[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2054 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2054

To amend the Public Health Service Act to establish a Nationwide Health 
               Tracking Network, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 21, 2002

 Mrs. Clinton (for herself, Mr. Reid, and Mr. Kennedy) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to establish a Nationwide Health 
               Tracking Network, 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 ``Nationwide Health Tracking Act of 
2002''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress finds that--
            (1) approximately 7 out of every 10 deaths in the United 
        States are attributable to chronic diseases;
            (2) with 100,000,000 people suffering from chronic diseases 
        each year, and $325,000,000,000 lost in annual health care and 
        productivity costs as a result, the national cost of chronic 
        diseases is extremely high and needs to be appropriately 
        addressed;
            (3) the rates of many chronic diseases, including asthma, 
        some birth defects, and cancers, are on the rise;
            (4) there is growing scientific evidence that environmental 
        factors are as strongly linked, or even more strongly linked, 
        to the incidence of certain chronic diseases as is genetic 
        predisposition;
            (5) a gap in critical knowledge exists in understanding the 
        prevalence and incidence of chronic diseases and the 
        environmental factors that may relate to them, including 
        statewide and community level incidence and prevalence data on 
        chronic diseases and related risk factors that is critically 
        needed to identify trends and patterns and to improve disease 
        prevention efforts;
            (6) States, territories, Indian tribes, and local 
        communities need assistance with chronic disease and 
        environmental hazard and exposure surveillance and prevention 
        efforts, including the establishment, operation, and 
        maintenance of the necessary infrastructure for such 
        activities; and
            (7) a nationwide health tracking network, including the 
        integration of data systems and collaborative programs and 
        partnerships among environmental and public health 
        professionals and other parts of the public health system, will 
        help target resources more efficiently to those areas most in 
        need.
    (b) Purposes.--It is the purpose of this Act to--
            (1) develop, operate, and maintain Nationwide and State 
        Health Tracking Networks and rapid response capabilities so 
        that the Federal Government, States, communities, territories, 
        and Indian tribes can more effectively monitor, investigate, 
        respond to, research, understand, and prevent increases in the 
        incidence and prevalence of certain chronic diseases and 
        relevant environmental, behavioral, socioeconomic, demographic, 
        and other risk factors;
            (2) develop, operate, and maintain Nationwide and State 
        Health Tracking Networks that will collect and provide 
        information to Federal, State, territorial, tribal, and local 
        agencies, public health practitioners and researchers, 
        policymakers, and the public about certain chronic diseases and 
        relevant environmental, behavioral, socioeconomic, demographic, 
        and other risk factors;
            (3) develop, operate, and maintain Nationwide and State 
        Health Tracking Networks by building upon, expanding, 
        coordinating among, integrating, and, where necessary, adding 
        to existing surveillance and data collection systems, 
        registries, surveys, laboratories, and other infrastructure for 
        chronic diseases and relevant environmental, behavioral, 
        socioeconomic, demographic, and other risk factors;
            (4) provide the support necessary to ensure the 
        availability of a sufficient number of well-trained 
        environmental health and public health personnel to participate 
        and provide leadership in the development, operation, and 
        maintenance of the Nationwide and State Health Tracking 
        Networks; and
            (5) improve coordination between the areas of public health 
        and environmental protection, including coordination of data 
        collection and research activities, and coordination between 
        environmental and public health professionals.

SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

           ``TITLE XXVIII--NATIONWIDE HEALTH TRACKING NETWORK

``SEC. 2800. DEFINITIONS.

    ``In this title:
            ``(1) Commission.--The term `Commission' means the 
        Commission on Nationwide Health Tracking established under 
        section 2802.
            ``(2) Nationwide network.--The term `Nationwide Network' 
        means the Nationwide Health Tracking Network established under 
        section 2804.
            ``(3) Priority chronic condition.--The term `priority 
        chronic condition' means a condition that appears on the list 
        developed under section 2804(b)(2)(A).
            ``(4) State network.--The term `State Network' means a 
        State Health Tracking Network established under section 2803.

     ``PART A--STATE BASED AND NATIONWIDE HEALTH TRACKING NETWORKS

``SEC. 2801. STATE PILOT PROGRAMS.

    ``(a) In General.--Beginning in fiscal year 2003, the Secretary, 
acting through the Director of the Centers for Disease Control and 
Prevention, in consultation with the Administrator of the Environmental 
Protection Agency and the Administrator of the Agency for Toxic 
Substances, and taking into consideration the findings, conclusions and 
recommendations of the Commission, shall enter into cooperative 
agreements, and continue existing health tracking cooperative 
agreements funded under the heading `Centers for Disease Control and 
Prevention' (disease control, research, and training) under title II of 
the Departments of Labor, Health and Human Services, and Education, and 
Related Agencies Appropriations Act, 2002 (Public Law 107-116), with 
States and political subdivisions of States, territories, and Indian 
tribes for the purpose of funding pilot programs to develop improved 
surveillance and data collection methods, procedures, practices, and 
systems, including integration of systems, for collecting, analyzing, 
and sharing data and identifying, understanding, preventing, and 
responding to regional concerns regarding chronic health conditions and 
relevant environmental, behavioral, and other factors.
    ``(b) Purpose.--The purpose of the pilot programs funded under 
subsection (a) is to provide for the establishment and operation of the 
Nationwide and State Health Tracking Networks as described in sections 
2803 and 2804. Upon the establishment of such Networks, such pilot 
programs shall be used to develop network enhancements and to develop 
programs to address specific local and regional concerns.
    ``(c) Application.--The Secretary may enter into, or continue 
existing, cooperative agreements under subsection (a) only if an 
application for such an agreement is submitted to the Secretary, and 
the application is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this section.
    ``(d) Coordination.--In approving applications under this section, 
the Secretary shall ensure that there is adequate coordination among 
the pilot programs to effectively advance the establishment and 
operation of the Nationwide Network under section 2804.
    ``(e) Authorization of Appropriations.--For the purpose of entering 
into, and continuing existing, cooperative agreements under subsection 
(a), there is authorized to be appropriated such sums as may be 
necessary for each of fiscal years 2003 through 2007.

