I 
111TH CONGRESS 
1ST SESSION 
H. R. 805 
To amend the Public Health Service Act to improve the Nation’s surveillance 
and reporting for diseases and conditions, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 3, 2009 
Ms. BALDWIN (for herself, Mr. TERRY, and Mr. TOWNS) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve the 
Nation’s surveillance and reporting for diseases and con-
ditions, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Strengthening Amer-
ica’s Public Health System Act’’. 
SEC. 2. PURPOSES. 
The purpose of the programs authorized under this 
Act is to strengthen public health surveillance systems and 
disease reporting by— 
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(1) delineating existing grant mechanisms at 
the Centers for Disease Control and Prevention de-
signed to enhance disease surveillance and reporting 
by improving and modernizing capacity at the State 
and local level— 
(A) to identify and monitor the occurrence 
of infectious diseases and other conditions of 
public health importance; 
(B) to detect new and emerging infectious 
disease threats; and 
(C) to identify and respond to disease out-
breaks; 
(2) expanding eligibility for grantees; 
(3) increasing funding to ensure all States and 
jurisdictions have appropriate surveillance and re-
porting capacity and can provide comprehensive elec-
tronic reporting, including laboratory reporting; 
(4) delineating existing applied epidemiology, 
laboratory science, and informatics fellowship pro-
grams designed to reduce documented workforce 
shortages for these essential public health profes-
sionals at the State and local level and increasing 
funding for these programs; 
(5) expanding the Epidemic Intelligence Serv-
ice; 
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(6) delineating a refined process for estab-
lishing a list of nationally notifiable diseases and 
conditions; 
(7) improving binational surveillance of diseases 
in the United States and Mexico border region, in-
cluding developing improved standards and protocols 
for binational epidemiology, surveillance, laboratory 
analyses, and control of infectious diseases between 
the two nations; and 
(8) establishing a forum to permit review and 
identification of best surveillance practices with a 
particular focus on improving coordination of ani-
mal-human disease surveillance. 
SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE 
SYSTEMS. 
Title XXVIII of the Public Health Service Act (42 
U.S.C. 300hh et seq.) is amended by adding at the end 
the following: 
‘‘Subtitle C—Strengthening Public 
Health Surveillance Systems 
‘‘SEC. 
2821. 
EPIDEMIOLOGY-LABORATORY 
CAPACITY 
GRANTS. 
‘‘(a) IN GENERAL.—Subject to the availability of ap-
propriations, the Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, shall 
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establish an Epidemiology and Laboratory Capacity Grant 
Program to award grants to eligible entities to assist pub-
lic health agencies in improving surveillance for, and re-
sponse to, infectious diseases and other conditions of pub-
lic health importance by— 
‘‘(1) strengthening epidemiologic capacity; 
‘‘(2) enhancing laboratory practice; 
‘‘(3) improving information systems; and 
‘‘(4) developing and implementing prevention 
and control strategies. 
‘‘(b) ELIGIBLE ENTITIES.—In this section, the term 
‘eligible entity’ means an entity that— 
‘‘(1) is— 
‘‘(A) a State health department; 
‘‘(B) a local health department that meets 
such criteria as the Director of the Centers for 
Diseases Control and Prevention determines for 
purposes of this section; 
‘‘(C) a tribal jurisdiction that meets such 
criteria as the Director of the Centers for Dis-
ease Control and Prevention determines for 
purposes of this section; or 
‘‘(D) a partnership established for pur-
poses of this section between one or more eligi-
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ble entities described in subparagraph (A), (B), 
or (C) and an academic center; and 
‘‘(2) submits to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—An eligible entity shall use 
amounts received under a grant under this section 
for core functions described in this subsection in-
cluding— 
‘‘(A) building public health capacity to 
identify and monitor the occurrence of infec-
tious diseases and other conditions of public 
health importance; 
‘‘(B) detecting new and emerging infec-
tious disease threats, including laboratory ca-
pacity to detect antimicrobial resistant infec-
tions; 
‘‘(C) identifying and responding to disease 
outbreaks; 
‘‘(D) hiring necessary staff; 
‘‘(E) conducting needed staff training and 
educational development; and 
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‘‘(F) other activities that improve surveil-
lance as determined by the Director of the Cen-
ters for Disease Control and Prevention. 
‘‘(2) DEVELOPMENT AND MAINTENANCE OF IN-
FORMATION EXCHANGE.— 
‘‘(A) NATIONAL
STANDARDS.—Not later 
than 180 days after the date of the enactment 
of this subtitle, the Secretary, acting through 
the Director of the Centers for Disease Control 
and Prevention, and in consultation with the 
National Coordinator for Health Information 
Technology, shall issue guidelines for public 
health entities that— 
‘‘(i) are designed to ensure that all 
State and local health departments and 
public health laboratories have access to 
information systems to receive, monitor, 
and report infectious diseases and other 
urgent conditions of public health impor-
tance; and 
‘‘(ii) are consistent with standards 
and recommendations for health informa-
tion technology by the National Coordi-
nator for Health Information Technology, 
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and by the American Health Information 
Community (AHIC) and its successors. 
