Social Determinants Accelerator Act of 2019

I 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. BARRAGA´N, Mr. ENGEL, Mr. BUTTERFIELD, Mr. CA´RDENAS, Mr. MORELLE, Mr. FITZPATRICK, Mr. SCHRADER, Mr. SOTO, Mr. MICHAEL F. DOYLE of Pennsylvania, and Ms. BLUNT ROCH- ESTER) introduced the following bill; which was referred to the Com- mittee 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 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 ‘‘Social Determinants 4 Accelerator Act of 2019’’. 5 SEC. 2. FINDINGS; PURPOSES. 6 (a) FINDINGS.—Congress finds the following: 7 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 4004 IH (1) There is a significant body of evidence 1 showing that economic and social conditions have a 2 powerful impact on individual and population health 3 outcomes and well-being, as well as medical costs. 4 (2) State, local, and Tribal governments and 5 the service delivery partners of such governments 6 face significant challenges in coordinating benefits 7 and services delivered through the Medicaid program 8 and other social services programs because of the 9 fragmented and complex nature of Federal and 10 State funding and administrative requirements. 11 (3) The Federal Government should prioritize 12 and proactively assist State and local governments 13 to strengthen the capacity of State and local govern- 14 ments to improve health and social outcomes for in- 15 dividuals, thereby improving cost-effectiveness and 16 return on investment. 17 (b) PURPOSES.—The purposes of this Act are as fol- 18 lows: 19 (1) To establish effective, coordinated Federal 20 technical assistance to help State and local govern- 21 ments to improve outcomes and cost-effectiveness of, 22 and return on investment from, health and social 23 services programs. 24 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 4004 IH (2) To build a pipeline of State and locally de- 1 signed, cross-sector interventions and strategies that 2 generate rigorous evidence about how to improve 3 health and social outcomes, and increase the cost-ef- 4 fectiveness of, and return on investment from, Fed- 5 eral, State, local, and Tribal health and social serv- 6 ices programs. 7 (3) To enlist State and local governments and 8 the service providers of such governments as part- 9 ners in identifying Federal statutory, regulatory, and 10 administrative challenges in improving the health 11 and social outcomes of, cost-effectiveness of, and re- 12 turn on investment from, Federal spending on indi- 13 viduals enrolled in Medicaid. 14 (4) To develop strategies to improve health and 15 social outcomes without denying services to, or re- 16 stricting the eligibility of, vulnerable populations. 17 SEC. 3. SOCIAL DETERMINANTS ACCELERATOR COUNCIL. 18 (a) ESTABLISHMENT.—The Secretary of Health and 19 Human Services (referred to in this Act as the ‘‘Sec- 20 retary’’), in coordination with the Administrator of the 21 Centers for Medicare & Medicaid Services (referred to in 22 this Act as the ‘‘Administrator’’), shall establish an inter- 23 agency council, to be known as the Social Determinants 24 Accelerator Interagency Council (referred to in this Act 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 4004 IH as the ‘‘Council’’) to achieve the purposes listed in section 1 2(b). 2 (b) MEMBERSHIP.— 3 (1) FEDERAL COMPOSITION.—The Council shall 4 be composed of at least one designee from each of 5 the following Federal agencies: 6 (A) The Office of Management and Budg- 7 et. 8 (B) The Department of Agriculture. 9 (C) The Department of Education. 10 (D) The Indian Health Service. 11 (E) The Department of Housing and 12 Urban Development. 13 (F) The Department of Labor. 14 (G) The Department of Transportation. 15 (H) Any other Federal agency the Chair of 16 the Council determines necessary. 17 (2) DESIGNATION.— 18 (A) IN GENERAL.—The head of each agen- 19 cy specified in paragraph (1) shall designate at 20 least one employee described in subparagraph 21 (B) to serve as a member of the Council. 22 (B) RESPONSIBILITIES.—An employee de- 23 scribed in this subparagraph shall be a senior 24 employee of the agency— 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 4004 IH (i) whose responsibilities relate to au- 1 thorities, policies, and procedures with re- 2 spect to the health and well-being of indi- 3 viduals receiving medical assistance under 4 a State plan (or a waiver of such plan) 5 under title XIX of the Social Security Act 6 (42 U.S.C. 1396 et seq.); or 7 (ii) who has authority to implement 8 and evaluate transformative initiatives that 9 harness data or conducts rigorous evalua- 10 tion to improve the impact and cost-effec- 11 tiveness of federally funded services and 12 benefits. 