REDUCE Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 5246 To direct the Secretary of Health and Human Services to carry out a Health in All Policies Demonstration Project, and for other purposes. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 21, 2019 Mr. PASCRELL (for himself, Mr. LEWIS, Ms. SA´NCHEZ, Mr. DANNY K. DAVIS of Illinois, Mr. SUOZZI, Mr. PANETTA, and Ms. SEWELL of Alabama) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned A BILL To direct the Secretary of Health and Human Services to carry out a Health in All Policies Demonstration Project, 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 ‘‘Researching and End- 4 ing Disparities by Understanding and Creating Equity Act 5 of 2019’’ or the ‘‘REDUCE Act of 2019’’. 6 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 2 •HR 5246 IH SEC. 2. HEALTH IN ALL POLICIES DEMONSTRATION 1 PROJECT. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services (in this section referred to as the ‘‘Sec- 4 retary’’) acting through the Director of the Centers for 5 Disease Control and Prevention, and in coordination with 6 relevant agencies including the Department of Education, 7 the Department of Agriculture, the Department of Hous- 8 ing and Urban Development, the Department of Justice, 9 the Department of Labor, the Environmental Protection 10 Agency, and the Department of Transportation, shall im- 11 plement a grant program, to be known as the Health in 12 All Policies Demonstration Project. 13 (b) GRANTS.—In carrying out subsection (a), the 14 Secretary shall award grants to eligible entities to estab- 15 lish, implement, or enhance, in the jurisdiction of the re- 16 spective entity, a collaborative, interdisciplinary, and com- 17 munity-focused approach to improve the health of all com- 18 munities and people that— 19 (1) integrates and articulates health consider- 20 ations in policymaking across sectors; 21 (2) addresses— 22 (A) health; 23 (B) equity; and 24 (C) sustainability; and 25 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 3 •HR 5246 IH (3) targets a significant proportion of Medicare 1 beneficiaries, Medicare-Medicaid dual eligibles, or 2 long-term care Medicaid recipients. 3 (c) EVALUATION.—The Secretary shall identify 4 metrics for evaluating the implementation of a grant 5 under this section and, using such metrics, evaluate each 6 grantee on the extent to which the approach implemented 7 through the grant— 8 (1) supports intersectoral collaboration; 9 (2) benefits multiple partners; 10 (3) engages stakeholders; 11 (4) creates structural or procedural change; 12 (5) impacts or relates to a model or demonstra- 13 tion project administered by the Centers for Medi- 14 care & Medicaid Services, such as an advanced pay- 15 ment model; and 16 (6) provides cost savings, delivers efficiencies, 17 and improves overall health, including health dis- 18 parity reduction and health equity improvements. 19 (d) ELIGIBILITY.—To be eligible to receive a grant 20 under this section, an entity shall— 21 (1) be a State, territory of the United States, 22 Tribe, city, or county; and 23 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 4 •HR 5246 IH (2) submit an application to the Secretary at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 (e) PRIORITIZATION; GEOGRAPHICAL DIVERSITY.— 4 In awarding grants under this section, the Secretary 5 shall— 6 (1) give priority to eligible entities seeking to 7 use a grant to improve, as described in subsection 8 (b), the health of populations that— 9 (A) are target populations described in 10 subsection (b)(3); and 11 (B) have significant health inequities 12 throughout the populations; and 13 (2) seek to ensure geographical diversity among 14 grantees. 15 (f) REPORTS BY GRANTEES.—As a condition on re- 16 ceipt of a grant under this section, the Secretary shall re- 17 quire grantees— 18 (1) to provide a report to the Secretary upon 19 completion of the Health in All Policies Demonstra- 20 tion Project; and 21 (2) to include in such report the extent to which 22 the approach implemented achieved the goals listed 23 in paragraphs (1) through (6) of subsection (c). 24 (g) REPORT TO CONGRESS.