Improving Social Determinants of Health Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 379 To authorize the Director of the Centers for Disease Control and Prevention to carry out a Social Determinants of Health Program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 21, 2021 Ms. BARRAGA´N (for herself, Mr. BUTTERFIELD, Mr. CA´RDENAS, Ms. CLARKE of New York, Ms. BLUNT ROCHESTER, Mr. RUSH, Ms. KELLY of Illinois, Mr. WELCH, Mr. KHANNA, Mr. DEUTCH, Ms. UNDERWOOD, Mr. HIG- GINS of New York, Mr. GRIJALVA, Ms. ROYBAL-ALLARD, Mr. COHEN, Ms. MOORE of Wisconsin, Ms. LEE of California, Mr. HASTINGS, Mr. CARSON, Ms. NORTON, Mr. RASKIN, Ms. SPANBERGER, Ms. JACKSON LEE, Mr. MORELLE, Mr. SABLAN, Ms. SA´NCHEZ, Mr. GARCI´A of Illinois, Mr. KILDEE, Mr. LEVIN of California, Ms. PORTER, and Ms. GARCIA of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To authorize the Director of the Centers for Disease Control and Prevention to carry out a Social Determinants of Health Program, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Improving Social De- 4 terminants of Health Act of 2021’’. 5 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 379 IH SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) Healthy People 2030 defines social deter- 3 minants of health as conditions in the environments 4 where people are born, live, learn, work, play, wor- 5 ship, and age that affect a wide range of health, 6 functioning, and quality-of-life outcomes and risks. 7 (2) One of the overarching goals of Healthy 8 People 2030 is to ‘‘create social, physical, and eco- 9 nomic environments that promote attaining the full 10 potential for health and well-being for all’’. 11 (3) Healthy People 2030 developed a ‘‘place- 12 based’’ organizing framework, reflecting five key 13 areas of social determinants of health namely— 14 (A) economic stability; 15 (B) education access and quality; 16 (C) social and community context; 17 (D) health care access and quality; and 18 (E) neighborhood and built environment. 19 (4) It is estimated that medical care accounts 20 for only 10 to 20 percent of the modifiable contribu- 21 tors to healthy outcomes for a population. 22 (5) The Centers for Medicare & Medicaid Serv- 23 ices has indicated the importance of the social deter- 24 minants in its work stating that, ‘‘As we seek to fos- 25 ter innovation, rethink rural health, find solutions to 26 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 379 IH the opioid epidemic, and continue to put patients 1 first, we need to take into account social deter- 2 minants of health and recognize their importance.’’. 3 (6) The Department of Health and Human 4 Services’ Public Health 3.0 initiative recognizes the 5 role of public health in working across sectors on so- 6 cial determinants of health, as well as the role of 7 public health as chief health strategist in commu- 8 nities. 9 (7) Through its Health Impact in 5 Years ini- 10 tiative, the Centers for Disease Control and Preven- 11 tion has highlighted nonclinical, community-wide ap- 12 proaches that show positive health impacts, results 13 within five years, and cost-effectiveness or cost-sav- 14 ings over the lifetime of the population or earlier. 15 (8) Health departments and the Centers for 16 Disease Control and Prevention are not funded for 17 such cross-cutting work. 18 SEC. 3. SOCIAL DETERMINANTS OF HEALTH PROGRAM. 19 (a) PROGRAM.—To the extent and in the amounts 20 made available in advance in appropriations Acts, the Di- 21 rector of the Centers for Disease Control and Prevention 22 (in this Act referred to as the ‘‘Director’’) shall carry out 23 a program, to be known as the Social Determinants of 24 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 379 IH Health Program (in this Act referred to as the ‘‘Pro- 1 gram’’), to achieve the following goals: 2 (1) Improve health outcomes and reduce health 3 inequities by coordinating social determinants of 4 health activities across the Centers for Disease Con- 5 trol and Prevention. 6 (2) Improve the capacity of public health agen- 7 cies and community organizations to address social 8 determinants of health in communities. 9 (b) ACTIVITIES.—To achieve the goals listed in sub- 10 section (a), the Director shall carry out activities including 11 the following: 12 (1) Coordinating across the Centers for Disease 13 Control and Prevention to ensure that relevant pro- 14 grams consider and incorporate social determinants 15 of health in grant awards and other activities. 16 (2) Awarding grants under section 4 to State, 17 local, territorial, and Tribal health agencies and or- 18 ganizations, and to other eligible entities, to address 19 social determinants of health in target communities. 20 (3) Awarding grants under section 5 to non- 21 profit organizations and public or other nonprofit in- 22 stitutions of higher education— 23 (A) to conduct research on best practices 24 to improve social determinants of health; 25 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 379 IH (B) to provide technical assistance, train- 1 ing, and evaluation assistance to grantees under 2 section 4; and 3 (C) to disseminate best practices to grant- 4 ees under section 4. 5 (4) Coordinating, supporting, and aligning ac- 6 tivities of the Centers for Disease Control and Pre- 7 vention related to social determinants of health with 8 activities of other Federal agencies related to social 9 determinants of health, including such activities of 10 agencies in the Department of Health and Human 11 Services such as the Centers for Medicare & Med- 12 icaid Services. 13 (5) Collecting and analyzing data related to the 14 social determinants of health. 15 SEC. 4. GRANTS TO ADDRESS SOCIAL DETERMINANTS OF 16 HEALTH. 17 (a) IN GENERAL.—The Director, as part of the Pro- 18 gram, shall award grants to eligible entities to address so- 19 cial determinants of health in their communities. 