[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 142 Introduced in Senate (IS)]
104th CONGRESS
1st Session
S. 142
To strengthen the capacity of State and local public health agencies to
carry out core functions of public health, by eliminating
administrative barriers and enhancing State flexibility, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
January 4, 1995
Mrs. Kassebaum introduced the following bill; which was read twice and
referred to the Committee on Labor and Human Resources
_______________________________________________________________________
A BILL
To strengthen the capacity of State and local public health agencies to
carry out core functions of public health, by eliminating
administrative barriers and enhancing State flexibility, 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 ``Public Health Enhancement Act of
1995''.
TITLE I--FORMULA GRANTS FOR STATE CORE FUNCTIONS OF PUBLIC HEALTH
SEC. 101. PURPOSE.
It is the purpose of this title to strengthen the capacity of State
and local public health agencies to carry out core functions of public
health, by eliminating administrative barriers, and enhancing State
flexibility.
SEC. 102. FORMULA GRANTS TO STATES FOR CORE FUNCTIONS OF PUBLIC HEALTH.
Part A of title XIX of the Public Health Service Act (42 U.S.C.
300w et seq.) is amended--
(1) by striking the part heading and inserting the
following:
``PART A--FORMULA GRANTS TO STATES FOR CORE FUNCTIONS OF PUBLIC
HEALTH'';
(2) by repealing sections 1901 through 1907;
(3) by inserting after the part heading the following new
sections:
``SEC. 1901. GRANTS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall make grants to
States in accordance with the formula described in subsection (d) for
the purpose of carrying out the functions described in subsection (b).
``(b) Core Functions of Public Health Programs.--For purposes of
subsection (a) and subject to the funding agreement described in
subsection (c), the functions described in this subsection are as
follows:
``(1) Data collection and activities related to population
health measurement and outcomes monitoring (including gender
differences, ethnic identifiers, and health differences between
racial and ethnic groups), and analysis for planning and needs
assessment.
``(2) Activities to protect the environment and to assure
the safety of housing, workplaces, food and water, and the
public health of communities (including support for poison
control centers and preventive health services programs to
reduce the prevalence of chronic diseases and to prevent
intentional and unintentional injuries).
``(3) Investigation and control of adverse health
conditions.
``(4) Public information and education programs to reduce
risks to health.
``(5) Accountability and quality assurance activities,
including quality of personal health services and any
communities' overall access to health services.
``(6) Provision of public health laboratory services.
``(7) Training and education with special emphasis placed
on the training of public health professions and occupational
health professionals.
``(8) Leadership, policy development and administration
activities.
``(c) Restrictions on Use of Grant.--
``(1) In general.--A funding agreement for a grant under
subsection (a) for a State is that the grant will not be
expended--
``(A) to provide inpatient services;
``(B) to make cash payments to intended recipients
of health services;
``(C) to purchase or improve land, purchase,
construct, or permanently improve (other than minor
remodeling) any building or other facility, or purchase
major medical equipment; or
``(D) to satisfy any requirement for the
expenditure of non-Federal funds as a condition for the
receipt of Federal funds.
``(2) Limitation on administrative expenses.--A funding
agreement for a grant under subsection (a) is that the State
involved will not expend more than 10 percent of the grant for
administrative expenses with respect to the grant.
``(d) Formula.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall develop and implement a formula to distribute funds,
which would have otherwise been distributed under the
provisions of law described in paragraph (2)(B) in effect on
January 1, 1995, to each State under this title. Such formula
shall incorporate measures of population, health status of the
population, and financial resources of the various States. The
Secretary shall submit the suggested formula and an
accompanying report describing the estimated funding impact on
States to the appropriate Congressional authorizing committees
not later than January 1, 1996.