``SEC. 2802. COMMISSION ON NATIONWIDE HEALTH TRACKING.

    ``(a) Establishment.--Not later than 3 months after the date of 
enactment of this title, the Secretary, jointly with the Administrator 
of the Environmental Protection Agency, shall establish a commission to 
be known as the Commission on Nationwide Health Tracking.
    ``(b) Membership.--
            ``(1) In general.--The Commission shall be composed of--
                    ``(A) 15 voting members appointed in accordance 
                with paragraphs (2) and (3); and
                    ``(B) nonvoting, ex officio members appointed in 
                accordance with paragraph (3)(C).
            ``(2) Background and expertise.--The voting members of the 
        Commission shall be appointed from among individuals who--
                    ``(A) are not officers or employees of the Federal 
                Government; and
                    ``(B) have expertise regarding--
                            ``(i) epidemiology;
                            ``(ii) environmental health;
                            ``(iii) public health;
                            ``(iv) pediatric health;
                            ``(v) vulnerable subpopulations and 
                        disproportionately impacted groups;
                            ``(vi) biomonitoring;
                            ``(vii) environmental factors;
                            ``(viii) chronic conditions;
                            ``(ix) data systems development and 
                        management; and
                            ``(x) privacy.
            ``(3) Representatives.--
                    ``(A) Appointments by secretary.--Nine of the 
                voting members of the Commission shall be appointed by 
                the Secretary, and shall include at least 1 individual 
                representing--
                            ``(i) an advocacy group that represents 
                        people who have been diagnosed with a priority 
                        chronic disease referred to in section 
                        2804(b)(2)(A);
                            ``(ii) a public health advocacy group;
                            ``(iii) a State or local public health 
                        department;
                            ``(iv) a health care provider;
                            ``(v) the hospital industry;
                            ``(vi) a community health group;
                            ``(vii) a pediatric health group;
                            ``(viii) an accredited school of public 
                        health or department of public health or 
                        similar department within an accredited school 
                        of medicine with expertise in environmental 
                        health; and
                            ``(ix) the research community.
                    ``(B) Administrator.--Six of the voting members of 
                the Commission shall be appointed by the Administrator 
                of the Environmental Protection Agency, and shall 
                include at least 1 individual representing--
                            ``(i) an environmental advocacy group;
                            ``(ii) a State or local environmental 
                        protection agency;
                            ``(iii) private industry;
                            ``(iv) an environmental health advocacy 
                        group;
                            ``(v) an environmental justice advocacy 
                        group; and
                            ``(vi) the research community.
                    ``(C) Ex officio members.--The Secretary shall 
                appoint officers or employees of the Department of 
                Health and Human Services and the Administrator shall 
                appoint officers or employees of the Environmental 
                Protection Agency as nonvoting, ex officio members of 
                the Commission.
    ``(c) Terms of Appointment.--Each member of the Commission shall 
serve for a term of 4 years, except that the terms of service of the 
members initially appointed under subsection (b)(1)(A) shall be (as 
specified by the Secretary or the Administrator, as the case may be) 
for such fewer number of years as will provide for the expiration of 
the terms of such members on a staggered basis.
    ``(d) Vacancies.--Any vacancy in the Commission shall not affect 
the powers of the Commission and shall be filled in the same manner as 
the original appointment.
    ``(e) Co-Chairs.--The Secretary and the Administrator shall each 
select a Co-Chair of the Commission from among the voting members of 
the Commission. A member selected as a Co-Chair shall serve as a Co-
Chair for a term of 2 years.
    ``(f) Duties.--
            ``(1) In general.--The Commission shall meet regularly to 
        provide advice and recommendations regarding the implementation 
        of this title to the Secretary and Administrator of the 
        Environmental Protection Agency, including providing advice and 
        recommendations regarding--
                    ``(A) the awarding and use of State grants 
                described in section 2803, including--
                            ``(i) methods for encouraging participation 
                        by all States in the establishment of State 
                        Networks; and
                            ``(ii) recommendations for providing 
                        technical assistance to those States determined 
                        to need such assistance to build the capacity 
                        of the State to the level necessary for the 
                        establishment of a State Network;
                    ``(B) the establishment and operation of the 
                Nationwide Network described in section 2804, 
                including--
                            ``(i) existing infrastructure, surveys, 
                        registries, protocols, surveillance systems, 
                        and databases that can be used and expanded 
                        upon in establishing and operating the Network 
                        and any additional infrastructure, surveys, 
                        registries, protocols, surveillance systems, 
                        and databases that may be necessary to 
                        establish and operate the Network; and
                            ``(ii) the minimum standards and procedures 
                        described in section 2804(b);
                    ``(C) the use of the Nationwide and State 
                Networks--
                            ``(i) to inform communities, public health 
                        professionals, researchers, members of the 
                        public, and policymakers about chronic 
                        conditions and relevant environmental, 
                        behavioral, socioeconomic, demographic, and 
                        other factors; and
                            ``(ii) to better identify, understand, 
                        respond to, and prevent the prevalence and 
                        incidence of priority chronic conditions and 
                        relevant risk factors in the United States;
                    ``(D) the establishment and duties of the National 
                Environmental Health Rapid Response Service established 
                under section 2805;
                    ``(E) the expansion of biomonitoring and other 
                research tools as described in section 2806;
                    ``(F) the most effective approaches for supporting 
                national priorities in carrying out activities under 
                this title, while providing appropriate flexibility to 
                the States;
                    ``(G) the establishment of guidelines to protect 
                individual privacy and confidentiality in the 
                establishment and operation of the Nationwide and State 
                Networks; and
                    ``(H) other issues specified by the Secretary and 
                the Administrator of the Environmental Protection 
                Agency.
            ``(2) Community participation.--In carrying out paragraph 
        (1), the Commission shall provide an opportunity for input from 
        Federal, State, and local government agencies and for public 
        participation through methods that include hearings and the 
        submission of comments.
            ``(3) Reports.--Not later than 9 months after the date of 
        enactment of this title, the Commission shall submit a report 
        to the Secretary and the Administrator of the Environmental 
        Protection Agency that shall review the recommendations and 
        findings of the CDC/ATSDR work groups. The Commission shall 
        annually thereafter submit a report to the Secretary and the 
        Administrator of the Environmental Protection Agency that 
        contains a detailed statement of the findings and conclusions 
        of the Commission together with additional recommendations for 
        such legislation and administrative actions as the Commission 
        considers to be appropriate.
            ``(4) Selections.--The Commission shall review applications 
        and make selections for the Centers of Excellence described in 
        section 2811 and the John H. Chafee Scholarships described in 
        section 2812.
    ``(g) Powers.--
            ``(1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out the objectives of this section.
            ``(2) Information from federal agencies.--The Commission 
        may secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        the provisions of this section. Upon request of the Commission, 
        the head of such department or agency shall furnish such 
        information to the Commission.
            ``(3) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other departments and agencies of the Federal Government.
    ``(h) Personnel.--
            ``(1) Travel expenses.--The members of the Commission shall 
        not receive compensation for the performance of services for 
        the Commission, but shall be allowed travel expenses, including 
        per diem in lieu of subsistence, at rates authorized for 
        employees of agencies under subchapter I of chapter 57 of title 
        5, United States Code, while away from their homes or regular 
        places of business in the performance of services for the 
        Commission. Notwithstanding section 1342 of title 31, United 
        States Code, the Secretary may accept the voluntary and 
        uncompensated services of members of the Commission.
            ``(2) Detail of government employees.--Any Federal 
        Government employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
            ``(3) Staff, information, and other assistance.--The 
        Secretary and the Administrator of the Environmental Protection 
        Agency shall provide to the Commission such staff, information, 
        and other assistance as may be necessary to carry out the 
        duties of the Commission.
    ``(i) Permanent Committee.--Section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply to the Commission.
    ``(j) Authorization of Appropriations.--There is authorized to be 
appropriated to the Commission such sums as may be necessary to carry 
out the objectives of this section.

