Social Determinants Accelerator Act of 2019
This bill establishes the Social Determinants Accelerator Interagency Council and provides funds for the council to (1) assist the Centers for Medicare & Medicaid Services (CMS) in awarding specified grants, (2) increase coordination among health and social service programs, and (3) provide program evaluation guidance and technical assistance to increase the impact of social service programs. Specifically, the bill provides funds for the CMS to award up to 25 grants to state, local, or tribal health or human services agencies for the development of social determinants accelerator plans that address at least one health and one social outcome for a specified target population.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4004 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 4004
To direct the Secretary of Health and Human Services to establish an
interagency council on social determinants of health, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 25, 2019
Mrs. Bustos (for herself, Mr. Cole, Mr. McGovern, Mrs. Rodgers of
Washington, Mr. Rush, Ms. Barragan, Mr. Engel, Mr. Butterfield, Mr.
Cardenas, Mr. Morelle, Mr. Fitzpatrick, Mr. Schrader, Mr. Soto, Mr.
Michael F. Doyle of Pennsylvania, and Ms. Blunt Rochester) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To direct the Secretary of Health and Human Services to establish an
interagency council on social determinants of health, 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 ``Social Determinants Accelerator Act
of 2019''.
SEC. 2. FINDINGS; PURPOSES.
(a) Findings.--Congress finds the following:
(1) There is a significant body of evidence showing that
economic and social conditions have a powerful impact on
individual and population health outcomes and well-being, as
well as medical costs.
(2) State, local, and Tribal governments and the service
delivery partners of such governments face significant
challenges in coordinating benefits and services delivered
through the Medicaid program and other social services programs
because of the fragmented and complex nature of Federal and
State funding and administrative requirements.
(3) The Federal Government should prioritize and
proactively assist State and local governments to strengthen
the capacity of State and local governments to improve health
and social outcomes for individuals, thereby improving cost-
effectiveness and return on investment.
(b) Purposes.--The purposes of this Act are as follows:
(1) To establish effective, coordinated Federal technical
assistance to help State and local governments to improve
outcomes and cost-effectiveness of, and return on investment
from, health and social services programs.
(2) To build a pipeline of State and locally designed,
cross-sector interventions and strategies that generate
rigorous evidence about how to improve health and social
outcomes, and increase the cost-effectiveness of, and return on
investment from, Federal, State, local, and Tribal health and
social services programs.
(3) To enlist State and local governments and the service
providers of such governments as partners in identifying
Federal statutory, regulatory, and administrative challenges in
improving the health and social outcomes of, cost-effectiveness
of, and return on investment from, Federal spending on
individuals enrolled in Medicaid.
(4) To develop strategies to improve health and social
outcomes without denying services to, or restricting the
eligibility of, vulnerable populations.
SEC. 3. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.
(a) Establishment.--The Secretary of Health and Human Services
(referred to in this Act as the ``Secretary''), in coordination with
the Administrator of the Centers for Medicare & Medicaid Services
(referred to in this Act as the ``Administrator''), shall establish an
interagency council, to be known as the Social Determinants Accelerator
Interagency Council (referred to in this Act as the ``Council'') to
achieve the purposes listed in section 2(b).
(b) Membership.--
(1) Federal composition.--The Council shall be composed of
at least one designee from each of the following Federal
agencies:
(A) The Office of Management and Budget.
(B) The Department of Agriculture.
(C) The Department of Education.
(D) The Indian Health Service.
(E) The Department of Housing and Urban
Development.
(F) The Department of Labor.
(G) The Department of Transportation.
(H) Any other Federal agency the Chair of the
Council determines necessary.
(2) Designation.--
(A) In general.--The head of each agency specified
in paragraph (1) shall designate at least one employee
described in subparagraph (B) to serve as a member of
the Council.
(B) Responsibilities.--An employee described in
this subparagraph shall be a senior employee of the
agency--
(i) whose responsibilities relate to
authorities, policies, and procedures with
respect to the health and well-being of
individuals receiving medical assistance under
a State plan (or a waiver of such plan) under
title XIX of the Social Security Act (42 U.S.C.
1396 et seq.); or
(ii) who has authority to implement and
evaluate transformative initiatives that
harness data or conducts rigorous evaluation to
improve the impact and cost-effectiveness of
federally funded services and benefits.
(3) HHS representation.--In addition to the designees under
paragraph (1), the Council shall include designees from at
least three agencies within the Department of Health and Human
Services, including the Centers for Medicare & Medicaid
Services, at least one of whom shall meet the criteria under
paragraph (2)(B).
(4) OMB role.--The Director of the Office of Management and
Budget shall facilitate the timely resolution of Governmentwide
and multiagency issues to help the Council achieve consensus
recommendations described under subsection (c)(1).
