II 118th CONGRESS 1st Session S. 2657 IN THE SENATE OF THE UNITED STATES July 27, 2023 Mr. Markey introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide for green and resilient health care infrastructure, and for other purposes.

1. Short title This Act may be cited as the Granting Resources for Eliminating Emissions Now in Hospitals Act or the GREEN Hospitals Act . 2. Green Hill-Burton funds for climate-ready medical facilities (a) Grants for construction or modernization projects (1) In general Section 1610(a) of the Public Health Service Act ( 42 U.S.C. 300r(a) ) is amended— (A) in paragraph (1)(A)— (i) in clause (i), by striking , or and inserting a semicolon; (ii) in clause (ii), by striking the period at the end and inserting ; or ; and (iii) by adding at the end the following: (iii) increase capacity to provide essential health care and update medical facilities to become more resilient to climate disasters and public health crises to ensure access and availability of quality health care for communities in need. ; and (B) by striking paragraph (3) and inserting the following: (3) Priority In awarding grants under this subsection, the Secretary shall give priority to applicants whose projects will include, by design, resilience against natural disasters, climate change mitigation, or other necessary predisaster adaptations to ensure continuous health care access and combat health risks due to climate change, such as— (A) installation of onsite distributed generation that combines energy-efficient devices, energy storage, and renewable energy in accordance with modern electrical safety standards for medical facilities to allow the medical facility to access essential energy during power outages and optimize use of onsite and offsite energy sources for emissions reductions; (B) improving air conditioning, monitoring, and purifying through installation of high-efficiency heat pumps that provide both cooling and heating, air purifiers, air filtration systems, and air quality monitoring systems integrated with energy systems and energy efficiency considerations in preparation for future natural hazards and public health crises, such as wildfire, smog, extreme heat events, and pandemics; (C) installation and maintenance of wetlands, drainage ponds, stormwater drainage, and any other green infrastructure to protect the medical facility from projected severe effects with respect to extreme weather, natural disasters, or climate change-related events, including sea-level rise, flooding, and increased risk of wildfire; (D) green rooftops, walls, and indoor plantings, particularly those that can provide publicly accessible temperature management and air quality improvements; (E) tree planting and other green infrastructure to create publicly accessible cool space to address urban heat islands; (F) infrastructure upgrades that protect access routes to the medical facility, such as long-term flood, wildfire, and other disaster mitigation for the roads, sidewalks, and public transit infrastructure that service the medical facility; (G) the long-term maintenance of decarbonization and zero-emissions infrastructure (regardless of the source of original funding for such infrastructure); and (H) any other type of plan or project the Secretary determines will increase the sustainability and resiliency of a medical facility, protect patient health and community access during extreme weather, and advance environmental justice. (4) Authorization of appropriations There is authorized to be appropriated to carry out this subsection $100,000,000,000 for fiscal year 2024, to remain available until expended. . (2) Technical amendment Section 1610(b) of the Public Health Service Act ( 42 U.S.C. 300r(b) ) is amended by striking paragraph (3). (b) Medical facility project applications (1) In general Section 1621(b)(1) of the Public Health Service Act ( 42 U.S.C. 300s–1(b)(1) ) is amended— (A) in subparagraph (J), by striking and at the end; (B) in subparagraph (K), by striking the period at the end and inserting a semicolon; and (C) by adding at the end the following: (L) reasonable assurance that the facility will have adequate staffing to fulfill the community service obligation; and (M) reasonable assurance that the facility— (i) has a collective bargaining agreement with 1 or more labor organizations representing employees at the facility; or (ii) has an explicit policy not to interfere with the rights of employees of the facility under section 7 of the National Labor Relations Act. . (2) Application for planning grants Section 1621 of the Public Health Service Act ( 42 U.S.C. 300s–1 ) is amended by adding at the end the following: (c) Application for planning grants An application for a project submitted under part A or B shall be deemed to be complete for purposes of section 3(d)(2) of the Granting Resources for Eliminating Emissions Now in Hospitals Act , and the application shall be deemed to have been submitted for purposes of consideration for a planning grant under that section. . 