is from reim3 bursements for medical care furnished to 

4 Medicare and Medicaid beneficiaries under 

5 titles XVIII and XIX of the Social Secu6 rity Act (42 U.S.C. 1395 et seq. and 1396 

7 et seq.); or 

8 (ii) a high proportion of patients is 

9 uninsured, as determined by the Secretary; 

10 and 

11 (B) that is located in a neighborhood or 

12 serves a patient population that— 

13 (i) experiences low air quality; 

14 (ii) lacks green space; 

15 (iii) bears higher cumulative pollution 

16 burdens; or 

17 (iv) is at disproportionate risk of ex18 periencing the adverse effects of climate 

19 change. 

20 (f) PLANNING ACTIVITIES.—Planning and evaluation 

21 activities carried out by an eligible entity using grant 

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

23 more of the following: 

24 (1) Performing project planning, community 

25 outreach and engagement, feasibility studies, and 


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1 needs assessments of the local community and pa2 tient populations. 

3 (2) Performing engineering and climate-risk as4 sessments of the medical facility infrastructure and 

5 the access routes to the medical facility. 

6 (3) Providing management and operational as7 sistance for developing and receiving funding for the 

8 proposed project. 

9 (4) Other planning and evaluation activities and 

10 assessments as the Secretary determines appro11 priate. 

12 (g) PROPOSED PROJECTS.—Construction and mod13 ernization activities carried out by a proposed project 

14 under a sustainability and resiliency plan developed pursu15 ant to a planning grant received under subsection (b) may 

16 include— 

17 (1) improvements to the infrastructure, build18 ings, and grounds of the medical facility, includ19 ing— 

20 (A) installation of onsite distributed gen21 eration that combines energy-efficient devices, 

22 energy storage, and renewable energy in accord23 ance with modern electrical safety standards for 

24 medical facilities to allow the medical facility to 

25 access essential energy during power outages 


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1 and optimize use of onsite and offsite energy 

2 sources for emissions reductions; and 

3 (B) improving air conditioning, monitoring, 

4 and purifying through installation of high-effi5 ciency heat pumps that provide both cooling 

6 and heating, air purifiers, air filtration systems, 

7 and air quality monitoring systems integrated 

8 with energy systems and energy efficiency con9 siderations in preparation for future natural 

10 hazards and public health crises such as wild11 fire, smog, extreme heat events, and pandemics; 

12 (2) green infrastructure projects, such as— 

13 (A) installation and maintenance of wet14 lands, drainage ponds, and any other green in15 frastructure that would protect the medical fa16 cility from projected severe effects with respect 

17 to extreme weather, natural disasters, or cli18 mate-change-related events, including sea-level 

19 rise, flooding, and increased risk of wildfire; 

20 and 

21 (B) green rooftops, walls, and indoor 

22 plantings, particularly those that can provide 

23 publicly accessible temperature management 

24 and air quality improvements; 


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1 (3) resiliency projects to secure local accessi2 bility to the medical facility by protecting the access 

3 routes to the medical facility, such as— 

4 (A) infrastructure upgrades that protect 

5 access routes to the medical facility, such as 

6 long-term flood, wildfire, and other disaster 

7 mitigation for the roads, sidewalks, and public 

8 transit infrastructure that service the medical 

9 facility; and 

10 (B) the long-term maintenance of 

11 decarbonization and zero-emissions infrastruc12 ture; and 

13 (4) any other type of activity the Secretary de14 termines will increase the sustainability and resil15 iency of a medical facility and protect patient health 

16 and community access during extreme weather. 

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

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

19 (i) TECHNICAL ASSISTANCE.—The Secretary, in co20 ordination with the Secretary of Energy, the Adminis21 trator of the Environmental Protection Agency, and the 

22 Secretary of Transportation, if necessary, directly or 

23 through partnerships with States, Tribal governments, 

24 and nonprofit organizations, shall provide technical assistVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 ance to eligible entities interested in carrying out proposed 

2 projects that— 

3 (1) serve environmental justice communities or 

4 medically underserved communities; 

5 (2) demonstrate a commitment to provide job 

6 training, apprenticeship programs, and contracting 

7 opportunities to residents and small businesses 

8 owned by residents of the community that the med9 ical facility serves; 

10 (3) identify and further community priority ac11 tions and conduct robust community engagement; 

12 and 

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

14 protection, restoration, or management of ecological 

15 systems to safeguard public health, provide clean air 

16 and water, increase natural hazard resilience, and 

17 sequester carbon. 

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

19 condition of receiving a grant or technical assistance under 

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

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

22 any staffing agency or training provider, that such agency 

23 or provider does not use, any provision in employment 

24 agreements, job training agreements, or apprenticeship 

25 program agreements that would require an employee or 


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1 training or apprenticeship program participant to pay a 

2 debt if the employee or training or apprenticeship program 

3 participant’s employment or work relationship or training 

4 period with a specified employer or business entity is ter5 minated. 

6 (k) ENVIRONMENTAL JUSTICE COMMUNITIES.—The 

7 Secretary shall ensure that not less than 50 percent of 

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

9 sustainability and resiliency plans for proposed projects lo10 cated in environmental justice communities. 

11 (l) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to the Secretary to carry 

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

14 remain available until expended. 

15 TITLE IV—HEALTH CARE 

16 SECTOR DECARBONIZATION 

17 SEC. 401. OFFICE OF SUSTAINABILITY AND ENVIRON18 MENTAL IMPACT. 

19 (a) ESTABLISHMENT.—There is hereby established in 

20 the Centers for Medicare & Medicaid Services an Office 

21 of Sustainability and Environmental Impact (in this sec22 tion referred to as the ‘‘Office’’) to prepare the health care 

23 system for the impacts of climate change by supporting 

24 health care decarbonization, sustainability, and environ25 mental efforts and to ensure that the health care system 


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1 minimizes and mitigates its climate harm while advancing 

2 patient health and safety. 

3 (b) PRIORITY GOALS.—The Office shall— 

4 (1) collaborate with the Office of Climate 

5 Change and Health Equity, the Environmental Pro6 tection Agency, and other interagency committees to 

7 support a whole-of-government and whole-of-health 

8 approach to addressing the climate crisis; 

9 (2) develop and promulgate regulations that 

10 support climate-informed care, support health care 

11 decarbonization and sustainability, and mitigate the 

12 environmental impacts of the health care system 

13 upon patients, communities, and health care work14 ers; 

15 (3) develop and promulgate regulations that 

16 support patient access to, and coverage of, climate17 informed health care services to prevent and address 

18 the health impacts of climate change; 

19 (4) conduct oversight of health care systems, 

20 their climate emissions, and environmental harms 

21 and provide interagency technical assistance in re22 mediating such emissions and environmental harms; 

23 and 

24 (5) issue ‘‘Climate-Friendly’’ health system des25 ignations and accreditations that identify health sysVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 tems that demonstrate commitment to, and substan2 tial evidence of, reducing emissions and environ3 mental harm while advancing health care quality 

4 and patient and worker safety. 

5 (c) DIRECTOR.— 

6 (1) IN GENERAL.—The Office shall be headed 

7 by a Director, to be known as the Director of Sus8 tainability and Environmental Impact, who shall be 

9 appointed by the Secretary of Health and Human 

10 Services (in this section referred to as the ‘‘Sec11 retary’’). 

12 (2) FUNCTIONS.—The Director shall— 

13 (A) convene stakeholders (including key 

14 health care stakeholders) for strategic planning 

15 towards the priority goals of the Office; 

16 (B) advise the Secretary and the Adminis17 trator of the Centers for Medicare & Medicaid 

18 Services in matters of sustainability and envi19 ronmental impact and the role of the Centers 

20 for Medicare & Medicaid Services in sustain21 ability and environmental impact; 

22 (C) collaborate with academic experts and 

23 community leaders to understand and establish 

24 best practices for decarbonizing health care op25 erations; and 


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1 (D) develop and evaluate the Office’s strat2 egy to tackle health care decarbonization and 

3 sustainability and mitigating environmental im4 pacts within the Centers for Medicare & Med5 icaid Services. 

6 (d) REPORT TO CONGRESS.—Not later than 2 years 

7 after the date of the enactment of this Act, and every 2 

8 years thereafter, the Secretary shall submit to Congress 

9 a Health Care Sustainability and Environmental Impact 

10 Report, which shall be prepared by the Director of Sus11 tainability and Environmental Impact, with appropriate 

12 assistance from other agencies in the executive branch of 

13 the Federal Government. Each such report shall include 

14 the following: 

15 (1) A summary of interagency collaboration. 

16 (2) A methodology to designate and accredit 

17 health systems that achieve substantial reductions in 

18 emissions and environmental harm as ‘‘Climate19 Friendly’’ health systems. 