``(2) Transition formula.--
``(A) In general.--With respect to each of the
fiscal years 1997, 1998, and 1999, the Secretary shall
ensure that a State under this title receives an
allotment that is equal to not less than 90 percent of
the amount of the allotments the State received in
fiscal year 1996 under the provisions of law described
in subparagraph (B). If the total allotment for all
States under this subparagraph is less than the total
allotment for all States for the previous year under
such provisions, the Secretary shall establish a
formula for the proportional reduction in each State's
allotment.
``(B) Provisions of law.--The provisions of law
referred to in subparagraph (A) are the following:
``(i) Section 1902, preventive health and
health services block grant.
``(ii) Section 318(e), prevention and
control of sexually transmitted disease.
``(iii) Section 318A(q), infertility and
sexually transmitted diseases.
``(iv) Section 317(j), immunization grant
program.
``(v) Section 317E(g), prevention health
services regarding tuberculosis.
``(vi) Section 399L(a), cancer registries.
``(vii) The authority for grants under
section 317 for preventive health services
programs for diabetes.
``(viii) The authority for grants under
section 317 for preventive health services
programs for tobacco use prevention.
``(ix) The authority for grants under
section 317 for preventive health services
programs for disabilities prevention.
``(x) Section 317A(1), lead poisoning
prevention.
``(xi) Section 1510(a), breast and cervical
cancer.
``(xii) The authority for grants under
section 317 for preventive health services
programs for human immunodeficiency virus
prevention.
``(3) Withholding.--
``(A) In general.--The Secretary shall, after
adequate notice and an opportunity for a hearing
conducted within the affected State, withhold funds
from any State which does not use its allotment in
accordance with the requirements of this section. The
Secretary shall withhold such funds until the Secretary
finds that the reason for the withholding has been
removed and there is reasonable assurance that it will
not recur.
``(B) Proceedings.--The Secretary may not institute
proceedings to withhold funds under this paragraph
unless the Secretary has conducted an investigation
concerning whether the State has used its allotment in
accordance with the requirements of this section.
Investigations required under this subparagraph shall
be conducted within the affected State by qualified
investigators.
``(C) Response to complaints.--The Secretary shall
respond in an expeditious manner to complaints of a
substantial or serious nature that a State has failed
to use funds in accordance with the requirements of
this section.
``(D) Limitation.--The Secretary may not withhold
funds under this paragraph from a State for a minor
failure to comply with the requirements of this
section.
``(4) Investigations.--
``(A) In general.--The Secretary shall conduct in
several States in each fiscal year investigations of
the use of funds received by the States under this
section in order to evaluate compliance with the
requirements of this section.
``(B) Comptroller general.--The Comptroller General
of the United States may conduct investigations of the
use of funds received under this section by a State in
order to insure compliance with the requirements of
this section.
``(5) Availability of books and records.--Each State, and
each entity which has received funds from an allotment made to
a State under this section, shall make appropriate books,
documents, papers, and records available to the Secretary or
the Comptroller General of the United States, or any of their
duly authorized representatives, for examination, copying, or
mechanical reproduction on or off the premises of the
appropriate entity upon a reasonable request therefore.
``(6) Request for information.--
``(A) In general.--In conducting any investigation
in a State under this subsection, the Secretary or the
Comptroller General of the United States may not make a
request for any information not readily available to
such State or an entity which has received funds from
an allotment made to the State under this section or
make an unreasonable request for information to be
compiled, collected, or transmitted in any form not
readily available.
``(B) Limitation.--Subparagraph (A) shall not apply
to the collection, compilation, or transmittal of data
in the course of a judicial proceeding.
``(e) Indian Tribes or Tribal Organizations.--
``(1) In general.--If the Secretary--
``(A) receives a request from the governing body of
an Indian tribe or tribal organization within any State
that funds under this title be provided directly by the
Secretary to such tribe or organization; and
``(B) determines that the members of such tribe or
tribal organization would be better served by means of
grants made directly by the Secretary under this
section,
the Secretary shall reserve from amounts which would otherwise
be allotted to such State under the formula under subsection
(d) for the fiscal year the amount determined under paragraph
(2).
