I 111th CONGRESS 1st Session H. R. 3426 IN THE HOUSE OF REPRESENTATIVES July 30, 2009 Ms. Pelosi (for herself, Ms. Slaughter, Mr. Markey of Massachusetts, Mrs. Capps, Ms. Schakowsky, Ms. Baldwin, Ms. DeLauro, Ms. McCollum, Mr. Serrano, Mr. Grijalva, and Mr. Hare) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to establish a Coordinated Environmental Public Health Network.
1.
Short title
This Act may be cited as the Coordinated Environmental Public Health Network Act of 2009.
2.
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: <enum>XXXI</enum><header>Coordinated Environmental Public Health Network</header> <section id="H2165806358B940A88C27AB429285E71C"><enum>3100.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text> <paragraph id="HF716B39AEB4E4C4E87C0293350F70368"><enum>(1)</enum><header>Administrator</header><text>The term <term>Administrator</term> means the Administrator of the Environmental Protection Agency.</text> </paragraph><paragraph id="HB5E6A65B27334BB3AA2527A01FD154E7"><enum>(2)</enum><header>Coordinated Network</header><text>The term <term>Coordinated Network</term> means the Coordinated Environmental Public Health Network established under section 3101(a).</text> </paragraph><paragraph id="HE4632F2A6C4948799930B0B8D54383E6"><enum>(3)</enum><header>Director</header><text>The term <term>Director</term> means the Director of the Centers for Disease Control and Prevention.</text> </paragraph><paragraph id="H62CDDC35B7F24FF98467D85779B82B4E"><enum>(4)</enum><header>Director of the Center</header><text>The term <term>Director of the Center</term> means the Director of the National Center for Environmental Health at the Centers for Disease Control and Prevention.</text> </paragraph><paragraph id="HE3F16BB7A2E84320B850801A9D1C5173"><enum>(5)</enum><header>Medical privacy regulations</header><text>The term <term>medical privacy regulations</term> means the regulations promulgated under section 264(c) of the <act-name parsable-cite="HIPAA">Health Insurance Portability and Accountability Act of 1996</act-name>.</text> </paragraph><paragraph id="H4785DA3CE99E49E1A901A64887078168"><enum>(6)</enum><header>Priority chronic conditions and health effects</header><text>The term <term>priority chronic conditions and health effects</term> means the conditions, as specified by the Secretary, to be tracked in the Coordinated Network and the State Networks.</text> </paragraph><paragraph id="HA65E406BC6AB46E1A19CFE4B5F6902F1"><enum>(7)</enum><header>State Network</header><text>The term <term>State Network</term> means a State Environmental Public Health Network established under section 3101(b).</text> </paragraph><paragraph id="H4F6357C1363741DBBCFC757E27DA5D26"><enum>(8)</enum><header>State</header><text>The term <term>State</term> means a State, local government, territory, or Indian tribe that is eligible to receive a health tracking grant under section 3101(b).</text> </paragraph></section><section id="HCD5405016C6744D4AE4F596E9746BE33"><enum>3101.</enum><header>Establishment of Coordinated and State Environmental Public Health Networks</header> <subsection id="HCE7BC33C99C44101BEC3DC276C194B02"><enum>(a)</enum><header>Coordinated Environmental Public Health Network</header> <paragraph id="H9AA84C9CA90446928337BD5CF31ADF06"><enum>(1)</enum><header>Establishment</header><text>Not later than 36 months after the date of the enactment of this title, the Secretary, acting through the Director, in consultation with the Administrator and the Director of the Center, and with the involvement of other Federal agencies, and State and local health departments, shall establish and operate a Coordinated Environmental Public Health Network. In establishing and operating the Coordinated Network, the Secretary shall, as practicable—</text> <subparagraph id="H98B5D95DCDCB4696967C7006CAEBC4BA"><enum>(A)</enum><text>identify, build upon, expand, and coordinate among existing data and surveillance systems, surveys, registries, and other Federal public health and environmental infrastructure as practicable, including—</text> <clause id="H586A9954C698476AAC0A491A577DB92B"><enum>(i)</enum><text>the Public Health Information Network;</text> </clause><clause id="H10A972E650DA4BDDB2AF826FE6FD0323"><enum>(ii)</enum><text>State birth defects surveillance systems as supported under section 317C;</text> </clause><clause id="H20603A690FD345158AE1BD17F884AE9F"><enum>(iii)</enum><text>State cancer registries as supported under part M of title III;</text> </clause><clause id="H156817960220463BAF9B66F799CC1332"><enum>(iv)</enum><text>State