(5) Non-federal composition.--The Comptroller General of
the United States may designate up to 6 Council designees--
(A) who have relevant subject matter expertise,
including expertise implementing and evaluating
transformative initiatives that harness data and
conduct evaluations to improve the impact and cost-
effectiveness of Federal Government services; and
(B) that each represent--
(i) State, local, and Tribal health and
human services agencies;
(ii) public housing authorities or State
housing finance agencies;
(iii) State and local government budget
offices;
(iv) State Medicaid agencies; or
(v) national consumer advocacy
organizations.
(6) Chair.--
(A) In general.--The Secretary shall select the
Chair of the Council from among the members of the
Council.
(B) Initiating guidance.--The Chair, on behalf of
the Council, shall identify and invite individuals from
diverse entities to provide the Council with advice and
information pertaining to addressing social
determinants of health, including--
(i) individuals from State and local
government health and human services agencies;
(ii) individuals from State Medicaid
agencies;
(iii) individuals from State and local
government budget offices;
(iv) individuals from public housing
authorities or State housing finance agencies;
(v) individuals from nonprofit
organizations, small businesses, and
philanthropic organizations;
(vi) advocates;
(vii) researchers; and
(viii) any other individuals the Chair
determines to be appropriate.
(c) Duties.--The duties of the Council are--
(1) to make recommendations to the Secretary and the
Administrator regarding the criteria for making awards under
section 4;
(2) to identify Federal authorities and opportunities for
use by States or local governments to improve coordination of
funding and administration of Federal programs, the
beneficiaries of whom include individuals described in section
2, and which may be unknown or underutilized and to make
information on such authorities and opportunities publicly
available;
(3) to provide targeted technical assistance to States
developing a social determinants accelerator plan under section
4, including identifying potential statutory or regulatory
pathways for implementation of the plan and assisting in
identifying potential sources of funding to implement the plan;
(4) to report to Congress annually on the subjects set
forth in subsection (e);
(5) to develop and disseminate evaluation guidelines and
standards that can be used to reliably assess the impact of an
intervention or approach that may be implemented pursuant to
this Act on outcomes, cost-effectiveness of, and return on
investment from Federal, State, local, and Tribal governments,
and to facilitate technical assistance, where needed, to help
to improve State and local evaluation designs and
implementation;
(6) to seek feedback from State, local, and Tribal
governments, including through an annual survey by an
independent third party, on how to improve the technical
assistance the Council provides to better equip State, local,
and Tribal governments to coordinate health and social service
programs;
(7) to solicit applications for grants under section 4; and
(8) to coordinate with other cross-agency initiatives
focused on improving the health and well-being of low-income
and at-risk populations in order to prevent unnecessary
duplication between agency initiatives.
(d) Schedule.--Not later than 60 days after the date of the
enactment of this Act, the Council shall convene to develop a schedule
and plan for carrying out the duties described in subsection (c),
including solicitation of applications for the grants under section 4.
(e) Report to Congress.--The Council shall submit an annual report
to Congress, which shall include--
(1) a list of the Council members;
(2) activities and expenditures of the Council;
(3) summaries of the interventions and approaches that will
be supported by State, local, and Tribal governments that
received a grant under section 4, including--
(A) the best practices and evidence-based
approaches such governments plan to employ to achieve
the purposes listed in section 2(b); and
(B) a description of how the practices and
approaches will impact the outcomes, cost-effectiveness
of, and return on investment from, Federal, State,
local, and Tribal governments with respect to such
purposes;
(4) the feedback received from State and local governments
on ways to improve the technical assistance of the Council,
including findings from a third-party survey and actions the
Council plans to take in response to such feedback; and
(5) the major statutory, regulatory, and administrative
challenges identified by State, local, and Tribal governments
that received a grant under section 4, and the actions that
Federal agencies are taking to address such challenges.
(f) FACA Applicability.--The Federal Advisory Committee Act (5
U.S.C. App.) shall not apply to the Council.
(g) Council Procedures.--The Secretary, in consultation with the
Comptroller General of the United States and the Director of the Office
of Management and Budget, shall establish procedures for the Council
to--
(1) ensure that adequate resources are available to
effectively execute the responsibilities of the Council;
(2) effectively coordinate with other relevant advisory
bodies and working groups to avoid unnecessary duplication;
(3) create transparency to the public and Congress with
regard to Council membership, costs, and activities, including
through use of modern technology and social media to
disseminate information; and
(4) avoid conflicts of interest that would jeopardize the
ability of the Council to make decisions and provide
recommendations.
SEC. 4. SOCIAL DETERMINANTS ACCELERATOR GRANTS TO STATES OR LOCAL
GOVERNMENTS.
(a) Grants to States, Local Governments, and Tribes.--Not later
than 180 days after the date of the enactment of this Act, the
Administrator, in consultation with the Secretary and the Council,
shall award on a competitive basis not more than 25 grants to eligible
applicants described in subsection (b), for the development of social
determinants accelerator plans, as described in subsection (f).
(b) Eligible Applicant.--An eligible applicant described in this
section is a State, local, or Tribal health or human services agency
that--
(1) demonstrates the support of relevant parties across
relevant State, local, or Tribal jurisdictions; and
(2) in the case of an applicant that is a local government
agency, provides to the Secretary a letter of support from the
lead State health or human services agency for the State in
which the local government is located.
