[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1028 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1028

    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

                              May 13, 2009

 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 ``Strengthening America's Public 
Health System 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, 2011, 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 $190,000,000 for each of fiscal 
years 2010 through 2013, of which--
            ``(1) not less than $95,000,000 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 
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 2010 through 2013, of which--
            ``(1) $5,000,000 shall be made available in each such 
        fiscal year for epidemiology fellowship training program 
        activities under subsections (b) and (c);
            ``(2) $5,000,000 shall be made available in each such 
        fiscal year for laboratory fellowship training programs under 
        subsection (b);
            ``(3) $5,000,000 shall be made available in each such 
        fiscal year for the Public Health Informatics Fellowship 
        Program under subsection (e); and
            ``(4) $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 Strengthening America's Public Health 
                System 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 U.S.-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 2010 through 2011.''.
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