[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3476 Introduced in Senate (IS)]
110th CONGRESS
2d Session
S. 3476
To amend the Public Health Service Act to improve the Nation's
surveillance and reporting for diseases and conditions, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 11, 2008
Mr. Hagel (for himself and Mr. Bingaman) 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 improve the Nation's
surveillance and reporting for diseases and conditions, 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 ``National Integrated Public Health
Surveillance Systems and Reportable Conditions Act''.
SEC. 2. PURPOSES.
The purpose of the programs authorized under this Act is to
strengthen public health surveillance systems and disease reporting
by--
(1) delineating existing grant mechanisms at the Centers
for Disease Control and Prevention designed to enhance disease
surveillance and reporting by improving and modernizing
capacity at the State and local level--
(A) to identify and monitor the occurrence of
infectious diseases and other conditions of public
health importance;
(B) to detect new and emerging infectious disease
threats; and
(C) to identify and respond to disease outbreaks;
(2) expanding eligibility for grantees;
(3) increasing funding to ensure all States and
jurisdictions have appropriate surveillance and reporting
capacity and can provide comprehensive electronic reporting,
including laboratory reporting;
(4) delineating existing applied epidemiology, laboratory
science, and informatics fellowship programs designed to reduce
documented workforce shortages for these essential public
health professionals at the State and local level and
increasing funding for these programs;
(5) expanding the Epidemic Intelligence Service;
(6) delineating a refined process for establishing a list
of nationally notifiable diseases and conditions;
(7) improving binational surveillance of diseases in the
United States and Mexico border region, including developing
improved standards and protocols for binational epidemiology,
surveillance, laboratory analyses, and control of infectious
diseases between the two nations; and
(8) establishing a forum to permit review and
identification of best surveillance practices with a particular
focus on improving coordination of animal-human disease
surveillance.
SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE SYSTEMS.
Title XXVIII of the Public Health Service Act (42 U.S.C. 300hh et
seq.) is amended by adding at the end the following:
``Subtitle C--Strengthening Public Health Surveillance Systems
``SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY GRANTS.
``(a) In General.--Subject to the availability of appropriations,
the Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall establish an Epidemiology and Laboratory
Capacity Grant Program to award grants to eligible entities to assist
public health agencies in improving surveillance for, and response to,
infectious diseases and other conditions of public health importance
by--
``(1) strengthening epidemiologic capacity;
``(2) enhancing laboratory practice;
``(3) improving information systems; and
``(4) developing and implementing prevention and control
strategies.
``(b) Eligible Entities.--In this section, the term `eligible
entity' means an entity that--
``(1) is--
``(A) a State health department;
``(B) a local health department that meets such
criteria as the Director of the Centers for Diseases
Control and Prevention determines for purposes of this
section;
``(C) a tribal jurisdiction that meets such
criteria as the Director of the Centers for Disease
Control and Prevention determines for purposes of this
section; or
``(D) a partnership established for purposes of
this section between one or more eligible entities
described in subparagraph (A), (B), or (C) and an
academic center; and
``(2) submits to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--
``(1) In general.--An eligible entity shall use amounts
received under a grant under this section for core functions
described in this subsection including--
``(A) building public health capacity to identify
and monitor the occurrence of infectious diseases and
other conditions of public health importance;
``(B) detecting new and emerging infectious disease
threats, including laboratory capacity to detect
antimicrobial resistant infections;
``(C) identifying and responding to disease
outbreaks;
``(D) hiring necessary staff;
``(E) conducting needed staff training and
educational development; and
``(F) other activities that improve surveillance as
determined by the Director of the Centers for Disease
Control and Prevention.
``(2) Development and maintenance of information
exchange.--
``(A) National standards.--Not later than 180 days
after the date of the enactment of this subtitle, the
Secretary, acting through the Director of the Centers
for Disease Control and Prevention, and in consultation
with the National Coordinator for Health Information
Technology, shall issue guidelines for public health
entities that--
``(i) are designed to ensure that all State
and local health departments and public health
laboratories have access to information systems
to receive, monitor, and report infectious
diseases and other urgent conditions of public
health importance; and
``(ii) are consistent with standards and
recommendations for health information
technology by the National Coordinator for
Health Information Technology, and by the
American Health Information Community (AHIC)
and its successors.