asthma surveillance systems as supported under section 317I;</text> </clause><clause id="HC0B4DF63C8A443E699CA5BEEA8EBD0F7"><enum>(v)</enum><text>the National Health and Nutrition Examination Survey;</text> </clause><clause id="HB5E2BFE49BD846A386528D277C63C270"><enum>(vi)</enum><text>the Behavioral Risk Factor Surveillance System;</text> </clause><clause id="HC420994ADBDC4F46A8E9EAE0826477F2"><enum>(vii)</enum><text>the Hazardous Substance Release/Health Effects Database;</text> </clause><clause id="HC47BCC890892414D9ECD91A705BC5710"><enum>(viii)</enum><text>the Hazardous Substances Emergency Events Surveillance System; and</text> </clause><clause id="H90161BAE3F7A447DB3EE173448116724"><enum>(ix)</enum><text display-inline="yes-display-inline">the State vital statistics systems as supported under section 306;</text> </clause></subparagraph><subparagraph id="HCD7EAD60FE8C4C9FB7B105B129B76532"><enum>(B)</enum><text>provide for public access to an electronic national database that accepts data from the State Networks on the incidence and prevalence of priority chronic conditions and health effects and relevant environmental and other factors, in a manner which protects personal privacy consistent with the medical privacy regulations;</text> </subparagraph><subparagraph id="HBFAE200B6DF94F6FA6E52F4A3E20ED94"><enum>(C)</enum><text display-inline="yes-display-inline">in order to allow the public to access and understand information about environmental health at the Federal, State, and, where practicable, local level, prepare, publish, make publicly available on the Web sites of the Centers for Disease Control and Prevention and the Environmental Protection Agency, and submit to Congress not later than 2 years after the date of the enactment of this title, and biennially thereafter, a Coordinated Network Health and Environment Report, including—</text> <clause id="H3F5D94945A6246D2ABC7E1ADA039CE00"><enum>(i)</enum><text>identification of gaps in the data of the Network, including diseases of concern and environmental exposures not tracked;</text> </clause><clause id="H190AEA71E6D14CAB9C662752F5CB4BB5"><enum>(ii)</enum><text>identification of activities carried out under this title and key milestones achieved during the preceding year; and</text> </clause><clause id="H64637D74548E499E991D260CFF9BA2C1"><enum>(iii)</enum><text>an analysis of the most currently available incidence, prevalence, and trends of priority chronic conditions and health effects, and potentially relevant environmental and other factors, by State and, as practicable by local areas, and recommendations regarding high risk populations, public health concerns, response and prevention strategies, and additional tracking needs;</text> </clause></subparagraph><subparagraph id="H4B81046E97924872A133F0C08860C3C6"><enum>(D)</enum><text>provide for the establishment of State Networks, and coordinate the State Networks as provided for under subsection (b);</text> </subparagraph><subparagraph id="H425A8ECF52F041288032673CF31B421D"><enum>(E)</enum><text>provide technical assistance to support the State Networks;</text> </subparagraph><subparagraph id="HE3263339B0224AE49262DED56BC6E681"><enum>(F)</enum><text>not later than 12 months after the date of the enactment of this title, develop minimum standards and procedures for data collection and reporting for the State Networks, to be updated not less than annually thereafter; and</text> </subparagraph><subparagraph id="H03EC537D60654E11B484B88360919BFF"><enum>(G)</enum><text>in developing the minimum standards and procedures under subparagraph (F), include mechanisms for allowing the States to set priorities, and allocate resources accordingly.</text> </subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HEC4ACB5DFC48428EA1E332C2B0E67F71"><enum>(2)</enum><header>Data collection and reporting by State networks</header><text>The minimum standards and procedures referred to in paragraph (1)(F) shall include—</text> <subparagraph commented="no" id="H0D340F368A2142C7B474ABB75FC37568"><enum>(A)</enum><text>a list and definitions of the priority chronic conditions and health effects to be tracked through the State Networks;</text> </subparagraph><subparagraph commented="no" id="H546BC811B6F34449BB6D24FEE021D944"><enum>(B)</enum><text>a list and definitions of relevant environmental exposures of concern to be tracked, to the extent practicable, through the State Networks, including—</text> <clause commented="no" id="HA42466D189A8445B9D2AD95E11DFF482"><enum>(i)</enum><text>hazardous air pollutants (as defined in