(c) Amount of Grant.--The Administrator, in coordination with the
Council, shall determine the total amount that the Administrator will
make available to each grantee under this section.
(d) Application.--An eligible applicant seeking a grant under this
section shall include in the application the following information:
(1) The target population (or populations) that would
benefit from implementation of the social determinants
accelerator plan proposed to be developed by the applicant.
(2) A description of the objective or objectives and
outcome goals of such proposed plan, which shall include at
least one health outcome and at least one other important
social outcome.
(3) The sources and scope of inefficiencies that, if
addressed by the plan, could result in improved cost-
effectiveness of or return on investment from Federal, State,
local, and Tribal governments.
(4) A description of potential interventions that could be
designed or enabled using such proposed plan.
(5) The State, local, Tribal, academic, nonprofit,
community-based organizations, and other private sector
partners that would participate in the development of the
proposed plan and subsequent implementation of programs or
initiatives included in such proposed plan.
(6) Such other information as the Administrator, in
consultation with the Secretary and the Council, determines
necessary to achieve the purposes of this Act.
(e) Use of Funds.--A recipient of a grant under this section may
use funds received through the grant for the following purposes:
(1) To convene and coordinate with relevant government
entities and other stakeholders across sectors to assist in the
development of a social determinant accelerator plan.
(2) To identify populations of individuals receiving
medical assistance under a State plan (or a waiver of such
plan) under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) who may benefit from the proposed approaches to
improving the health and well-being of such individuals through
the implementation of the proposed social determinants
accelerator plan.
(3) To engage qualified research experts to advise on
relevant research and to design a proposed evaluation plan, in
accordance with the standards and guidelines issued by the
Administrator.
(4) To collaborate with the Council to support the
development of social determinants accelerator plans.
(5) To prepare and submit a final social determinants
accelerator plan to the Council.
(f) Contents of Plans.--A social determinant accelerator plan
developed under this section shall include the following:
(1) A description of the target population (or populations)
that would benefit from implementation of the social
determinants accelerator plan, including an analysis describing
the projected impact on the well-being of individuals described
in subsection (e)(2).
(2) A description of the interventions or approaches
designed under the social determinants accelerator plan and the
evidence for selecting such interventions or approaches.
(3) The objectives and outcome goals of such interventions
or approaches, including at least one health outcome and at
least one other important social outcome.
(4) A plan for accessing and linking relevant data to
enable coordinated benefits and services for the jurisdictions
described in subsection (b)(1) and an evaluation of the
proposed interventions and approaches.
(5) A description of the State, local, Tribal, academic,
nonprofit, or community-based organizations, or any other
private sector organizations that would participate in
implementing the proposed interventions or approaches, and the
role each would play to contribute to the success of the
proposed interventions or approaches.
(6) The identification of the funding sources that would be
used to finance the proposed interventions or approaches.
(7) A description of any financial incentives that may be
provided, including outcome-focused contracting approaches to
encourage service providers and other partners to improve
outcomes of, cost-effectiveness of, and return on investment
from, Federal, State, local, or Tribal government spending.
(8) The identification of the applicable Federal, State,
local, or Tribal statutory and regulatory authorities,
including waiver authorities, to be leveraged to implement the
proposed interventions or approaches.
(9) A description of potential considerations that would
enhance the impact, scalability, or sustainability of the
proposed interventions or approaches and the actions the grant
awardee would take to address such considerations.
(10) A proposed evaluation plan, to be carried out by an
independent evaluator, to measure the impact of the proposed
interventions or approaches on the outcomes of, cost-
effectiveness of, and return on investment from, Federal,
State, local, and Tribal governments.
(11) Precautions for ensuring that vulnerable populations
will not be denied access to Medicaid or other essential
services as a result of implementing the proposed plan.
SEC. 5. FUNDING.
(a) In General.--Out of any money in the Treasury not otherwise
appropriated, there is appropriated to carry out this Act $25,000,000,
of which up to $5,000,000 may be used to carry out this Act, to remain
available for obligation until the date that is 5 years after the date
of enactment of this Act.
(b) Reservation of Funds.--
(1) In general.--Of the funds made available under
subsection (a), the Secretary shall reserve not less than 20
percent to award grants to eligible applicants for the
development of social determinants accelerator plans under
section 4 intended to serve rural populations.
(2) Exception.--In the case of a fiscal year for which the
Secretary determines that there are not sufficient eligible
applicants to award up to 25 grants under section 4 that are
intended to serve rural populations and the Secretary cannot
satisfy the 20-percent requirement, the Secretary may reserve
an amount that is less than 20 percent of amounts made
available under subsection (a) to award grants for such
purpose.
(c) Rule of Construction.--Nothing in this Act shall prevent
Federal agencies represented on the Council from contributing
additional funding from other sources to support activities to improve
the effectiveness of the Council.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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