``SEC. 2803. STATE HEALTH TRACKING NETWORK GRANTS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, in consultation with 
the Administrator of the Environmental Protection Agency and the 
Administrator of the Agency for Toxic Substances and Disease Registry, 
and taking into consideration the findings, conclusions, and 
recommendations of the Commission, shall award grants to eligible 
States, political subdivisions of States, territories, and Indian 
tribes for the establishment, maintenance, and operation of State 
Networks in accordance with the minimum standards and procedures 
established by the Secretary under section 2804(b).
    ``(b) Use of Funds.--A State, political subdivision of a State, 
territory, or Indian tribe that receives a grant under this section 
shall use the amounts provided through the grant to--
            ``(1) conduct surveillance activities, building and 
        expanding on existing procedures and systems where appropriate 
        and available, to collect data, report data, and make data 
        available to researchers and the public, in accordance with the 
        minimum standards and procedures established by the Secretary 
        under section 2804(b);
            ``(2) collect data through biomonitoring and other advanced 
        methods;
            ``(3) analyze collected data in accordance with the minimum 
        standards and procedures established under section 2804(b) to 
        identify populations at high risk, examine and respond to 
        health concerns, recognize and address relevant environmental, 
        behavioral, socioeconomic, demographic, and other factors, 
        effectively communicate risk, assess the efficacy of medical 
        and public health intervention efforts, and establish and 
        implement prevention strategies;
            ``(4) establish the capacity to respond in a timely manner 
        to actual and perceived incidence and prevalence rates of 
        priority chronic diseases that are higher than expected, acute 
        and potential environmental hazards and exposures, and other 
        community environmental health concerns, including concerns 
        regarding vulnerable subpopulations and disproportionately 
        impacted subpopulations;
            ``(5) establish an early warning system to detect, 
        investigate, and where necessary, respond to, emergent public 
        health concerns detected through the State Network;
            ``(6) recruit public health employees, including the 
        Environmental Health Investigators described in subsection 
        (e)(2)(B);
            ``(7) train public health employees in epidemiology, 
        environmental health, risk communication, and other relevant 
        fields;
            ``(8) pay for such staffing, administrative, and other 
        operating costs as may be required to carry out this section;
            ``(9) enhance the public health infrastructure, including 
        laboratories, outreach and communication programs, and other 
        related initiatives; and
            ``(10) carry out such other activities as the Secretary may 
        determine necessary.
    ``(c) Existing Surveillance Systems, Registries, and Surveys.--To 
the maximum extent practicable, States, political subdivisions of 
States, territories, and Indian tribes shall use, expand, and integrate 
existing surveillance and data collection systems, registries, and 
surveys in the development and operation of a State Network.
    ``(d) Limitation.--A State, political subdivision of a State, 
territory, or Indian tribe that receives a grant under this section may 
use not more than 10 percent of the funds made available through the 
grant for administrative costs.
    ``(e) Eligibility.--
            ``(1) Application.--
                    ``(A) In general.--To be eligible to receive a 
                grant under subsection (a) a State, political 
                subdivision of a State, territory, or Indian tribe 
                shall submit to the Secretary for approval an 
                application that is in such form, submitted in such 
                manner, and accompanied by such information, as the 
                Secretary may specify.
                    ``(B) Requirement for approval.--An application 
                submitted under subparagraph (A) may not be approved by 
                the Secretary unless the application--
                            ``(i) contains assurances that the State, 
                        political subdivision of a State, territory, or 
                        Indian tribe--
                                    ``(I) will use grant funds only for 
                                the purposes specified in the approved 
                                application and in accordance with the 
                                requirements of this section; and
                                    ``(II) will establish such fiscal 
                                control and fund accounting procedures 
                                as may be necessary to assure proper 
                                disbursement and accounting of Federal 
                                funds paid to the State, political 
                                subdivision of a State, territory, or 
                                Indian tribe under the grant; and
                            ``(ii) contains the assurances described in 
                        paragraph (2).
            ``(2) Assurances.--A State, political subdivision of a 
        State, territory, or Indian tribe shall provide assurances 
        satisfactory to the Secretary that the State, political 
        subdivision of a State, territory, or Indian tribe will--
                    ``(A) establish a Health Tracking Network in 
                accordance with subsection (a) that will provide--
                            ``(i) a means to ensure the complete 
                        reporting of priority chronic conditions, as 