section 302(g) of the <act-name parsable-cite="CAA">Clean Air Act</act-name>);</text> </clause><clause commented="no" id="H4DB883C8623348C58B6DDDD5DE63D802"><enum>(ii)</enum><text>air pollutants for which national primary ambient air quality standards have been promulgated under section 109 of the <act-name parsable-cite="CAA">Clean Air Act</act-name>;</text> </clause><clause commented="no" id="HFD71101B8C6A4D81B2A7C5F34E314D81"><enum>(iii)</enum><text>pollutants or contaminants (as defined in section 101 of the <act-name parsable-cite="CERCL">Comprehensive Environmental Response, Compensation, and Liability Act of 1980</act-name>);</text> </clause><clause commented="no" id="HB417D6E84BA94370BDC6D1B982017C6F"><enum>(iv)</enum><text>toxic chemicals (as described in section 313 of the Emergency Planning and Community Right-to-Know Act of 1986);</text> </clause><clause commented="no" id="HFEB64F9A129E4BF0A1A7DCBF18EEC56D"><enum>(v)</enum><text>substances reported under the <act-name parsable-cite="TSCA">Toxic Substances Control Act</act-name> Inventory Update Rule as provided for in part 710 of title 40, Code of Federal Regulations, or successor regulations;</text> </clause><clause commented="no" id="H51E6820D8B2F436C8BB4D86E097F4DD2"><enum>(vi)</enum><text>pesticides (as defined in section 2(u) of the <act-name parsable-cite="FIFRA">Federal Insecticide, Fungicide, and Rodenticide Act</act-name>); and</text> </clause><clause commented="no" id="H6E912FD407F04B6E8730ABF607255AF2"><enum>(vii)</enum><text>such other potentially relevant environmental factors as the Secretary may specify;</text> </clause></subparagraph><subparagraph commented="no" id="HC14A1C4395B746BCA57F8C1F5ED565A0"><enum>(C)</enum><text>a list and definitions of potentially relevant behavioral, socioeconomic, and demographic factors known to be associated with these priority chronic conditions and health effects and other risk factors, such as race, ethnic status, gender, age, occupation, and primary language, to be tracked through the State Networks;</text> </subparagraph><subparagraph commented="no" id="HA5FFEADB18CC41BFAC7C6DB0CDBDB4AB"><enum>(D)</enum><text>procedures for the complete and timely collection and reporting of data to the Coordinated Network by local areas, such as a census tract or other political subdivision determined appropriate by the Secretary, in consultation with the Administrator, regarding the factors described in subparagraphs (A), (B), and (C);</text> </subparagraph><subparagraph commented="no" id="H518671B9617A4A2EB25665290971F353"><enum>(E)</enum><text>procedures for making data available to the public and researchers, and for reporting to the Coordinated Network, while protecting the confidentiality of all personal data reported, in accordance with medical privacy regulations; and</text> </subparagraph><subparagraph commented="no" id="H42953DD024504B068F3C66E0DABBB00C"><enum>(F)</enum><text>standards and procedures for the establishment, operation, and maintenance of laboratories conducting biomonitoring, in order to expand the scope and amount of biomonitoring data collected by the Centers for Disease Control and Prevention as described in section 3104.</text> </subparagraph></paragraph></subsection><subsection id="HFAA74A69E3F149EBAB0E9450E45FD894"><enum>(b)</enum><header>State Environmental Public Health Networks</header> <paragraph id="HBD19191926A04D7CB5D9CCC3AA78CBA5"><enum>(1)</enum><header>Grants</header><text>Not later than 12 months after the date of the enactment of this title, the Secretary, acting through the Director, in consultation with the Administrator and the Director of the Center shall award grants to States for the establishment, maintenance, and operation of State Networks in accordance with the minimum standards and procedures established by the Secretary under subsection (a)(1)(F).</text> </paragraph><paragraph id="H26279D9CA70147A987FCA9F94737B90C"><enum>(2)</enum><header>Specialized assistance</header><text>The Coordinated Network shall provide specialized assistance to grantees in the establishment, maintenance, and operation of State Networks.