II 

110TH CONGRESS 

2D SESSION H. R. 1532 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 25 (legislative day, SEPTEMBER 17), 2008 

Received 

AN ACT 

To amend the Public Health Service Act with respect to 

making progress toward the goal of eliminating tuberculosis, and for other purposes. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Comprehensive Tuberculosis Elimination Act of 2008’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—DEPARTMENT OF HEALTH AND HUMAN SERVICES IN 

COORDINATION WITH THE CENTERS FOR DISEASE CONTROL 

AND PREVENTION AND OTHER APPROPRIATE AGENCIES 

Subtitle A—National Strategy for Combating and Eliminating Tuberculosis 

Sec. 101. National strategy. 

Subtitle B—Interagency Collaboration 

Sec. 111. Advisory Council for Elimination of Tuberculosis and the Federal Tuberculosis Task Force . 

Subtitle C—Evaluation of Public Health Authorities 

Sec. 121. Evaluation of public health authorities. 

Subtitle D—Authorization of Appropriations 

Sec. 131. Authorizations of appropriations. 

TITLE II—NATIONAL INSTITUTES OF HEALTH 

Sec. 201. Research and development concerning tuberculosis. 


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1 TITLE I—DEPARTMENT OF 

2 HEALTH AND HUMAN SERV3 ICES IN COORDINATION WITH 

4 THE CENTERS FOR DISEASE 

5 CONTROL AND PREVENTION 

6 AND OTHER APPROPRIATE 

7 AGENCIES 

8 Subtitle A—National Strategy for 

9 Combating and Eliminating Tu10 berculosis 

11 SEC. 101. NATIONAL STRATEGY. 

12 Section 317E of the Public Health Service Act (42 

13 U.S.C. 247b–6) is amended— 

14 (1) by striking the heading for the section and 

15 inserting the following: ‘‘NATIONAL STRATEGY FOR

16 COMBATING AND ELIMINATING TUBERCULOSIS’’; 

17 (2) by amending subsection (b) to read as fol18 lows: 

19 ‘‘(b) RESEARCH AND DEVELOPMENT; DEMONSTRA20 TION PROJECTS; EDUCATION AND TRAINING.—With re21 spect to the prevention, treatment, control, and elimi22 nation of tuberculosis, the Secretary may, directly or 

23 through grants to public or nonprofit private entities, 

24 carry out the following: 


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1 ‘‘(1) Research, with priority given to research 

2 and development concerning latent tuberculosis in3 fection, strains of tuberculosis resistant to drugs, 

4 and research concerning cases of tuberculosis that 

5 affect certain populations at risk for tuberculosis. 

6 ‘‘(2) Research and development and related ac7 tivities to develop new tools for the elimination of tu8 berculosis, including drugs, diagnostics, vaccines, 

9 and public health interventions, such as directly ob10 served therapy and non-pharmaceutical intervention, 

11 and methods to enhance detection and response to 

12 outbreaks of tuberculosis, including multidrug resist13 ant tuberculosis. The Secretary is encouraged to give 

14 priority to programmatically relevant research so 

15 that new tools can be utilized in public health prac16 tice. 

17 ‘‘(3) Demonstration projects for— 

18 ‘‘(A) the development of regional capabili19 ties to prevent, control, and eliminate tuber20 culosis and prevent multidrug resistant and ex21 tensively drug resistant strains of tuberculosis; 

22 ‘‘(B) the intensification of efforts to reduce 

23 health disparities in the incidence of tuber24 culosis; 


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1 ‘‘(C) the intensification of efforts to con2 trol tuberculosis along the United States-Mexico 

3 border and among United States-Mexico bina4 tional populations, including through expansion 

5 of the scope and number of programs that— 

6 ‘‘(i) detect and treat binational cases 

7 of tuberculosis; and 

8 ‘‘(ii) treat high-risk cases of tuber9 culosis referred from Mexican health de10 partments; 

11 ‘‘(D) the intensification of efforts to pre12 vent, detect, and treat tuberculosis among for13 eign-born persons who are in the United States; 

14 ‘‘(E) the intensification of efforts to pre15 vent, detect, and treat tuberculosis among pop16 ulations and settings documented as having a 

17 high risk for tuberculosis; and 

18 ‘‘(F) tuberculosis detection, control, and 

19 prevention. 

20 ‘‘(4) Public information and education activi21 ties. 

22 ‘‘(5) Education, training, clinical skills improve23 ment activities, and workplace exposure prevention 

24 for health professionals, including allied health per25 sonnel and emergency response employees. 


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1 ‘‘(6) Support of Centers to carry out activities 

2 under paragraphs (1) through (4). 

