Improving Social Determinants of Health Act of 2021

II 117TH CONGRESS 1ST SESSION S. 104 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 SENATE OF THE UNITED STATES JANUARY 28, 2021 Ms. SMITH (for herself, Mr. MURPHY, Mr. BROWN, Ms. BALDWIN, Mr. WYDEN, Mr. DURBIN, Mr. WHITEHOUSE, Ms. KLOBUCHAR, and Mr. BLUMENTHAL) introduced the following bill; which was read twice and re- ferred to the Committee on Health, Education, Labor, and Pensions 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 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 104 IS (1) Healthy People 2030 defines social deter- 1 minants of health as conditions in the environments 2 where people are born, live, learn, work, play, wor- 3 ship, and age that affect a wide range of health, 4 functioning, and quality-of-life outcomes and risks. 5 (2) One of the overarching goals of Healthy 6 People 2030 is to ‘‘create social, physical, and eco- 7 nomic environments that promote attaining the full 8 potential for health and well-being for all’’. 9 (3) Healthy People 2030 developed a ‘‘place- 10 based’’ organizing framework, reflecting five key 11 areas of social determinants of health namely— 12 (A) economic stability; 13 (B) education access and quality; 14 (C) social and community context; 15 (D) health care access and quality; and 16 (E) neighborhood and built environment. 17 (4) It is estimated that medical care accounts 18 for only 10 to 20 percent of the modifiable contribu- 19 tors to healthy outcomes for a population. 20 (5) The Centers for Medicare & Medicaid Serv- 21 ices has indicated the importance of the social deter- 22 minants in its work stating that, ‘‘As we seek to fos- 23 ter innovation, rethink rural health, find solutions to 24 the opioid epidemic, and continue to put patients 25 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 104 IS first, we need to take into account social deter- 1 minants of health and recognize their importance.’’. 2 (6) The Department of Health and Human 3 Services’ Public Health 3.0 initiative recognizes the 4 role of public health in working across sectors on so- 5 cial determinants of health, as well as the role of 6 public health as chief health strategist in commu- 7 nities. 8 (7) Through its Health Impact in 5 Years ini- 9 tiative, the Centers for Disease Control and Preven- 10 tion has highlighted nonclinical, community-wide ap- 11 proaches that show positive health impacts, results 12 within five years, and cost effectiveness or cost sav- 13 ings over the lifetime of the population or earlier. 14 (8) Health departments and the Centers for 15 Disease Control and Prevention are not funded for 16 such cross-cutting work. 17 SEC. 3. SOCIAL DETERMINANTS OF HEALTH PROGRAM. 18 (a) PROGRAM.—To the extent and in the amounts 19 made available in advance in appropriations Acts, the Sec- 20 retary of Health and Human Services, acting through the 21 Director of the Centers for Disease Control and Preven- 22 tion (in this Act referred to as the ‘‘Director’’), shall carry 23 out a program, to be known as the Social Determinants 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 104 IS of 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 departments and 18 organizations, and to other eligible entities, to ad- 19 dress social determinants of health in target commu- 20 nities. 21 (3) Awarding grants under section 5 to non- 22 profit organizations and public or other nonprofit in- 23 stitutions of higher education— 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 104 IS (A) to conduct research on best practices 1 to improve social determinants of health; 2 (B) to provide technical assistance, train- 3 ing, and evaluation assistance to grantees under 4 section 4; and 5 (C) to disseminate best practices to grant- 6 ees under section 4. 7 (4) Coordinating, supporting, and aligning ac- 8 tivities of the Centers for Disease Control and Pre- 9 vention related to social determinants of health with 10 activities of other Federal agencies related to social 11 determinants of health, including such activities of 12 agencies in the Department of Health and Human 13 Services such as the Centers for Medicare & Med- 14 icaid Services. 15 (5) Collecting and analyzing data related to the 16 social determinants of health. 17 SEC. 4. GRANTS TO ADDRESS SOCIAL DETERMINANTS OF 18 HEALTH. 19 (a) IN GENERAL.—The Director, as part of the Pro- 20 gram, shall award grants to eligible entities to address so- 21 cial determinants of health in their communities. 22 (b) ELIGIBILITY.—To be eligible to apply for a grant 23 under this section, an entity shall be— 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 104 IS (1) a State, local, territorial, or Tribal health 1 agency or organization; 2 (2) a qualified nongovernmental entity, as de- 3 fined by the Director; or 4 (3) a consortium of entities that includes a 5 State, local, territorial, or Tribal health agency or 6 organization. 7 (c) USE OF FUNDS.— 8 (1) IN GENERAL.—A grant under this section 9 shall be used to address social determinants of 10 health in a target community by designing and im- 11 plementing innovative, evidence-based, cross-sector 12 strategies. 13 (2) TARGET COMMUNITY.—For purposes of this 14 section, a target community shall be a State, county, 15 city, Tribe, or other municipality. 16 (d) PRIORITY AND SET ASIDE.— 17 (1) PRIORITY.