20 (3) An inventory of ‘‘Climate-Friendly’’ des21 ignated health systems, their strategies, challenges, 

22 and best practices for sustainability and mitigating 

23 environmental impact, and any significant effects of 

24 these efforts on— 

25 (A) quality of care; 


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1 (B) patient safety; 

2 (C) safety of health care workers and 

3 health care facility workers; 

4 (D) health care costs; and 

5 (E) environmental health and overall 

6 health of the community served. 

7 (4) An analysis of the demographics and cli8 mate vulnerability of patients and types of commu9 nities served by ‘‘Climate-Friendly’’ health systems. 

10 (5) Recommendations for actions by health sys11 tems and for Federal technical assistance and sup12 portive resources for the health system to achieve 

13 substantial reductions in emissions and environ14 mental harm in order to attain ‘‘Climate-Friendly’’ 

15 designation. 

16 (6) A summary of oversight efforts of the Cen17 ters for Medicare & Medicaid Services regarding 

18 emissions and environmental impacts and payment 

19 and coverage impacts on climate change prepared20 ness, mitigation, and response. 

21 (7) Recommendations for such legislation and 

22 administration action as the Secretary determines 

23 appropriate to regulate and promote health care sus24 tainability, decarbonization, and mitigate environ25 mental impact within the health care system. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section 

3 $2,000,000 for each of fiscal years 2024 through 2033. 

4 SEC. 402. CLIMATE RISK DISCLOSURE FOR MEDICAL SUP5 PLIES. 

6 Subchapter B of chapter V of the Federal Food, 

7 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend8 ed by adding at the end the following: 

9 ‘‘SEC. 524C. CLIMATE RISK DISCLOSURE FOR MEDICAL SUP10 PLIES. 

11 ‘‘(a) TASK FORCE.— 

12 ‘‘(1) IN GENERAL.—The Secretary, in coordina13 tion with the Commissioner and the Administrator 

14 of the Environmental Protection Agency, shall estab15 lish a task force for purposes of developing a strat16 egy to establish climate risk disclosure policies for 

17 manufacturers of drugs (including biological prod18 ucts) and devices. 

19 ‘‘(2) DUTIES.—The task force established 

20 under paragraph (1) shall— 

21 ‘‘(A) recommend a methodology for drug 

22 and device manufacturers to calculate the emis23 sions and climate risk due to clinical use of the 

24 drug or device, factoring in emissions from the 


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1 manufacture, transport, use, processing, reproc2 essing, and waste relating to the drug or device; 

3 ‘‘(B) recommend a policy and process for 

4 mandatory public disclosure of emissions and 

5 climate risk relating to drugs and devices; 

6 ‘‘(C) recommend a policy for oversight of 

7 disclosures to ensure accuracy and transparency 

8 of emissions reporting as described in subpara9 graph (B), and to ensure that patient safety 

10 and necessary access is maintained; 

11 ‘‘(D) develop methods to disseminate infor12 mation to clinicians for low environmental im13 pact options for clinically equivalent treatment 

14 options; 

15 ‘‘(E) develop suggestions for the reduction 

16 of emissions by drug and device manufacturers 

17 without harming or risking patient safety; and 

18 ‘‘(F) provide technical assistance and es19 tablish partnerships to facilitate lower emissions 

20 design and manufacture of comparable drugs 

21 and comparable devices. 

22 ‘‘(3) MEMBERSHIP.—The task force established 

23 under paragraph (1) shall be composed of the fol24 lowing: 


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1 ‘‘(A) 3 representatives of the Food and 

2 Drug Administration, appointed by the Com3 missioner. 

4 ‘‘(B) 3 representatives of the Environ5 mental Protection Agency, appointed by the Ad6 ministrator of the Environmental Protection 

7 Agency. 

8 ‘‘(C) 3 representatives of the Office of Cli9 mate Change and Health Equity of the Depart10 ment of Health and Human Services, appointed 

11 by the Secretary. 

12 ‘‘(b) REGULATIONS.—Not later than 1 year after the 

13 date of enactment of the Green New Deal for Health Act, 

14 the Secretary shall promulgate regulations to— 

15 ‘‘(1) establish mandatory climate risk disclosure 

16 and transparency policies for drugs and devices ap17 proved, licensed, or cleared under section 505, 

18 510(k), 513(f)(2), or 515 of this Act or section 351 

19 of the Public Health Service Act; and 

20 ‘‘(2) incorporate climate risk into policies re21 lated to transparency, labeling, and other regulatory 

22 policies related to drugs and devices, based on the 

23 recommendations of the task force described in sub24 section (a). 


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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 $4,000,000 for fiscal year 2024, to remain available until 

4 expended.’’. 

5 SEC. 403. GREEN HEALTH CARE MANUFACTURING. 

6 (a) IN GENERAL.—There is established a Federal 

7 interagency working group, to be known as the ‘‘Council 

8 on Green Health Care Manufacturing’’ (referred to in this 

9 section as the ‘‘Council’’). 

10 (b) MEMBERSHIP.—The membership of the Council 

11 shall consist of— 

12 (1) the Secretary of Health and Human Serv13 ices (referred to in this section as the ‘‘Secretary’’), 

14 who shall serve as the Chair; 

15 (2) the Secretary of Energy; 

16 (3) the Secretary of Transportation; 

17 (4) the Secretary of Labor; 

18 (5) the Administrator of the Environmental 

19 Protection Agency; 

20 (6) the Director of the Office of Climate 

21 Change and Health Equity; 

22 (7) the Director of Sustainability and Environ23 mental Impact; 

24 (8) the Chair of the Council on Environmental 

25 Quality; 


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1 (9) the United States Trade Representative; 

2 and 

3 (10) the heads of other Federal agencies, as de4 termined necessary by the Chair. 

5 (c) DUTIES.— 

6 (1) ASSESSMENT AND REPORT.— 

7 (A) IN GENERAL.—Not later than 1 year 

8 after the date of enactment of this Act, the 

9 Council shall conduct an assessment of global 

10 and domestic medical supply chains, including 

11 an assessment of— 

12 (i) the environmental and climate im13 pacts of medical supply chains, including— 

14 (I) emissions from the produc15 tion, transportation, and packaging of 

16 medical and pharmaceutical products; 

17 (II) chemical and other environ18 mental pollution; 

19 (III) excessive energy consump20 tion; 

21 (IV) negative externalities relat22 ing to waste; and 

23 (V) any other environmental or 

24 climate impacts the Council deter25 mines relevant; 


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1 (ii) labor conditions for workers in the 

2 United States and globally who produce 

3 medical and pharmaceutical products con4 sumed by individuals residing in the 

5 United States, including the degree to 

6 which such workers— 

7 (I) are ensured a protected right 

8 to organize; 

9 (II) are provided adequate work10 place safety protections; and 

11 (III) are adequately com12 pensated; 

13 (iii) efficiency and resiliency of proc14 esses under medical supply chains, includ15 ing the ability of medical supply chains to 

16 adapt to sudden shifts in demand, includ17 ing shifts in demand within discrete geo18 graphic regions; 

19 (iv) the reliance of the United States 

20 on international supply chains for medical 

21 products, including information about 

22 which types of medical products are pri23 marily manufactured outside of the United 

24 States, and where such products are manu25 factured; and 


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1 (v) human rights abuses in manufac2 turing of medical and pharmaceutical prod3 ucts and sourcing of those products, in4 cluding abuses of indigenous rights and 

5 traditions. 

6 (B) REPORT.—On completion of the as7 sessment conducted under subparagraph (A), 

8 the Council shall submit to Congress and make 

9 publicly available a report, to be known as the 

10 ‘‘Green Health Care Manufacturing Report’’, 

11 that describes the findings of the assessment. 

12 (2) RECOMMENDATIONS.— 

13 (A) IN GENERAL.—Based on the findings 

14 of the assessment conducted under paragraph 

15 (1)(A), the Council shall develop recommenda16 tions for regulations that would support a med17 ical supply chain that is— 

18 (i) sustainable; 

19 (ii) free of greenhouse gas emissions; 

20 and 

21 (iii) based in the United States. 

22 (B) INCLUSIONS.—The proposed regula23 tions under subparagraph (A) shall— 


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1 (i) support good labor conditions, 

2 worker protections, and employee rights to 

3 organize and collectively bargain; and 

4 (ii) ensure the global trade competi5 tiveness of the United States, including by 

6 considering the comparative carbon inten7 sity of domestic and internationally manu8 factured pharmaceuticals and medical 

9 products. 

10 (3) GRANT PROGRAM.—Based on the findings 

11 of the assessment conducted under paragraph 

12 (1)(A), the Council shall develop recommendations 

13 for a grant program to be carried out by the Sec14 retary under which the Secretary would make grants 

15 for medical manufacturing to support the develop16 ment and establishment of sustainable and zero17 emission medical supply chains based in the United 

18 States. 

19 (d) REGULATIONS.— 

20 (1) IN GENERAL.—Not later than 1 year after 

21 the date of enactment of this Act, the Secretary 

22 shall develop and promulgate regulations to support 

23 a medical supply chain that is— 

24 (A) sustainable; 

25 (B) free of greenhouse gas emissions; and 


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1 (C) based in the United States. 