``(2) Reservation.--The Secretary shall reserve, for the
purposes of paragraph (1), from amounts that would otherwise be
allotted to such State under the formula under subsection (d),
an amount equal to the amount which bears the same ratio to the
State's allotment for the fiscal year involved as the total
amount provided or allotted for fiscal year 1996 by the
Secretary to such tribe or tribal organization under the
provisions of law referred to in subsection (d)(2)(B) bore to
the total amount provided or allotted for such fiscal year by
the Secretary to the State and entities (including Indian
tribes and tribal organizations) in the State under such
provisions of law.
``(3) Grants.--The amount reserved by the Secretary on the
basis of a determination under this subsection shall be granted
to the Indian tribe or tribal organization serving the
individuals for whom such a determination has been made.
``(4) Plan.--In order for an Indian tribe or tribal
organization to be eligible for a grant for a fiscal year under
this subsection, it shall submit to the Secretary a plan for
such fiscal year in accordance with section 1902.
``(5) Definitions.--As used in this subsection, the terms
`Indian tribe' and `tribal organization' have the same meaning
given such terms in section 4(b) and section 4(c) of the Indian
Self-Determination and Education Assistance Act.
``(6) Accountability.--The provisions of subsection (d)(3)
relating to accountability shall apply to this subsection.
``(f) Authorization of Appropriations.--
``(1) In general.--For the purpose of making grants under
this section, there are authorized to be appropriated,
$1,100,000,000 for fiscal year 1997, and such sums as may be
necessary for each of the fiscal years 1998 through 2000.
``(2) Administrative expenses.--The Secretary may use not
more than 5 percent of the amounts appropriated in any fiscal
year under paragraph (1) for expenses related to the
administration of this part.
``(3) Reduction in payments.--The Secretary, at the request
of a State or Indian Tribe, may reduce the amount of payments
under subsection (a) by--
``(A) the fair market value of any supplies or
equipment furnished the State; and
``(B) the amount of the pay, allowances, and travel
expenses of any officer, fellow, or employee of the
Federal Government when detailed to the State or Indian
Tribe and the amount of any other costs incurred in
connection with the detail of such officer, fellow, or
employee;
when the furnishing of supplies or equipment or the detail of
an officer, fellow, or employee is for the convenience of and
at the request of the State or Indian Tribe and for the purpose
of conducting activities described in this section. The amount
by which any payment may be reduced under this paragraph shall
be available for payment by the Secretary of the costs incurred
in furnishing the supplies or equipment or in detailing the
personnel, on which the reduction of the payment is based, and
the amount shall be deemed to be part of the payment and shall
be deemed to have been paid to the State or Indian Tribe.
``(g) Maintenance of Effort.--
``(1) Current core functions of public health
expenditures.--A funding agreement for a grant under subsection
(a) is that the State involved will maintain expenditures of
non-Federal amounts for core health functions at a level that
is not less than the level of such expenditures, adjusted for
changes in the Consumer Price Index, maintained by the State
for the fiscal year preceding the first fiscal year for which
the State receives such a grant. The Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall develop uniform criteria to help States identify their
public health department expenditures that shall be used in
calculating core public health function expenditures.
``(2) Reductions.--The Secretary may reduce the amount of
any grant awarded to a State under this section by an amount
that equals the amount by which the Secretary determines that
the State has reduced State expenditures for core public health
functions.
``SEC. 1902. APPLICATION.
``(a) Development of Uniform Application.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
shall develop a uniform application that States shall use to apply for
grants under this part. In developing such uniform application, the
Secretary shall require the provision of information consistent with
data on the interventions comprising and the outcomes attributable to,
core public health functions as such data is included in the uniform
reporting system in section 1903. Such a uniform application shall be
developed to take into account the requirements in of subsection (b).
``(b) State Assurances.--An application submitted under this part
shall include the following:
``(1) A description of the existing deficiencies and
successes in the public health system of the State based upon
indicators included in the uniform application data set.
