[Congressional Record Volume 166, Number 169 (Tuesday, September 29, 2020)]
[House]
[Pages H5010-H5012]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               TRIBAL HEALTH DATA IMPROVEMENT ACT OF 2020

  Mr. PALLONE. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 7948) to amend the Public Health Service Act with respect to 
the collection and availability of health data with respect to Indian 
Tribes, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 7948

       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 ``Tribal Health Data 
     Improvement Act of 2020''.

     SEC. 2. COLLECTION AND AVAILABILITY OF HEALTH DATA WITH 
                   RESPECT TO INDIAN TRIBES.

       (a) Data Collection.--Section 3101(a)(1) of the Public 
     Health Service Act (42 U.S.C. 300kk(a)(1)) is amended--
       (1) by striking ``, by not later than 2 years after the 
     date of enactment of this title,''; and
       (2) in subparagraph (B), by inserting ``Tribal,'' after 
     ``State,''.
       (b) Data Reporting and Dissemination.--Section 3101(c) of 
     the Public Health Service Act (42 U.S.C. 300kk(c)) is 
     amended--
       (1) by amending subparagraph (F) of paragraph (1) to read 
     as follows:
       ``(F) the Indian Health Service, Indian Tribes, Tribal 
     organizations, and epidemiology centers authorized under the 
     Indian Health Care Improvement Act;''; and
       (2) in paragraph (3), by inserting ``Indian Tribes, Tribal 
     organizations, and epidemiology centers,'' after ``Federal 
     agencies,''.
       (c) Protection and Sharing of Data.--Section 3101(e) of the 
     Public Health Service Act (42 U.S.C. 300kk(e)) is amended by 
     adding at the end the following new paragraphs:
       ``(3) Data sharing strategy.--With respect to data access 
     for Tribal epidemiology centers and Tribes, the Secretary 
     shall create a data sharing strategy that takes into 
     consideration recommendations by the Secretary's Tribal 
     Advisory Committee for--
       ``(A) ensuring that Tribal epidemiology centers and Indian 
     Tribes have access to the data sources necessary to 
     accomplish their public health responsibilities; and
       ``(B) protecting the privacy and security of such data.
       ``(4) Tribal public health authority.--
       ``(A) Availability.--Beginning not later than 180 days 
     after the date of the enactment of the Tribal Health Data 
     Improvement Act of 2020, the Secretary shall make available 
     to the entities listed in subparagraph (B) all data that is 
     collected pursuant to this title with respect to health care 
     and public health surveillance programs and activities, 
     including such programs and activities that are federally 
     supported or conducted, so long as--
       ``(i) such entities request the data pursuant to statute; 
     and
       ``(ii) the data is requested for use--

       ``(I) consistent with Federal law and obligations; and
       ``(II) to satisfy a particular purpose or carry out a 
     specific function consistent with the purpose for which the 
     data was collected.

       ``(B) Entities.--The entities listed in this subparagraph 
     are--
       ``(i) the Indian Health Service;
       ``(ii) Indian Tribes and Tribal organizations; and
       ``(iii) epidemiology centers.''.
       (d) Technical Updates.--Section 3101 of the Public Health 
     Service Act (42 U.S.C. 300kk) is amended--
       (1) by striking subsections (g) and (h); and
       (2) by redesignating subsection (i) as subsection (h).
       (e) Definitions.--After executing the amendments made by 
     subsection (d), section 3101 of the Public Health Service Act 
     (42 U.S.C. 300kk) is amended by inserting after subsection 
     (f) the following new subsection:
       ``(g) Definitions.--In this section:
       ``(1) The term `epidemiology center' means an epidemiology 
     center established under section 214 of the Indian Health 
     Care Improvement Act, including such Tribal epidemiology 
     centers serving Indian Tribes regionally and any Tribal 
     epidemiology center serving Urban Indian organizations 
     nationally.
       ``(2) The term `Indian Tribe' has the meaning given to the 
     term `Indian tribe' in section 4 of the Indian Self-
     Determination and Education Assistance Act.
       ``(3) The term `Tribal organization' has the meaning given 
     to the term `tribal organization' in section 4 of the of the 
     Indian Self-Determination and Education Assistance Act.
       ``(4) The term `Urban Indian organization' has the meaning 
     given to that term in section 4 of the Indian Health Care 
     Improvement Act.''.
       (f) Technical Correction.--Section 3101(b) of the Public 
     Health Service Act (42 U.S.C. 300kk(b)) is amended by 
     striking ``Data Analysis.--'' and all that follows through 
     ``For each federally'' and inserting ``Data Analysis.--For 
     each federally''.