                        set forth in section 2804(b)(2)(A), and 
                        relevant environmental, behavioral, 
                        socioeconomic, demographic, and other factors 
                        as set forth in subparagraphs (B) and (C) of 
                        section 2804(b)(2), to the State Network by 
                        health care providers, hospitals, or other 
                        facilities that provide screening, diagnostic, 
                        or therapeutic services to patients;
                            ``(ii) a means to access necessary records 
                        that would identify the incidence and 
                        prevalence of priority chronic conditions and 
                        relevant environmental, behavioral, 
                        socioeconomic, demographic, and other factors;
                            ``(iii) a means to collect information 
                        regarding relevant environmental factors 
                        through biomonitoring and other methods, except 
                        that a State, political subdivision of a State, 
                        territory, or Indian tribe may satisfy the 
                        requirement of this clause through the use of 
                        either its own laboratory or through an 
                        agreement with other laboratories;
                            ``(iv) a means for the reporting of 
                        priority chronic conditions and relevant 
                        environmental, behavioral, socioeconomic, 
                        demographic, and other factors to the 
                        Nationwide Network in such a format, with such 
                        data elements, and in accordance with such 
                        standards of quality, timeliness, and 
                        completeness, as may be established by the 
                        Secretary;
                            ``(v) a means for the protection of the 
                        confidentiality of all personal data reported, 
                        in accordance with the regulations promulgated 
                        under section 264(c) of the Health Insurance 
                        Portability and Accountability Act of 1996 (42 
                        U.S.C. 1320d-2 note);
                            ``(vi) a means by which confidential data 
                        may, in accordance with Federal and State law, 
                        be disclosed to researchers for the purposes of 
                        public health research; and
                            ``(vii) a means for providing the fullest 
                        possible access to data collected by the State 
                        Network while ensuring that individual privacy 
                        is protected in accordance with clause (v) and 
                        that potential risk is effectively 
                        communicated;
                    ``(B) appoint--
                            ``(i) in the case of a State, a State 
                        department or agency;
                            ``(ii) in the case of a political 
                        subdivision of a State, a local governmental 
                        department or agency;
                            ``(iii) in the case of a territory, a 
                        territorial department or agency; or
                            ``(iv) in the case of an Indian tribe, a 
                        tribal office;
                as the environmental health lead department or agency 
                that will be responsible for reporting to the Governor 
                of the State (or other appropriate State, territorial, 
                or tribal official as the case may be) regarding the 
                State Network, be responsible for the development, 
                operation, and maintenance of the State Network, and 
                ensure the appropriate coordination among State and 
                local agencies regarding the development, operation, 
                and maintenance of the State Network;
                    ``(C) appoint or hire an Environmental Health 
                Investigator who meets the criteria established by the 
                Secretary under section 2804(b)(2)(H) and who will 
                provide leadership with respect to the establishment, 
                operation, and maintenance of the State Network;
                    ``(D) comply with such minimum standards and 
                procedures as the Secretary may prescribe;
                    ``(E) maintain such records and data and afford 
                such access thereto as the Secretary may find necessary 
                to assure the correctness of, and to verify, reports 
                submitted to the Nationwide Network under this section;
                    ``(F) establish an advisory committee to ensure 
                local community input to the State Network;
                    ``(G) use the funds provided under this section to 
                build on, expand, and coordinate among the existing 
                public health and environmental infrastructure, 
                including surveys, registries, protocols, surveillance 
                and data collection systems, and health alert and other 
                early warning networks; and
                    ``(H) provide an appropriate means for referring 
                individuals with priority chronic conditions to 
                appropriate health services and for determining their 
                eligibility for health coverage under the medicaid 
                program carried out under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.) or the State 
                Children's Health Insurance Program under title XXI of 
                the Social Security Act (42 U.S.C. 1397aa et seq.).
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $100,000,000 for each of fiscal 
years 2005 through 2009.

