I 
117TH CONGRESS 
1ST SESSION H. R. 3841 
To amend the Public Health Service Act with respect to the collection and 
availability of health data with respect to Indian Tribes, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 11, 2021 
Mr. MULLIN (for himself and Mr. O’HALLERAN) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act with respect to 
the collection and availability of health data with respect 
to Indian Tribes, and for other purposes. 
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 ‘‘Tribal Health Data 
Improvement Act of 2021’’. 
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SEC. 2. COLLECTION AND AVAILABILITY OF HEALTH DATA 
WITH RESPECT TO INDIAN TRIBES. 
(a) DATA COLLECTION.—Section 3101(a)(1) of the 
Public Health Service Act (42 U.S.C. 300kk(a)(1)) is 
amended— 
(1) by striking ‘‘, by not later than 2 years 
after the date of enactment of this title,’’; and 
(2) in subparagraph (B), by inserting ‘‘Tribal,’’ 
after ‘‘State,’’. 
(b) DATA REPORTING AND DISSEMINATION.—Sec-
tion 3101(c) of the Public Health Service Act (42 U.S.C. 
300kk(c)) is amended— 
(1) by amending subparagraph (F) of para-
graph (1) to read as follows: 
‘‘(F) the Indian Health Service, Indian 
Tribes, Tribal organizations, and epidemiology 
centers authorized under the Indian Health 
Care Improvement Act;’’; and 
(2) in paragraph (3), by inserting ‘‘Indian 
Tribes, Tribal organizations, and epidemiology cen-
ters,’’ after ‘‘Federal agencies,’’. 
(c) PROTECTION AND SHARING OF DATA.—Section 
3101(e) of the Public Health Service Act (42 U.S.C. 
300kk(e)) is amended by adding at the end the following 
new paragraphs: 
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‘‘(3) DATA SHARING STRATEGY.—With respect 
to data access for Tribal epidemiology centers and 
Tribes, the Secretary shall create a data sharing 
strategy that takes into consideration recommenda-
tions by the Secretary’s Tribal Advisory Committee 
for— 
‘‘(A) ensuring that Tribal epidemiology 
centers and Indian Tribes have access to the 
data sources necessary to accomplish their pub-
lic health responsibilities; and 
‘‘(B) protecting the privacy and security of 
such data. 
‘‘(4) TRIBAL PUBLIC HEALTH AUTHORITY.— 
‘‘(A) AVAILABILITY.—Beginning not later 
than 180 days after the date of the enactment 
of the Tribal Health Data Improvement Act of 
2021, the Secretary shall make available to the 
entities listed in subparagraph (B) all data that 
is collected pursuant to this title with respect to 
health care and public health surveillance pro-
grams and activities, including such programs 
and activities that are federally supported or 
conducted, so long as— 
‘‘(i) such entities request the data 
pursuant to statute; and 
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‘‘(ii) the data is requested for use— 
‘‘(I) consistent with Federal law 
and obligations; and 
‘‘(II) to satisfy a particular pur-
pose or carry out a specific function 
consistent with the purpose for which 
the data was collected. 
‘‘(B) ENTITIES.—The entities listed in this 
subparagraph are— 
‘‘(i) the Indian Health Service; 
‘‘(ii) Indian Tribes and Tribal organi-
zations; and 
‘‘(iii) epidemiology centers.’’. 
(d) TECHNICAL UPDATES.—Section 3101 of the 
Public Health Service Act (42 U.S.C. 300kk) is amend-
ed— 
(1) by striking subsections (g) and (h); and 
(2) by redesignating subsection (i) as subsection 
(h). 
(e) DEFINITIONS.—After executing the amendments 
made by subsection (d), section 3101 of the Public Health 
Service Act (42 U.S.C. 300kk) is amended by inserting 
after subsection (f) the following new subsection: 
‘‘(g) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘epidemiology center’ means an 
epidemiology center established under section 214 of 
the Indian Health Care Improvement Act, including 
such Tribal epidemiology centers serving Indian 
Tribes regionally and any Tribal epidemiology center 
serving Urban Indian organizations nationally. 
‘‘(2) The term ‘Indian Tribe’ has the meaning 
given to the term ‘Indian tribe’ in section 4 of the 
Indian Self-Determination and Education Assistance 
Act. 