—In awarding grants under this 18 section, the Director shall prioritize applicants pro- 19 posing to serve target communities with significant 20 unmet health and social needs, as defined by the Di- 21 rector. 22 (2) SET ASIDE.—The Director shall set aside 5 23 percent of amounts appropriated to carry out this 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 104 IS section in each fiscal year to award grants to Indian 1 Tribes and Tribal organizations. 2 (e) APPLICATION.—To seek a grant under this sec- 3 tion, an eligible entity shall— 4 (1) submit an application at such time, in such 5 manner, and containing such information as the Di- 6 rector may require; 7 (2) propose a set of activities to address social 8 determinants of health through evidence-based, 9 cross-sector strategies, which activities may in- 10 clude— 11 (A) collecting quantifiable data from health 12 care, social services, and other entities regard- 13 ing the most significant gaps in health-pro- 14 moting social, economic, and environmental 15 needs; 16 (B) identifying evidence-based approaches 17 to meeting the nonmedical, social needs of pop- 18 ulations identified by data collection described 19 in subparagraph (A), such as unstable housing 20 or food insecurity; 21 (C) developing scalable methods to meet 22 patients’ social needs identified in clinical set- 23 tings or other sites; 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 104 IS (D) convening entities such as local and 1 State governmental and nongovernmental orga- 2 nizations, health systems, payors, and commu- 3 nity-based organizations to review, plan, and 4 implement community-wide interventions and 5 strategies to advance health-promoting social 6 conditions; 7 (E) monitoring and evaluating the impact 8 of activities funded through the grant on the 9 health and well-being of the residents of the 10 target community and on the cost of health 11 care; and 12 (F) such other activities as may be speci- 13 fied by the Director; 14 (3) demonstrate how the eligible entity will col- 15 laborate with— 16 (A) health systems; 17 (B) payors, including, as appropriate, Med- 18 icaid managed care organizations (as defined in 19 section 1903(m)(1)(A) of the Social Security 20 Act (42 U.S.C. 1396b(m)(1)(A))), Medicare 21 Advantage plans under part C of title XVIII of 22 such Act (42 U.S.C. 1395w–21 et seq.), and 23 health insurance issuers and group health plans 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 104 IS (as such terms are defined in section 2791 of 1 the Public Health Service Act); 2 (C) other relevant stakeholders and initia- 3 tives in areas of need, such as the Accountable 4 Health Communities Model of the Centers for 5 Medicare & Medicaid Services, health homes 6 under the Medicaid program under title XIX of 7 the Social Security Act (42 U.S.C. 1396 et 8 seq.), community-based organizations, and 9 human services organizations; 10 (D) other non-health care sector organiza- 11 tions, including organizations focusing on trans- 12 portation, housing, or food access; and 13 (E) local employers; and 14 (4) identify key health inequities in the target 15 community and demonstrate how the proposed ef- 16 forts of the eligible entity would address such inequi- 17 ties. 18 (f) MONITORING AND EVALUATION.—As a condition 19 of receipt of a grant under this section, a grantee shall 20 agree to submit an annual report to the Director describ- 21 ing the activities carried out through the grant and the 22 outcomes of such activities. 23 (g) INDEPENDENT NATIONAL EVALUATION.— 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 104 IS (1) IN GENERAL.—Not later than 5 years after 1 the first grants are awarded under this section, the 2 Director shall provide for the commencement of an 3 independent national evaluation of the Program 4 under this section. 5 (2) REPORT TO CONGRESS.—Not later than 60 6 days after receiving the results of such independent 7 national evaluation, the Director shall report such 8 results to the Committee on Health, Education, 9 Labor, and Pensions of the Senate and the Com- 10 mittee on Energy and Commerce of the House of 11 Representatives. 12 SEC. 5. RESEARCH AND TRAINING. 13 The Director, as part of the Program— 14 (1) shall award grants to nonprofit organiza- 15 tions and public or other nonprofit institutions of 16 higher education— 17 (A) to conduct research on best practices 18 to improve social determinants of health; 19 (B) to provide technical assistance, train- 20 ing, and evaluation assistance to grantees under 21 section 4; and 22 (C) to disseminate best practices to grant- 23 ees under section 4; and 24 VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 104 IS (2) may require a grantee under paragraph (1) 1 to provide technical assistance and capacity building 2 to entities that are eligible entities under section 4 3 but not receiving funds through such section. 4 SEC. 6. FUNDING. 5 (a) IN GENERAL.—There is authorized to be appro- 6 priated to carry out this Act, $50,000,000 for each of fis- 7 cal years 2021 through 2026. 8 (b) ALLOCATION.—Of the amount made available to 9 carry out this Act for a fiscal year, not less than 75 per- 10 cent shall be used for grants under sections 4 and 5. 11 Æ VerDate Sep 11 2014 22:41 Feb 10, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S104.IS S104 pamtmann on DSKBC07HB2PROD with BILLS