``SEC. 2804. ESTABLISHMENT AND OPERATION OF THE NATIONWIDE HEALTH 
              TRACKING NETWORK.

    ``(a) In General.--Not later than 36 months after the date of 
enactment of this title, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, in consultation with 
the Administrator of the Environmental Protection Agency, the 
Administrator of the Agency for Toxic Substances and Disease Registry, 
States, political subdivisions of States, Indian tribes, and 
territories and taking into consideration the findings, conclusions, 
and recommendations of the Commission, shall establish and operate a 
Nationwide Health Tracking Network. In establishing and operating the 
Nationwide Network, the Secretary shall--
            ``(1) identify, build upon, expand, and coordinate among 
        existing data and surveillance systems, surveys, registries, 
        and other Federal public health and environmental 
        infrastructure wherever possible, including--
                    ``(A) the National Electronic Disease Surveillance 
                System;
                    ``(B) State birth defects surveillance systems as 
                supported under section 317C;
                    ``(C) State cancer registries as supported under 
                part M of title III;
                    ``(D) State asthma surveillance systems as 
                supported under section 317I;
                    ``(E) the National Health and Nutrition Examination 
                Survey;
                    ``(F) the Behavioral Risk Factor Surveillance 
                System;
                    ``(G) the Substance Release/Health Effects 
                Database;
                    ``(H) the Hazardous Substances Emergency Events 
                Surveillance System;
                    ``(I) the National Exposure Registry;
                    ``(J) the Health Alert Network; and
                    ``(K) such other data and surveillance systems, 
                registries, and surveys as considered appropriate by 
                the Secretary and the Administrator of the 
                Environmental Protection Agency;
            ``(2) develop, operate, and maintain a national database 
        that accepts data from the State Networks on the occurrence, 
        including incidence and prevalence, of priority chronic 
        conditions and relevant environmental, behavioral, 
        socioeconomic, demographic, and other factors;
            ``(3) coordinate the State Networks as provided for under 
        section 2803 and provide technical assistance to support these 
        Networks;
            ``(4) establish minimum standards and procedures for data 
        collection, reporting, and availability to ensure that data 
        collected by the Nationwide and State Networks are--
                    ``(A) accurate and of a high quality;
                    ``(B) accessible to the public in a form that 
                provides for the protection of individual privacy and 
                provides for effective communication of potential risk 
                (including in an electronic format);
                    ``(C) accessible and sufficient to be used and 
                analyzed on a national scale by interested parties; and
                    ``(D) maintained in a manner that supports the 
                purposes of this title and protects individual privacy; 
                and
            ``(5) develop guidance for appropriate data analysis, 
        response, risk communication, and prevention activities at the 
        Federal, State, and local level.
    ``(b) Establishment of Minimum Standards and Procedures.--
            ``(1) In general.--Not later than 36 months after the date 
        of enactment of this title, the Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, and 
        in consultation with the Administrator of the Environmental 
        Protection Agency, the Administrator of the Agency for Toxic 
        Substances and Disease Registry, the Surgeon General, the 
        Director of the National Institutes of Health, States, Indian 
        tribes, territories, and other interested parties, shall 
        establish minimum standards and procedures for the 
        establishment and operation of the State Networks. In 
        developing such minimum standards and procedures, the Secretary 
shall take into consideration the findings, conclusions, and 
recommendations of the Commission.
            ``(2) Contents.--The minimum standards and procedures 
        established under paragraph (1) shall include--
                    ``(A) a list and definitions of the priority 
                chronic conditions to be tracked through the State 
                Networks, including--
                            ``(i) birth defects;
                            ``(ii) developmental disabilities (such as 
                        cerebral palsy, autism, and mental 
                        retardation);
                            ``(iii) asthma and chronic respiratory 
                        diseases;
                            ``(iv) cancer, including pediatric cancers;
                            ``(v) neurological diseases (such as 
                        Parkinson's, Multiple Sclerosis, and 
                        Alzheimer's); and
                            ``(vi) other such priority chronic 
                        conditions as the Secretary may specify;
                    ``(B) a list and definitions of relevant 
                environmental factors to be tracked through the State 
                Networks;
                    ``(C) a list and definitions of relevant 
                behavioral, socioeconomic, demographic, and other risk 
                factors, including race, ethnic status, gender, age, 
                occupation, and primary language, to be tracked through 
                the State Networks;
                    ``(D) procedures for the complete, timely, and 
                high-quality collection and reporting of annual data by 
                census tract, or other political or administrative 
                subdivision determined appropriate by the Secretary, 
                regarding the incidence and prevalence of the priority 
                chronic diseases listed under subparagraph (A), the 
                relevant environmental factors listed under 
                subparagraph (B), and the relevant behavioral, 
                socioeconomic, demographic, and other factors listed 
                under subparagraph (C) that will ensure the utility, 
                accuracy, and sufficiency of the data for all 
                interested parties and the protection of individual 
                privacy;
                    ``(E) procedures for making data available to the 
                public at a community level, in an easily accessible 
                and readily available format, ensuring the protection 
                of individual privacy and effective communication of 
                potential risk, and as quickly as possible after it is 
                collected so that public health officials and members 
                of the public can respond with appropriate public 
                health activities;
                    ``(F) procedures for making data available to 
                researchers while maintaining adequate protections of 
                individual privacy;
                    ``(G) procedures for analyzing collected data to 
                identify populations at high risk, examining and 
                responding to health concerns, recognizing and 
                addressing related environmental and other risk 
                factors, effectively communicating potential risk, and 
                developing and implementing prevention strategies;
                    ``(H) procedures for developing an early warning 
                system to detect, investigate, and where necessary, 
                respond to, emergent public health concerns detected 
                through the State Network;
                    ``(I) criteria for Environmental Health 
                Investigators as required under section 2803(e)(2)(C); 
                and
                    ``(J) procedures for record and data maintenance 
                and verification.
            ``(3) State priorities.--In developing the minimum 
        standards and procedures under paragraph (1), the Secretary, 
        acting through the Director of the Centers for Disease Control 
        and Prevention, shall include mechanisms for allowing States, 
        political subdivisions of States, territories, and Indian 
        tribes to set priorities, and allocate resources accordingly, 
        among the priority chronic conditions described in paragraph 
        (2)(A), and the relevant environmental, behavioral, 
        socioeconomic, demographic, and other risk factors described in 
        subparagraphs (B) and (C) of paragraph (2).
    ``(c) Technical Assistance.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, and the 
Administrator, shall directly or through grants or contracts, or both, 
provide technical assistance to States, political subdivisions of 
States, territories, and Indian tribes in the establishment and 
operation of the State Networks, including providing--
            ``(1) training for Environmental Health Investigators as 
        described in section 2803(e)(2)(C), for personnel of State, 
        local, territorial, and tribal health agencies, and for other 
        appropriate personnel to develop environmental health 
        leadership capacity at the State (including territories and 
        Indian tribes) and local level, including investigative, 
        diagnostic, analytical, risk communication, and response and 
        prevention capabilities;
            ``(2) assistance in improving relevant regional and State 
        laboratory capacity and other activities to complement State 
        (including territories and Indian tribes) and local 
        investigative capabilities;
            ``(3) assistance in establishing a computerized data 
        collection, reporting, and processing system;
            ``(4) technical assistance to those States (including 
        territories and Indian tribes) and local governments determined 
        to need such assistance to build capacity to the level 
        necessary for the establishment of a State Network; and
            ``(5) any other technical assistance the Secretary or 
        Administrator determines to be necessary.
    ``(d) Report to Congress.--Not later than September 30, 2004, and 
biennially thereafter, the Secretary shall submit to Congress, and make 
public, a report concerning the implementation of this title.
    ``(e) Authorization of Appropriations.--For the purposes of 
establishing, operating, and maintaining the Nationwide Network, there 
is authorized to be appropriated $15,000,000 for each of fiscal years 
2003 through 2007.