</text> </paragraph><paragraph id="HEFBD562F196647E5AE892275F4018F2A"><enum>(3)</enum><header>Requirements</header><text>A State receiving a grant under this subsection shall use the grant—</text> <subparagraph id="HD6E4C362985641D7978EE2C86C4A2AD3"><enum>(A)</enum><text>to establish an environmental public health network that will provide—</text> <clause id="HF7C56DE609384D478F7602179326F4DD"><enum>(i)</enum><text>for the tracking of the incidence, prevalence, and trends of priority chronic conditions and health effects, as well as any additional priority chronic conditions and health effects and potentially related environmental exposures of concern to that State;</text> </clause><clause id="H1EA92F310BCA43D4B24B5D9F092BCBFA"><enum>(ii)</enum><text>for identification of priority chronic conditions and health effects and potentially relevant environmental and other factors that disproportionately impact low income and minority communities;</text> </clause><clause id="HC4DC8C4AA9894FFB93C4E27975CCC5B0"><enum>(iii)</enum><text>for the protection of the confidentiality of all personal data reported, in accordance with the medical privacy regulations;</text> </clause><clause id="HB2ADB2F226CC42B894E7088C857EAF41"><enum>(iv)</enum><text>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;</text> </clause><clause id="H1CBEF62A4C724DE087BA8ACBF1FC5BDA"><enum>(v)</enum><text>the fullest possible public access to data collected by the State Network or through the Coordinated Network, while ensuring that individual privacy is protected in accordance with subsection (a)(1)(B); and</text> </clause><clause id="H940821690825473F95762A0378B73D06"><enum>(vi)</enum><text>for the collection of exposure data through biomonitoring and other methods, which may include the entering into of cooperative agreements as described in section 3104;</text> </clause></subparagraph><subparagraph id="H7446BB19497D4C37A6DEE783CA5B7B72"><enum>(B)</enum><text>to develop a publicly available plan for establishing the State Network in order to meet minimum standards and procedures as developed by the Secretary under subsection (a)(1)(F);</text> </subparagraph><subparagraph id="H375846CEBE96451FBF413A023723ABA4"><enum>(C)</enum><text>to appoint a lead public health department or agency that will be responsible for the development, operation, and maintenance of the State Network, and ensure the appropriate coordination among State and local agencies, including environmental agencies, regarding the development, operation, and maintenance of the State Network; and</text> </subparagraph><subparagraph id="HEF7A7B64F12F410FA56A69B1ACD0AF08"><enum>(D)</enum><text>to recruit and train public health officials to continue to expand the State Network.</text> </subparagraph></paragraph><paragraph id="H1BD380F5BAE6468584910BE17AC3A539"><enum>(4)</enum><header>Limitation</header><text>A State that receives a grant under this section may not use more than 10 percent of the funds made available through the grant for administrative costs.</text> </paragraph><paragraph id="H4E10107832AA4C1B9C9FF7F332DAB488"><enum>(5)</enum><header>Application</header><text>To seek a grant under this section, a State shall submit to the Secretary an application at such time, in such form and manner, and accompanied by such information as the Secretary may specify.</text> </paragraph></subsection><subsection id="H97B416D9044F4E5E90C5C5C17597BAA5"><enum>(c)</enum><header>Pilot Projects</header> <paragraph id="H4D9AEAA9DB874A30AE2F6D57D93368A9"><enum>(1)</enum><header>In general</header><text>A State may apply for a grant under this subsection to implement a pilot project that is approved by the Secretary, acting through the Director and in consultation with the Administrator, and the Director of the Center.</text> </paragraph><paragraph id="H90CDE0A49A8C4413B931B9A55E778224"><enum>(2)</enum><header>Activities</header><text>A State shall use amounts received under a grant under this subsection to carry out a pilot project designed to develop State Network enhancements and to develop programs to address specific local and regional concerns.</text> </paragraph><paragraph id="HA4893DCF94254CB8BB7500BC1C1B954A"><enum>(3)</enum><header>Results</header><text>The Secretary may consider the results of the pilot projects under this subsection for inclusion into the Coordinated Network.</text> </paragraph></subsection><subsection commented="no" id="H50FB5BE5505C447A94138827728F85AD"><enum>(d)</enum><header>Privacy</header><text>In establishing and operating the Coordinated Network under subsection (a), and in making grants under subsections (b) and (c), the Secretary shall ensure the protection of privacy of individually identifiable health information, including ensuring protection consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.</text> </subsection><subsection id="HC2E84DD52DE745148CF06F8713191678"><enum>(e)</enum><header>Authorization of Appropriations</header><text>There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.