13 (3) HHS REPRESENTATION.—In addition to 14 the designees under paragraph (1), the Council shall 15 include designees from at least three agencies within 16 the Department of Health and Human Services, in- 17 cluding the Centers for Medicare & Medicaid Serv- 18 ices, at least one of whom shall meet the criteria 19 under paragraph (2)(B). 20 (4) OMB ROLE.—The Director of the Office of 21 Management and Budget shall facilitate the timely 22 resolution of Governmentwide and multiagency 23 issues to help the Council achieve consensus rec- 24 ommendations described under subsection (c)(1). 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 4004 IH (5) NON-FEDERAL COMPOSITION.—The Comp- 1 troller General of the United States may designate 2 up to 6 Council designees— 3 (A) who have relevant subject matter ex- 4 pertise, including expertise implementing and 5 evaluating transformative initiatives that har- 6 ness data and conduct evaluations to improve 7 the impact and cost-effectiveness of Federal 8 Government services; and 9 (B) that each represent— 10 (i) State, local, and Tribal health and 11 human services agencies; 12 (ii) public housing authorities or State 13 housing finance agencies; 14 (iii) State and local government budg- 15 et offices; 16 (iv) State Medicaid agencies; or 17 (v) national consumer advocacy orga- 18 nizations. 19 (6) CHAIR.— 20 (A) IN GENERAL.—The Secretary shall se- 21 lect the Chair of the Council from among the 22 members of the Council. 23 (B) INITIATING GUIDANCE.—The Chair, 24 on behalf of the Council, shall identify and in- 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 4004 IH vite individuals from diverse entities to provide 1 the Council with advice and information per- 2 taining to addressing social determinants of 3 health, including— 4 (i) individuals from State and local 5 government health and human services 6 agencies; 7 (ii) individuals from State Medicaid 8 agencies; 9 (iii) individuals from State and local 10 government budget offices; 11 (iv) individuals from public housing 12 authorities or State housing finance agen- 13 cies; 14 (v) individuals from nonprofit organi- 15 zations, small businesses, and philan- 16 thropic organizations; 17 (vi) advocates; 18 (vii) researchers; and 19 (viii) any other individuals the Chair 20 determines to be appropriate. 21 (c) DUTIES.—The duties of the Council are— 22 (1) to make recommendations to the Secretary 23 and the Administrator regarding the criteria for 24 making awards under section 4; 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 4004 IH (2) to identify Federal authorities and opportu- 1 nities for use by States or local governments to im- 2 prove coordination of funding and administration of 3 Federal programs, the beneficiaries of whom include 4 individuals described in section 2, and which may be 5 unknown or underutilized and to make information 6 on such authorities and opportunities publicly avail- 7 able; 8 (3) to provide targeted technical assistance to 9 States developing a social determinants accelerator 10 plan under section 4, including identifying potential 11 statutory or regulatory pathways for implementation 12 of the plan and assisting in identifying potential 13 sources of funding to implement the plan; 14 (4) to report to Congress annually on the sub- 15 jects set forth in subsection (e); 16 (5) to develop and disseminate evaluation guide- 17 lines and standards that can be used to reliably as- 18 sess the impact of an intervention or approach that 19 may be implemented pursuant to this Act on out- 20 comes, cost-effectiveness of, and return on invest- 21 ment from Federal, State, local, and Tribal govern- 22 ments, and to facilitate technical assistance, where 23 needed, to help to improve State and local evaluation 24 designs and implementation; 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 4004 IH (6) to seek feedback from State, local, and 1 Tribal governments, including through an annual 2 survey by an independent third party, on how to im- 3 prove the technical assistance the Council provides 4 to better equip State, local, and Tribal governments 5 to coordinate health and social service programs; 6 (7) to solicit applications for grants under sec- 7 tion 4; and 8 (8) to coordinate with other cross-agency initia- 9 tives focused on improving the health and well-being 10 of low-income and at-risk populations in order to 11 prevent unnecessary duplication between agency ini- 12 tiatives. 