``SEC. 2805. NATIONAL ENVIRONMENTAL HEALTH RAPID RESPONSE SERVICE.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall establish within 
the Epidemic Intelligence Service a National Environmental Health Rapid 
Response Service.
    ``(b) Duties.--The National Environmental Health Rapid Response 
Service established under subsection (a) shall--
            ``(1) work with States, political subdivisions of States, 
        territories, Indian tribes, and other interested parties to 
        develop and implement strategies, protocols, and guidelines for 
        coordinated, rapid responses to actual and perceived higher 
        than expected incidence and prevalence rates of priority 
        chronic conditions and to acute and potential environmental 
        hazards and exposures, taking into consideration the findings, 
        conclusions, and recommendations of the Commission;
            ``(2) serve as a resource for communities with concerns 
        regarding higher than expected incidence and prevalence rates 
        of priority chronic conditions or concerns regarding acute 
        environmental exposures, and where appropriate, conduct 
        investigations into higher than expected incidence and 
        prevalence rates of priority chronic conditions or acute 
        environmental exposures;
            ``(3) coordinate activities carried out under this title 
        with activities carried out under sections 319 through 319G; 
        and
            ``(4) coordinate activities carried out under this section 
        with the Administrator of the Environmental Protection Agency, 
        the Administrator of the Agency for Toxic Substances and 
        Disease Registry, the Surgeon General, and the Director of the 
        National Institutes of Health.
    ``(c) Training.--The Secretary shall expand the Centers for Disease 
Control and Prevention Epidemic Intelligence Service and Public Health 
Prevention Service to recruit and train public health officers in 
epidemiology, environmental health, and other relevant areas to prepare 
them to respond rapidly and effectively to actual and perceived higher 
than expected incidence and prevalence rates of priority chronic 
conditions and to acute and potential environmental hazards and 
exposures.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2003 through 2007.

``SEC. 2806. EXPANSION OF BIOMONITORING CAPABILITIES AND DATA 
              COLLECTION.