</text> </subsection></section><section id="H60313A9A477D49DBB424CBEBB88A8886"><enum>3102.</enum><header>Increasing public health personnel capacity</header> <subsection id="H6D999BBB265945079FA0B5E519567076"><enum>(a)</enum><header>In general</header><text>Beginning in fiscal year 2010, the Secretary, acting through the Director, shall enter into a cooperative agreement with the Council of State and Territorial Epidemiologists to train and place, in State and local health departments, applied epidemiology fellows to enhance State and local public health capacity in the areas of environmental health, chronic and other noninfectious diseases and conditions, and public health surveillance.</text> </subsection><subsection id="HA19C448437C94EAF8F6323F76DAEF2C5"><enum>(b)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.</text> </subsection></section><section id="H182F68AC0C9D4F98B046992F421F3DB1"><enum>3103.</enum><header>General provisions</header> <subsection id="H17D5B9D9280B4FE4B05F219CE1ED6162"><enum>(a)</enum><header>Integration of environmental health tracking programs</header><text display-inline="yes-display-inline">The Secretary shall integrate the enactment of this title with all environmental health tracking programs funded prior to the date of the enactment of this title, including by integrating the programs, in existence on the date of the enactment of this title, to develop State Network enhancements and to develop programs to address specific local and regional concerns.</text> </subsection><subsection id="H9DAD42C6E3EA4F4B95A9A13085A6DF0E"><enum>(b)</enum><header>Coordination With Agency for Toxic Substances and Disease Registry</header><text>In carrying out this title, the Secretary, acting through the Director, shall coordinate activities and responses with the Agency for Toxic Substances and Disease Registry.</text> </subsection></section><section id="H0D4E76F321E545229799D194C584FEE7"><enum>3104.</enum><header>Expansion of biomonitoring capabilities and data collection</header> <subsection id="H1F306D6DA71C4126A193D330A6535347"><enum>(a)</enum><header>Purpose</header><text>It is the purpose of this section to expand the scope and amount of biomonitoring data collected and analyzed by the Centers for Disease Control and Prevention, State laboratories, and consortia of State laboratories, in order to obtain robust information, including information by geographically defined areas and subpopulations, about a range of environmental exposures.</text> </subsection><subsection id="H6E7532C2A90B497E8FD5E22CD738502C"><enum>(b)</enum><header>In general</header><text>In meeting the purpose of this section, the Secretary shall ensure that biomonitoring data are collected intramurally through appropriate sources, including the National Health and Nutrition Examination Survey, and extramurally shall enter into collaboration or partnerships with other entities to obtain additional information regarding vulnerable subpopulations or other subpopulations.</text> </subsection><subsection id="H4ABA57B6079C4B39BC4DB944822C16CE"><enum>(c)</enum><header>Cooperative agreements</header> <paragraph id="HD5BB9C9D4B2344FB96067D0C47F04573"><enum>(1)</enum><header>In general</header><text>The Secretary, acting through the Director, shall enter into cooperative agreements with States or consortia of States to support the purposes of this title.</text> </paragraph><paragraph id="H617FCFDC1B5248E5B3F8BBF6A3CB860A"><enum>(2)</enum><header>Applications</header><text>Applications for such cooperative agreements by consortia of States shall address the manner in which such States will coordinate activities with other States in the region, and shall designate a lead State for administrative purposes.</text> </paragraph><paragraph id="H7E7CFD42A9FD4A568CE7C9DD500E50B6"><enum>(3)</enum><header>Training and quality assurance</header><text>The Secretary, acting through the Director, shall through the cooperative agreements with States or a consortia of States provide laboratory training and quality assurance.</text> </paragraph></subsection><subsection commented="no" id="H1324BC354C544D5D8206CF3EB1382F34"><enum>(d)</enum><header>Privacy</header><text>In carrying out this section, the Secretary shall ensure the protection of privacy of individually identifiable health information, including ensuring protection consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.</text> </subsection><subsection id="H705B6C4C987A48039532229A018756D9"><enum>(e)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2014.</text> </subsection></section>.