II 

113TH CONGRESS 

2D SESSION S. 2268 

To establish grant programs to improve the health of border area residents 

and for all hazards preparedness in the border area including bioterrorism, infectious disease, and noncommunicable emerging threats, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 29, 2014 

Mr. UDALL of New Mexico (for himself, Mr. HEINRICH, and Mrs. GILLIBRAND) introduced the following bill; which was read twice and referred 

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

A BILL 

To establish grant programs to improve the health of border 

area residents and for all hazards preparedness in the 

border area including bioterrorism, infectious disease, 

and noncommunicable emerging threats, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Border Health Secu5 rity Act of 2013’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) The United States-Mexico border is an 

2 interdependent and dynamic region of more than 

3 15,000,000 people with significant and unique public 

4 health challenges. 

5 (2) These challenges include low rates of health 

6 insurance coverage, poor access to health care serv7 ices, high unemployment rates, low educational at8 tainment, and high rates of dangerous diseases, such 

9 as tuberculosis, diabetes, obesity, and other non10 communicable diseases. 

11 (3) As the 2009 novel influenza A (H1N1) pan12 demic illustrated, diseases do not respect inter13 national boundaries, and a strong public health ef14 fort at and along the borders is crucial to not only 

15 protect and improve the health of Americans but 

16 also to help secure the country against threats to 

17 biosecurity and other emerging threats. 

18 (4) For 11 years, the United States-Mexico 

19 Border Health Commission has served as a crucial 

20 binational institution to address these unique and 

21 truly cross-border health issues. 

22 (5) More than 75 percent of Canadians live 

23 within 100 miles of the United States border. The 

24 2003 epidemic of severe acute respiratory syndrome 


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1 caused more than 250 illnesses in the Greater To2 ronto Area, just 80 miles from New York. 

3 SEC. 3. UNITED STATES-MEXICO BORDER HEALTH COMMIS4 SION ACT AMENDMENTS. 

5 The United States-Mexico Border Health Commis6 sion Act (22 U.S.C. 290n et seq.) is amended— 

7 (1) in section 3— 

8 (A) in paragraph (1), by striking ‘‘; and’’ 

9 and inserting ‘‘;’’; 

10 (B) in paragraph (2), by striking the pe11 riod and inserting a semicolon; and 

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

13 ‘‘(3) to cooperate with the Canada-United 

14 States Pan Border Public Health Preparedness 

15 Council (referred to in this Act as the ‘Council’), as 

16 appropriate; and 

17 ‘‘(4) to serve as an independent and objective 

18 body to both recommend and implement initiatives 

19 that solve border health issues.’’; 

20 (2) in section 5— 

21 (A) in subsection (b), by striking ‘‘should 

22 be the leader’’ and inserting ‘‘shall be the 

23 Chair’’; and 

24 (B) by adding at the end the following: 


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1 ‘‘(d) PROVIDING ADVICE AND RECOMMENDATIONS.— 

2 Members of the Commission and the Council may at any 

3 time provide advice or recommendations to the Secretary, 

4 Congress, or any Member of Congress concerning issues 

5 that are considered by the Commission or Council. Such 

6 advice or recommendations may be provided regardless of 

7 whether a request for such is made and regardless of 

8 whether the member or individual is authorized to provide 

9 such advice or recommendations by the Commission or 

10 Council or any other Federal official.’’; 

11 (3) by redesignating section 8 as section 12; 

12 (4) by striking section 7 and inserting the fol13 lowing: 

14 ‘‘SEC. 7. BORDER HEALTH GRANTS. 

15 ‘‘(a) ELIGIBLE ENTITY DEFINED.—In this section, 

16 the term ‘eligible entity’ means a State, public institution 

17 of higher education, local government, Indian tribe, tribal 

18 organization, urban Indian organization, nonprofit health 

19 organization, trauma center, critical access hospital or 

20 other hospital that serves rural or other vulnerable com21 munities and populations, faith-based entity, or commu22 nity health center receiving assistance under section 330 

23 of the Public Health Service Act (42 U.S.C. 254b), that 

24 is located in the United States-Mexico border area or the 

25 United States-Canada border area. 


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1 ‘‘(b) AUTHORIZATION.—From amounts appropriated 

2 under section 11, the Secretary, in consultation with mem3 bers of the Commission and Council and in coordination 

4 with the Office of Global Affairs, shall award grants to 

5 eligible entities to address priorities and recommendations 

6 outlined by the strategic plan and operational work plan 

7 of the Commission and the Council, as authorized under 

8 section 9, to improve the health of United States-Mexico 

9 border area and United States-Canada border area resi10 dents. 