3 ‘‘(7) Collaboration with international organiza4 tions and foreign countries in carrying out such ac5 tivities. 

6 ‘‘(8) Develop, enhance, and expand information 

7 technologies that support tuberculosis control includ8 ing surveillance and database management systems 

9 with cross-jurisdictional capabilities, which shall con10 form to the standards and implementation specifica11 tions for such information technologies as rec12 ommended by the Secretary.’’; and 

13 (3) in subsection (d), by adding at the end the 

14 following: 

15 ‘‘(3) DETERMINATION OF AMOUNT OF NON16 FEDERAL CONTRIBUTIONS.— 

17 ‘‘(A) PRIORITY.—In awarding grants 

18 under subsection (a) or (b), the Secretary shall 

19 give highest priority to an applicant that pro20 vides assurances that the applicant will con21 tribute non-Federal funds to carry out activities 

22 under this section, which may be provided di23 rectly or through donations from public or pri24 vate entities and may be in cash or in kind, in25 cluding equipment or services. 


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1 ‘‘(B) FEDERAL AMOUNTS NOT TO BE IN2 CLUDED AS CONTRIBUTIONS.—Amounts pro3 vided by the Federal Government, or services 

4 assisted or subsidized to any significant extent 

5 by the Federal Government, may not be in6 cluded in determining the amount of non-Fed7 eral contributions as described in subparagraph 

8 (A).’’. 

9 Subtitle B—Interagency 

10 Collaboration 

11 SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TU12 BERCULOSIS AND THE FEDERAL TUBER13 CULOSIS TASK FORCE. 

14 (a) IN GENERAL.—Section 317E(f) of the Public 

15 Health Service Act (42 U.S.C. 247b–6(f)) is amended— 

16 (1) by redesignating paragraph (5) as para17 graph (6); and 

18 (2) by striking paragraphs (2) through (4), and 

19 inserting the following: 

20 ‘‘(2) DUTIES.—The Council shall provide advice 

21 and recommendations regarding the elimination of 

22 tuberculosis to the Secretary. In addition, the Coun23 cil shall, with respect to eliminating such disease, 

24 provide to the Secretary and other appropriate Fed25 eral officials advice on— 


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1 ‘‘(A) coordinating the activities of the De2 partment of Health and Human Services and 

3 other Federal agencies that relate to the dis4 ease, including activities under subsection (b); 

5 ‘‘(B) responding rapidly and effectively to 

6 emerging issues in tuberculosis; and 

7 ‘‘(C) efficiently utilizing the Federal re8 sources involved. 

9 ‘‘(3) COMPREHENSIVE PLAN.— 

10 ‘‘(A) IN GENERAL.—In carrying out para11 graph (2), the Council shall make or update 

12 recommendations on the development, revision, 

13 and implementation of a comprehensive plan to 

14 eliminate tuberculosis in the United States. 

15 ‘‘(B) CONSULTATION.—In carrying out 

16 subparagraph (A), the Council may consult with 

17 appropriate public and private entities, which 

18 may, subject to the direction or discretion of 

19 the Secretary, include— 

20 ‘‘(i) individuals who are scientists, 

21 physicians, laboratorians, and other health 

22 professionals, who are not officers or em23 ployees of the Federal Government and 

24 who represent the disciplines relevant to 

25 tuberculosis elimination; 


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1 ‘‘(ii) members of public-private part2 nerships or private entities established to 

3 address the elimination of tuberculosis; 

4 ‘‘(iii) members of national and inter5 national nongovernmental organizations 

6 whose purpose is to eliminate tuberculosis; 

7 ‘‘(iv) members from the general public 

8 who are knowledgeable with respect to tu9 berculosis elimination including individuals 

10 who have or have had tuberculosis; and 

11 ‘‘(v) scientists, physicians, 

12 laboratorians, and other health profes13 sionals who reside in a foreign country 

14 with a substantial incidence or prevalence 

15 of tuberculosis, and who represent the spe16 cialties and disciplines relevant to the re17 search under consideration. 

18 ‘‘(C) CERTAIN COMPONENTS OF PLAN.—In 

19 carrying out subparagraph (A), the Council 

20 shall, subject to the direction or discretion of 

21 the Secretary— 

22 ‘‘(i) consider recommendations for the 

23 involvement of the United States in con24 tinuing global and cross-border tuber25 culosis control activities in countries where 


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1 a high incidence of tuberculosis directly af2 fects the United States; and 

3 ‘‘(ii) review the extent to which 

4 progress has been made toward eliminating 

5 tuberculosis. 

