[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.
                                 <all>
S 142 IS----2