11 ‘‘(c) APPLICATION.—An eligible entity that desires a 

12 grant under subsection (b) shall submit an application to 

13 the Secretary at such time, in such manner, and con14 taining such information as the Secretary may require. 

15 ‘‘(d) USE OF FUNDS.—An eligible entity that receives 

16 a grant under subsection (b) shall use the grant funds for 

17 any of the following: 

18 ‘‘(1) Programs relating to any one or more of 

19 the following: 

20 ‘‘(A) Maternal and child health. 

21 ‘‘(B) Primary care and preventative health. 

22 ‘‘(C) Infectious disease testing, monitoring, 

23 and surveillance. 

24 ‘‘(D) Public health and public health infra25 structure. 


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1 ‘‘(E) Health promotion. 

2 ‘‘(F) Oral health. 

3 ‘‘(G) Behavioral and mental health. 

4 ‘‘(H) Substance abuse prevention and 

5 harm reduction. 

6 ‘‘(I) Health conditions that have a high 

7 prevalence in the United States-Mexico border 

8 area or United States-Canada border area. 

9 ‘‘(J) Medical and health services research. 

10 ‘‘(K) Workforce training and development. 

11 ‘‘(L) Community health workers and 

12 promotoras. 

13 ‘‘(M) Health care infrastructure problems 

14 in the United States-Mexico border area or 

15 United States-Canada border area (including 

16 planning and construction grants). 

17 ‘‘(N) Health disparities in the United 

18 States-Mexico border area or United States19 Canada border area. 

20 ‘‘(O) Environmental health. 

21 ‘‘(P) Health education. 

22 ‘‘(Q) Outreach and enrollment services 

23 with respect to Federal programs (including 

24 programs authorized under titles XIX and XXI 


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1 of the Social Security Act (42 U.S.C. 1396 et 

2 seq. and 1397aa et seq.)). 

3 ‘‘(R) Trauma care. 

4 ‘‘(S) Health research with an emphasis on 

5 infectious disease and pressing issues related to 

6 noncommunicable diseases. 

7 ‘‘(T) Epidemiology and health research. 

8 ‘‘(U) Cross-border health surveillance co9 ordinated with Mexican Health Authorities or 

10 Canadian Health Authorities. 

11 ‘‘(V) Obesity, particularly childhood obe12 sity. 

13 ‘‘(W) Crisis communication, domestic vio14 lence, health literacy, or cancer. 

15 ‘‘(X) Community-based participatory re16 search on border health issues. 

17 ‘‘(Y) Violence prevention. 

18 ‘‘(Z) Cross-border public health prepared19 ness. 

20 ‘‘(2) Other programs determined appropriate by 

21 the Secretary. 

22 ‘‘(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro23 vided to an eligible entity awarded a grant under sub24 section (b) shall be used to supplement and not supplant 


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1 other funds available to the eligible entity to carry out the 

2 activities described in subsection (d). 

3 ‘‘SEC. 8. GRANTS FOR EARLY WARNING INFECTIOUS DIS4 EASE SURVEILLANCE (EWIDS) IN THE BOR5 DER AREA. 

6 ‘‘(a) ELIGIBLE ENTITY DEFINED.—In this section, 

7 the term ‘eligible entity’ means a State, local government, 

8 Indian tribe, tribal organization, urban Indian organiza9 tion, trauma center, regional trauma center coordinating 

10 entity, or public health entity. 