‘‘(3) The term ‘Tribal organization’ has the 
meaning given to the term ‘tribal organization’ in 
section 4 of the of the Indian Self-Determination 
and Education Assistance Act. 
‘‘(4) The term ‘Urban Indian organization’ has 
the meaning given to that term in section 4 of the 
Indian Health Care Improvement Act.’’. 
(f) TECHNICAL CORRECTION.—Section 3101(b) of 
the Public Health Service Act (42 U.S.C. 300kk(b)) is 
amended by striking ‘‘DATA ANALYSIS.—’’ and all that 
follows through ‘‘For each federally’’ and inserting ‘‘DATA 
ANALYSIS.—For each federally’’. 
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SEC. 3. IMPROVING HEALTH STATISTICS REPORTING WITH 
RESPECT TO INDIAN TRIBES. 
(a) TECHNICAL AID TO STATES AND LOCALITIES.— 
Section 306(d) of the Public Health Service Act (42 
U.S.C. 242k(d)) is amended by inserting ‘‘, Indian Tribes, 
Tribal organizations, and epidemiology centers’’ after ‘‘ju-
risdictions’’. 
(b) COOPERATIVE HEALTH STATISTICS SYSTEM.— 
Section 306(e)(3) of the Public Health Service Act (42 
U.S.C. 242k(e)(3)) is amended by inserting ‘‘, Indian 
Tribes, Tribal organizations, and epidemiology centers’’ 
after ‘‘health agencies’’. 
(c) FEDERAL-STATE-TRIBAL COOPERATION.—Sec-
tion 306(f) of the Public Health Service Act (42 U.S.C. 
242k(f)) is amended— 
(1) by inserting ‘‘the Indian Health Service,’’ 
before ‘‘the Departments of Commerce’’; 
(2) by inserting a comma after ‘‘the Depart-
ments of Commerce and Labor’’; 
(3) by inserting ‘‘, Indian Tribes, Tribal organi-
zations, and epidemiology centers’’ after ‘‘State and 
local health departments and agencies’’; and 
(4) by striking ‘‘he shall’’ and inserting ‘‘the 
Secretary shall’’. 
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(d) 
REGISTRATION
AREA
RECORDS.—Section 
306(h)(1) of the Public Health Service Act (42 U.S.C. 
242k(h)(1)) is amended— 
(1) by striking ‘‘in his discretion’’ and inserting 
‘‘in the discretion of the Secretary’’; and 
(2) by striking ‘‘Hispanics, Asian Americans, 
and Pacific Islanders’’ and inserting ‘‘American In-
dians and Alaska Natives, Hispanics, Asian Ameri-
cans, and Native Hawaiian and other Pacific Island-
ers’’. 
(e) NATIONAL COMMITTEE ON VITAL AND HEALTH 
STATISTICS.—Section 306(k) of the Public Health Service 
Act (42 U.S.C. 242k(k)) is amended— 
(1) in paragraph (3), by striking ‘‘, not later 
than 60 days after the date of the enactment of the 
Health Insurance Portability and Accountability Act 
of 1996,’’ each place it appears; and 
(2) in paragraph (7), by striking ‘‘Not later 
than 1 year after the date of the enactment of the 
Health Insurance Portability and Accountability Act 
of 1996, and annually thereafter, the Committee 
shall’’ and inserting ‘‘The Committee shall, on a bi-
ennial basis,’’. 
(f) GRANTS FOR ASSEMBLY AND ANALYSIS OF DATA 
ON
ETHNIC
AND
RACIAL
POPULATIONS.—Section 
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306(m)(4) of the Public Health Service Act (42 U.S.C. 