6 ‘‘(4) BIENNIAL REPORT.— 

7 ‘‘(A) IN GENERAL.—The Council shall sub8 mit a biennial report to the Secretary, as deter9 mined necessary by the Secretary, on the activi10 ties carried under this section. Each such re11 port shall include the opinion of the Council on 

12 the extent to which its recommendations re13 garding the elimination of tuberculosis have 

14 been implemented, including with respect to— 

15 ‘‘(i) activities under subsection (b); 

16 and 

17 ‘‘(ii) the national plan referred to in 

18 paragraph (3). 

19 ‘‘(B) PUBLIC.—The Secretary shall make 

20 a report submitted under subparagraph (A) 

21 public. 

22 ‘‘(5) COMPOSITION.—The Council shall be com23 posed of— 

24 ‘‘(A) ex officio representatives from the 

25 Centers for Disease Control and Prevention, the 


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1 National Institutes of Health, the United States 

2 Agency for International Development, the 

3 Agency for Healthcare Research and Quality, 

4 the Health Resources and Services Administra5 tion, the United States-Mexico Border Health 

6 Commission, and other Federal departments 

7 and agencies that carry out significant activities 

8 related to tuberculosis; 

9 ‘‘(B) State and local tuberculosis control 

10 and public health officials; 

11 ‘‘(C) individuals who are scientists, physi12 cians, laboratorians, and other health profes13 sionals who represent disciplines relevant to tu14 berculosis elimination; and 

15 ‘‘(D) members of national and inter16 national nongovernmental organizations estab17 lished to address the elimination of tuber18 culosis.’’. 

19 (b) RULE OF CONSTRUCTION REGARDING CURRENT

20 MEMBERSHIP.—With respect to the advisory council 

21 under section 317E(f) of the Public Health Service Act, 

22 the amendments made by subsection (a) may not be con23 strued as terminating the membership on such council of 

24 any individual serving as such a member as of the day 

25 before the date of the enactment of this Act. 


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1 (c) FEDERAL TUBERCULOSIS TASK FORCE.—Section 

2 317E of the Public Health Service Act (42 U.S.C. 247b– 

3 6) is amended— 

4 (1) by redesignating subsection (g) as sub5 section (h); and 

6 (2) by inserting after subsection (f) the fol7 lowing subsection: 

8 ‘‘(g) FEDERAL TUBERCULOSIS TASK FORCE.— 

9 ‘‘(1) DUTIES.—The Federal Tuberculosis Task 

10 Force (in this subsection referred to as the ‘Task 

11 Force’) shall provide to the Secretary and other ap12 propriate Federal officials advice on research into 

13 new tools under subsection (b)(2), including advice 

14 regarding the efficient utilization of the Federal re15 sources involved. 

16 ‘‘(2) COMPREHENSIVE PLAN FOR NEW TOOLS

17 DEVELOPMENT.—In carrying out paragraph (1), the 

18 Task Force shall make recommendations on the de19 velopment of a comprehensive plan for the creation 

20 of new tools for the elimination of tuberculosis, in21 cluding drugs, diagnostics, and vaccines. 

22 ‘‘(3) CONSULTATION.—In developing the com23 prehensive plan under paragraph (1), the Task 

24 Force shall consult with external parties including 

25 representatives from groups such as— 


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1 ‘‘(A) scientists, physicians, laboratorians, 

2 and other health professionals who represent 

3 the specialties and disciplines relevant to the re4 search under consideration; 

5 ‘‘(B) members from public-private partner6 ships, private entities, or foundations (or both) 

7 engaged in activities relevant to research under 

8 consideration; 

9 ‘‘(C) members of national and inter10 national nongovernmental organizations estab11 lished to address tuberculosis elimination; 

12 ‘‘(D) members from the general public who 

13 are knowledgeable with respect to tuberculosis 

14 including individuals who have or have had tu15 berculosis; and 

16 ‘‘(E) scientists, physicians, laboratorians, 

17 and other health professionals who reside in a 

18 foreign country with a substantial incidence or 

19 prevalence of tuberculosis, and who represent 

20 the specialties and disciplines relevant to the re21 search under consideration.’’. 


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1 Subtitle C—Evaluation of Public 

2 Health Authorities 

3 SEC. 121. EVALUATION OF PUBLIC HEALTH AUTHORITIES. 

4 (a) IN GENERAL.—Not later than 180 days after the 

5 date of enactment of the Comprehensive Tuberculosis 

6 Elimination Act of 2008, the Secretary of Health and 

7 Human Services shall prepare and submit to the appro8 priate committees of Congress a report that evaluates and 

9 provides recommendations on changes needed to Federal 

10 and State public health authorities to address current dis11 ease containment challenges such as isolation and quar12 antine. 