3. Planning and Evaluation Grant Program (a) Definitions In this section: (1) Medical facility The term medical facility means a hospital, public health center, outpatient medical facility, rehabilitation facility, facility for long-term care, or other facility (as may be designated by the Secretary) for the provision of health care to ambulatory patients. (2) Proposed project The term proposed project means a construction or modernization project proposed by an eligible entity in a sustainability and resiliency plan. (3) Secretary The term Secretary means the Secretary of Health and Human Services. (4) Sustainability and resiliency plan The term sustainability and resiliency plan means a plan, including comprehensive preproject evaluation, for a construction or modernization project that would, in order to protect patient health and community access, enhance— (A) the sustainability of a medical facility and infrastructure surrounding the medical facility; and (B) the resiliency of that medical facility and infrastructure surrounding the medical facility to climate change and public health crises. (b) Establishment The Secretary shall establish a grant program, to be known as the Planning and Evaluation Grant Program , under which the Secretary shall make planning grants to eligible entities to develop sustainability and resiliency plans for medical facilities owned or operated by the eligible entity and infrastructure surrounding the medical facilities. (c) Eligible entities To be eligible to receive a planning grant under subsection (b), an applicant shall be— (1) a State, Tribal government, or political subdivision of a State or Tribal government, including any city, town, county, borough, hospital district authority, or public or quasi-public corporation; or (2) a nonprofit private entity. (d) Applications (1) In general Except as provided in paragraph (2), an eligible entity seeking a planning grant under subsection (b) shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may by regulation prescribe, including— (A) a description of the proposed project; (B) a summary and breakdown of the demographics of the patient population served or potentially served by the medical facility under the proposed project, including information on— (i) whether the medical facility is a facility for which a majority of the revenue the facility receives for patient care is from reimbursements for medical care furnished to Medicare and Medicaid beneficiaries under titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq. and 1396 et seq.); and (ii) other indications that individuals vulnerable to climate change are served or potentially served by the medical facility; (C) a description of the ways in which the proposed project— (i) will carry out 1 or more activities described in subsection (g); (ii) meet the needs of the community the medical facility serves, especially the needs of vulnerable populations; and (iii) meet the sustainability and resiliency needs of the medical facility due to climate risks and hazards; (D) a description of whether the community served by the medical facility is an environmental justice community; (E) a description of the ways in which the planning grant would be used to carry out 1 or more planning and evaluation activities described in subsection (f); (F) reasonable assurance that all laborers and mechanics employed by contractors or subcontractors in the performance of work on a project will be paid wages at rates not less than those prevailing on similar work in the locality as determined by the Secretary of Labor in accordance with subchapter IV of chapter 31 of part A of subtitle II of title 40, United States Code (commonly referred to as the Davis-Bacon Act ) and the Secretary of Labor shall have with respect to such labor standards the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (64 Stat. 1267; 5 U.S.C. App.) and section 3145 of title 40, United States Code; and (G) reasonable assurance that the facility— (i) has a collective bargaining agreement with 1 or more labor organizations representing employees at the facility; or (ii) has an explicit policy not to interfere with the rights of employees at the facility under section 7 of the National Labor Relations Act ( 29 U.S.C. 157 ). (2) Additional applications An application submitted under part A or B of title XVI of the Public Health Service Act ( 42 U.S.C. 300q et seq. and 42 U.S.C. 300r ) shall be deemed to be a complete application submitted for purposes of consideration for a planning grant under subsection (b). (e) Selection The Secretary shall— (1) in coordination with the Secretary of Energy and the Administrator of the Environmental Protection Agency, if necessary, develop metrics to evaluate applications for planning grants under subsection (b); and (2) give priority to applications that focus on improving a medical facility— (A) for which— (i) a majority of the revenue the facility receives for patient care is from reimbursements for medical care furnished to Medicare and Medicaid beneficiaries under titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq. and 1396 et seq.); or (ii) a high proportion of patients is uninsured, as determined by the Secretary; and (B) that is located in a neighborhood or serves a patient population that— (i) experiences low-air quality; (ii) lacks green space; (iii) bears higher cumulative pollution burdens; or (iv) is at disproportionate risk of experiencing the adverse