11 ‘‘(b) AUTHORIZATION.—From funds appropriated 

12 under section 11, the Secretary shall award grants for 

13 Early Warning Infectious Disease Surveillance (EWIDS) 

14 to eligible entities for infectious disease surveillance activi15 ties in the United States-Mexico border area or United 

16 States-Canada border area. 

17 ‘‘(c) APPLICATION.—An eligible entity that desires a 

18 grant under this section shall submit an application to the 

19 Secretary at such time, in such manner, and containing 

20 such information as the Secretary may require. 

21 ‘‘(d) USES OF FUNDS.—An eligible entity that re22 ceives a grant under subsection (b) shall use the grant 

23 funds, in coordination with State and all local hazards pro24 grams, to— 


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1 ‘‘(1) develop and implement infectious disease 

2 surveillance plans and networks and public health 

3 emergency and readiness assessments and prepared4 ness plans, and purchase items necessary for such 

5 plans; 

6 ‘‘(2) coordinate infectious disease surveillance 

7 planning and interjurisdictional risk assessments in 

8 the region with appropriate United States-based 

9 agencies and organizations and appropriate authori10 ties in Mexico or Canada; 

11 ‘‘(3) improve infrastructure, including surge ca12 pacity, syndromic surveillance, and isolation/decon13 tamination capacity, and policy preparedness, includ14 ing for mutual assistance and for the sharing of in15 formation and resources; 

16 ‘‘(4) improve laboratory capacity, in order to 

17 maintain and enhance capability and capacity to de18 tect potential infectious disease, whether naturally 

19 occurring or the result of terrorism; 

20 ‘‘(5) create and maintain a health alert net21 work, including risk communication and information 

22 dissemination that is culturally competent and takes 

23 into account the needs of at-risk populations, includ24 ing individuals with disabilities; 


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1 ‘‘(6) educate and train clinicians, epidemiolo2 gists, laboratories, and emergency management per3 sonnel; 

4 ‘‘(7) implement electronic data and infrastruc5 ture inventory systems to coordinate the triage, 

6 transportation, and treatment of multicasualty inci7 dent victims; 

8 ‘‘(8) provide infectious disease testing in the 

9 United States-Mexico border area or United States10 Canada border area; and 

11 ‘‘(9) carry out such other activities identified by 

12 the Secretary, members of the Commission, members 

13 of the Council, State or local public health authori14 ties, representatives of border health offices, or au15 thorities at the United States-Mexico or United 

16 States-Canada borders. 

17 ‘‘SEC. 9. PLANS, REPORTS, AUDITS, AND BY-LAWS. 

18 ‘‘(a) STRATEGIC PLAN.— 

19 ‘‘(1) IN GENERAL.—Not later than 2 years 

20 after the date of enactment of this section, and every 

21 5 years thereafter, the Commission (including the 

22 participation of members representing both the 

23 United States and Mexican sections) and the Coun24 cil (including the participation of members rep25 resenting both the United States and Canada) shall 


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1 each prepare a binational strategic plan to guide the 

2 operations of the Commission and the Council and 

3 submit such plan to the Secretary and Congress. 

4 ‘‘(2) REQUIREMENTS.—The binational strategic 

5 plan under paragraph (1) shall include— 

6 ‘‘(A) health-related priority areas deter7 mined most important by the full membership 

8 of the Commission or Council, as applicable; 

9 ‘‘(B) recommendations for goals, objec10 tives, strategies, and actions designed to ad11 dress such priority areas; and 

12 ‘‘(C) a proposed evaluation framework with 

13 output and outcome indicators appropriate to 

14 gauge progress toward meeting the objectives 

15 and priorities of the Commission or Council, as 

16 applicable. 

17 ‘‘(b) WORK PLAN.—Not later than January 1, 2015, 

18 and every 2 years thereafter, the Commission and the 

19 Council shall develop and approve an operational work 

20 plan and budget based on the strategic plan under sub21 section (a). 

22 ‘‘(c) GAO REVIEW.—Not later than January 1, 

23 2016, and every 2 years thereafter, the Comptroller Gen24 eral of the United States shall conduct an evaluation of 

25 the activities conducted by the Commission and the CounVerDate Mar 15 2010 00:05 May 01, 2014 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2268.IS S2268

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1 cil based on the operational work plans described in sub2 section (b) for the previous year and the output and out3 come indicators included in the strategic plan described 

4 in subsection (a). The evaluation shall include a request 

5 for written evaluations from members of the Commission 

6 and the Council about barriers and facilitators to exe7 cuting successfully the work plans of the Commission and 

8 the Council. 