2 (2) REQUIREMENT.—The Secretary shall de3 velop the regulations under paragraph (1) based on 

4 the recommendations for regulations developed by 

5 the Council under subsection (c)(2). 

6 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 such sums as are necessary. 

9 TITLE V—A HEALTH WORK10 FORCE TO TACKLE THE CLI11 MATE CRISIS 

12 SEC. 501. EDUCATION AND TRAINING RELATING TO 

13 HEALTH RISKS ASSOCIATED WITH CLIMATE 

14 CHANGE. 

15 Part D of title VII of the Public Health Service Act 

16 (42 U.S.C. 294 et seq.) is amended by inserting after sec17 tion 757 the following: 

18 ‘‘SEC. 758. EDUCATION AND TRAINING RELATING TO 

19 HEALTH RISKS ASSOCIATED WITH CLIMATE 

20 CHANGE. 

21 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

22 date of the enactment of the Green New Deal for Health 

23 Act, the Secretary shall establish a competitive grant pro24 gram to award grants to health professions schools to sup25 port the development and integration into such schools of 


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1 education and training programs for identifying, treating, 

2 and mitigating mental and physical health risks associated 

3 with climate change for whole populations and for individ4 uals disproportionately affected by climate change. 

5 ‘‘(b) APPLICATION.—To be eligible for a grant under 

6 this section, a health profession school shall submit to the 

7 Secretary an application at such time, in such form, and 

8 containing such information as the Secretary may require, 

9 which shall include, at a minimum, a description of the 

10 following: 

11 ‘‘(1) How the health profession school will en12 gage with frontline communities to climate change 

13 or environmental justice communities, and stake14 holder organizations representing such communities, 

15 in developing and implementing the education and 

16 training programs supported by the grant. 

17 ‘‘(2) How the health profession school will en18 gage with individuals disproportionately affected by 

19 climate change, and stakeholder organizations rep20 resenting such individuals, in developing and imple21 menting the education and training programs sup22 ported by the grant. 

23 ‘‘(3) How the health profession school will en24 sure that such education and training programs will 

25 address racial and ethnic disparities in exposure to, 


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1 and the effects of, risks associated with climate 

2 change for individuals vulnerable to climate change. 

3 ‘‘(4) How the health profession school will build 

4 inclusive career opportunities and pathways to build 

5 up and expand the health care workforce ready to 

6 address the health burdens of climate change. 

7 ‘‘(c) USE OF FUNDS.—A health profession school 

8 awarded a grant under this section shall use the grant 

9 funds to develop, and integrate into the curriculum and 

10 continuing education of such health profession school, edu11 cation and training on each of the following: 

12 ‘‘(1) Identifying risks associated with climate 

13 change for individuals disproportionately affected by 

14 climate change, with consideration of co-morbidities 

15 and socioeconomic risk factors. 

16 ‘‘(2) Identifying risks to reproductive health as17 sociated with climate change for individuals dis18 proportionately affected by climate change. 

19 ‘‘(3) How risks and combinations of risks asso20 ciated with climate change affect individuals dis21 proportionately affected by climate change and indi22 viduals with the intent to become pregnant. 

23 ‘‘(4) Racial and ethnic disparities in exposure 

24 to, and the effects of, risks associated with climate 

25 change for individuals disproportionately affected by 


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1 climate change and individuals with the intent to be2 come pregnant. 

3 ‘‘(5) Patient counseling and mitigation strate4 gies relating to risks associated with climate change 

5 for both mental and physical health for individuals 

6 disproportionately affected by climate change. 

7 ‘‘(6) Relevant services and support for individ8 uals disproportionately affected by climate change 

9 relating to risks associated with climate change and 

10 strategies for ensuring that such individuals have ac11 cess to such services and support. 

12 ‘‘(7) Implicit and explicit bias, racism, and dis13 crimination. 

14 ‘‘(8) Related topics identified by such health 

15 profession school based on the engagement of such 

16 health profession school with individuals vulnerable 

17 to climate change and stakeholder organizations rep18 resenting such individuals. 

19 ‘‘(d) PARTNERSHIPS.—In carrying out activities with 

20 grant funds, a health profession school awarded a grant 

21 under this section may partner with one or more of the 

22 following: 

23 ‘‘(1) A State, local, or Tribal public health de24 partment. 


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1 ‘‘(2) A labor union organization representing 

2 workers in health care settings. 

3 ‘‘(3) A health care professional membership as4 sociation. 

5 ‘‘(4) A patient advocacy organization. 

6 ‘‘(5) A community health center or organiza7 tion. 

8 ‘‘(6) A health profession school or other institu9 tion of higher education, which may be a health pro10 fession school. 

11 ‘‘(7) A public school or school district. 

12 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

13 provide technical assistance to health profession schools 

14 and partnership organizations to assist application plan15 ning and preparation for schools and partnerships that 

16 train individuals from, and that serve, medically under17 served communities. 

18 ‘‘(f) REPORTS TO SECRETARY.— 

19 ‘‘(1) ANNUAL REPORT.—For each fiscal year 

20 during which a health profession school receives 

21 grant funds under this section, such health profes22 sion school shall submit to the Secretary a report 

23 that describes the activities carried out with such 

24 grant funds during such fiscal year. 


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1 ‘‘(2) FINAL REPORT.—Not later than the date 

2 that is 1 year after the end of the last fiscal year 

3 during which a health profession school receives 

4 grant funds under this section, the health profession 

5 school shall submit to the Secretary a final report 

6 that summarizes the activities carried out with such 

7 grant funds. 

8 ‘‘(g) REPORT TO CONGRESS.—Not later than 6 years 

9 after the date on which the program is established under 

10 subsection (a), the Secretary shall submit to Congress and 

11 publish on the public website of the Department of Health 

12 and Human Services a report that includes the following: 

13 ‘‘(1) A summary of the reports submitted under 

14 subsection (e). 

15 ‘‘(2) Recommendations to improve education 

16 and training programs at health profession schools 

17 with respect to identifying and addressing risks as18 sociated with climate change for individuals vulner19 able to climate change. 

20 ‘‘(h) DEFINITIONS.—In this section: 

21 ‘‘(1) ENVIRONMENTAL JUSTICE COMMUNITY.— 

22 The term ‘environmental justice community’ has the 

23 meaning given such term in section 2 of the Green 

24 New Deal for Health Act. 


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1 ‘‘(2) HEALTH PROFESSION SCHOOL.—The term 

2 ‘health profession school’ means an accredited— 

3 ‘‘(A) medical school; 

4 ‘‘(B) school of nursing; 

5 ‘‘(C) midwifery program or other evidence6 based birth care training program; 

7 ‘‘(D) physician assistant education pro8 gram; 

9 ‘‘(E) school of psychiatry, psychology, 

10 counseling, or social work; 

11 ‘‘(F) career and technical education health 

12 sciences program; 

13 ‘‘(G) public health program; 

14 ‘‘(H) community health worker training 

15 program; 

16 ‘‘(I) teaching hospital; 

17 ‘‘(J) residency or fellowship program; or 

18 ‘‘(K) other school or program determined 

19 appropriate by the Secretary. 

20 ‘‘(3) INDIVIDUAL DISPROPORTIONATELY AF21 FECTED BY CLIMATE CHANGE.—The term ‘indi22 vidual disproportionately affected by climate change’ 

23 means an individual that may face elevated mental 

24 and physical health risks due to climate change 

25 based on 2 or more of the following factors: 


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1 ‘‘(A) Age under 5 years old or over 65 

2 years old. 

3 ‘‘(B) Race and ethnicity, and experience of 

4 racial bias. 

5 ‘‘(C) Sex, gender, and gender minority sta6 tus. 

7 ‘‘(D) Being of reproductive age. 

8 ‘‘(E) Exposure to environmental health 

9 risks due to living conditions or location, includ10 ing current or past experience of homelessness. 

11 ‘‘(F) Occupation or exposure to occupa12 tional hazards. 

13 ‘‘(G) Household income. 

14 ‘‘(H) Disability. 

15 ‘‘(I) Co-morbidities. 

16 ‘‘(J) Current or past exposure to personal 

17 or systemic trauma, including natural disasters. 

18 ‘‘(K) Immigration status. 

19 ‘‘(L) Language isolation. 

20 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

21 The term ‘medically underserved community’ has the 

22 meaning given such term in section 799B. 

23 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

24 authorized to be appropriated to carry out this section 


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1 $9,000,000,000 for fiscal year 2024, to remain available 

2 until expended.’’. 

