Title: Public Health Infrastructure Saves Lives Act
Policy area: Health

Summary:
Public Health Infrastructure Saves Lives Act
This bill provides annual funding for the Centers for Disease Control and Prevention (CDC) to strengthen core public health infrastructure. Core public health infrastructure includes the elements and workforce capabilities that enable health departments to perform critical functions such as disease surveillance and emergency response.
Specifically, the CDC must award grants to health departments for their core infrastructure needs. In addition, the CDC must support the development of accreditation standards for health departments that emphasize core public health infrastructure. Health departments must meet those (or similar) standards as a condition of receiving grants beginning in FY2025.
The CDC must also take steps to expand and improve its own public health infrastructure.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 674 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                 S. 674

                To support public health infrastructure.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 10, 2021

Mrs. Murray (for herself, Mr. Bennet, Mr. Brown, Ms. Warren, Mr. Reed, 
 Mr. Merkley, Mr. Blumenthal, Mr. Markey, Mr. Schatz, Ms. Baldwin, Mr. 
  Menendez, Ms. Smith, Ms. Duckworth, Mr. Casey, Mr. Van Hollen, Ms. 
  Klobuchar, Ms. Rosen, Ms. Hirono, Mr. Durbin, 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 support public health infrastructure.

    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 ``Public Health Infrastructure Saves 
Lives Act''.

SEC. 2. CORE PUBLIC HEALTH INFRASTRUCTURE FOR STATE, TERRITORIAL, 
              LOCAL, AND TRIBAL HEALTH DEPARTMENTS.

    (a) Program.--The Secretary of Health and Human Services (referred 
to in this Act as the ``Secretary''), acting through the Director of 
the Centers for Disease Control and Prevention, shall establish a core 
public health infrastructure program to strengthen the public health 
system of the United States, including the Nation's ability to respond 
to the COVID-19 pandemic, consisting of awarding grants under 
subsection (b).
    (b) Grants.--
            (1) Award.--For the purpose of addressing core public 
        health infrastructure needs, the Secretary--
                    (A) shall award a grant to each State or 
                territorial health department, and to local health 
                departments that serve 500,000 people or more; and
                    (B) shall award grants on a competitive basis to 
                State, territorial, or local health departments.
            (2) Allocation.--Of the total amount of funds awarded as 
        grants under this subsection for a fiscal year--
                    (A) not less than 50 percent shall be for grants to 
                health departments under paragraph (1)(A); and
                    (B) not less than 30 percent shall be for grants to 
                State, territorial, or local health departments under 
                paragraph (1)(B).
    (c) Use of Funds.--The Secretary may award a grant to an entity 
under subsection (b)(1) only if the entity agrees to use the full 
amount of the grant to address core public health infrastructure needs, 
including those identified in the accreditation process under 
subsection (h).
    (d) Formula Grants to Health Departments.--In making grants under 
subsection (b)(1)(A), the Secretary shall award funds to each health 
department in accordance with--
            (1) a formula--
                    (A) based on population size, burden of preventable 
                disease and disability, and poverty rate, with special 
                consideration given to territories; and
                    (B) which, in the event of an award made during the 
                public health emergency declared under section 319 of 
                the Public Health Service Act (42 U.S.C. 247d) in 
                response to COVID-19, shall consider the COVID-19 
                burden of each jurisdiction; and
            (2) application requirements established by the Secretary, 
        including a requirement that the health department submit a 
        plan by the end of year 1 of the grant that demonstrates to the 
        satisfaction of the Secretary that the health department will--
                    (A) address its highest priority core public health 
                infrastructure needs;
                    (B) in the case of such a plan submitted during the 
                public health emergency described in paragraph (1)(B), 
                identify the core public health infrastructure needs 
                that are the highest priority for strengthening the 
                response to COVID-19 and similar public health threats 
                and other public health emergencies; and
                    (C) for State health departments, allocate at least 
                25 percent of the grant funds to local health 
                departments within the State to support the local 
                jurisdiction's contribution to core public health 
                infrastructure.
    (e) Competitive Grants to State, Territorial, and Local Health 
Departments.--In making grants under subsection (b)(1)(B), the 
Secretary shall give priority to applicants demonstrating core public 
health infrastructure needs for all public health agencies in the 
applicant's jurisdiction to be certified by the accreditation process 
under subsection (h), or for an entity for which a waiver has been 
received under subparagraph (A) or (B) of subsection (h)(2), that has 
otherwise demonstrated the applicant has core public health 
infrastructure needs for all public health agencies.
    (f) Permitted Use.--The Secretary may make available a subset of 
the funds available for grants under subsection (b)(1) for purposes of 
awarding planning grants to health departments eligible to receive a 
grant under subsection (b)(1)(B). Recipients of such a planning grant 
may use such award to assess core public health infrastructure needs.
    (g) Maintenance of Effort.--The Secretary may award a grant to an 
entity under subsection (b) only if the entity demonstrates to the 
satisfaction of the Secretary that--
            (1) funds received through the grant will be expended only 
        to supplement, and not supplant, non-Federal and Federal funds 
        otherwise available to the entity for the purpose of addressing 
        core public health infrastructure needs; and
            (2) with respect to activities for which the grant is 
        awarded, the entity will maintain expenditures of non-Federal 
        amounts for such activities at a level not less than the level 
        of such expenditures maintained by the entity for the fiscal 
        year preceding the fiscal year for which the entity receives 
        the grant.
    (h) Support of a National Public Health Accreditation Program.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall--
                    (A) support continued development, and periodic 
                review and updating of standards for accreditation of 
                State, territorial, local, or tribal health departments 
                for the purpose of advancing the quality and 
                performance of such departments with an emphasis on 
                core public health infrastructure;
                    (B) implement a program to accredit such health 
                departments in accordance with such standards; and
                    (C) beginning in fiscal year 2025, ensure that any 
                entity receiving a grant under subsection (b) is 
                accredited as described in subparagraph (A) or meets 
                another standard of accountability specific to public 
                health infrastructure, subject to paragraph (2).
            (2) Waivers.--The Secretary may waive the requirement under 
        paragraph (1)(C) with respect to--
                    (A) any individual entity until fiscal year 2027; 
                or
                    (B) after fiscal year 2027, any individual entity 
                that demonstrates that it would be a significant 
                hardship to comply with such requirement.
            (3) Cooperative agreement.--The Secretary may enter into a 
        cooperative agreement with a private nonprofit entity to carry 
        out this subsection.
    (i) Report.--The Secretary shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives an annual report on 
progress being made to accredit entities under subsection (h). Such 
report shall include--
            (1) a strategy, including goals and objectives, for 
        accrediting entities under subsection (h) and achieving the 
        purpose described in subsection (h)(1);
            (2) a list of funding recipients and the amounts received, 
        including directly funded entities under subsection (b)(1), as 
        well as local health departments that receive funding in 
        accordance with subsection (d)(2)(C);
            (3) data reported by grantees funded under this section 
        pursuant to a minimum data set required by the Secretary, which 
        shall include each grantee's activities, standardized financial 
        reporting, and resource allocation data; and
            (4) identification of gaps in research related to core 
        public health infrastructure and recommendations of priority 
        areas for such research.
    (j) Tribal Set-Aside.--Of the amount appropriated under subsection 
(a) for a fiscal year, the Secretary shall reserve 3 percent for 
purposes of, acting through the Director of the Centers for Disease 
Control and Prevention and in consultation with the Director of the 
Indian Health Service, awarding grants under this section to Tribal 
health departments and to epidemiology centers established under 
section 214 of the Indian Health Care Improvement Act (25 U.S.C. 
1621m).

