Border Health Security Act of 2021
Bill: H.R.4812 | Sponsor: Rep. Escobar, Veronica (D-TX)
Policy area: International Affairs

Summary:
Border Health Security Act of 2021
This bill modifies the duties and activities of the United States-Mexico Border Health Commission and the Canada-United States Pan-Border Public Health Preparedness Council and makes other changes to address health issues along the U.S. border.
Specifically, the commission must cooperate with the council where appropriate, and both the commission and the council must develop strategic plans, work plans, evaluations, and reports concerning their activities.
The Department of Health and Human Services must award grants to (1) eligible entities in border areas to address recommendations of the commission and the council to improve the health of border area residents; and (2) trauma centers, public health entities, and state, local, or tribal entities for infectious disease surveillance activities in border areas. In addition, the Office of the Assistant Secretary for Preparedness and Response may coordinate with the Department of Homeland Security in establishing a system that alerts clinicians and public health officials to emerging health threats in border areas.
The Government Accountability Office must evaluate commission and council activities every two years.

To establish grant programs to improve the health of residents along 
 the United States-Mexico and United States-Canada borders and for all 
  hazards preparedness in the border areas, including with respect to 
 bioterrorism, infectious disease, and other emerging biothreats, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Border Health Security Act of 
2021''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The United States-Mexico border is an interdependent 
        and dynamic region of approximately 15,000,000 residents and 
        millions of border crossings each year, with significant and 
        unique public health challenges.
            (2) These challenges include low rates of health insurance 
        coverage, poor access to health care services, lack of 
        education or access to information, poverty-related illness, 
        including undernutrition, and high rates of infectious 
        diseases, such as tuberculosis, West Nile virus, and Zika 
        virus, as well as other noncommunicable diseases such as 
        cardiovascular disease, asthma, diabetes, and obesity.
            (3) As the COVID-19 pandemic has illustrated, diseases do 
        not respect international boundaries, and a strong public 
        health effort at and along the United States, Mexico, and 
        Canada borders is crucial to not only protect and improve the 
        health of Americans but also to help secure the country against 
        biosecurity and other emerging threats.
            (4) For over 20 years, the United States-Mexico Border 
        Health Commission has served as a crucial binational 
        institution to address these unique and truly cross-border 
        health issues.
            (5) The COVID-19 pandemic has also highlighted the need for 
        continued coordination of resources, effective communication, 
        and information sharing between countries to address emerging 
        public health crises.

SEC. 3. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT AMENDMENTS.

    The United States-Mexico Border Health Commission Act (22 U.S.C. 
290n et seq.) is amended--
            (1) in section 3--
                    (A) by striking ``It should be the duty'' and 
                inserting the following:
    ``(a) In General.--It should be the duty'';
                    (B) in paragraph (1), by striking ``; and'' and 
                inserting ``;'';
                    (C) in paragraph (2)(B), by striking the period and 
                inserting a semicolon;
                    (D) by adding at the end the following:
            ``(3) to evaluate the Commission's progress in carrying out 
        the duties described in paragraphs (1) and (2) and report on 
        such progress and make recommendations, as appropriate, to the 
        Secretary of Health and Human Services and Congress regarding 
        such duties; and
            ``(4) to serve as an independent and objective body to both 
        recommend and implement initiatives that solve border health 
        issues.''; and
                    (E) by adding at the end the following:
    ``(b) United States Section Members.--The members of the United 
States section of the Commission, acting independently of the 
Commission overall, may--
            ``(1) provide reports and recommendations to, and consult 
        with, the Secretary of Health and Human Services and Congress 
        on the matters described in subsection (a)(3); and
            ``(2) cooperate with the Canada-United States Pan Border 
        Public Health Preparedness Council (referred to in this Act as 
        the `Council'), as appropriate.'';
            (2) in section 5(b), by striking ``should be the leader'' 
        and inserting ``shall be the Chair'';
            (3) by redesignating section 8 as section 12;
            (4) by striking section 7 and inserting the following:

``SEC. 7. BORDER HEALTH GRANTS.

