UNDERSTAND Act

II 116TH CONGRESS 1ST SESSION S. 1323 To amend titles XVIII and XIX of the Social Security Act to collect informa- tion under Medicare, Medicaid, and the Children’s Health Insurance Program related to social determinants of health, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 6, 2019 Mr. PORTMAN (for himself and Mr. CASEY) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend titles XVIII and XIX of the Social Security Act to collect information under Medicare, Medicaid, and the Children’s Health Insurance Program related to social determinants of health, 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 ‘‘Utilizing National 4 Data, Effectively Reforming Standards and Tools, to Ad- 5 dress Negative Determinates of Health Act’’ or the ‘‘UN- 6 DERSTAND Act’’. 7 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 2 •S 1323 IS SEC. 2. COLLECTION OF INFORMATION RELATED TO SO- 1 CIAL DETERMINANTS OF THE HEALTH OF 2 MEDICARE BENEFICIARIES. 3 (a) REPORTING OF INFORMATION.—Section 1809 of 4 the Social Security Act (42 U.S.C. 1395b–10) is amended 5 by adding at the end the following: 6 ‘‘(d) COLLECTION OF INFORMATION RELATED TO 7 SOCIAL DETERMINANTS OF HEALTH.— 8 ‘‘(1) PROPOSED RULE.— 9 ‘‘(A) IN GENERAL.—Not later than Octo- 10 ber 1, 2020, the Secretary shall issue a pro- 11 posed rule so as to allow for the collection of in- 12 formation related to social determinants that 13 may factor into the health of beneficiaries 14 under this title. The proposed rule shall allow 15 for the collection of such information from li- 16 censed health professionals (as defined in sec- 17 tion 1819(b)(5)(G)) and community health 18 workers (as defined in section 2113(f)(4)). 19 ‘‘(B) PHASED-IN IMPLEMENTATION; PUB- 20 LIC AVAILABILITY OF INFORMATION.—The Sec- 21 retary shall— 22 ‘‘(i) phase-in implementation of the 23 collection of information in accordance 24 with subparagraph (A) over a 3-year pe- 25 riod, in such manner as the Secretary de- 26 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 3 •S 1323 IS termines appropriate in order to minimize 1 any adverse impact on the licensed health 2 professionals providing such information; 3 and 4 ‘‘(ii) make such information collected 5 available to the public and updated at least 6 annually during the phase-in period. 7 ‘‘(2) SOCIAL DETERMINANTS OF HEALTH.—The 8 information collected in accordance with paragraph 9 (1) shall include (but is not limited to) the following 10 possible social determinants of health, as identified 11 in the ICD–10 diagnostic codes Z55 through Z65 12 (or any such successor diagnostic codes): 13 ‘‘(A) Problems related to education and lit- 14 eracy. 15 ‘‘(B) Employment and unemployment. 16 ‘‘(C) Occupations exposure risk factors. 17 ‘‘(D) Problems related to housing and eco- 18 nomic circumstances. 19 ‘‘(E) Problems related to social environ- 20 ments. 21 ‘‘(F) Problems related to upbringing. 22 ‘‘(G) Problems related to family cir- 23 cumstances, including primary support groups. 24 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 4 •S 1323 IS ‘‘(H) Psychosocial circumstances resulting 1 from pregnancy. 2 ‘‘(I) Conviction in civil or criminal pro- 3 ceedings.’’. 4 (b) REPORT ON DATA ANALYSES.—Section 5 1809(b)(2) of such Act (42 U.S.C. 1395b–10(b)(2)) is 6 amended— 7 (1) by striking ‘‘Not later than’’ and inserting 8 the following: 9 ‘‘(A) INITIAL REPORTS.—Not later than’’; 10 and 11 (2) by adding at the end the following: 12 ‘‘(B) REPORTS ON COLLECTION OF INFOR- 13 MATION RELATED TO SOCIAL DETERMINANTS 14 OF HEALTH.—Not later than 5 years after the 15 date of the enactment of this subparagraph, the 16 Secretary shall submit to Congress a report 17 that includes aggregate findings and trends 18 across respective beneficiary populations for im- 19 proving the identification of health care dispari- 20 ties for beneficiaries under this title based on 21 analyses of the data collected under subsection 22 (d).’’. 23 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 5 •S 1323 IS SEC. 3. COLLECTION OF INFORMATION RELATED TO SO- 1 CIAL DETERMINANTS OF THE HEALTH OF 2 MEDICAID AND CHIP BENEFICIARIES. 3 (a) REPORTING OF INFORMATION.—Section 1946 of 4 the Social Security Act (42 U.S.C. 1396w–5) is amended 5 by adding at the end the following: 6 ‘‘(d) COLLECTION OF INFORMATION RELATED TO 7 SOCIAL DETERMINANTS OF HEALTH.— 8 ‘‘(1) DEVELOPMENT OF MODEL UNIFORM RE- 9 PORTING FIELD.— 10 ‘‘(A) IN GENERAL.—Not later than Octo- 11 ber 1, 2020, the Secretary shall, in consultation 12 with the States, develop and make available to 13 the States a model uniform reporting field that 14 States may use for purposes of reporting to the 15 Secretary through the Transformed Medicaid 16 Statistical Information System (T–MSIS) (or a 17 successor system) information related to social 18 determinants that may factor into the health of 19 beneficiaries under this title and beneficiaries 20 under title XXI and be collected from licensed 21 health professionals (as defined in section 22 1919(b)(5)(G)) and community health workers 23 (as defined in section 2113(f)(4)). 24 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 6 •S 1323 IS ‘‘(B) PHASED-IN IMPLEMENTATION; PUB- 1 LIC AVAILABILITY OF INFORMATION.