SEC. 3. CORE PUBLIC HEALTH INFRASTRUCTURE AND ACTIVITIES FOR CDC.

    (a) In General.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall expand and improve 
the core public health infrastructure and activities of the Centers for 
Disease Control and Prevention to address unmet and emerging public 
health needs and provide technical assistance to grantees funded under 
this provision, including the administration of the grants under 
section 2(b)(1).
    (b) Report.--The Secretary shall submit to the Congress an annual 
report on the activities funded through this section.

SEC. 4. CORE PUBLIC HEALTH INFRASTRUCTURE DEFINED.

    For purposes of this Act, the term ``core public health 
infrastructure'' means all of the following elements, and the workforce 
needed to establish and maintain such elements:
            (1) Assessment (including surveillance, epidemiology, and 
        laboratory capacity).--The ability to track the health of a 
        community through data, case finding, and laboratory tests with 
        particular attention to those most at risk.
            (2) All hazards preparedness and response.--The capacity to 
        respond to emergencies of all kinds.
            (3) Policy development and support.--The ability to 
        translate public health science into appropriate policy and 
        regulation.
            (4) Communications.--The ability to reach the public 
        effectively with timely, science-based information to mitigate 
        the impact of public health threats, with particular attention 
        to hard-to-reach populations.
            (5) Community partnership development.--The capacity to 
        harness and align community resources and organizations to 
        advance the health of all members of the community.
            (6) Organizational competencies (leadership and 
        governance).--The ability to lead internal and external 
        stakeholders to consensus and action.
            (7) Accountability and performance management (including 
        quality improvement, information technology, human resources, 
        financial management, and law).--The ability to apply business 
        practices, including a standardized approach to financial 
        reporting, that ensure efficient use of resources, achieve 
        desired outcomes, and foster a continuous learning environment.
            (8) Equity.--Utilizing all of the preceding elements, the 
        capacity to address and correct health disparities (including 
        disparities related to race, ethnicity, national origin, 
        socioeconomic status, primary language, sex (including sexual 
        orientation and gender identity), disability status, and other 
        factors), advance health equity in all communities, and 
        implement culturally and linguistically appropriate programs 
        and interventions.

SEC. 5. FUNDING.

    (a) In General.--To carry out this Act, there are hereby 
appropriated, out of amounts in the Treasury not otherwise 
appropriated, the following to be made available until expended:
            (1) For fiscal year 2022, $750,000,000.
            (2) For fiscal year 2023, $1,000,000,000.
            (3) For fiscal year 2024, $2,000,000,000.
            (4) For fiscal year 2025, $3,000,000,000.
            (5) For fiscal year 2026 and each subsequent fiscal year, 
        $4,500,000,000.
    (b) Core Public Health Infrastructure and Activities.--Of the 
amounts made available under this section for a fiscal year, not more 
than $350,000,000 shall be used to carry out section 3.
    (c) Supplement.--Amounts made available under this section shall be 
used to supplement, and not supplant, amounts otherwise made available 
for the purposes described in this Act.
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