‘‘(B) SECURE
INFORMATION
SYSTEMS.— 
An eligible entity shall use amounts received 
through a grant under this section to ensure 
that the entity has access to a web-based, se-
cure information system that complies with the 
guidelines developed under subparagraph (A). 
Such a system shall be designed— 
‘‘(i) to receive automated case reports 
of State and national reportable conditions 
from clinical systems and health care of-
fices that use electronic health records and 
from clinical and public health labora-
tories, and to submit reports of nationally 
reportable conditions to the Director of the 
Centers for Disease Control and Preven-
tion; 
‘‘(ii) to receive and analyze, within 24 
hours, de-identified electronic clinical data 
for situational awareness and to forward 
such reports immediately to the Centers 
for Disease Control and Prevention at the 
time of receipt; 
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‘‘(iii) to manage, link, and process dif-
ferent types of data, including information 
on newly reported cases, exposed contacts, 
laboratory results, number of people vac-
cinated or given prophylactic medications, 
adverse events monitoring and follow-up, in 
an integrated outbreak management sys-
tem; 
‘‘(iv) to geocode analyze, display, re-
port, and map, using Geographic Informa-
tion System technology, accumulated data 
and to share data with other local health 
departments, State health departments, 
and the Centers for Disease Control and 
Prevention; 
‘‘(v) to receive, manage, and dissemi-
nate alerts, protocols, and other informa-
tion, including Health Alert Network and 
Epi-X information, as appropriate, for 
public health workers, health care pro-
viders, and public health partners in emer-
gency response within each health depart-
ment’s jurisdiction and to automate the ex-
change and cascading of such information 
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with external partners using national 
standards; 
‘‘(vi) to have information technology 
security and critical infrastructure protec-
tion as appropriate to protect public health 
information; 
‘‘(vii) to have the technical infrastruc-
ture needed to ensure availability, backup, 
and disaster recovery of data, application 
services, and communications systems dur-
ing natural disasters such as floods, tor-
nados, hurricanes, and power outages; and 
‘‘(viii) to provide for other capabilities 
as the Secretary determines appropriate. 
‘‘(C) LABORATORY SYSTEMS.—An eligible 
entity shall use amounts received under a grant 
under this section to ensure that State or local 
public health laboratories are utilizing web- 
based, secure systems that are in compliance 
with the guidelines developed by the Secretary 
under subparagraph (A) and that— 
‘‘(i) are fully integrated laboratory in-
formation systems; 
‘‘(ii) provide for the reporting of elec-
tronic test results to the appropriate local 
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and State health departments using cur-
rently existing national format and coding 
standards; 
‘‘(iii) have information technology se-
curity and critical infrastructure protection 
to protect public health information (as de-
termined by the Secretary); 
‘‘(iv) have the technical infrastructure 
needed to ensure availability, backup, and 
disaster recovery of data, application serv-
ices, and communications systems during 
natural disasters including floods, torna-
does, hurricanes, and power outages; and 
‘‘(v) address other capabilities as the 
Secretary determines appropriate. 
‘‘(D) OTHER USES.—In addition to the ac-
tivities described in subparagraphs (B) and (C), 
an eligible entity (including the entity’s public 
health laboratory) may use amounts received 
under a grant under this section for systems 
development and maintenance, hiring necessary 
staff, and staff technical training. Grantees 
under this section may elect to develop their 
own systems or use federally developed systems 
in carrying out activities under this paragraph. 
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‘‘(d) PRIORITY.—In allocating funds under sub-
section (f)(2) for activities under subsection (c)(2)(B) (re-
lating to secure information systems), the Secretary shall 
give priority to eligible entities that demonstrate need. 
‘‘(e) REPORTS.—Not later than September 30, 2011, 
and each September 30 thereafter, the Secretary shall 
submit to Congress an annual report on the activities car-
ried out under this section by recipients of assistance 
under this section. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$190,000,000 for each of fiscal years 2010 through 2013, 
of which— 
‘‘(1) not less than $95,000,000 shall be made 
available each such fiscal year for activities under 
subsection (c)(1); 
‘‘(2) not less than $60,000,000 shall be made 
available each such fiscal year for activities under 
subsection (c)(2)(B); and 
‘‘(3) not less than $32,000,000 shall be made 
available each such fiscal year for activities under 
subsection (c)(2)(C). 
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‘‘SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC 
HEALTH EPIDEMIOLOGY, PUBLIC HEALTH 
LABORATORY 
SCIENCE, 
PUBLIC 
HEALTH 
INFORMATICS, AND EXPANSION OF THE EPI-
DEMIC INTELLIGENCE SERVICE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, may carry out activities to address documented 
workforce shortages in State and local health departments 
in the critical areas of applied public health epidemiology 
and public health laboratory science and informatics and 
may expand the Epidemic Intelligence Service. 