     SEC. 3. IMPROVING HEALTH STATISTICS REPORTING WITH RESPECT TO 
                   INDIAN TRIBES.

       (a) Technical Aid to States and Localities.--Section 306(d) 
     of the Public Health Service Act (42 U.S.C. 242k(d)) is 
     amended by inserting ``, Indian Tribes, Tribal organizations, 
     and epidemiology centers'' after ``jurisdictions''.
       (b) Cooperative Health Statistics System.--Section 
     306(e)(3) of the Public Health Service Act (42 U.S.C. 
     242k(e)(3)) is amended by inserting ``, Indian Tribes, Tribal 
     organizations, and epidemiology centers'' after ``health 
     agencies''.
       (c) Federal-State-Tribal Cooperation.--Section 306(f) of 
     the Public Health Service Act (42 U.S.C. 242k(f)) is 
     amended--
       (1) by inserting ``the Indian Health Service,'' before 
     ``the Departments of Commerce'';
       (2) by inserting a comma after ``the Departments of 
     Commerce and Labor'';
       (3) by inserting ``, Indian Tribes, Tribal organizations, 
     and epidemiology centers'' after ``State and local health 
     departments and agencies''; and
       (4) by striking ``he shall'' and inserting ``the Secretary 
     shall''.
       (d) Registration Area Records.--Section 306(h)(1) of the 
     Public Health Service Act (42 U.S.C. 242k(h)(1)) is amended--
       (1) by striking ``in his discretion'' and inserting ``in 
     the discretion of the Secretary''; and
       (2) by striking ``Hispanics, Asian Americans, and Pacific 
     Islanders'' and inserting ``American Indians and Alaska 
     Natives, Hispanics, Asian Americans, and Native Hawaiian and 
     other Pacific Islanders''.
       (e) National Committee on Vital and Health Statistics.--
     Section 306(k) of the Public Health Service Act (42 U.S.C. 
     242k(k)) is amended--
       (1) in paragraph (3), by striking ``, not later than 60 
     days after the date of the enactment of the Health Insurance 
     Portability and Accountability Act of 1996,'' each place it 
     appears; and
       (2) in paragraph (7), by striking ``Not later than 1 year 
     after the date of the enactment of the Health Insurance 
     Portability and Accountability Act of 1996, and annually 
     thereafter, the Committee shall'' and inserting ``The 
     Committee shall, on an biennial basis,''.
       (f) Grants for Assembly and Analysis of Data on Ethnic and 
     Racial Populations.--Section 306(m)(4) of the Public Health 
     Service Act (42 U.S.C. 242k(m)(4)) is amended--
       (1) in subparagraph (A)--
       (A) by striking ``Subject to subparagraph (B), the'' and 
     inserting ``The''; and
       (B) by striking ``and major Hispanic subpopulation groups 
     and American Indians'' and inserting ``, major Hispanic 
     subgroups, and American Indians and Alaska Natives''; and
       (2) by amending subparagraph (B) to read as follows:
       ``(B) In carrying out subparagraph (A), with respect to 
     American Indians and Alaska Natives, the Secretary shall--
       ``(i) consult with Indian Tribes, Tribal organizations, the 
     Tribal Technical Advisory Group of the Centers for Medicare & 
     Medicaid Services maintained under section 5006(e) of the 
     American Recovery and Reinvestment Act of 2009, and the 
     Tribal Advisory Committee established by the Centers for 
     Disease Control and Prevention, in coordination with 
     epidemiology centers, to develop guidelines for State and 
     local health agencies to improve the quality and accuracy of 
     data with respect to the birth and death records of American 
     Indians and Alaska Natives;
       ``(ii) confer with Urban Indian organizations to develop 
     guidelines for State and local health agencies to improve the 
     quality and accuracy of data with respect to the birth and 
     death records of American Indians and Alaska Natives;
       ``(iii) enter into cooperative agreements with Indian 
     Tribes, Tribal organizations, Urban Indian organizations, and 
     epidemiology centers to address misclassification and 
     undersampling of American Indians and Alaska Natives with 
     respect to--
       ``(I) birth and death records; and
       ``(II) health care and public health surveillance systems, 
     including, but not limited to, data with respect to chronic 
     and infectious diseases, unintentional injuries, 
     environmental health, child and adolescent health, maternal 
     health and mortality, foodborne and waterborne illness, 
     reproductive health, and any other notifiable disease or 
     condition;
       ``(iv) encourage States to enter into data sharing 
     agreements with Indian Tribes, Tribal organizations, and 
     epidemiology centers to improve the quality and accuracy of 
     public health data; and
       ``(v) not later than 180 days after the date of enactment 
     of the Tribal Health Data Improvement Act of 2020, and 
     biennially thereafter, issue a report on the following:
       ``(I) Which States have data sharing agreements with Indian 
     Tribes, Tribal organizations,