13 (d) SCHEDULE.—Not later than 60 days after the 14 date of the enactment of this Act, the Council shall con- 15 vene to develop a schedule and plan for carrying out the 16 duties described in subsection (c), including solicitation of 17 applications for the grants under section 4. 18 (e) REPORT TO CONGRESS.—The Council shall sub- 19 mit an annual report to Congress, which shall include— 20 (1) a list of the Council members; 21 (2) activities and expenditures of the Council; 22 (3) summaries of the interventions and ap- 23 proaches that will be supported by State, local, and 24 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 4004 IH Tribal governments that received a grant under sec- 1 tion 4, including— 2 (A) the best practices and evidence-based 3 approaches such governments plan to employ to 4 achieve the purposes listed in section 2(b); and 5 (B) a description of how the practices and 6 approaches will impact the outcomes, cost-effec- 7 tiveness of, and return on investment from, 8 Federal, State, local, and Tribal governments 9 with respect to such purposes; 10 (4) the feedback received from State and local 11 governments on ways to improve the technical assist- 12 ance of the Council, including findings from a third- 13 party survey and actions the Council plans to take 14 in response to such feedback; and 15 (5) the major statutory, regulatory, and admin- 16 istrative challenges identified by State, local, and 17 Tribal governments that received a grant under sec- 18 tion 4, and the actions that Federal agencies are 19 taking to address such challenges. 20 (f) FACA APPLICABILITY.—The Federal Advisory 21 Committee Act (5 U.S.C. App.) shall not apply to the 22 Council. 23 (g) COUNCIL PROCEDURES.—The Secretary, in con- 24 sultation with the Comptroller General of the United 25 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 4004 IH States and the Director of the Office of Management and 1 Budget, shall establish procedures for the Council to— 2 (1) ensure that adequate resources are available 3 to effectively execute the responsibilities of the 4 Council; 5 (2) effectively coordinate with other relevant ad- 6 visory bodies and working groups to avoid unneces- 7 sary duplication; 8 (3) create transparency to the public and Con- 9 gress with regard to Council membership, costs, and 10 activities, including through use of modern tech- 11 nology and social media to disseminate information; 12 and 13 (4) avoid conflicts of interest that would jeop- 14 ardize the ability of the Council to make decisions 15 and provide recommendations. 16 SEC. 4. SOCIAL DETERMINANTS ACCELERATOR GRANTS TO 17 STATES OR LOCAL GOVERNMENTS. 18 (a) GRANTS TO STATES, LOCAL GOVERNMENTS, AND 19 TRIBES.—Not later than 180 days after the date of the 20 enactment of this Act, the Administrator, in consultation 21 with the Secretary and the Council, shall award on a com- 22 petitive basis not more than 25 grants to eligible appli- 23 cants described in subsection (b), for the development of 24 VerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004 pamtmann on DSKBFK8HB2PROD with BILLS 12 •HR 4004 IH social determinants accelerator plans, as described in sub- 1 section (f). 2 (b) ELIGIBLE APPLICANT.—An eligible applicant de- 3 scribed in this section is a State, local, or Tribal health 4 or human services agency that— 5 (1) demonstrates the support of relevant parties 6 across relevant State, local, or Tribal jurisdictions; 7 and 8 (2) in the case of an applicant that is a local 9 government agency, provides to the Secretary a let- 10 ter of support from the lead State health or human 11 services agency for the State in which the local gov- 12 ernment is located. 13 (c) AMOUNT OF GRANT.—The Administrator, in co- 14 ordination with the Council, shall determine the total 15 amount that the Administrator will make available to each 16 grantee under this section. 17 (d) APPLICATION.—An eligible appl [Text truncated for display. 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