‘‘(b) SPECIFIC USES.—In carrying out subsection 
(a), the Secretary, acting through the Director of the Cen-
ters for Disease Control and Prevention, shall provide for 
the expansion of existing Council of State and Territorial 
Epidemiologists and Association of Public Health Labora-
tories fellowship programs operated through the Centers 
for Disease Control and Prevention in a manner that is 
designed to alleviate shortages of the type described in 
subsection (a). 
‘‘(c) OTHER
PROGRAMS.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, may provide for the expansion of other 
applied epidemiology training programs that meet objec-
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tives similar to the objectives of the programs described 
in subsection (b). 
‘‘(d) WORK OBLIGATION.—Participation in fellow-
ship training programs under this section shall be deemed 
to be service for purposes of satisfying work obligations 
stipulated in contracts under section 338I(j). 
‘‘(e) GENERAL SUPPORT.—Amounts may be used 
from grants awarded under this section to expand the 
Public Health Informatics Fellowship Program at the 
Centers for Disease Control and Prevention to better sup-
port all public health systems at all levels of government. 
‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$39,500,000 for each of fiscal years 2010 through 2013, 
of which— 
‘‘(1) $5,000,000 shall be made available in each 
such fiscal year for epidemiology fellowship training 
program activities under subsections (b) and (c); 
‘‘(2) $5,000,000 shall be made available in each 
such fiscal year for laboratory fellowship training 
programs under subsection (b); 
‘‘(3) $5,000,000 shall be made available in each 
such fiscal year for the Public Health Informatics 
Fellowship Program under subsection (e); and 
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‘‘(4) $24,500,000 shall be made available for 
expanding the Epidemic Intelligence Service under 
subsection (a). 
‘‘SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CON-
DITIONS. 
‘‘(a) IN GENERAL.—At the request of the Council of 
State and Territorial Epidemiologists, the Director of the 
Centers for Disease Control and Prevention shall assist 
the Council in developing or improving a process for 
States to conduct surveillance and submit reports to the 
Director on nationally notifiable diseases and conditions. 
‘‘(b) LIST OF NATIONALLY NOTIFIABLE DISEASES 
AND CONDITIONS.—The process under subsection (a) 
shall include a list of nationally notifiable diseases and 
conditions as follows: 
‘‘(1) The Council of State and Territorial Epi-
demiologists and the Director of the Centers for Dis-
ease Control and Prevention will jointly develop— 
‘‘(A) not later than 1 year after the date 
of the enactment of the Strengthening Amer-
ica’s Public Health System Act, a list of nation-
ally notifiable diseases and conditions; and 
‘‘(B) a process for reviewing the list on an 
annual basis and, as appropriate, modifying the 
list, taking into account newly recognized dis-
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eases and conditions of public health impor-
tance and advances in diagnostic technology. 
‘‘(2) A disease or condition will be included on 
the list only if a majority of the States represented 
on the Council approve such inclusion. 
‘‘(3) The list will include standard definitions 
for confirmed, probable, and suspect cases for each 
nationally notifiable disease or condition. 
‘‘(4) The list will distinguish between— 
‘‘(A) diseases and conditions of urgent 
public health importance for which immediate 
action may be needed; and 
‘‘(B) diseases and conditions for which re-
porting is less urgent and mainly for the pur-
pose of monitoring trends and evaluating public 
health intervention programs. 
‘‘(c) NOTIFICATIONS TO CDC.—The process under 
subsection (a) shall provide for reporting to the Director 
of the Centers for Disease Control and Prevention as fol-
lows: 
‘‘(1) For diseases and conditions described in 
subsection (b)(4)(A), reporting will occur— 
‘‘(A) by telephone or by using a system de-
scribed in section 2821(c)(2)(B); and 
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‘‘(B) within 24 hours of the State making 
a determination that a disease or condition 
meets the criteria for national reporting for 
that disease or condition. 
‘‘(2) For diseases and conditions described in 
subsection (b)(4)(B), reporting will occur— 
‘‘(A) by using a system described in sec-
tion 2821(c)(2)(B); and 
‘‘(B) only if funding is sufficient for the 
State to conduct individual case surveillance 
and to have the necessary systems to support 
electronic reporting. 
‘‘(d) DEFINITIONS.—In this section, the term ‘na-
tionally notifiable’, with respect to a disease or condition, 
means included on the list developed pursuant to sub-
section (b). 
‘‘SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND 
NOTIFICATION. 
‘‘(a) FINDINGS.—The Congress finds as follows: 
‘‘(1) Nearly 1,000,000 people cross the inter-
national border between the United States and Mex-
ico on a daily basis, and this transmobility of popu-
lation presents actual cases and the potential risk of 
transmission of infectious diseases and disease 
agents between these countries. 
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