[[Page H5011]]

     Urban Indian organizations, and Tribal epidemiology centers 
     to improve the quality and accuracy of health data.
       ``(II) What the Centers for Disease Control and Prevention 
     is doing to encourage States to enter into data sharing 
     agreements with Indian Tribes, Tribal organizations, Urban 
     Indian organizations, and Tribal epidemiology centers to 
     improve the quality and accuracy of health data.
       ``(III) Best practices and guidance for States, Indian 
     Tribes, Tribal organizations, Urban Indian organizations, and 
     Tribal epidemiology centers that wish to enter into data 
     sharing agreements.
       ``(IV) Best practices and guidance for local, State, 
     Tribal, and Federal uniform standards for the collection of 
     data on race and ethnicity.''.
       (g) Definitions.--Section 306 of the Public Health Service 
     Act (42 U.S.C. 242k) is amended--
       (1) by redesignating subsection (n) as subsection (o); and
       (2) by inserting after subsection (m) the following:
       ``(n) In this section:
       ``(1) The term `epidemiology center' means an epidemiology 
     center established under section 214 of the Indian Health 
     Care Improvement Act, including such Tribal epidemiology 
     centers serving Indian Tribes regionally and any Tribal 
     epidemiology center serving Urban Indian organizations 
     nationally.
       ``(2) The term `Indian Tribe' has the meaning given to the 
     term `Indian tribe' in section 4 of the Indian Self-
     Determination and Education Assistance Act.
       ``(3) The term `Tribal organization' has the meaning given 
     to the term `tribal organization' in section 4 of the Indian 
     Self-Determination and Education Assistance Act.
       ``(4) The term `Urban Indian organization' has the meaning 
     given to that term in section 4 of the Indian Health Care 
     Improvement Act.''.
       (h) Authorization of Appropriations.--Section 306(o) of the 
     Public Health Service Act, as redesignated by subsection (g), 
     is amended to read as follows:
       ``(o)(1) To carry out this section, there is authorized to 
     be appropriated $185,000,000 for each of the fiscal years 
     2021 through 2025.
       ``(2) Of the amount authorized to be appropriated to carry 
     out this section for a fiscal year, the Secretary shall not 
     use more than 10 percent for the combined costs of--
       ``(A) administration of this section; and
       ``(B) carrying out subsection (m)(2).''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Oregon (Mr. Walden) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 7948.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, the health of American Indian and Alaska Native 
populations lags behind all other races in the United States. Economic 
adversity and poor social conditions have contributed to 
disproportionate disease burden, lower life expectancies, and other 
health inequalities in Tribal communities. Tragically, Tribal members 
are expected to live 5.5 fewer years than other races.
  Now, the coronavirus pandemic has further highlighted these 
longstanding health inequalities. According to CDC data, more than one-
third of nonelderly American Indians and Alaska Natives are at high 
risk of developing a serious illness resulting from a COVID-19 
infection, compared with one-fifth of the White nonelderly adults.
  Today, we are taking an important step in improving health outcomes 
by improving data access for Tribal Epidemiology Centers. These centers 
manage regional public health information systems, disease prevention 
and control programs, and coordinate with other public health 
authorities in the collection and study of epidemiological data. None 
of these functions work if Federal, State, and local partners are not 
sharing relevant data in a secured manner.
  H.R. 7948, the Tribal Health Data Improvement Act, ensures that 
Tribal Nations are equipped with the necessary public health data to 
operate public health programs and improve health outcomes within their 
communities. It does this by clarifying the Federal role in collection 
and availability of health data with respect to Indian Tribes.
  The legislation also mandates ways of improving health statistics 
reporting with respect to Indian Tribes, such as requiring the 
Secretary to release all applicable public health data on Tribal 
Epidemiology Centers within 180 days of enactment and requiring the CDC 
to expand and improve their assistance to States with respect to 
sharing data with Tribal entities.
  Finally, the bill reauthorizes the National Center for Health 
Statistics with additional funding for the new programs that are 
established by the bill.
  I want to thank Representatives Gianforte, Lujan, Rodgers, Mullin, 
O'Halleran, and Ruiz for the excellent bipartisan work on this 
legislation.
  I urge my colleagues to support the bill, and I reserve the balance 
of my time.
  Mr. WALDEN. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in strong support of H.R. 7948, the 
Tribal Health Data Improvement Act, introduced by my Energy and 
Commerce Committee colleagues, Representatives Gianforte, Ruiz, 
Rodgers, O'Halleran, and Lujan.
  This is really important public health legislation. It addresses some 
chronic challenges that are faced by Tribal Nations and Tribal 
Epidemiology Centers as they try to gain access to critical Federal 
healthcare and public health surveillance data.
  Obtaining this data is critical for engaging in preventive public 
health work and combating current health crises in American Indian and 
Alaska Native communities. However, structural barriers to accessing 
data have been especially problematic during the COVID-19 pandemic, 
which, tragically, has disproportionately impacted these very 
communities.
  In order to ensure Tribal Nations and Tribal Epidemiology Centers 
have access to the data necessary to accomplish public health 
priorities, this legislation requires the Secretary of Health and Human 
Services to create a data-sharing strategy that takes into 
consideration the recommendations of the Secretary's Tribal Advisory 
Committee.
  In addition, in reauthorizing the CDC's National Center for Health 
Statistics, the bill requires the Secretary to make public health 
surveillance data available to the Indian Health Service, Indian 
Tribes, Tribal organizations, and Tribal Epidemiology Centers, so long 
as the data requested for use is consistent with Federal law and, of 
course, obligations.
  The Secretary must also consult with Indian Tribes, Tribal 
organizations, urban Indian organizations, and the Tribal Health 
Advisory Group of the Centers for Medicare and Medicaid Services to 
develop guidelines for State and local health agencies to improve the 
quality and accuracy of birth and death records of American Indians and 
Alaska Natives.
  By improving the sharing of data between the Federal Government and 
the Tribes, this important bill would help address the health 
disparities in American Indian and Alaska Native communities.
  Madam Speaker, I urge a ``yes'' vote on this legislation, and I 
reserve the balance of my time.