3 SEC. 502. BUILDING A COMMUNITY HEALTH WORKFORCE 

4 FOR THE CLIMATE CRISIS. 

5 Section 399V of the Public Health Service Act (42 

6 U.S.C. 280g–11) is amended— 

7 (1) in subsection (b)— 

8 (A) by redesignating the paragraphs (2) 

9 through (6) as paragraphs (4) through (8), re10 spectively; 

11 (B) by inserting after paragraph (1) the 

12 following: 

13 ‘‘(2) build career paths for community health 

14 workers by— 

15 ‘‘(A) establishing accessible, inclusive, low16 cost or no-cost training, credentialing, or ap17 prenticeship opportunities for community health 

18 workers to acquire skills and expertise con19 cerning health risks caused by climate change 

20 and environmental hazards; 

21 ‘‘(B) establishing accessible, inclusive, low22 cost or no-cost educational, training, 

23 credentialing, or apprenticeship opportunities 

24 for entry into the community health worker 

25 profession; or 


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1 ‘‘(C) expanding career advancement oppor2 tunities and career pathways, including scholar3 ships for advanced or specialized training; 

4 ‘‘(3) expand the community health workforce by 

5 establishing permanent community health worker po6 sitions that pay, at minimum, the prevailing wage 

7 for such workers, through long-term, stable funding, 

8 in order to staff the medical needs of a community 

9 sufficiently while ensuring reasonable workloads for 

10 individual workers;’’; 

11 (C) in paragraph (4) (as so redesig12 nated)— 

13 (i) in subparagraph (A)(i), by insert14 ing ‘‘and linguistically isolated popu15 lations’’ before the semicolon; and 

16 (ii) in subparagraph (B)— 

17 (I) in clause (i), by striking 

18 ‘‘and’’ after the semicolon; 

19 (II) by redesignating clause (ii) 

20 as clause (iii); and 

21 (III) by inserting after clause (i) 

22 the following: 

23 ‘‘(ii) connecting population groups at 

24 disproportionate risk for specific health 

25 threats and effects from environmental 


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1 hazards, climate change, and extreme 

2 weather, such as increased heat-related ill3 nesses and injuries, degraded air and 

4 water quality, vector-borne illnesses, men5 tal and behavioral health effects, and food, 

6 water, and nutrient insecurity to available 

7 resources; and’’; 

8 (D) in paragraph (7) (as so redesignated), 

9 by striking ‘‘and’’ after the semicolon; 

10 (E) in paragraph (8) (as so redesignated), 

11 by striking the period at the end and inserting 

12 a semicolon; and 

13 (F) by adding at the end the following: 

14 ‘‘(9) support community health workers in edu15 cating, guiding, and providing home visitation serv16 ices regarding the assessment and mitigation of the 

17 health risks of climate change, including geography18 specific and condition-specific risks and environ19 mental health hazards and the cumulative health im20 pacts of such risks and hazards; and 

21 ‘‘(10) provide outreach and communication to 

22 promote preparedness and response strategies to cli23 mate change and extreme weather.’’; 

24 (2) in subsection (d)— 

25 (A) in paragraph (1)— 


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1 (i) in subparagraph (D), by striking 

2 ‘‘or’’ at the end; 

3 (ii) in subparagraph (E), by adding 

4 ‘‘or’’ after the semicolon; and 

5 (iii) by adding at the end the fol6 lowing: 

7 ‘‘(F) environmental justice communities 

8 (as defined in section 2 of the Green New Deal 

9 for Health Act);’’; 

10 (B) in paragraph (3), by inserting ‘‘and 

11 experience training community health workers’’ 

12 before the semicolon; 

13 (C) in paragraph (4), by striking ‘‘and’’ at 

14 the end; 

15 (D) in paragraph (5), by striking the pe16 riod at the end and inserting ‘‘; and’’; and 

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

18 ‘‘(6) have a documented collective bargaining 

19 agreement with 1 or more labor organizations rep20 resenting employees of the applicant or have an ex21 plicit policy not to interfere with the rights of em22 ployees of the applicant under section 7 of the Na23 tional Labor Relations Act.’’; 

24 (3) by redesignating subsections (e) through (j) 

25 as subsections (f) through (k), respectively; 


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1 (4) by inserting after subsection (d) the fol2 lowing: 

3 ‘‘(e) WORKFORCE EXPANSION.—The Secretary, in 

4 consultation with the Secretary of Labor, shall develop a 

5 plan to expand the community health workforce by 

6 150,000 workers by 2028 through the creation of career 

7 pathways, full-time positions, and training opportunities 

8 described in subsection (b).’’; 

9 (5) in subsection (j) (as so redesignated), by 

10 striking ‘‘$50,000,000 for each of fiscal years 2023 

11 through 2027’’ and inserting ‘‘$10,000,000,000 for 

12 each of fiscal years 2024 through 2033’’; and 

13 (6) in paragraph (1) of subsection (k) (as so re14 designated)— 

15 (A) by inserting ‘‘a nonprofit community 

16 health organization, a nonprofit community 

17 health worker association,’’ after ‘‘a public 

18 health department,’’; and 

19 (B) by striking ‘‘((as defined’’ and insert20 ing ‘‘(as defined’’. 

21 SEC. 503. SAFEGUARDING ESSENTIAL HEALTH CARE WORK22 ERS. 

23 The Public Health Service Act is amended by insert24 ing after section 319D–1 (42 U.S.C. 247d–4b) the fol25 lowing: 


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1 ‘‘SEC. 319D–2. EMERGENCY GRANTS TO SAFEGUARD ESSEN2 TIAL HEALTH CARE WORKERS. 

3 ‘‘(a) DEFINITIONS.—In this section: 

4 ‘‘(1) EMERGENCY OR DISASTER.—The term 

5 ‘emergency or disaster’ means— 

6 ‘‘(A) a major disaster declared by the 

7 President under section 401 of the Robert T. 

8 Stafford Disaster Relief and Emergency Assist9 ance Act; 

10 ‘‘(B) an emergency declared by the Presi11 dent under section 501 of the Robert T. Staf12 ford Disaster Relief and Emergency Assistance 

13 Act; 

14 ‘‘(C) a national emergency declared by the 

15 President under the National Emergencies Act; 

16 ‘‘(D) a public health emergency declared 

17 under section 319; and 

18 ‘‘(E) a State or local emergency or dis19 aster, as declared by the applicable State or 

20 local government. 

21 ‘‘(2) ELIGIBLE HEALTH CARE WORKER.—The 

22 term ‘eligible health care worker’ means an essential 

23 health care worker whose work cannot be conducted 

24 remotely. 

25 ‘‘(3) ESSENTIAL HEALTH CARE WORKER.—The 

26 term ‘essential health care worker’ means— 


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1 ‘‘(A) a health care provider, including a di2 rect care worker (as defined in section 799B); 

3 ‘‘(B) a medical technologist; 

4 ‘‘(C) a public health worker; 

5 ‘‘(D) an orderly (as defined in the 2010 

6 Standard Occupational Classifications of the 

7 Department of Labor under the code for Order8 lies (31–1015)); 

9 ‘‘(E) an environmental service, janitorial, 

10 or custodial worker in a health care setting; and 

11 ‘‘(F) any other professional role that the 

12 Secretary determines is essential to the care of 

13 patients or the maintenance of public health. 

14 ‘‘(b) GRANTS.— 

15 ‘‘(1) IN GENERAL.—The Secretary may make 

16 grants to public or private nonprofit health care fa17 cilities and home health agencies for use in accord18 ance with paragraph (2). 

19 ‘‘(2) USE OF FUNDS.— 

20 ‘‘(A) HAZARDOUS DUTY COMPENSATION.— 

21 ‘‘(i) IN GENERAL.—The recipient of a 

22 grant under paragraph (1) shall use the 

23 grant funds to provide hazardous duty 

24 compensation to eligible health care work25 ers for work performed during the period 


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1 of an emergency or disaster in cases in 

2 which the Secretary determines that— 

3 ‘‘(I) the performance of the work 

4 by the eligible health care worker for 

5 the applicable health care facility or 

6 home health agency is hazardous; or 

7 ‘‘(II) the commute of the eligible 

8 health care worker is hazardous. 

9 ‘‘(ii) REQUIREMENT.— 

10 ‘‘(I) IN GENERAL.—Subject to 

11 subclause (II), the amount of haz12 ardous duty compensation under 

13 clause (i) shall be not more than $13 

14 per hour, which shall be in addition to 

15 the wages or remuneration the eligible 

16 health care worker otherwise receives 

17 for the work. 

18 ‘‘(II) MAXIMUM AMOUNT.—The 

19 total amount of hazardous duty com20 pensation received by any 1 eligible 

21 health care worker under this sub22 paragraph may not exceed $25,000 

23 per year. 