``(2) A plan to improve such deficiencies and to continue
successes. Such plan shall have been developed with the
broadest possible input from State and local health departments
and public and non-profit private entities performing core
functions of public health in that State. In compiling such
plan the State shall describe why funding for a successful
intervention continues to be needed, including a description of
the detriment that would occur if such funding were not to
occur using the indicators found in the uniform application
data set.
``(3) A description of the activities of the State for the
previous year, including the problems addressed and changes
made in the relevant health indicators included in the uniform
application data set.
``(4) Information concerning the maintenance of effort
requirements described in section 1901(h).
``SEC. 1903. UNIFORM CORE PUBLIC HEALTH FUNCTIONS REPORTING SYSTEM.
``(a) In General.--
``(1) Development.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall develop and implement a Uniform Core Public Health
Functions Reporting System to collect program and fiscal data
concerning the interventions comprising, and the outcomes
attributable to, core functions of public health.
``(2) Requirements.--The system developed under paragraph
(1) shall--
``(A) use outcomes consistent with the goals of
Healthy People 2000;
``(B) be designed so that information collected
will be relevant to the requirements of this part; and
``(C) be designed and implemented not later than 2
years after the date of enactment of this section.
``(b) State Public Health Officers.--In developing the data set to
be used under the Uniform Core Public Health Functions Reporting System
the Secretary shall consult with State public health officers.'';
(4) in section 1908(b) (42 U.S.C. 300w-7(b)), by striking
``1902'' and inserting ``1901''; and
(5) in section 1910(a) (42 U.S.C. 300w-9(a)), by striking
``1904(a)(1)(F)'' and inserting ``1901''.
TITLE II--CENTERS FOR DISEASE CONTROL AND PREVENTION ACTIVITIES
SEC. 201. REPORT OF DIRECTOR OF CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) In General.--The Secretary of Health and Human Services,
acting through the Director of the Centers for Disease Control and
Prevention, shall prepare and submit to the President and to the
appropriate committees of Congress a report that shall contain--
(1) a description of the activities carried out by and
through the Centers for Disease Control and Prevention and the
policies with respect to such programs and such recommendations
concerning such policies and proposals for legislative changes
in the Public Health Service Act as the Secretary considers
appropriate; and
(2) a description of the activities undertaken to improve
and streamline grants and contracting accountability within
such Centers.
(b) Time for Reporting.--Not later than July 1, 1996, the Secretary
shall submit the report required under subsection (a). Such report
shall relate to fiscal year 1995, to the implementation of part A of
title XIX of the Public Health Service Act (as amended by section 101),
and to the implementation of a program of the type described in section
301(e) of such Act (as added by section 202).
SEC. 202. PRIORITY PUBLIC HEALTH NEEDS OF REGIONAL AND NATIONAL
SIGNIFICANCE.
Section 301 of the Public Health Service Act (42 U.S.C. 241) is
amended by adding at the end thereof the following new subsection:
``(e)(1) The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall address priority public
health needs of regional and national significance through the
provision of--
``(A) training and technical assistance to States,
political subdivisions of States, and public or private
nonprofit entities through direct assistance or grants or
contracts;
``(B) applied research into the prevention and control of
diseases and conditions; or
``(C) demonstration projects for the prevention and control
of diseases.
In carrying out subparagraphs (B) and (C), the Secretary may make
grants to, or enter into cooperative agreements with, States, political
subdivisions of States, and public or private nonprofit entities.
``(2) Priority public health needs of regional and national
significance may include, emerging infectious diseases, environmental
and occupational threats, chronic diseases, injuries, and other
priority diseases and conditions as determined appropriate by the
Secretary.
``(3)(A) Recipients of grants, cooperative agreements, and
contracts under this subsection shall comply with information and
application requirements determined appropriate by the Secretary.
``(B) With respect to a grant, cooperative agreement, or contract
awarded under this subsection, the period during which payments under
such award are made to the recipient may not exceed 5 years. The
provision of such payments shall be subject to annual approval by the
Secretary and the availability of appropriations for the fiscal year
involved. This subparagraph may not be construed as limiting the number
of awards under the program involved that may be made to an entity.