    ``(a) In General.--The Secretary shall expand the scope and amount 
of biomonitoring data collected by the Centers for Disease Control and 
Prevention, including the collection of biomonitoring data through the 
National Health and Nutrition Examination Survey so that such 
biomonitoring data will provide robust information, by census tract or 
other political or administrative subdivision determined appropriate by 
the Secretary, on a range of environmental exposures, including 
prenatal exposures.
    ``(b) Increasing Regional Laboratory Capacity.--The Secretary, 
acting through the Director of the Centers for Disease Control and 
Prevention, shall enter into cooperative agreements with States, groups 
of States, academic institutions, or consortia of academic institutions 
to establish and operate at least 5 regional biomonitoring laboratories 
to support the purposes of this title.
    ``(c) Geographical Distribution.--In entering into cooperative 
agreements under this section, the Secretary shall provide for an 
equitable geographical distribution of regional biomonitoring 
laboratories.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            ``(1) $50,000,000 for each of fiscal years 2003 through 
        2007 for the expansion of biomonitoring data collection by the 
        Centers for Disease Control and Prevention; and
            ``(2) $50,000,000 for each of the fiscal years 2003 through 
        2007 for entering into cooperative agreements to establish and 
        operate at least 5 regional biomonitoring laboratories.

``SEC. 2807. THE NATIONAL HEALTH TRACKING REPORT.

    ``(a) In General.--Not later than 48 months after the date of 
enactment of this title, and annually thereafter, the Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
and in coordination with the Administrator of the Environmental 
Protection Agency and the Administrator of the Agency for Toxic 
Substances and Disease Registry, shall publish a report, in an easy to 
understand format, that will provide the public with the findings of 
the Nationwide Network (including key hazards, exposures, and health 
outcomes) and other information that will assist the public in gauging 
progress and shaping national goals with respect to environmental 
health. In developing the report, the Secretary and the Administrator 
shall take into consideration the findings, conclusions, and 
recommendations of the Commission.
    ``(b) Consultation.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall consult with the 
Commission, the Administrator of the Environmental Protection Agency, 
the Administrator of the Agency for Toxic Substances and Disease 
Registry, States, political subdivisions of States, territories, Indian 
tribes, and other interested parties concerning the format, content, 
and methods of dissemination with respect to the National Health 
Tracking Report under subsection (a).
    ``(c) Requirements.--Each report published under subsection (a) 
shall include, in addition to any other information that the Secretary 
and the Administrator of the Environmental Protection Agency determine 
appropriate--
            ``(1) a statement of the activities carried out under this 
        title during the period covered by the report and the extent to 
        which such activities achieve the purposes of this title;
            ``(2) an analysis of the incidence and prevalence of 
        priority chronic conditions and relevant environmental, 
        behavioral, socioeconomic, demographic, and other factors by 
        State and census tract (or other political or administrative 
        subdivision determined appropriate by the Secretary and the 
        Administrator of the Environmental Protection Agency) for the 
        calendar year preceding the year for which the report is 
        prepared;
            ``(3) the identification of data gaps that remain to be 
        filled; and
            ``(4) recommendations regarding high risk populations, 
        public health concerns, response and prevention strategies, and 
        additional tracking needs.
    ``(d) Dissemination.--The National Health Tracking Report under 
subsection (a) shall be made available in an electronic format and be 
disseminated to the public on as wide a basis as is practicable.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

         ``PART B--INCREASING PUBLIC HEALTH PERSONNEL CAPACITY

``SEC. 2811. SCHOOLS OF PUBLIC HEALTH CENTERS OF EXCELLENCE.

