[Congressional Record Volume 167, Number 108 (Tuesday, June 22, 2021)]
[House]
[Pages H2950-H2952]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               TRIBAL HEALTH DATA IMPROVEMENT ACT OF 2021

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3841) 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.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3841

       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 2021''.

     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 2021, 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 a 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

[[Page H2951]]

     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 2021, and 
     biennially thereafter, issue a report on the following:
       ``(I) Which States have data sharing agreements with Indian 
     Tribes, Tribal organizations, 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 
     2022 through 2026.
       ``(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 Florida (Mr. Bilirakis) 
each will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
to include any extraneous material on H.R. 3841.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, American Indian and Alaska Native communities experience 
disproportionately worse health outcomes than other groups in the 
United States. The root causes of these poor health outcomes are 
complex, but, unfortunately, not surprising. For centuries, American 
Indian and Alaska Native communities have been displaced and damaged by 
violence, poverty, disease, and adverse social conditions. As a result, 
Tribal members live shorter lives than any other demographic group.
  Unfortunately, the COVID-19 pandemic has also devastated Tribal 
communities. According to data from the Centers for Disease Control and 
Prevention, American Indians and Alaska Natives are at greater risk of 
COVID-19 infection and more than three times more likely to be 
hospitalized.
  Moreover, there are significant gaps in data collection and the full 
picture of the disease burden is really unknown. So it is important for 
us to improve Tribal health data collection efforts so that we can 
improve health outcomes. Tribal Epidemiology Centers manage regional 
public health information systems and disease prevention and control 
services. These centers also collaborate with other public health 
authorities to study, collect, and analyze epidemiological data.
  Clear communication and coordination by Federal, State, and local 
public health departments is necessary to the success and security of 
these efforts. So the bill before us, H.R. 3841, the Tribal Health Data 
Improvement Act, equips Tribal communities with enhanced resources to 
collect public health data and adapt public health programs to improve 
health outcomes.
  The bill clarifies the Federal Government's role in the collection 
and distribution of public health and disease surveillance data. It 
does this by creating a strategy to share information with the Indian 
Health Service, Indian Tribes and organizations, and Tribal 
Epidemiology Centers.
  The legislation requires the Secretary of Health and Human Services 
to release all applicable public health data to Tribal entities within 
180 days of enactment.
  It also requires the CDC to encourage and enhance collaborative 
efforts between States and Tribal organizations to synergize data 
collection.
  Finally, the bill reauthorizes the National Center for Health 
Statistics with an additional $185 million in funding to implement the 
programs established by the legislation.
  I thank Representatives Mullin and O'Halleran for their bipartisan 
efforts to bringing this bill forward. They are always champions for 
the Tribes.
  Mr. Speaker, I urge my colleagues to support the bill, and I reserve 
the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 3841, the Tribal Health 
Data Improvement Act of 2021, introduced by my Energy and Commerce 
colleagues, Representatives Mullin and O'Halleran.
  This important public health bill addresses the chronic challenges 
faced by Tribal Nations and Tribal Epidemiology Centers in gaining 
access to critical healthcare and public health surveillance data.
  Obtaining this data is necessary for engaging in preventative public 
health work and combating the current health crises in American Indian 
and Alaska Native communities.
  Structural barriers to accessing data have been especially 
problematic during the COVID-19 pandemic, which has disproportionately 
impacted these communities. In order to ensure that Tribal Nations and 
Tribal Epidemiology Centers have access to the data necessary to 
accomplish public health priorities, the bill requires that the 
Secretary of HHS 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, the Tribal organizations, and Tribal Epidemiology Centers so 
long as the data requested for use is consistent with Federal law and 
obligations.
  The Secretary must also consult with Indian Tribes, Tribal 
organizations, urban Indian organizations, and the Tribal Technical 
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.
  It makes a lot of sense. By improving the sharing of data between the 
Federal Government and the Tribes, this

[[Page H2952]]

important bill would help address the health disparities in American 
Indian and Alaska Native communities.
  I urge a ``yes'' vote on this particular bill. Let's pass this bill 
swiftly and get it to the Senate.
  Mr. Speaker, I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I also urge support for 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. 3841.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROSENDALE. Mr. Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this motion 
are postponed.


                         Parliamentary Inquiry

  Mr. DEUTCH. Mr. Speaker, I make a point of order.
  The SPEAKER pro tempore. The gentleman will state his point of order.
  Mr. DEUTCH. Mr. Speaker, on all of these good bills that are being 
debated with strong bipartisan support on the Democratic side and the 
Republican side when they go to a voice vote, Mr. Speaker, does there 
need to be even one ``no'' vote, which there have not been for this 
whole series, for a Member to ask for a recorded vote?
  The SPEAKER pro tempore. The gentleman has not stated a proper point 
of order, but the Chair would inform Members that the gentleman from 
Montana requested the yeas and nays, and pursuant to section 3(s) of 
House Resolution 8, the yeas and nays have been ordered.

                          ____________________