effects of climate change. (f) Planning activities Planning and evaluation activities carried out by an eligible entity using grant funds received under subsection (b) shall include 1 or more of the following: (1) Performing project planning, community outreach and engagement, feasibility studies, and needs assessments of the local community and patient populations. (2) Performing engineering and climate-risk assessments of the medical facility infrastructure and the access routes to the medical facility. (3) Providing management and operational assistance for developing and receiving funding for the proposed project. (4) Other planning and evaluation activities and assessments as the Secretary determines appropriate. (g) Proposed projects Construction and modernization activities carried out by a proposed project under a sustainability and resiliency plan developed pursuant to a planning grant received under subsection (b) may include— (1) improvements to the infrastructure, buildings, and grounds of the medical facility, including— (A) installation of onsite distributed generation that combines energy-efficient devices, energy storage, and renewable energy in accordance with modern electrical safety standards for medical facilities to allow the medical facility to access essential energy during power outages and optimize use of onsite and offsite energy sources for emissions reductions; and (B) improving air conditioning, monitoring, and purifying through installation of high-efficiency heat pumps that provide both cooling and heating, air purifiers, air filtration systems, and air quality monitoring systems integrated with energy systems and energy efficiency considerations in preparation for future natural hazards and public health crises such as wildfire, smog, extreme heat events, and pandemics; (2) green infrastructure projects, such as— (A) installation and maintenance of wetlands, drainage ponds, and any other green infrastructure that would protect the medical facility from projected severe effects with respect to extreme weather, natural disasters, or climate change-related events, including sea-level rise, flooding, and increased risk of wildfire; and (B) green rooftops, walls, and indoor plantings, particularly those that can provide publicly accessible temperature management and air quality improvements; (3) resiliency projects to secure local accessibility to the medical facility by protecting the access routes to the medical facility, such as— (A) infrastructure upgrades that protect access routes to the medical facility, such as long-term flood, wildfire, and other disaster mitigation for the roads, sidewalks, and public transit infrastructure that service the medical facility; and (B) the long-term maintenance of decarbonization and zero-emissions infrastructure; and (4) any other type of activity the Secretary determines will increase the sustainability and resiliency of a medical facility and protect patient health and community access during extreme weather. (h) Amount of grant The total amount of a grant under subsection (b) shall not exceed $500,000. (i) Technical assistance The Secretary, in coordination with the Secretary of Energy, the Administrator of the Environmental Protection Agency, and the Secretary of Transportation, if necessary, directly or through partnerships with States, Tribal governments, and nonprofit organizations, shall provide technical assistance to eligible entities interested in carrying out proposed projects that— (1) serve environmental justice communities or medically underserved communities; (2) demonstrate a commitment to provide job training, apprenticeship programs, and contracting opportunities to residents and small businesses owned by residents of the community that the medical facility serves; (3) identify and further community priority actions and conduct robust community engagement; and (4) employ nature-based solutions that focus on protection, restoration, or management of ecological systems to safeguard public health, provide clean air and water, increase natural hazard resilience, and sequester carbon. (j) Prohibition on training repayment As a condition of receiving a grant or technical assistance under this section, an eligible entity shall certify that the eligible entity does not use, and if the eligible entity contracts with any staffing agency or training provider, that such agency or provider does not use, any provision in employment agreements, job training agreements, or apprenticeship program agreements that would require an employee or training or apprenticeship program participant to pay a debt if the employee or training or apprenticeship program participant's employment or work relationship or training period with a specified employer or business entity is terminated. (k) Environmental justice communities The Secretary shall ensure that not less than 50 percent of grant funds awarded under subsection (b) are used for sustainability and resiliency plans for proposed projects located in environmental justice communities. (l) Authorization of Appropriations There is authorized to be appropriated to the Secretary to carry out this section $5,000,000,000 for fiscal year 2024, to remain available until expended.