                              {time}  1530

  Mr. PALLONE. Madam Speaker, I yield such time as he may consume to 
the gentleman from New Mexico (Mr. Lujan), a leader on Tribal issues.
  Mr. LUJAN. Madam Speaker, during this COVID-19 pandemic, which has 
already killed more than 200,000 Americans, it is crucial that the CDC 
and State health departments are sharing essential, lifesaving public 
health data from Tribal epidemiology centers to protect the health of 
the people they serve.
  TECs, like any State or local health department, are legally entitled 
to access to the same data, but for the first months of the public 
health emergency, this data was withheld, despite the urging of Tribal 
leaders, myself, and fellow members of the Energy and Commerce 
Committee.
  This data, including information on COVID-19 testing, positive case 
numbers, contact tracing, and more, is essential for Tribes and TECs to 
protect the health and well-being of the communities they serve.
  That is why Representative Gianforte and I introduced the bipartisan 
Tribal Health Data Improvement Act with the support of the National

[[Page H5012]]

Indian Health Board. While the CDC Director has fulfilled the 
commitment he made to me to share COVID-related data with all the TECs, 
there are still barriers to accessing other important data sets that 
are crucial to protecting the public health during and after this 
pandemic.
  This important legislation makes it clear that the Department of 
Health and Human Services and State health departments are required to 
share data with Tribal health authorities, and it includes additional 
funding to make this happen.
  This legislation is about justice and living up to the Federal 
Government's legal responsibility. It would help save lives as we 
continue working to defeat this virus. Tribes and TECs are working hard 
to protect public health in their communities, and it is their right to 
access the CDC data to do so.
  Madam Speaker, I look forward to seeing the House pass this 
legislation, and I will urge my colleagues in the Senate to act with 
the same urgency.
  Mr. WALDEN. Madam Speaker, I want to thank my colleagues, especially 
my friend from New Mexico for his leadership on this legislation. I 
would just say that they have all worked very hard on this. It is 
extraordinarily important to pass this.
  Madam Speaker, I yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I also urge support of the bill, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 7948, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________