    ``(a) Eligible Entity Defined.--In this section, the term `eligible 
entity' means a State, public institution of higher education, local 
government, Indian Tribe, Tribal organization, urban Indian 
organization, nonprofit health organization, trauma center, critical 
access hospital or other hospital that serves rural or other vulnerable 
communities and populations, faith-based entity, or community health 
center receiving assistance under section 330 of the Public Health 
Service Act (42 U.S.C. 254b), that is located in the United States-
Mexico border area or the United States-Canada border area.
    ``(b) Authorization.--From amounts appropriated under section 11, 
the Secretary, in consultation with members of the Commission and 
Council and in coordination with the Office of Global Affairs, shall 
award grants to eligible entities to improve the health of residents of 
the United States-Mexico and United States-Canada border areas with 
appropriate priority given to grants that address recommendations 
outlined by the strategic plan and operational work plan of the 
Commission and the Council under section 9.
    ``(c) Application.--An eligible entity that desires a grant under 
subsection (b) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Use of Funds.--An eligible entity that receives a grant under 
subsection (b) shall use the grant funds for any of the following:
            ``(1) Programs relating to any one or more of the 
        following:
                    ``(A) Maternal and child health.
                    ``(B) Primary care and preventative health.
                    ``(C) Infectious disease testing, monitoring, and 
                surveillance.
                    ``(D) Public health and public health 
                infrastructure.
                    ``(E) Health promotion, health literacy, and health 
                education.
                    ``(F) Oral health.
                    ``(G) Behavioral and mental health.
                    ``(H) Substance abuse prevention and harm 
                reduction.
                    ``(I) Health conditions that have a high prevalence 
                in the United States-Mexico border area or United 
                States-Canada border area.
                    ``(J) Medical and health services research in 
                border communities.
                    ``(K) Workforce training and development.
                    ``(L) Community health workers and promotoras.
                    ``(M) Health care infrastructure problems in the 
                United States-Mexico border area or United States-
                Canada border area (including planning and construction 
                grants).
                    ``(N) Health disparities in the United States-
                Mexico border area or United States-Canada border area.
                    ``(O) Environmental health.
                    ``(P) Bioterrorism and zoonosis.
                    ``(Q) Outreach and enrollment services with respect 
                to Federal programs (including programs authorized 
                under titles XIX and XXI of the Social Security Act (42 
                U.S.C. 1396 et seq., 42 U.S.C. 1397aa et seq.)).
                    ``(R) Trauma care.
                    ``(S) Health research with an emphasis on the 
                prevalence of infectious diseases, such as measles, in 
                the border areas, as well as other pressing health 
                issues, such as noncommunicable diseases like diabetes 
                and obesity.
                    ``(T) Epidemiology and health research.
                    ``(U) Cross-border health surveillance coordinated 
                with Mexican Health Authorities or Canadian Health 
                Authorities.
                    ``(V) Community-based participatory research on 
                border health issues.
                    ``(W) Domestic violence and violence prevention.
                    ``(X) Cross-border public health preparedness.
            ``(2) Other programs as the Secretary determines 
        appropriate.
    ``(e) Supplement, Not Supplant.--Amounts provided to an eligible 
entity awarded a grant under subsection (b) shall be used to supplement 
and not supplant other funds available to the eligible entity to carry 
out the activities described in subsection (d).

``SEC. 8. GRANTS FOR EARLY WARNING INFECTIOUS DISEASE SURVEILLANCE IN 
              THE BORDER AREA.

    ``(a) Eligible Entity Defined.--In this section, the term `eligible 
entity' means a State, local government, Indian Tribe, Tribal 
organization, urban Indian organization, trauma center, regional trauma 
center coordinating entity, or public health entity.
    ``(b) Authorization.--From funds appropriated under section 11, the 
Secretary shall award grants for Early Warning Infectious Disease 
Surveillance to eligible entities for infectious disease surveillance 
activities in the United States-Mexico border area or United States-
Canada border area.
    ``(c) Application.--An eligible entity that desires a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require.
    ``(d) Uses of Funds.--An eligible entity that receives a grant 
under subsection (b) shall use the grant funds, in coordination with 
State and local all hazards programs, to--
            ``(1) develop and implement infectious disease surveillance 
        plans and networks and public health emergency and readiness 
        assessments and preparedness plans, and purchase items 
        necessary for such plans;
            ``(2) coordinate infectious disease surveillance planning 
        and interjurisdictional risk assessments in the region with 
        appropriate United States-based agencies and organizations and 
        appropriate authorities in Mexico or Canada;
            ``(3) improve infrastructure, including surge capacity, 
        syndromic surveillance, and isolation and decontamination 
        capacity, and policy preparedness, including for mutual 
        assistance and for the sharing of information and resources;
            ``(4) improve laboratory capacity, in order to maintain and 
        enhance capability and capacity to detect potential infectious 
        disease, whether naturally occurring or the result of 
        terrorism;
            ``(5) create and maintain a health alert network, including 
        risk communication and information dissemination that is 
        culturally competent and takes into account the needs of at-
        risk populations;
            ``(6) educate and train clinicians, epidemiologists, 
        laboratories, and emergency management personnel;
            ``(7) implement electronic data and infrastructure 
        inventory systems to coordinate the triage, transportation, and 
        treatment of multicasualty incident victims;
            ``(8) provide infectious disease testing in the United 
        States-Mexico border area or United States-Canada border area; 
        and
            ``(9) carry out such other activities identified by the 
        Secretary, members of the Commission, members of the Council, 
        State or local public health authorities, representatives of 
        border health offices, or authorities at the United States-
        Mexico or United States-Canada borders.

``SEC. 9. PLANS, REPORTS, AUDITS, AND BY-LAWS.