24 ‘‘(B) ADDITIONAL USES.—The recipient of 

25 a grant under paragraph (1) may use the grant 


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1 funds to provide safety measures to safeguard 

2 and protect eligible health care workers from 

3 hazards due to the applicable emergency or dis4 aster, including alternative transit options, per5 sonal protective equipment, and other safety 

6 measures. 

7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 such sums as may be necessary.’’. 

10 TITLE VI—SAFE, STRONG, AND 

11 RESILIENT COMMUNITIES 

12 Subtitle A—Empowering Resilient 

13 Community Mental Health 

14 SEC. 601. GRANTS FOR RESILIENT COMMUNITY MENTAL 

15 HEALTH. 

16 Title III of the Public Health Service Act (42 U.S.C. 

17 241 et seq.) is amended by inserting after section 317V 

18 the following: 

19 ‘‘SEC. 317W. GRANT PROGRAM FOR COMMUNITY WELLNESS 

20 AND RESILIENCE PROGRAMS. 

21 ‘‘(a) GRANTS.— 

22 ‘‘(1) PROGRAM GRANTS.— 

23 ‘‘(A) AWARDS.—The Secretary, in coordi24 nation with the Assistant Secretary for Mental 

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1 trator of the Health Resources and Services Ad2 ministration, shall carry out a program of 

3 awarding grants to eligible entities, on a com4 petitive basis, for the purpose of establishing, 

5 operating, or expanding community mental 

6 wellness and resilience programs. 

7 ‘‘(B) AMOUNT.—An eligible entity awarded 

8 a grant under subparagraph (A) may receive 

9 not more than $300,000 per year for not more 

10 than 4 years. 

11 ‘‘(2) PLANNING GRANTS.— 

12 ‘‘(A) AWARDS.—The Secretary, in coordi13 nation with the Assistant Secretary for Mental 

14 Health and Substance Use and the Adminis15 trator of the Health Resources and Services Ad16 ministration, shall award grants to entities— 

17 ‘‘(i) to organize a resilience coordi18 nating network that meets the require19 ments of subsection (c)(2); 

20 ‘‘(ii) to perform assessments of need 

21 with respect to community mental wellness 

22 and resilience; and 

23 ‘‘(iii) to prepare an application for a 

24 grant under paragraph (1). 


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1 ‘‘(B) AMOUNT.—The amount of a grant 

2 under subparagraph (A), with respect to any re3 silience coordinating network to be organized 

4 for applying for a grant under paragraph (1), 

5 shall not exceed $100,000. 

6 ‘‘(b) PROGRAM REQUIREMENTS.—A community men7 tal wellness and resilience program funded pursuant to a 

8 grant under subsection (a)(1) shall take a public health 

9 approach to mental health to strengthen the entire com10 munity’s psychological and emotional wellness and resil11 ience, including by— 

12 ‘‘(1) collecting and analyzing information from 

13 residents as well as quantitative data to identify— 

14 ‘‘(A) protective factors that enhance and 

15 sustain the community’s capacity for mental 

16 wellness and resilience; and 

17 ‘‘(B) risk factors that undermine such ca18 pacity; 

19 ‘‘(2) strengthening such protective factors and 

20 addressing such risk factors; 

21 ‘‘(3) building awareness, skills, tools, curricula, 

22 and leadership in the community to— 

23 ‘‘(A) facilitate using a public health ap24 proach to mental health; and 


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1 ‘‘(B) heal mental health and psychosocial 

2 problems among all adults and youth; and 

3 ‘‘(4) developing, implementing, and continually 

4 evaluating and improving a comprehensive strategic 

5 plan for carrying out the activities described in para6 graphs (1), (2) and (3) that includes utilizing devel7 opmentally, linguistically, and culturally appropriate 

8 evidence-based, evidence-informed, promising-best, 

9 or indigenous practices for— 

10 ‘‘(A) engaging community members in 

11 building social connections across cultural, geo12 graphic, and economic boundaries; 

13 ‘‘(B) enhancing local economic and envi14 ronmental conditions and environmental resil15 ience, including with respect to the built envi16 ronment; 

17 ‘‘(C) becoming trauma-informed and learn18 ing simple self-administrable mental wellness 

19 and resilience skills; 

20 ‘‘(D) engaging in community activities and 

21 mutual aid networks that strengthen mental 

22 wellness and resilience; 

23 ‘‘(E) partaking in nonclinical group and 

24 community-minded recovery and healing pro25 grams; 


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1 ‘‘(F) embedding trauma-informed climate 

2 education and mental resilience curricula and 

3 programming into schools for students, work4 ers, and the broader community; and 

5 ‘‘(G) other activities to promote mental 

6 wellness and resilience, manage climate anxiety, 

7 and heal individual and community traumas. 

8 ‘‘(c) ELIGIBLE ENTITIES.— 

9 ‘‘(1) IN GENERAL.—To be eligible to receive a 

10 grant under subsection (a)(1), an applicant shall be 

11 a nonprofit or community organization that has— 

12 ‘‘(A) organized a resilience coordinating 

13 network that meets the requirements of para14 graph (2); and 

15 ‘‘(B) been approved by such resilience co16 ordinating network to serve as its fiscal spon17 sor. 

18 ‘‘(2) RESILIENCE COORDINATING NETWORKS

19 DESCRIBED.—A resilience coordinating network or20 ganized under paragraph (1)(A) shall be composed 

21 of 1 or more representatives of entities from not 

22 fewer than 8 of the following categories: 

23 ‘‘(A) Grassroots groups, neighborhood as24 sociations, and volunteer civic organizations. 


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1 ‘‘(B) Elementary and secondary schools, 

2 institutions of higher education including com3 munity colleges, job-training programs, and 

4 other education or training agencies or organi5 zations. 

6 ‘‘(C) Youth after-school and summer pro7 grams. 

8 ‘‘(D) Family and early childhood education 

9 programs. 

10 ‘‘(E) Faith and spirituality organizations. 

11 ‘‘(F) Senior care organizations. 

12 ‘‘(G) Climate change mitigation and adap13 tation, and environmental conservation, groups 

14 and organizations. 

15 ‘‘(H) Social and environmental justice 

16 groups and organizations. 

17 ‘‘(I) Disaster preparedness and response 

18 groups and organizations. 

19 ‘‘(J) Local labor organizations. 

20 ‘‘(K) Businesses and business associations. 

21 ‘‘(L) Agencies and organizations involved 

22 with community safety. 

23 ‘‘(M) Social work, mental health, behav24 ioral health, substance use, physical health, and 

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1 cies and institutions; and mental health, behav2 ioral health, social work, and other profes3 sionals, groups, organizations, agencies, and in4 stitutions in the health and human services 

5 fields. 

6 ‘‘(N) The general public, including individ7 uals who have experienced mental health or 

8 psychosocial problems who can represent and 

9 engage with populations relevant to the commu10 nity. 

11 ‘‘(d) REPORT.— 

12 ‘‘(1) SUBMISSION.—Not later than December 

13 31, 2028, the Secretary shall submit a report to the 

14 Congress on the results of the grants under sub15 section (a)(1). 

16 ‘‘(2) CONTENTS.—Such report shall include a 

17 summary of the best practices used by grantees in 

18 establishing, operating, or expanding community 

19 mental wellness and resilience programs. 

20 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

21 provide technical assistance— 

22 ‘‘(1) to assist eligible entities in developing ap23 plications for grants under paragraph (1) or (2) of 

24 subsection (a); and 


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1 ‘‘(2) to enable the sharing of best practices 

2 learned from successful resilience coordinating net3 works. 

4 ‘‘(f) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘community’ means people, 

6 groups, and organizations that reside in or work 

7 within a specific geographic area, such as a city, 

8 neighborhood, subdivision, urban, suburban, or rural 

9 locale. 

10 ‘‘(2) The term ‘community trauma’ means a 

11 blow to the basic fabric of social life that damages 

12 the bonds attaching people together, impairs their 

13 prevailing sense of community, undermines their 

14 fundamental sense of safety, justice, equity, and se15 curity, and heightens individual and collective fears 

16 and feelings of vulnerability. 

17 ‘‘(3) The term ‘mental wellness’ means a state 

18 of well-being in which an individual can— 

19 ‘‘(A) realize their own potential; 

20 ‘‘(B) constructively cope with the stresses 

21 of life; 

22 ‘‘(C) work productively and fruitfully; and 

23 ‘‘(D) make a contribution to their commu24 nity. 


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1 ‘‘(4) The term ‘protective factors’ means 

2 strengths, skills, resources, and characteristics 

3 that— 

4 ‘‘(A) are associated with a lower likelihood 

5 of negative outcomes of adversities; or 

6 ‘‘(B) reduce the impact on people of toxic 

7 stresses or a traumatic experience. 

8 ‘‘(5) The term ‘psychosocial problem’ means the 

9 ways in which an individual’s mental health or be10 havioral health problem disturbs others such as chil11 dren, families, communities, or society. 

