II 117th CONGRESS 2d Session S. 3968 IN THE SENATE OF THE UNITED STATES March 30, 2022 Ms. Warren (for herself, Mr. Heinrich , Ms. Smith , Ms. Klobuchar , Mr. Booker , Ms. Baldwin , and Mr. Sanders ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To improve State, local, and Tribal public health security.

1. Short title This Act may be cited as the CDC Tribal Public Health Security and Preparedness Act . 2. Improving State, local, and Tribal public health security Section 319C–1 of the Public Health Service Act ( 42 U.S.C. 247d–3a ) is amended— (1) in the section heading, by striking and local and inserting , local, and Tribal ; (2) in subsection (b)— (A) in paragraph (1)— (i) in subparagraph (B), by striking or at the end; (ii) in subparagraph (C), by striking and at the end and inserting or ; and (iii) by adding at the end the following: (D) be an Indian Tribe, a Tribal organization, or a consortium of Indian Tribes or Tribal organizations; and ; and (B) in paragraph (2)— (i) in subparagraph (A)(viii)— (I) by inserting and Tribal after with State ; (II) by striking (as defined in section 8101 of the Elementary and Secondary Education Act of 1965) and inserting and Tribal educational agencies (as defined in sections 8101 and 6132, respectively, of the Elementary and Secondary Education Act of 1965) ; and (III) by inserting and Tribal after and State ; (ii) in subparagraph (G), by inserting (including Indian Tribes, Tribal organizations, and urban Indian organizations) after stakeholders ; and (iii) in subparagraph (H), by inserting , Indian Tribes, and urban Indian organizations after public health ; (3) in subsection (e), by inserting Indian Tribes, Tribal organizations, urban Indian organizations, after local emergency plans, ; (4) in subsection (h)— (A) by amending subparagraph (A) of paragraph (1) to read as follows: (A) In general For the purpose of carrying out this section, there is authorized to be appropriated $750,000,000 for each of fiscal years 2023 through 2025 for awards pursuant to paragraph (3) (subject to the authority of the Secretary to make awards pursuant to paragraphs (4) and (5)) and paragraph (8), of which not less than 5 percent shall be reserved each fiscal year for awards under paragraph (8). ; (B) in the heading of paragraph (3), by inserting for States after amount ; and (C) by adding at the end the following: (8) Tribal eligible entities (A) Determination of funding amount (i) In general The Secretary shall award at least 10 cooperative agreements under this section, in amounts not less than the minimum amount determined under clause (ii), to eligible entities described in subsection (b)(1)(D) that submit to the Secretary an application that meets the criteria of the Secretary for the receipt of such an award and that meets other reasonable implementation conditions established by the Secretary, in consultation with Indian Tribes, for such awards. (ii) Minimum amount In determining the minimum amount of an award pursuant to clause (i), the Secretary, in consultation with Indian Tribes, shall first determine an amount the Secretary considers appropriate for the eligible entity. (B) Available until expended Amounts provided to a Tribal eligible entity under a cooperative agreement under this section for a fiscal year and remaining unobligated at the end of such year shall remain available to such entity during the entirety of the performance period, for the purposes for which said funds were provided. (C) No matching requirement Subparagraphs (B) and (C) of paragraph (1) shall not apply with respect to cooperative agreements awarded under this section to eligible entities described in subsection (b)(1)(D). ; and (5) by adding at the end the following: (l) Special rules related to Tribal eligible entities (1) Modifications After consultation with Indian Tribes, the Secretary may make necessary and appropriate modifications with respect to subsections (b)(2), (g), and (i) to facilitate the use of the cooperative agreement program by eligible entities described in subsection (b)(1)(D). (2) Waivers (A) In general Except as provided in subparagraph (B), the Secretary shall waive or specify alternative requirements for any provision of this section (including regulations) that the Secretary administers in connection with this section if the Secretary, after consultation with Indian Tribes, finds that the waiver or alternative requirement is appropriate for the effective delivery and administration of this program with respect to eligible entities described in subsection (b)(1)(D). (B) Exception The Secretary may not waive or specify alternative requirements under subparagraph (A) relating to labor standards or the environment. (3) Consultation The Secretary shall consult with Indian Tribes and Tribal organizations on the design of this program with respect to such Tribes and organizations to ensure the effectiveness of the program in enhancing the security of Indian Tribes with respect to public health emergencies. (4) Reporting (A) In general Not later than 2 years after the date of enactment of this subsection, and as an addendum to the biennial evaluations required under subsection (k), the Secretary, in coordination with the Director of the Indian Health Service, shall— (i) conduct a review of the implementation of this section with respect to eligible entities described in subsection (b)(1)(D), including any factors that may have limited its success; (ii) compile a report containing— (I) a description of the results of the review described in clause (i); (II) a breakdown of the eligible entities described in subsection (b)(1)(D) that— (aa) received an award under this section; (bb) received an award under this section and a waiver as described in paragraph (2); and (cc) applied under this section but did not receive an award; (III) a list of any requirements of this section for which the Secretary provided a waiver or alternative requirement, and the reasoning for issuing a waiver or alternative requirement; and (IV) recommendations to Congress for program modifications necessary to improve the implementation of the program with respect to eligible entities described in subsection (b)(1)(D); and (iii) submit the report described in clause (ii) to— (I) the Committee on Indian Affairs, the Committee on Health, Education, Labor, and Pensions, and the Committee on Appropriations of the Senate; and (II) the Subcommittee on Indigenous People of the Committee on Natural Resources, the Committee on Energy and Commerce, and the Committee on Appropriations of the House of Representatives. (B) Analysis of Tribal public health emergency infrastructure limitation The Secretary shall include in the initial report submitted under subparagraph (A) a description of any public health emergency infrastructure limitation encountered by eligible entities described in subsection (b)(1)(D). .