``(B) Secure information systems.--An eligible
entity shall use amounts received through a grant under
this section to ensure that the entity has access to a
web-based, secure information system that complies with
the guidelines developed under subparagraph (A). Such a
system shall be designed--
``(i) to receive automated case reports of
State and national reportable conditions from
clinical systems and health care offices that
use electronic health records and from clinical
and public health laboratories, and to submit
reports of nationally reportable conditions to
the Director of the Centers for Disease Control
and Prevention;
``(ii) to receive and analyze, within 24
hours, de-identified electronic clinical data
for situational awareness and to forward such
reports immediately to the Centers for Disease
Control and Prevention at the time of receipt;
``(iii) to manage, link, and process
different types of data, including information
on newly reported cases, exposed contacts,
laboratory results, number of people vaccinated
or given prophylactic medications, adverse
events monitoring and follow-up, in an
integrated outbreak management system;
``(iv) to geocode analyze, display, report,
and map, using Geographic Information System
technology, accumulated data and to share data
with other local health departments, State
health departments, and the Centers for Disease
Control and Prevention;
``(v) to receive, manage, and disseminate
alerts, protocols, and other information,
including Health Alert Network and Epi-X
information, as appropriate, for public health
workers, health care providers, and public
health partners in emergency response within
each health department's jurisdiction and to
automate the exchange and cascading of such
information with external partners using
national standards;
``(vi) to have information technology
security and critical infrastructure protection
as appropriate to protect public health
information;
``(vii) to have the technical
infrastructure needed to ensure availability,
backup, and disaster recovery of data,
application services, and communications
systems during natural disasters such as
floods, tornados, hurricanes, and power
outages; and
``(viii) to provide for other capabilities
as the Secretary determines appropriate.
``(C) Laboratory systems.--An eligible entity shall
use amounts received under a grant under this section
to ensure that State or local public health
laboratories are utilizing web-based, secure systems
that are in compliance with the guidelines developed by
the Secretary under subparagraph (A) and that--
``(i) are fully integrated laboratory
information systems;
``(ii) provide for the reporting of
electronic test results to the appropriate
local and State health departments using
currently existing national format and coding
standards;
``(iii) have information technology
security and critical infrastructure protection
to protect public health information (as
determined by the Secretary);
``(iv) have the technical infrastructure
needed to ensure availability, backup, and
disaster recovery of data, application
services, and communications systems during
natural disasters including floods, tornadoes,
hurricanes, and power outages; and
``(v) address other capabilities as the
Secretary determines appropriate.
``(D) Other uses.--In addition to the activities
described in subparagraphs (B) and (C), an eligible
entity (including the entity's public health
laboratory) may use amounts received under a grant
under this section for systems development and
maintenance, hiring necessary staff, and staff
technical training. Grantees under this section may
elect to develop their own systems or use federally
developed systems in carrying out activities under this
paragraph.
``(d) Priority.--In allocating funds under subsection (f)(2) for
activities under subsection (c)(2)(B) (relating to secure information
systems), the Secretary shall give priority to eligible entities that
demonstrate need.
``(e) Reports.--Not later than September 30, 2009, and each
September 30 thereafter, the Secretary shall submit to Congress an
annual report on the activities carried out under this section by
recipients of assistance under this section.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $180,000,000 for each of fiscal
years 2009 through 2012, of which--
``(1) not less than $88,000,000 shall be made available
each such fiscal year for activities under subsection (c)(1);
``(2) not less than $60,000,000 shall be made available
each such fiscal year for activities under subsection
(c)(2)(B); and
``(3) not less than $32,000,000 shall be made available
each such fiscal year for activities under subsection
(c)(2)(C).
``SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC HEALTH EPIDEMIOLOGY,
PUBLIC HEALTH LABORATORY SCIENCE, PUBLIC HEALTH
INFORMATICS, AND EXPANSION OF THE EPIDEMIC INTELLIGENCE
SERVICE.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, may carry out
activities to address documented workforce shortages in State and local
health departments in the critical areas of applied public health
epidemiology and public health laboratory science and informatics and
may expand the Epidemic Intelligence Service.
``(b) Specific Uses.--In carrying out subsection (a), the
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall provide for the expansion of existing
Council of State and Territorial Epidemiologists and Association of
Public Health Laboratories fellowship programs operated through the
Centers for Disease Control and Prevention in a manner that is designed
to alleviate shortages of the type described in subsection (a).
``(c) Other Programs.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, may provide for the
expansion of other applied epidemiology training programs that meet
objectives similar to the objectives of the programs described in
subsection (b).
``(d) Work Obligation.--Participation in fellowship training
programs under this section shall be deemed to be service for purposes
of satisfying work obligations stipulated in contracts under section
338I(j).
``(e) General Support.--Amounts may be used from grants awarded
under this section to expand the Public Health Informatics Fellowship
Program at the Centers for Disease Control and Prevention to better
support all public health systems at all levels of government.
``(f) Authorizations of Appropriations.--There are authorized to be
appropriated to carry out this section $39,500,000 for each of fiscal
years 2009 through 2012, of which--
``(1) not less than $5,000,000 shall be made available in
each such fiscal year for epidemiology fellowship training
program activities under subsections (b) and (c);
``(2) not less than $5,000,000 shall be made available in
each such fiscal year for laboratory fellowship training
programs under subsection (b);
``(3) not less than $5,000,000 shall be made available in
each such fiscal year for the Public Health Informatics
Fellowship Program under subsection (e); and
``(4) not less than $24,500,000 shall be made available for
expanding the Epidemic Intelligence Service under subsection
(a).
``SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CONDITIONS.
``(a) In General.--At the request of the Council of State and
Territorial Epidemiologists, the Director of the Centers for Disease
Control and Prevention shall assist the Council in developing or
improving a process for States to conduct surveillance and submit
reports to the Director on nationally notifiable diseases and
conditions.
``(b) List of Nationally Notifiable Diseases and Conditions.--The
process under subsection (a) shall include a list of nationally
notifiable diseases and conditions as follows:
``(1) The Council of State and Territorial Epidemiologists
and the Director of the Centers for Disease Control and
Prevention will jointly develop--
``(A) not later than 1 year after the date of the
enactment of the National Integrated Public Health
Surveillance Systems and Reportable Conditions Act, a
list of nationally notifiable diseases and conditions;
and
``(B) a process for reviewing the list on an annual
basis and, as appropriate, modifying the list, taking
into account newly recognized diseases and conditions
of public health importance and advances in diagnostic
technology.
``(2) A disease or condition will be included on the list
only if a majority of the States represented on the Council
approve such inclusion.
``(3) The list will include standard definitions for
confirmed, probable, and suspect cases for each nationally
notifiable disease or condition.
``(4) The list will distinguish between--
``(A) diseases and conditions of urgent public
health importance for which immediate action may be
needed; and
``(B) diseases and conditions for which reporting
is less urgent and mainly for the purpose of monitoring
trends and evaluating public health intervention
programs.
``(c) Notifications to CDC.--The process under subsection (a) shall
provide for reporting to the Director of the Centers for Disease
Control and Prevention as follows:
``(1) For diseases and conditions described in subsection
(b)(4)(A), reporting will occur--
``(A) by telephone or by using a system described
in section 2821(c)(2)(B); and
``(B) within 24 hours of the State making a
determination that a disease or condition meets the
criteria for national reporting for that disease or
condition.
``(2) For diseases and conditions described in subsection
(b)(4)(B), reporting will occur--
``(A) by using a system described in section
2821(c)(2)(B); and
``(B) only if funding is sufficient for the State
to conduct individual case surveillance and to have the
necessary systems to support electronic reporting.