12 ‘‘(6) The term ‘public health approach to men13 tal health’ means methods that— 

14 ‘‘(A) take a population-level approach to 

15 promote mental wellness and resilience to pre16 vent problems before they emerge and heal 

17 them when they do appear, not merely treating 

18 individuals one at a time after symptoms of pa19 thology appear; and 

20 ‘‘(B) address mental health and psycho21 social problems by— 

22 ‘‘(i) identifying and strengthening ex23 isting protective factors, and forming new 

24 ones, that buffer people from and enhance 


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1 their capacity for psychological and emo2 tional resilience; and 

3 ‘‘(ii) taking a holistic systems perspec4 tive that recognizes that most mental 

5 health and psychosocial problems result 

6 from numerous interrelated personal, fam7 ily, social, economic, and environmental 

8 factors that require multipronged commu9 nity-based interventions. 

10 ‘‘(7) The term ‘resilience’ means that people de11 velop cognitive, psychological, emotional capabilities 

12 and social connections that enable them to calm 

13 their body, mind, emotions, and behaviors during 

14 toxic stresses or traumatic experiences in ways that 

15 enable them to— 

16 ‘‘(A) respond without negative con17 sequences for themselves or others; and 

18 ‘‘(B) use the experiences as catalysts to de19 velop a constructive new sense of meaning, pur20 pose, and hope. 

21 ‘‘(8) The term ‘Secretary’ means the Secretary, 

22 acting through the Director of the Centers for Dis23 ease Control and Prevention. 


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1 ‘‘(9) The term ‘toxic stress’ means exposure to 

2 persistent overwhelming traumatic and stressful sit3 uations. 

4 ‘‘(g) FUNDING.— 

5 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

6 To carry out this section, there is authorized to be 

7 appropriated $100,000,000 for each of fiscal years 

8 2024 through 2028. 

9 ‘‘(2) RURAL COMMUNITIES.—The Secretary 

10 shall award not less than 20 percent of the amounts 

11 made available under paragraph (1) for grants 

12 under paragraphs (1) and (2) of subsection (a) to el13 igible entities that are establishing, operating, or ex14 panding community mental wellness and resilience 

15 programs that are located in or serve a rural area 

16 (as defined in section 520 of the Housing Act of 

17 1949 (42 U.S.C. 1490)). 

18 ‘‘(3) ENVIRONMENTAL JUSTICE COMMU19 NITIES.—The Secretary shall award not less than 20 

20 percent of the amounts made available under para21 graph (1) for grants under paragraphs (1) and (2) 

22 of subsection (a) to eligible entities that are estab23 lishing, operating, or expanding community mental 

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1 mental justice communities (as defined in section 2 

2 of the Green New Deal for Health Act).’’. 

3 Subtitle B—Understanding and 

4 Preventing Heat Risk 

5 SEC. 611. DEFINITIONS. 

6 In this subtitle: 

7 (1) EXTREME HEAT.—The term ‘‘extreme 

8 heat’’ means heat that substantially exceeds local cli9 matological norms in terms of any combination of 

10 the following: 

11 (A) Duration of an individual heat event. 

12 (B) Intensity. 

13 (C) Season length. 

14 (D) Frequency. 

15 (2) HEAT.—The term ‘‘heat’’ means any com16 bination of the atmospheric parameters associated 

17 with modulating human thermal regulation, such as 

18 air temperature, humidity, solar exposure, and wind 

19 speed. 

20 (3) HEAT EVENT.—The term ‘‘heat event’’ 

21 means an occurrence of extreme heat that may have 

22 heat-health implications. 

23 (4) HEAT-HEALTH.—The term ‘‘heat-health’’ 

24 means mental and physical health effects to humans 

25 from heat or the risk of such effects. 


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1 (5) PLANNING.—The term ‘‘planning’’ means 

2 activities performed across time scales (including 

3 days, weeks, months, years, and decades) with sce4 nario-based, probabilistic or deterministic informa5 tion to identify and take actions to proactively miti6 gate heat-health risks from increased frequency, du7 ration, and intensity of heat waves and increased 

8 ambient temperature. 

9 (6) PREPAREDNESS.—The term ‘‘preparedness’’ 

10 means activities performed across time scales (in11 cluding days, weeks, months, years, and decades) 

12 with probabilistic or deterministic information to 

13 manage risk in advance of a heat event and in14 creased ambient temperature. 

15 (7) TRIBAL GOVERNMENT.—The term ‘‘Tribal 

16 government’’ means the recognized governing body 

17 of any Indian or Alaska Native tribe, band, nation, 

18 pueblo, village, community, component band, or com19 ponent reservation, individually identified (including 

20 parenthetically) in the list published most recently as 

21 of the date of enactment of this Act pursuant to sec22 tion 104 of the Federally Recognized Indian Tribe 

23 List Act of 1994 (25 U.S.C. 5131). 

24 (8) VULNERABLE POPULATIONS.—The term 

25 ‘‘vulnerable populations’’ means populations that 


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1 face health, financial, educational, or housing dis2 parities that would render them more susceptible to 

3 the negative impacts of extreme heat. 

4 SEC. 612. STUDY ON EXTREME HEAT INFORMATION AND 

5 RESPONSE. 

6 (a) STUDY.— 

7 (1) IN GENERAL.—Not later than 120 days 

8 after the date of the enactment of this Act, the 

9 Under Secretary of Commerce for Oceans and At10 mosphere, in consultation with representatives from 

11 the Department of Health and Human Services as 

12 the Secretary of Health and Human Services con13 siders appropriate, shall seek to enter into an agree14 ment with the National Academies of Sciences, En15 gineering, and Medicine to conduct a study on ex16 treme heat information and response, to be com17 pleted not later than 2 years after the date of the 

18 enactment of this Act. 

19 (2) ELEMENTS.—The study described in para20 graph (1) shall— 

21 (A) identify the policy, research, oper22 ations, communications, and data gaps affecting 

23 heat-health planning, preparedness, response, 

24 resilience, and adaptation, and impacts to vul25 nerable populations; 


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1 (B) provide recommendations for address2 ing gaps identified under subparagraph (A); 

3 (C) provide recommendations, in addition 

4 to the recommendations provided under sub5 paragraph (B), which may include strategies 

6 for— 

7 (i) communicating warnings to and 

8 promoting resilience of populations vulner9 able to extreme heat; 

10 (ii) distributing extreme heat warn11 ings, including to individuals with limited 

12 English proficiency and individuals who 

13 may have other established barriers to 

14 such information; 

15 (iii) designing warnings described in 

16 clause (ii) to convey the urgency and sever17 ity of heat events and achieve behavior 

18 changes that reduce the mortality and 

19 morbidity of extreme heat effects; 

20 (iv) understanding compound and cas21 cading risks to inform development and 

22 implementation of heat-health risk reduc23 tion interventions; and 

24 (v) promoting community resilience 

25 and addressing specific decision support 


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1 service needs of vulnerable populations; 

2 and 

3 (D) consider the effectiveness of country4 or local-level heat awareness and communica5 tion tools, preparedness plans, or mitigation. 

6 (3) DEVELOPMENT OF DEFINITIONS.—In con7 ducting the study described in paragraph (1), the 

8 National Academies of Sciences, Engineering, and 

9 Medicine shall work with heat and health experts to 

10 identify consistent and agreed-upon definitions for 

11 heat events, heat waves, and other relevant terms. 

12 (b) REPORT.—Not later than 90 days after comple13 tion of the study described in subsection (a)(1), the Under 

14 Secretary of Commerce for Oceans and Atmosphere 

15 shall— 

16 (1) make available to the public on an internet 

17 website of the National Oceanic and Atmospheric 

18 Administration a report on the findings and conclu19 sions of the study; and 

20 (2) submit the report to— 

21 (A) the Committee on Commerce, Science, 

22 and Transportation of the Senate; 

23 (B) the Committee on Health, Education, 

24 Labor, and Pensions of the Senate; 


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1 (C) the Committee on Science, Space, and 

2 Technology of the House of Representatives; 

3 (D) the Committee on Energy and Com4 merce of the House of Representatives; and 

5 (E) the Committee on Education and the 

6 Workforce of the House of Representatives. 

7 SEC. 613. FINANCIAL ASSISTANCE FOR RESEARCH AND RE8 SILIENCE IN ADDRESSING EXTREME HEAT 

9 RISKS. 

10 (a) ESTABLISHMENT OF PROGRAM.—Subject to the 

11 availability of appropriations, not later than 1 year after 

12 the date of the enactment of this Act, the Under Secretary 

13 of Commerce for Oceans and Atmosphere shall establish 

14 and administer a community heat resilience program to 

15 provide financial assistance to eligible entities to carry out 

16 projects described in subsection (e) to ameliorate the men17 tal and physical human health impacts of extreme heat 

18 events. 