    ``(a) In General.--Beginning in fiscal year 2003, the Secretary may 
make grants to, or enter into cooperative agreements with, at least 5 
accredited schools of public health or departments of public health or 
similar departments within accredited schools of medicine for the 
establishment, maintenance, and operation of centers for research and 
demonstration with respect to chronic conditions and relevant 
environmental factors.
    ``(b) Areas of Research and Demonstration.--In addition to areas of 
research specified by the Secretary and the Administrator of the 
Environmental Protection Agency, after taking into consideration the 
findings, conclusions, and recommendations of the Commission, centers 
established, maintained, or operated under this section shall undertake 
research and development projects in at least 1 of the following areas:
            ``(1) Investigating causal connections between chronic 
        conditions and environmental factors, including effects of 
        environmental factors on the health of children and other 
        vulnerable subpopulations.
            ``(2) Increasing the understanding of the causes of higher 
        than expected incidence and prevalence rates of priority 
        chronic conditions and developing more effective intervention 
        methods for when such elevated rates occur.
            ``(3) Identifying additional chronic conditions and 
        environmental factors that could provide information with 
        respect to potential public health benefits if surveyed through 
        the Nationwide Network, including such conditions as 
        reproductive health, endocrine disorders, cardiovascular 
        diseases, and other chronic conditions that may be related to 
        environmental factors.
            ``(4) Improving the translation of Nationwide Network 
        tracking results into effective prevention activities.
            ``(5) Improving the training of the public health workforce 
        in environmental epidemiology.
    ``(c) Requirements.--Each center established, maintained, or 
operated under this section shall be located in a school of public 
health or a department of public health or similar department within an 
accredited school of medicine--
            ``(1) that has a core faculty in epidemiology, 
        biostatistics, social and behavioral sciences, environmental 
        health sciences, health communication, and health services 
        administration;
            ``(2) with a proximity to, and that collaborates with, a 
        laboratory with expertise in biomonitoring and other techniques 
        for measuring and quantifying environmental factors and 
        exposures;
            ``(3) that provides graduate training programs relevant to 
        disease prevention and environmental health;
            ``(4) that has a multidisciplinary faculty that has working 
        relationships with relevant groups in such fields as medicine, 
        psychology, nursing, pediatrics, social work, education, 
        environmental sciences, and life sciences;
            ``(5) that has a demonstrated curriculum in disease 
        prevention;
            ``(6) that has a capability for residency training in 
        public health or preventive medicine;
            ``(7) that maintains collaborative partnerships with State 
        and local health departments; and
            ``(8) that meets such other qualifications as the Secretary 
        may prescribe.
    ``(d) Community Involvement.--
            ``(1) In general.--In conducting research and demonstration 
        projects under subsection (b), each center established, 
        maintained, or operated under this section shall involve 
        community organizations to ensure that local concerns are 
        adequately addressed and that aggregated data resulting from 
        the projects are readily accessible and contain information 
        useful for local activities.
            ``(2) Requirements.--The centers established, maintained, 
        or operated under this section shall--
                    ``(A) utilize community outreach and organization 
                techniques and other methods of educating and 
                motivating communities; and
                    ``(B) work with community organizations to 
                routinely evaluate the Nationwide Network and State 
                Networks with respect to local needs and to ensure 
                appropriate dissemination and interpretation of 
                tracking data.
    ``(e) Application.--To be eligible to receive a grant or 
cooperative agreement under subsection (a) an accredited school of 
public health or a department of public health or similar department 
within an accredited school of medicine shall submit to the Commission 
for approval an application that is in such form, submitted in such 
manner, and accompanied by such information, as the Secretary and the 
Commission may specify.
    ``(f) Selection.--In determining which applications to approve 
under subsection (e), the Commission shall--
            ``(1) provide for an equitable geographical distribution of 
        centers established, maintained, and operated under this 
        section; and
            ``(2) provide for the distribution of such centers among 
        areas containing a range of population groups which exhibit 
        incidence rates of chronic conditions that are--
                    ``(A) higher than would normally be expected;
                    ``(B) likely to be related to environmental 
                factors; and
                    ``(C) most likely to respond to preventive 
                intervention efforts.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2003 through 2007.

``SEC. 2812. JOHN H. CHAFEE PUBLIC HEALTH SCHOLAR PROGRAM.

    ``(a) In General.--The Secretary shall award scholarships, to be 
know as John H. Chafee Public Health Scholarships, to eligible students 
who meet the criteria established under subsection (b) and who are 
enrolled in an accredited school of public health or a department of 
public health or similar department within an accredited school of 
medicine.
    ``(b) Criteria for Scholarships.--The Secretary and the 
Administrator of the Environmental Protection Agency, taking into 
consideration the recommendations of the Commission, shall establish 
specific criteria upon which to award scholarships under subsection 
(a), which shall include criteria relating to appropriate basic and 
advanced training in chronic conditions and environmental epidemiology, 
environmental health sciences, risk communication, and community 
outreach and intervention.
    ``(c) Eligibility.--To be eligible to receive a scholarship under 
this section, an individual shall--
            ``(1) be enrolled on a full-time basis in, or accepted to, 
        a master's or doctoral level program in public health at an 
        accredited school of public health or a department of public 
        health or similar department within an accredited school of 
        medicine;
            ``(2) submit an application to the Secretary at such time, 
        in such manner, and containing such agreements, assurances, and 
        information as the Secretary and the Administrator determine to 
        be necessary to carry out this section; and
            ``(3) enter into an obligated service agreement with the 
        Secretary under which the individual agrees to accept 
        employment, following the completion of the recipient's course 
        of study, in a State, local, municipal, tribal, territory, or 
        Federal public health agency for 1 year for each year that the 
        recipient received such a scholarship.
    ``(d) Selection.--The recipients of scholarships under this section 
shall be selected by the Commission based on the applications 
submitted.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $2,500,000 for each of fiscal 
years 2003 through 2007.

                      ``PART C--GENERAL PROVISIONS

``SEC. 2821. GENERAL PROVISIONS.

    ``(a) Internal Monitoring and Coordination Regarding Centers for 
Disease Control and Prevention.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall place 
primary responsibility for the coordination of the programs established 
under this title in the Office of the Director. In addition, the 
officers or employees of such Centers who are assigned responsibility 
for monitoring and coordinating the activities carried out under this 
title by such Centers include officers or employees within the Office 
of the Director of such Centers.
    ``(b) Funding Through Appropriations Account for Public Health 
Improvement.--All authorizations of appropriations established in this 
title are authorizations exclusively for appropriations to the account 
that, among appropriations accounts for the Centers for Disease Control 
and Prevention, is designated `public health improvement'.
    ``(c) Date Certain for Obligation of Appropriations.--With respect 
to the process of receiving applications for and making awards of 
grants, cooperative agreements, and contracts under this title, the 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, shall to the extent practicable design the 
process to ensure that amounts appropriated under this title for such 
awards for a fiscal year are obligated not later than the beginning of 
the fourth quarter of the fiscal year, subject to compliance with 
section 1512 of title 31, United States Code (relating to deficiency or 
supplemental appropriations), and other applicable law regarding 
appropriations accounting.
    ``(d) Coordination With Agency for Toxic Substances and Disease 
Registry.--For carrying out the purposes of this title, the Secretary, 
acting through the Director of the Centers for Disease Control and 
Prevention, shall coordinate activities and responses with the Agency 
for Toxic Substances and Disease Registry.''.
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