—The Sec- 2 retary shall— 3 ‘‘(i) phase-in implementation of the 4 collection of information in accordance 5 with subparagraph (A) over a 3-year pe- 6 riod, in such manner as the Secretary de- 7 termines appropriate in order to minimize 8 any adverse impact on the licensed health 9 professionals and community health work- 10 ers providing such information; and 11 ‘‘(ii) make such information collected 12 available to the public and updated at least 13 annually during the phase-in period. 14 ‘‘(2) SOCIAL DETERMINANTS OF HEALTH.—The 15 information collected in accordance with paragraph 16 (1) shall include (but is not limited to) the following 17 possible social determinants of health, as identified 18 in the ICD–10 diagnostic codes Z55 through Z65 19 (or any such successor diagnostic codes): 20 ‘‘(A) Problems related to education and lit- 21 eracy. 22 ‘‘(B) Employment and unemployment. 23 ‘‘(C) Occupations exposure risk factors. 24 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 7 •S 1323 IS ‘‘(D) Problems related to housing and eco- 1 nomic circumstances. 2 ‘‘(E) Problems related to social environ- 3 ments. 4 ‘‘(F) Problems related to upbringing and 5 family circumstances including primary support 6 groups. 7 ‘‘(G) Psychosocial circumstances resulting 8 from pregnancy. 9 ‘‘(H) Conviction in civil or criminal pro- 10 ceedings.’’. 11 (b) REPORT ON DATA ANALYSES.—Section 12 1946(b)(2) of such Act (42 U.S.C. 1396w–5(b)(2)) is 13 amended— 14 (1) by striking ‘‘Not later than’’ and inserting 15 the following: 16 ‘‘(A) INITIAL REPORTS.—Not later than’’; 17 and 18 (2) by adding at the end the following: 19 ‘‘(B) REPORTS ON COLLECTION OF INFOR- 20 MATION RELATED TO SOCIAL DETERMINANTS 21 OF HEALTH.—Not later than 5 years after the 22 date of the enactment of this subparagraph, the 23 Secretary shall submit to Congress a report 24 that includes aggregate findings and trends 25 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 8 •S 1323 IS across respective beneficiary populations for im- 1 proving the identification of health care dispari- 2 ties for beneficiaries under this title and bene- 3 ficiaries under title XXI based on analyses of 4 the data collected under subsection (d).’’. 5 SEC. 4. COLLECTION OF INFORMATION RELATED TO SO- 6 CIAL DETERMINANTS OF THE HEALTH OF IN- 7 DIVIDUALS RECEIVING CARE THROUGH 8 HEALTH CENTERS. 9 Part A of title III of the Public Health Service Act 10 (42 U.S.C. 241 et seq.) is amended by adding at the end 11 the following: 12 ‘‘SEC. 310B. COLLECTION OF INFORMATION RELATED TO 13 SOCIAL DETERMINANTS OF HEALTH. 14 ‘‘(a) IN GENERAL.— 15 ‘‘(1) IN GENERAL.—Not later than October 1, 16 2020, the Secretary, acting through the Adminis- 17 trator of the Health Resources and Services Admin- 18 istration, shall promulgate regulations to allow for 19 the collection of information related to social deter- 20 minants that may factor into the health of individ- 21 uals receiving services at federally qualified health 22 centers (as defined in section 1861(aa)(4) of the So- 23 cial Security Act). Such regulations shall allow for 24 the collection of such information from licensed 25 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 9 •S 1323 IS health professionals (as defined in section 1 1919(b)(5)(G) of the Social Security Act) and com- 2 munity health workers (as defined in section 3 2113(f)(4) of the Social Security Act) providing 4 services at such health centers. 5 ‘‘(2) PHASED-IN IMPLEMENTATION; PUBLIC 6 AVAILABILITY OF INFORMATION.—The Secretary 7 shall— 8 ‘‘(A) phase-in implementation of the collec- 9 tion of information in accordance with para- 10 graph (1) over a 3-year period, in such manner 11 as the Secretary determines appropriate in 12 order to minimize any adverse impact on the li- 13 censed health professionals and community 14 health workers providing such information; and 15 ‘‘(B) make such information collected 16 available to the public and updated at least an- 17 nually during the phase-in period. 18 ‘‘(b) SOCIAL DETERMINANTS OF HEALTH.—The in- 19 formation collected in accordance with subsection (a) shall 20 include (but is not limited to) the following possible social 21 determinants of health, as identified in the ICD–10 diag- 22 nostic codes Z55 through Z65 (or any such successor diag- 23 nostic codes): 24 ‘‘(1) Problems related to education and literacy. 25 VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS 10 •S 1323 IS ‘‘(2) Employment and unemployment. 1 ‘‘(3) Occupations exposure risk factors. 2 ‘‘(4) Problems related to housing and economic 3 circumstances. 4 ‘‘(5) Problems related to social environments. 5 ‘‘(6) Problems related to upbringing. 6 ‘‘(7) Problems related to family circumstances, 7 including primary support groups. 8 ‘‘(8) Psychosocial circumstances resulting from 9 pregnancy. 10 ‘‘(9) Conviction in civil or criminal proceedings. 11 ‘‘(c) REPORTS ON COLLECTION OF INFORMATION 12 RELATED TO SOCIAL DETERMINANTS OF HEALTH.—Not 13 later than 5 years after the date of the enactment of this 14 section, the Secretary shall submit to Congress a report 15 that includes aggregate findings and trends across respec- 16 tive patient populations for improving the identification of 17 health care disparities for individuals receiving health 18 services at federally qualified health centers based on anal- 19 yses of the data collected under subsection (a).’’. 20 Æ VerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S1323.IS S1323 pbinns on DSK79D2C42PROD with BILLS