19 (b) PURPOSE.—The purpose of the financial assist20 ance provided under this section is to further scientific re21 search regarding extreme heat and fund efforts to educate 

22 communities about extreme heat. 

23 (c) FORMS OF ASSISTANCE.—Financial assistance 

24 provided under this section may be in the form of con25 tracts, grants, or cooperative agreements. 


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1 (d) ELIGIBLE ENTITIES.—Entities eligible to receive 

2 financial assistance under this section to carry out 

3 projects described in subsection (e) include— 

4 (1) nonprofit entities; 

5 (2) academic institutions; 

6 (3) States; 

7 (4) Tribal governments; 

8 (5) local governments; and 

9 (6) political subdivisions of States, Tribal gov10 ernments, and local governments. 

11 (e) ELIGIBLE PROJECTS.—Projects described in this 

12 subsection include projects— 

13 (1) to expand public awareness of heat risks; 

14 (2) to conduct heat mapping campaigns; 

15 (3) to conduct scientific research to assess gaps 

16 and priorities regarding the risks of extreme heat in 

17 communities; 

18 (4) to communicate risks to isolated commu19 nities; and 

20 (5) to educate such communities about how to 

21 respond to extreme heat events. 

22 (f) PRIORITIES.—In selecting eligible entities to re23 ceive financial assistance under this section, the Under 

24 Secretary of Commerce for Oceans and Atmosphere shall 

25 prioritize entities that will carry out projects that provide 


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1 benefits for historically disadvantaged communities and 

2 communities found to have the greatest risk or highest 

3 incidence of heat-related illnesses and mortalities. 

4 SEC. 614. AUTHORIZATION OF APPROPRIATIONS. 

5 (a) STUDY ON EXTREME HEAT INFORMATION AND

6 RESPONSE.—There is authorized to be appropriated to 

7 the National Oceanic and Atmospheric Administration to 

8 contract with the National Academies of Sciences, Engi9 neering, and Medicine to carry out section 612 $500,000 

10 for each of fiscal years 2024 through 2026. 

11 (b) FINANCIAL ASSISTANCE TO ADDRESS EXTREME

12 HEAT.—There is authorized to be appropriated to the Na13 tional Oceanic and Atmospheric Administration to carry 

14 out section 613 $30,000,000 for each of fiscal years 2024 

15 through 2028. 

16 Subtitle C—Home Resiliency for 

17 Medical Needs 

18 SEC. 621. MEDICARE COVERAGE OF MEDICALLY NEC19 ESSARY HOME RESILIENCY SERVICES. 

20 (a) COVERAGE.—Section 1861 of the Social Security 

21 Act (42 U.S.C. 1395x) is amended— 

22 (1) in subsection (s)(2)— 

23 (A) in subparagraph (II), by striking 

24 ‘‘and’’ at the end; 


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1 (B) in subparagraph (JJ), by inserting 

2 ‘‘and’’ at the end; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(KK) in the case of an individual who is medi6 cally at risk in the event of a climate or man-made 

7 disaster (as determined by the Secretary in accord8 ance with subsection (nnn)), home resiliency services 

9 (as defined in such subsection);’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(nnn) HOME RESILIENCY SERVICES; DETERMINA13 TION OF INDIVIDUALS MEDICALLY AT RISK.— 

14 ‘‘(1) HOME RESILIENCY SERVICES.—The term 

15 ‘home resiliency services’ means items and serv16 ices— 

17 ‘‘(A) furnished on or after January 1, 

18 2024, to an individual described in subsection 

19 (s)(2)(KK); and 

20 ‘‘(B) that the Secretary determines are 

21 medically necessary for such individual in the 

22 case of a climate or man-made disaster, such as 

23 a heat pump for an individual vulnerable to ex24 treme temperatures, solar batteries for an indi25 vidual reliant on electrical medical equipment 


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1 (including home mechanical ventilators), and 

2 energy-efficient cold storage for heat-sensitive 

3 medical supplies. 

4 ‘‘(2) DETERMINATION OF INDIVIDUALS MEDI5 CALLY AT RISK.—For purposes of subsection 

6 (s)(2)(KK) and this subsection, the Secretary, in 

7 consultation with the Office of Climate Change and 

8 Health Equity, the National Institutes of Health, 

9 the Centers of Medicare & Medicaid Services, and 

10 the National Oceanic and Atmospheric Administra11 tion, shall establish a process to determine the con12 ditions under which an individual would be deter13 mined to be medically at risk in the event of a dis14 aster or climate hazards, including extreme heat, ex15 treme cold, flooding, and loss of power. Such a proc16 ess shall consider— 

17 ‘‘(A) geography-specific climate risks and 

18 regional preparedness for different climate 

19 risks; 

20 ‘‘(B) the regional history of disaster or cli21 mate hazards and infrastructure failure in the 

22 preceding 20 years or the forward-looking pre23 dicted risk of disaster or climate hazards and 

24 infrastructure failure in the next 20 years; 


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1 ‘‘(C) medical reliance on equipment, phar2 maceuticals, mobility aids, and other supplies 

3 that are sensitive to exposure to extreme tem4 peratures, poor air quality, flooding and water 

5 damage, or dependent on electrical power; and 

6 ‘‘(D) chronic medical conditions, disabil7 ities, and co-morbidities that increase patient 

8 vulnerability during disaster.’’. 

9 (b) PAYMENT.—Section 1833(a)(1) of the Social Se10 curity Act (42 U.S.C. 1395l(a)(1)) is amended— 

11 (1) by striking ‘‘and’’ before ‘‘(HH)’’; and 

12 (2) by inserting before the semicolon at the end 

13 the following: ‘‘and (II) with respect to home resil14 iency services described in section 1861(s)(2)(KK), 

15 the amount paid shall be an amount equal to 100 

16 percent of the lesser of the actual charge for the 

17 services or the amount determined under a fee 

18 schedule established by the Secretary’’. 


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1 TITLE VII—RESEARCH AND IN2 NOVATION FOR CLIMATE AND 

3 HEALTH 

4 SEC. 701. RESEARCH AND INNOVATION FOR CLIMATE AND 

5 HEALTH. 

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

7 241 et seq.) is amended by adding at the end the fol8 lowing: 

9 ‘‘PART W—RESEARCH AND INNOVATION FOR 

10 CLIMATE AND HEALTH 

11 ‘‘SEC. 399OO. NATIONAL CLIMATE AND HEALTH RESEARCH 

12 AND INNOVATION INITIATIVE. 

13 ‘‘(a) ESTABLISHMENT.—The President shall estab14 lish and implement an initiative, to be known as the ‘Na15 tional Climate and Health Research and Innovation Initia16 tive’ (referred to in this part as the ‘Initiative’), to be car17 ried out by the Secretary, acting through the Assistant 

18 Secretary for Health. 

19 ‘‘(b) PURPOSE.—The purpose of the Initiative is to 

20 develop the tools, research, innovations, and under21 standing of climate change and health needed to prevent, 

22 treat, and mitigate the health harms of climate change 

23 in order to protect the collective health and well-being of 

24 the people of the United States. 


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1 ‘‘(c) ACTIVITIES.—In carrying out the Initiative, the 

2 President, acting through the Office of Climate Change 

3 and Health Equity, the Interagency Committee, and such 

4 agency heads as the President considers appropriate, shall 

5 carry out activities that include the following: 

6 ‘‘(1) Supporting research to understand, pre7 dict, and prevent the health burdens of climate 

8 change and improve the ability to treat health harms 

9 due to climate change, including— 

10 ‘‘(A) research to understand and predict 

11 the impacts of climate change on both physical 

12 and mental health, including disproportionate 

13 impacts based on race, ethnicity, language, gen14 der, sex, pregnancy status, disability, age, loca15 tion, occupation, and immigration status; 

16 ‘‘(B) research into, and mitigation of, ad17 verse mental and physical health effects of his18 torical and ongoing environmental racism and 

19 the subsequent combined health risk of climate 

20 change and environmental pollution; 

21 ‘‘(C) research to model and predict occupa22 tional hazards that will occur or intensify due 

23 to climate change; 

24 ‘‘(D) development of medical education 

25 curricula relating to the clinical hazards of, and 


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1 interventions for, climate-change-based health 

2 burdens; 

3 ‘‘(E) research to address climate-related 

4 housing and community development issues, in5 cluding the impact of, and mitigation strategies 

6 for, challenges such as isolation, low-quality 

7 housing, housing precarity, and homelessness, 

8 and the vulnerabilities and the mental and 

9 physical health risks those challenges present; 

10 and 

11 ‘‘(F) research to study the social and eco12 nomic factors and policies that create healthy, 

13 resilient communities prepared to adapt to the 

14 challenges posed by climate change. 