``(C) The Secretary may require that an entity that applies for a
grant, contract, or cooperative agreement under this subsection provide
non-Federal matching funds, as determined appropriate by the Secretary,
to ensure the institutional commitment of the entity to the projects
funded under the grant, contract, or cooperative agreement. Such non-
Federal matching funds made be provided directly or through donations
from public or private entities and may be in cash or in kind, fairly
evaluated, including plant, equipment, or services.
``(D) With respect to activities for which a grant, cooperative
agreement, or contract is awarded under this subsection, the recipient
shall agree to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the level of such
expenditures maintained by the entity for such fiscal year preceding
the fiscal year for which the entity receives such a grant, contract,
or cooperative agreement.
``(E)(i) An application for a grant, contract, or cooperative
agreement under this subsection shall ensure that amounts received
under such grant, contract, or agreement will not be expended--
``(I) to provide inpatient services;
``(II) to make cash payments to intended recipients of
health services;
``(III) to purchase or improve land, purchase, construct,
or permanently improve (other than minor remodeling) any
building or other facility, or purchase major medical
equipment; or
``(IV) to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of Federal
funds.
``(ii) A funding agreement for a grant, contract, or cooperative
agreement under this subsection is that the entity involved will not
expend more than 10 percent of the grant, contract, or agreement for
administrative expenses with respect to the grant, contract, or
agreement.
``(4) The Secretary, at the request of a State or a political
subdivision of a State, or a public or private nonprofit entity, may
reduce the amount of payments under this subsection by--
``(A) the fair market value of any supplies or equipment
furnished the State, political subdivision of the State, or a
public of private nonprofit entity; and
``(B) the amount of the pay, allowances, and travel
expenses of any officer, fellow, or employee of the Government
when detailed to the State, a political subdivision of the
State, or a public or private non-profit entity, and the amount
of any other costs incurred in connection with the detail of
such officer, fellow, or employee;
when the furnishing of such officer, fellow, or employee is for the
convenience of and at the request of the State, political subdivision
of the State, or public or private non-profit entity and for the
purpose of conducting activities described in this subsection. The
amount by which any payment is so reduced shall be available for
payment by the Secretary of the costs incurred in furnishing the
supplies or equipment or in detailing the personnel, on which the
reduction of the payment is based, and the amount shall be deemed to
have been paid to the State, political subdivision of the State, or
public or private non-profit entity.
``(5)(A) The Director of the Centers for Disease Control and
Prevention shall establish information and education programs to
disseminate the findings of the research, demonstration, and training
programs under this section to the general public and to health
professionals.
``(B) The Director shall take such action as may be necessary to
insure that all methods of dissemination and exchange of scientific
knowledge and public health information are maintained between the
Centers and the public, and the Centers and other scientific
organizations, both nationally and internationally.
``(6) There are authorized to be appropriated to carry out this
subsection, $327,000,000 for fiscal year 1997, and such sums as may be
necessary for each of the fiscal years 1998 through 2000.''.
TITLE III--REPEALS
SEC. 301. REPEALS.
(a) In General.--The following provisions of the Public Health
Service Act are repealed:
(1) Subparagraph (A) of section 317(j)(1) (42 U.S.C.
247b(j)(1)(A))
(2) Section 317A (42 U.S.C. 247b-1).
(3) Subsection (g) of section 317E (42 U.S.C. 247b-6(g)).
(4) Subsection (e) of section 318 (42 U.S.C. 247c(e)).
(5) Subsection (q) of section 318A (42 U.S.C. 247c-1(q)).
(6) Section 1510 (42 U.S.C. 300n-5).
(b) Conforming Amendment.--Subparagraph (B) of section 317(j)(1)
(42 U.S.C. 247b(j)(1)(A)) is amended by striking the subparagraph
designation.
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