13 (b) CONTENTS OF EVALUATION.—The report de14 scribed in subsection (a) shall include— 

15 (1) an evaluation of the effectiveness of current 

16 policies to detain patients with active tuberculosis; 

17 (2) an evaluation of whether Federal laws 

18 should be strengthened to expressly address the 

19 movement of individuals with active tuberculosis; 

20 and 

21 (3) specific legislative recommendations for 

22 changes to Federal laws, if any. 

23 (c) UPDATE OF QUARANTINE REGULATIONS.—Not 

24 later than 240 days after the date of enactment of this 

25 Act, the Secretary of Health and Human Services shall 


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1 promulgate regulations to update the current interstate 

2 and foreign quarantine regulations found in parts 70 and 

3 71 of title 42, Code of Federal Regulations. 

4 Subtitle D—Authorization of 

5 Appropriations 

6 SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS. 

7 Section 317E of the Public Health Service Act, as 

8 amended by section 111(c) of this Act, is amended by 

9 striking subsection (h) and inserting the following: 

10 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

11 ‘‘(1) GENERAL PROGRAM.— 

12 ‘‘(A) IN GENERAL.—For the purpose of 

13 carrying out this section, there are authorized 

14 to be appropriated $200,000,000 for fiscal year 

15 2009, $210,000,000 for fiscal year 2010, 

16 $220,500,000 for fiscal year 2011, 

17 $231,525,000 for fiscal year 2012, and 

18 $243,101,250 for fiscal year 2013. 

19 ‘‘(B) RESERVATION FOR EMERGENCY

20 GRANTS.—Of the amounts appropriated under 

21 subparagraph (A) for a fiscal year, the Sec22 retary may reserve not more than 25 percent 

23 for emergency grants under subsection (a) for 

24 any geographic area, State, political subdivision 

25 of a State, or other public entity in which there 


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1 is, relative to other areas, a substantial number 

2 of cases of tuberculosis, multidrug resistant tu3 berculosis, or extensively drug resistant tuber4 culosis or a substantial rate of increase in such 

5 cases. 

6 ‘‘(C) PRIORITY.—In allocating amounts 

7 appropriated under subparagraph (A), the Sec8 retary shall give priority to allocating such 

9 amounts for grants under subsection (a). 

10 ‘‘(D) ALLOCATION OF FUNDS.— 

11 ‘‘(i) REQUIREMENT OF FORMULA.—Of 

12 the amounts appropriated under subpara13 graph (A), not reserved under subpara14 graph (B), and allocated by the Secretary 

15 for grants under subsection (a), the Sec16 retary shall distribute a portion of such 

17 amounts to grantees under subsection (a) 

18 on the basis of a formula. 

19 ‘‘(ii) RELEVANT FACTORS.—The for20 mula developed by the Secretary under 

21 clause (i) shall take into account the level 

22 of tuberculosis morbidity and case com23 plexity in the respective geographic area 

24 and may consider other factors relevant to 

25 tuberculosis in such area. 


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1 ‘‘(iii) NO CHANGE TO FORMULA RE2 QUIRED.—This subparagraph does not re3 quire the Secretary to modify the formula 

4 that was used by the Secretary to dis5 tribute funds to grantees under subsection 

6 (a) for fiscal year 2009. 

7 ‘‘(2) LIMITATION.—The authorization of appro8 priations established in paragraph (1) for a fiscal 

9 year is effective only if the amount appropriated 

10 under such paragraph for such year equals or ex11 ceeds the amount appropriated to carry out this sec12 tion for fiscal year 2009.’’. 

13 TITLE II—NATIONAL INSTITUTES 

14 OF HEALTH 

15 SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TU16 BERCULOSIS. 

17 Subpart 2 of part C of title IV of the Public Health 

18 Service Act (42 U.S.C. 285b et seq.) is amended by insert19 ing after section 424B the following section: 

20 ‘‘SEC. 424C. TUBERCULOSIS. 

21 ‘‘(a) IN GENERAL.—The Director of the National In22 stitutes of Health may expand, intensify, and coordinate 

23 research and development and related activities of the In24 stitutes with respect to tuberculosis including activities to25 ward the goal of eliminating such disease. 


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1 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub2 section (a) may include— 

3 ‘‘(1) enhancing basic and clinical research on 

4 tuberculosis, including drug resistant tuberculosis; 

5 ‘‘(2) expanding research on the relationship be6 tween such disease and the human immunodeficiency 

7 virus; and 

8 ‘‘(3) developing new tools for the elimination of 

9 tuberculosis, including public health interventions 

10 and methods to enhance detection and response to 

11 outbreaks of tuberculosis, including multidrug resist12 ant tuberculosis.’’. 

Passed the House of Representatives September 24, 

2008. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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