9 ‘‘(d) BIANNUAL REPORTING.—The Commission and 

10 Council shall each issue a biannual report to the Secretary 

11 that provides independent policy recommendations related 

12 to border health issues. Not later than 3 months following 

13 receipt of each such biannual report, the Secretary shall 

14 provide to Congress the report and any studies or other 

15 materials produced independently by the Commission and 

16 Council. 

17 ‘‘(e) AUDITS.—The Secretary shall annually prepare 

18 an audited financial report to account for all appropriated 

19 assets expended by the Commission and Council to ad20 dress both the strategic and operational work plans for 

21 the year involved. 

22 ‘‘(f) BY-LAWS.—Not later than 6 months after the 

23 date of enactment of this section, the Commission and 

24 Council shall develop and approve bylaws to provide fully 

25 for compliance with the requirements of this section. 


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1 ‘‘(g) TRANSMITTAL TO CONGRESS.—The Commission 

2 and Council shall submit copies of the operational work 

3 plan and by-laws to Congress. The Comptroller General 

4 of the United States shall submit a copy of each evaluation 

5 completed under subsection (c) to Congress. 

6 ‘‘SEC. 10. COORDINATION. 

7 ‘‘(a) IN GENERAL.—To the extent practicable and 

8 appropriate, plans, systems, and activities to be funded (or 

9 supported) under this Act for all hazard preparedness, and 

10 general border health, shall be coordinated with Federal, 

11 State, and local authorities in Mexico, Canada, and the 

12 United States. 

13 ‘‘(b) COORDINATION OF HEALTH SERVICES AND

14 SURVEILLANCE.—The Secretary, acting through the As15 sistant Secretary for Preparedness and Response, when 

16 appropriate, may coordinate with the Secretary of Home17 land Security in establishing a health alert system that— 

18 ‘‘(1) alerts clinicians and public health officials 

19 of emerging disease clusters and syndromes along 

20 the United States-Mexico border area and United 

21 States-Canada border area; and 

22 ‘‘(2) warns of health threats, extreme weather 

23 conditions, disasters of mass scale, bioterrorism, and 

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1 ico border area and United States-Canada border 

2 area. 

3 ‘‘SEC. 11. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There is authorized to be appropriated to carry out 

5 this Act $7,000,000 for fiscal year 2014 and each suc6 ceeding year, subject to the availability of appropriations 

7 for such purpose, of which $4,650,000 shall be made avail8 able to fund operationally feasible functions, activities, and 

9 grants with respect to the United States-Mexico border 

10 and the border health activities under cooperative agree11 ments with the border health offices of the States of Cali12 fornia, Arizona, New Mexico, and Texas, and $2,350,000 

13 shall be allocated for the administration of United States 

14 activities under this Act on the United States-Canada bor15 der and the border health authorities, acting through the 

16 Canada-United States Pan-Border Public Health Pre17 paredness Council.’’; and 

18 (5) in section 12 (as so redesignated)— 

19 (A) by redesignating paragraphs (3) and 

20 (4) as paragraphs (4) and (6), respectively; 

21 (B) by inserting after paragraph (2), the 

22 following: 

23 ‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANI24 ZATION; URBAN INDIAN ORGANIZATION.—The terms 

25 ‘Indian’, ‘Indian tribe’, ‘tribal organization’, and 


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1 ‘urban Indian organization’ have the meanings given 

2 such terms in section 4 of the Indian Health Care 

3 Improvement Act (25 U.S.C. 1603).’’; and 

4 (C) by inserting after paragraph (4), as so 

5 redesignated, the following: 

6 ‘‘(5) UNITED STATES-CANADA BORDER AREA.— 

7 The term ‘United States-Canada border area’ means 

8 the area located in the United States and Canada 

9 within 100 kilometers of the border between the 

10 United States and Canada.’’. 

Æ 


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