    ``(a) Strategic Plan.--
            ``(1) In general.--Not later than 2 years after the date of 
        enactment of this section, and every 5 years thereafter, the 
        Commission (including the participation of members representing 
        both the United States and Mexican sections) and the Council 
        (including the participation of members representing both the 
        United States and Canada) shall each prepare a binational 
        strategic plan to guide the operations of the Commission and 
        the Council and submit such plan to the Secretary and Congress.
            ``(2) Requirements.--The binational strategic plan under 
        paragraph (1) shall include--
                    ``(A) health-related priority areas identified by 
                the full membership of the Commission or Council, as 
                applicable;
                    ``(B) recommendations for goals, objectives, 
                strategies, and actions designed to address such 
                priority areas; and
                    ``(C) a proposed evaluation framework with output 
                and outcome indicators appropriate to gauge progress 
                toward meeting the objectives and priorities of the 
                Commission or Council, as applicable.
    ``(b) Work Plan.--Not later than January 1, 2024, and every 2 years 
thereafter, the Commission and the Council shall develop and approve an 
operational work plan and budget based on the strategic plan under 
subsection (a).
    ``(c) GAO Review.--Not later than January 1, 2025, and every 2 
years thereafter, the Comptroller General of the United States shall 
conduct an evaluation of the activities conducted by the Commission and 
the Council based on the operational work plans described in subsection 
(b) for the previous year and the output and outcome indicators 
included in the strategic plan described in subsection (a). The 
evaluation shall include a request for written evaluations from members 
of the Commission and the Council about barriers and facilitators to 
executing successfully the work plans of the Commission and the 
Council.
    ``(d) Biannual Reporting.--
            ``(1) By commission and council.--The Commission and 
        Council shall each issue a biannual report to the Secretary 
        that--
                    ``(A) provides independent policy recommendations 
                related to border health issues; and
                    ``(B) details the expenditures of the Commission 
                and Council over the reporting period.
            ``(2) By secretary.--Not later than 3 months following 
        receipt of each such biannual report, the Secretary shall 
        provide to Congress the report and any studies or other 
        materials produced independently by the Commission and Council.
    ``(e) Audits.--The Secretary shall annually prepare an audited 
financial report to account for all appropriated assets expended by the 
Commission and Council to address both the strategic and operational 
work plans for the year involved.
    ``(f) By-Laws.--Not later than 6 months after the date of enactment 
of this section, the Commission and Council shall develop and approve 
bylaws to provide fully for compliance with the requirements of this 
section.
    ``(g) Transmittal to Congress.--The Commission and Council shall 
submit copies of the operational work plan and by-laws to Congress. The 
Comptroller General of the United States shall submit a copy of each 
evaluation completed under subsection (c) to Congress.

``SEC. 10. COORDINATION.

    ``(a) In General.--To the extent practicable and appropriate, 
plans, systems, and activities to be funded (or supported) under this 
Act for all hazard preparedness, and general border health, including 
with respect to infectious disease, shall be coordinated with Federal, 
State, and local authorities in Mexico, Canada, and the United States.
    ``(b) Coordination of Health Services and Surveillance.--
    ``(c) In General.--The Secretary, acting through the Assistant 
Secretary for Preparedness and Response, when appropriate, may 
coordinate with the Secretary of Homeland Security in establishing a 
health alert system that--
            ``(1) alerts clinicians and public health officials of 
        emerging disease clusters and syndromes along the United 
        States-Mexico border area and United States-Canada border area;
            ``(2) warns of health threats, extreme weather conditions, 
        disasters of mass scale, bioterrorism, and other emerging 
        threats along the United States-Mexico border area and United 
        States-Canada border area; and
            ``(3) is coordinated with other systems and agencies to 
        avoid duplication.

``SEC. 11. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this Act 
$20,000,000 for fiscal year 2022 and each succeeding year, of which for 
each such fiscal year--
            ``(1) $14,000,000 shall be made available to fund 
        operationally feasible functions, activities, and grants with 
        respect to the United States-Mexico border and the border 
        health activities under cooperative agreements with the border 
        health offices of the States of California, Arizona, New 
        Mexico, and Texas; and
            ``(2) $6,000,000 shall be made available for the 
        administration of United States activities under this Act on 
        the United States-Canada border and the border health 
        authorities, acting through the Canada-United States Pan-Border 
        Public Health Preparedness Council.''; and
            (5) in section 12 (as so redesignated)--
                    (A) by redesignating paragraphs (3) and (4) as 
                paragraphs (4) and (6), respectively;
                    (B) by inserting after paragraph (2), the 
                following:
            ``(3) Indians; indian tribe; tribal organization; urban 
        indian organization.--The terms `Indian', `Indian Tribe', 
        `Tribal organization', and `urban Indian organization' have the 
        meanings given such terms in section 4 of the Indian Health 
        Care Improvement Act (25 U.S.C. 1603).''; and
                    (C) by inserting after paragraph (4), as so 
                redesignated, the following:
            ``(5) United states-canada border area.--The term `United 
        States-Canada border area' means the area located in the United 
        States and Canada within 100 kilometers of the border between 
        the United States and Canada.''.
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