15 ‘‘(2) Supporting research and development of 

16 sustainable and equitable health care operations and 

17 clinical practices that reduce greenhouse gas emis18 sions, climate risk, and environmental health haz19 ards, including— 

20 ‘‘(A) research into effective models of 

21 health care delivery— 

22 ‘‘(i) to mitigate the impact of long23 standing climate change and environmental 

24 hazards on health; and 


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1 ‘‘(ii) in preparation for, and in re2 sponse to, climate disasters; 

3 ‘‘(B) research to model and predict the 

4 necessary health care capacity surplus required 

5 to absorb both acute and chronic surges in 

6 health care demand due to climate-generated 

7 health burden, with attention to geographical 

8 climate risks and patient demographic health 

9 care needs; 

10 ‘‘(C) the development of methods to reduce 

11 health sector environmental pollution; 

12 ‘‘(D) research into, and mitigation of, the 

13 environmental impacts of hazardous substances 

14 used in health care and the health care supply 

15 chain, including the placement of facilities that 

16 use hazardous substances and the proximity of 

17 those facilities to historically marginalized com18 munities; 

19 ‘‘(E)(i) research and development of inno20 vations that shift the lifecycle of medical sup21 plies and devices from single use to sustainable, 

22 circular economies, including low-environmental 

23 impact sterilization techniques; and 


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1 ‘‘(ii) support of public-private partnerships 

2 that enable scientific translation of those inno3 vations; 

4 ‘‘(F) the development of clinically equiva5 lent and improved, low-climate-footprint inter6 ventions and pharmaceuticals and the study of 

7 the environmental impacts of those interven8 tions and pharmaceuticals to enable high-qual9 ity, environmentally conscious clinical decision 

10 making; and 

11 ‘‘(G) conducting and supporting research, 

12 development, demonstration, and commercial 

13 application of renewable energy technologies 

14 and strategies to meet the energy demand and 

15 energy security needs of infrastructure critical 

16 to health care. 

17 ‘‘(d) TERMINATION.—The Initiative shall terminate 

18 on December 31, 2033. 

19 ‘‘SEC. 399OO–1. INTERAGENCY COORDINATION. 

20 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

21 date of enactment of the Green New Deal for Health Act, 

22 the President shall establish an interagency committee (re23 ferred to in this part as the ‘Interagency Committee’), to 

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1 partments, offices, and agencies described in subsection 

2 (b)(1). 

3 ‘‘(b) MEMBERSHIP.— 

4 ‘‘(1) IN GENERAL.—The membership of the 

5 Interagency Committee shall consist of— 

6 ‘‘(A) 3 representatives of the Department 

7 of Health and Human Services, which shall in8 clude— 

9 ‘‘(i) 1 representative of the Office of 

10 Climate Change and Health Equity; and 

11 ‘‘(ii) 1 representative of the National 

12 Institutes of Health; 

13 ‘‘(B) 1 representative of the Office of 

14 Science and Technology Policy; 

15 ‘‘(C) 1 representative of the National 

16 Science Foundation; 

17 ‘‘(D) 1 representative of the Environ18 mental Protection Agency; 

19 ‘‘(E) 1 representative of the Department of 

20 Energy; 

21 ‘‘(F) 1 representative of the Department of 

22 Housing and Urban Development; and 

23 ‘‘(G) 1 representative of the Department of 

24 Labor. 


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1 ‘‘(2) CO-CHAIRS.—The Interagency Committee 

2 shall be co-chaired by the representatives described 

3 in subparagraphs (A)(i) and (B) of paragraph (1). 

4 ‘‘(c) MEETINGS.—The Interagency Committee shall 

5 meet not less frequently than quarterly. 

6 ‘‘(d) DUTIES.—The Interagency Committee shall— 

7 ‘‘(1) provide for interagency coordination of the 

8 activities of the Initiative; 

9 ‘‘(2) develop a plan that describes how the de10 partments, offices, and agencies described in sub11 section (b)(1) will collectively carry out the activities 

12 described in section 399OO(c), including— 

13 ‘‘(A) a description of how each depart14 ment, office, and agency will execute a subset of 

15 the activities described in that section; and 

16 ‘‘(B) a description of collaborations across 

17 the departments, offices, and agencies; 

18 ‘‘(3) annually submit to Congress a report de19 scribing the progress of the Initiative, activities of 

20 the Interagency Committee, and policy recommenda21 tions that derive from the results of the Initiative; 

22 and 

23 ‘‘(4) as part of the President’s annual budget 

24 request to Congress, propose an annually coordi25 nated interagency budget for the Initiative to the OfVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 fice of Management and Budget that is intended to 

2 ensure that the balance of funding across the Initia3 tive is sufficient to meet the goals and priorities es4 tablished for the Initiative. 

5 ‘‘SEC. 399OO–2. ADVISORY COUNCIL. 

6 ‘‘(a) IN GENERAL.—The Secretary shall establish an 

7 advisory council (referred to in this section as the ‘Advi8 sory Council’) to advise and provide recommendations to 

9 the Initiative. 

10 ‘‘(b) MEMBERSHIP.— 

11 ‘‘(1) IN GENERAL.—The membership of the Ad12 visory Council shall consist of— 

13 ‘‘(A) the members of the Interagency Com14 mittee; and 

15 ‘‘(B) the non-Federal members appointed 

16 under paragraph (2). 

17 ‘‘(2) APPOINTED MEMBERS.—The Secretary 

18 shall appoint the following non-Federal members of 

19 the Advisory Council: 

20 ‘‘(A) Not more than 4 members who are 

21 representatives of research institutions, aca22 demic institutions, or medical industry entities. 

23 ‘‘(B) Not fewer than 1 member who is a 

24 representative of a critical access hospital (as 


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1 defined in section 1861(mm)(1) of the Social 

2 Security Act). 

3 ‘‘(C) Not fewer than 1 member who is a 

4 representative of a hospital that receives dis5 proportionate share payments under section 

6 1886(d)(5)(F) of the Social Security Act. 

7 ‘‘(D) Not fewer than 1 member who is a 

8 representative of a community health center re9 ceiving funding under section 330. 

10 ‘‘(E) Not fewer than 1 member who is a 

11 representative of an Indian Health Service facil12 ity operated by an Indian tribe or tribal organi13 zation (as defined in section 4 of the Indian 

14 Health Care Improvement Act). 

15 ‘‘(F) Not fewer than 1 member who is a 

16 representative of a State, local, or Tribal de17 partment of public health. 

18 ‘‘(G) Not fewer than 4 members who— 

19 ‘‘(i) are representatives of labor orga20 nizations representing health care workers; 

21 and 

22 ‘‘(ii) collectively represent a diversity 

23 of health care professions, such as workers 

24 in environmental services, direct care work25 ers, nurses, and physicians. 


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1 ‘‘(H) Not fewer than 4 members who are 

2 representatives of community-based patient ad3 vocacy or public health advocacy organizations, 

4 each of which are from different geographic re5 gions of the United States. 

6 ‘‘(3) DIVERSE REPRESENTATION.—The Sec7 retary shall ensure that the membership of the Advi8 sory Council reflects the diversity of the patient pop9 ulations that are geographically and demographically 

10 representative of the United States, especially front11 line populations and populations that are subject to 

12 negative disparate outcomes in health. 

13 ‘‘(4) DUTIES.—The Advisory Council shall ad14 vise the President and the Secretary on matters re15 lating to the Initiative, including recommendations 

16 related to— 

17 ‘‘(A) the research and innovation needs of 

18 frontline communities, environmental justice 

19 communities (as defined in section 2 of the 

20 Green New Deal for Health Act), medically un21 derserved communities (as defined in section 

22 799B), and individuals vulnerable to climate 

23 change; 

24 ‘‘(B) the current gaps and challenges in 

25 the scientific understanding of the health imVerDate Sep 11 2014 23:19 Apr 25, 2023 Jkt 039200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\S1229.IS S1229

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1 pacts of climate change and the impact of 

2 health care on climate; 

3 ‘‘(C) emerging research and innovation 

4 needs from clinical practice; 

5 ‘‘(D) whether issues of health disparities 

6 are adequately addressed by the Initiative; 

7 ‘‘(E) the balance of activities and funding 

8 across the Initiative; 

9 ‘‘(F) bottlenecks in translating research 

10 findings into clinical advances, mitigation strat11 egies, and workplace safety; and 

12 ‘‘(G) accountability and ethical use of re13 search funds. 

14 ‘‘(5) MEETINGS.—The Advisory Council shall 

15 meet not less frequently than annually, and such 

16 meetings shall be open to the public. 

17 ‘‘(6) TERMINATION.—The Advisory Council 

18 shall terminate on December 31, 2033. 

19 ‘‘SEC. 399OO–3. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There is authorized to be appropriated to carry out 

21 section 399OO $5,000,000,000 for each of fiscal years 

22 2024 through 2033.’’. 

Æ 


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