242k(m)(4)) is amended— 
(1) in subparagraph (A)— 
(A) by striking ‘‘Subject to subparagraph 
(B), the’’ and inserting ‘‘The’’; and 
(B) by striking ‘‘and major Hispanic sub-
population groups and American Indians’’ and 
inserting ‘‘, major Hispanic subgroups, and 
American Indians and Alaska Natives’’; and 
(2) by amending subparagraph (B) to read as 
follows: 
‘‘(B) In carrying out subparagraph (A), with respect 
to American Indians and Alaska Natives, the Secretary 
shall— 
‘‘(i) consult with Indian Tribes, Tribal organi-
zations, the Tribal Technical Advisory Group of the 
Centers for Medicare & Medicaid Services main-
tained under section 5006(e) of the American Recov-
ery and Reinvestment Act of 2009, and the Tribal 
Advisory Committee established by the Centers for 
Disease Control and Prevention, in coordination with 
epidemiology centers, to develop guidelines for State 
and local health agencies to improve the quality and 
accuracy of data with respect to the birth and death 
records of American Indians and Alaska Natives; 
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‘‘(ii) confer with Urban Indian organizations to 
develop guidelines for State and local health agencies 
to improve the quality and accuracy of data with re-
spect to the birth and death records of American In-
dians and Alaska Natives; 
‘‘(iii) enter into cooperative agreements with In-
dian Tribes, Tribal organizations, Urban Indian or-
ganizations, and epidemiology centers to address 
misclassification and undersampling of American In-
dians and Alaska Natives with respect to— 
‘‘(I) birth and death records; and 
‘‘(II) health care and public health surveil-
lance systems, including, but not limited to, 
data with respect to chronic and infectious dis-
eases, unintentional injuries, environmental 
health, child and adolescent health, maternal 
health and mortality, foodborne and waterborne 
illness, reproductive health, and any other 
notifiable disease or condition; 
‘‘(iv) encourage States to enter into data shar-
ing agreements with Indian Tribes, Tribal organiza-
tions, and epidemiology centers to improve the qual-
ity and accuracy of public health data; and 
‘‘(v) not later than 180 days after the date of 
enactment of the Tribal Health Data Improvement 
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Act of 2021, and biennially thereafter, issue a report 
on the following: 
‘‘(I) Which States have data sharing agree-
ments with Indian Tribes, Tribal organizations, 
Urban Indian organizations, and Tribal epide-
miology centers to improve the quality and ac-
curacy of health data. 
‘‘(II) What the Centers for Disease Control 
and Prevention is doing to encourage States to 
enter into data sharing agreements with Indian 
Tribes, Tribal organizations, Urban Indian or-
ganizations, and Tribal epidemiology centers to 
improve the quality and accuracy of health 
data. 
‘‘(III) Best practices and guidance for 
States, Indian Tribes, Tribal organizations, 
Urban Indian organizations, and Tribal epide-
miology centers that wish to enter into data 
sharing agreements. 
‘‘(IV) Best practices and guidance for 
local, State, Tribal, and Federal uniform stand-
ards for the collection of data on race and eth-
nicity.’’. 
(g) DEFINITIONS.—Section 306 of the Public Health 
Service Act (42 U.S.C. 242k) is amended— 
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(1) by redesignating subsection (n) as sub-
section (o); and 
(2) by inserting after subsection (m) the fol-
lowing: 
‘‘(n) In this section: 
‘‘(1) The term ‘epidemiology center’ means an 
epidemiology center established under section 214 of 
the Indian Health Care Improvement Act, including 
such Tribal epidemiology centers serving Indian 
Tribes regionally and any Tribal epidemiology center 
serving Urban Indian organizations nationally. 
‘‘(2) The term ‘Indian Tribe’ has the meaning 
given to the term ‘Indian tribe’ in section 4 of the 
Indian Self-Determination and Education Assistance 
Act. 
‘‘(3) The term ‘Tribal organization’ has the 
meaning given to the term ‘tribal organization’ in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act. 
‘‘(4) The term ‘Urban Indian organization’ has 
the meaning given to that term in section 4 of the 
Indian Health Care Improvement Act.’’. 
(h) AUTHORIZATION OF APPROPRIATIONS.—Section 
306(o) of the Public Health Service Act, as redesignated 
by subsection (g), is amended to read as follows: 
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‘‘(o)(1) To carry out this section, there is authorized 
to be appropriated $185,000,000 for each of the fiscal 
years 2022 through 2026. 
‘‘(2) Of the amount authorized to be appropriated to 
carry out this section for a fiscal year, the Secretary shall 
not use more than 10 percent for the combined costs of— 
‘‘(A) administration of this section; and 
‘‘(B) carrying out subsection (m)(2).’’. 
Æ 
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