``(d) Definitions.--In this section, the term `nationally
notifiable', with respect to a disease or condition, means included on
the list developed pursuant to subsection (b).
``SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND NOTIFICATION.
``(a) Findings.--The Congress finds as follows:
``(1) Nearly 1,000,000 people cross the international
border between the United States and Mexico on a daily basis,
and this transmobility of population presents actual cases and
the potential risk of transmission of infectious diseases and
disease agents between these countries.
``(2) Numerous infectious disease cases in the United
States are binational in origin, thus requiring improved
epidemiology, surveillance, follow-up investigations, and
disease case management along the United States and Mexico
border.
``(b) Guidelines for Binational Cooperation.--Not later than 1 year
after the date of the enactment of this subtitle, the Director of the
Centers for Disease Control and Prevention shall--
``(1) develop an expedited review and approval process and
adopt the resultant version of the `Guidelines for US-Mexico
Coordination on Epidemiological Events of Mutual Interest',
which have been developed with input from United States and
Mexican State health agencies, including the Mexican Federal
Health Secretariat, the United States Department of Health and
Human Services, and the Centers for Disease Control and
Prevention; and
``(2) use these guidelines as the basis for developing
improved standards and protocols for binational epidemiology,
surveillance, laboratory analyses, and control of infectious
diseases between the United States and Mexico.
``(c) Definition.--In this section, the term `binational' refers to
both sides of the United States-Mexico border, whether collectively,
such as an activity or program being carried out concurrently by or in
both countries, a phenomenon (for example, a disease outbreak or health
emergency) affecting a population or geographic area in both countries,
or a disease case that originated on one side of the border and was
transmitted to the other.
``SEC. 2825. EVALUATION OF BEST PRACTICES IN PUBLIC HEALTH
SURVEILLANCE.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall establish a
committee--
``(1) to evaluate best practices in public health
surveillance, including human and animal disease surveillance
and environmental health monitoring of harmful exposures
through air, water, soil, or other means; and
``(2) to assess systems needed for improving coordination
among public health surveillance and monitoring systems.
``(b) Composition.--The committee established under subsection (a)
shall be composed of--
``(1) an epidemiologist employed and designated by the
Director of the Centers for Disease Control and Prevention;
``(2) an informatics specialist designated by the Director
of the Centers for Disease Control and Prevention;
``(3) an epidemiologist designated by the Director of the
Centers for Disease Control and Prevention to represent the
National Center for Environmental Health and the Agency for
Toxic Substances and Disease Registry;
``(4) a representative of an academic center or
professional, scientific association designated by the American
Society for Microbiology;
``(5) a food scientist designated by the Commissioner of
Food and Drugs;
``(6) an individual designated by the Secretary of
Agriculture from the Division of Veterinary Services;
``(7) a wildlife disease specialist designated by the
Secretary of Agriculture;
``(8) an epidemiologist employed by a State and designated
by the Council of State and Territorial Epidemiologists;
``(9) a public health laboratorian employed by a State and
designated by the Association of Public Health Laboratories;
``(10) a public health veterinarian employed by a State and
designated by the National Association of State Public Health
Veterinarians;
``(11) a laboratorian designated by the American
Association of Veterinary Laboratory Diagnosticians;
``(12) a State health official designated by the
Association of State and Territorial Health Officials;
``(13) a local health official designated by the National
Association of County and City Health Officials;
``(14) an environmental health scientist employed and
designated by the Administrator of the Environmental Protection
Agency; and
``(15) a representative with expertise in the Department of
Veterans Affairs' disease monitoring systems.
``(c) Functions.--The committee established under subsection (a)
shall--
``(1) review innovative approaches adopted by State and
local agencies to improve disease detection;
``(2) evaluate best practices in public health
surveillance;
``(3) develop model data sharing agreements among local,
State, and Federal health agencies;
``(4) assess systems needed for coordinated animal and
human disease surveillance and develop recommendations for the
improvement of such surveillance; and
``(5) disseminate findings and recommendations to relevant
local, State and Federal agencies.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $750,000 for each of fiscal
years 2009 through 2010.''.
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