20 (b) ELIGIBILITY.—To be eligible to apply for a grant 21 under this section, an entity shall be— 22 (1) a State, local, territorial, or Tribal health 23 agency or organization; 24 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 379 IH (2) a qualified nongovernmental entity, as de- 1 fined by the Director; or 2 (3) a consortium of entities that includes a 3 State, local, territorial, or Tribal health agency or 4 organization. 5 (c) USE OF FUNDS.— 6 (1) IN GENERAL.—A grant under this section 7 shall be used to address social determinants of 8 health in a target community by designing and im- 9 plementing innovative, evidence-based, cross-sector 10 strategies. 11 (2) TARGET COMMUNITY.—For purposes of this 12 section, a target community shall be a State, county, 13 city, or other municipality. 14 (d) PRIORITY.—In awarding grants under this sec- 15 tion, the Director shall prioritize applicants proposing to 16 serve target communities with significant unmet health 17 and social needs, as defined by the Director. 18 (e) APPLICATION.—To seek a grant under this sec- 19 tion, an eligible entity shall— 20 (1) submit an application at such time, in such 21 manner, and containing such information as the Di- 22 rector may require; 23 (2) propose a set of activities to address social 24 determinants of health through evidence-based, 25 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 379 IH cross-sector strategies, which activities may in- 1 clude— 2 (A) collecting quantifiable data from health 3 care, social services, and other entities regard- 4 ing the most significant gaps in health-pro- 5 moting social, economic, and environmental 6 needs; 7 (B) identifying evidence-based approaches 8 to meeting the nonmedical, social needs of pop- 9 ulations identified by data collection described 10 in subparagraph (A), such as unstable housing 11 or food insecurity; 12 (C) developing scalable methods to meet 13 patients’ social needs identified in clinical set- 14 tings or other sites; 15 (D) convening entities such as local and 16 State governmental and nongovernmental orga- 17 nizations, health systems, payors, and commu- 18 nity-based organizations to review, plan, and 19 implement community-wide interventions and 20 strategies to advance health-promoting social 21 conditions; 22 (E) monitoring and evaluating the impact 23 of activities funded through the grant on the 24 health and well-being of the residents of the 25 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 379 IH target community and on the cost of health 1 care; and 2 (F) such other activities as may be speci- 3 fied by the Director; 4 (3) demonstrate how the eligible entity will col- 5 laborate with— 6 (A) health systems; 7 (B) payors, including, as appropriate, med- 8 icaid managed care organizations (as defined in 9 section 1903(m)(1)(A) of the Social Security 10 Act (42 U.S.C. 1396b(m)(1)(A))), Medicare 11 Advantage plans under part C of title XVIII of 12 such Act (42 U.S.C. 1395w–21 et seq.), and 13 health insurance issuers and group health plans 14 (as such terms are defined in section 2791 of 15 the Public Health Service Act); 16 (C) other relevant stakeholders and initia- 17 tives in areas of need, such as the Accountable 18 Health Communities Model of the Centers for 19 Medicare & Medicaid Services, health homes 20 under the Medicaid program under title XIX of 21 the Social Security Act (42 U.S.C. 1396 et 22 seq.), community-based organizations, and 23 human services organizations; 24 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 379 IH (D) other non-health care sector organiza- 1 tions, including organizations focusing on trans- 2 portation, housing, or food access; and 3 (E) local employers; and 4 (4) identify key health inequities in the target 5 community and demonstrate how the proposed ef- 6 forts of the eligible entity would address such inequi- 7 ties. 8 (f) MONITORING AND EVALUATION.—As a condition 9 of receipt of a grant under this section, a grantee shall 10 agree to submit an annual report to the Director describ- 11 ing the activities carried out through the grant and the 12 outcomes of such activities. 13 (g) INDEPENDENT NATIONAL EVALUATION.— 14 (1) IN GENERAL.—Not later than 5 years after 15 the first grants are awarded under this section, the 16 Director shall provide for the commencement of an 17 independent national evaluation of the program 18 under this section. 19 (2) REPORT TO CONGRESS.—Not later than 60 20 days after receiving the results of such independent 21 national evaluation, the Director shall report such 22 results to the Congress. 23 SEC. 5. RESEARCH AND TRAINING. 24 The Director, as part of the Program— 25 VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 379 IH (1) shall award grants to nonprofit organiza- 1 tions and public or other nonprofit institutions of 2 higher education— 3 (A) to conduct research on best practices 4 to improve social determinants of health; 5 (B) to provide technical assistance, train- 6 ing, and evaluation assistance to grantees under 7 section 4; and 8 (C) to disseminate best practices to grant- 9 ees under section 4; and 10 (2) may require a grantee under paragraph (1) 11 to provide technical assistance and capacity building 12 to entities that are eligible entities under section 4 13 but not receiving funds through such section. 14 SEC. 6. FUNDING. 15 (a) IN GENERAL.—There is authorized to be appro- 16 priated to carry out this Act, $50,000,000 for each of fis- 17 cal years 2022 through 2027. 18 (b) ALLOCATION.—Of the amount made available to 19 carry out this Act for a fiscal year, not less than 75 per- 20 cent shall be used for grants under sections 4 and 5. 21 Æ VerDate Sep 11 2014 00:32 Feb 08, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H379.IH H379 pbinns on DSKJLVW7X2PROD with BILLS