— 25 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 5 •HR 5246 IH (1) SUBMISSION.—The Secretary shall submit 1 to the Congress— 2 (A) not later than one year after the date 3 of enactment of this Act, an initial report on 4 the Health in All Policies Demonstration 5 Project; and 6 (B) not later than one year after the com- 7 pletion of the Demonstration Project, a final re- 8 port on the Demonstration Project. 9 (2) CONTENTS OF INITIAL REPORT.—The re- 10 port under paragraph (1)(A) shall include— 11 (A) evaluation of the success of soliciting 12 applications; 13 (B) identification of the number of applica- 14 tions received; 15 (C) specification of the timeline for award- 16 ing funding; and 17 (D) identification of barriers to imple- 18 menting the Health in All Policies Demonstra- 19 tion Project, if any. 20 (3) CONTENTS OF FINAL REPORT.—The report 21 under paragraph (1)(B) shall each include the fol- 22 lowing: 23 (A) An assessment of the Health in All 24 Policies Demonstration Project, including an 25 VerDate Sep 11 2014 21:35 Dec 05, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 6 •HR 5246 IH evaluation of the effectiveness of the Dem- 1 onstration Project. 2 (B) Recommendations for Federal legisla- 3 tive actions— 4 (i) to integrate, based on such assess- 5 ment, a collaborative and interdisciplinary 6 approach to improve the health of all com- 7 munities; and 8 (ii) to support eligible entities in pur- 9 suing a comparable integration of such an 10 approach across State programs. 11 (h) DEFINITIONS.—In this section: 12 (1) The term ‘‘Medicare beneficiaries’’ means 13 individuals entitled to part A of XVIII of the Social 14 Security Act and enrolled under part B of such title. 15 (2) The term ‘‘Medicare-Medicaid dual eligi- 16 bles’’ means individuals who are dually eligible for 17 benefits under title XVIII of the Social Security Act 18 and title XIX of such Act. 19 (i) AUTHORIZATION OF APPROPRIATIONS.—To carry 20 out this section, there is authorized to be appropriated 21 $2,000,000 for the period of fiscal years 2021 through 22 2024. 23 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 7 •HR 5246 IH SEC. 3. NATIONAL ACADEMIES OF SCIENCES, ENGINEER- 1 ING, AND MEDICINE REPORT. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services shall seek to enter into an arrangement, 4 not later than 60 days after the date of enactment of this 5 Act, with the National Academies of Sciences, Engineer- 6 ing, and Medicine (or if the Academies decline to enter 7 into such arrangement, another appropriate entity) under 8 which the Academies (or other appropriate entity) agrees 9 to prepare a report on eliminating health disparities to im- 10 prove health equity. 11 (b) REPORT.— 12 (1) CONTENTS.—The report prepared pursuant 13 to subsection (a) shall— 14 (A) review evidence on how social deter- 15 minants of health affect health outcomes among 16 middle-income Medicare beneficiaries and Medi- 17 care-Medicaid dual eligibles; 18 (B) examine successful interventions, in- 19 cluding with respect to health outcomes, that 20 address social determinants of health (including 21 transportation, meals, housing, access to health 22 care, personal care assistance, and access to 23 long-term services and supports), reduce health 24 disparities, and improve health equity; 25 (C) make conclusions regarding— 26 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 8 •HR 5246 IH (i) the effectiveness of existing pro- 1 grams and policies of the Centers for 2 Medicare & Medicaid Services intended to 3 reduce health disparities; 4 (ii) best practices and successful 5 strategies that reduce health disparities; 6 and 7 (iii) efforts needed to address health 8 disparities related to health care workforce 9 shortages; and 10 (D) make recommendations regarding— 11 (i) priorities for health disparities 12 interventions within Federal health care 13 programs; and 14 (ii) potential opportunities for expan- 15 sion or replication of successful interven- 16 tions and payment models to reduce health 17 disparities and improve health equity. 18 (2) SUBMISSION.—The arrangement under sub- 19 section (a) shall require the National Academies of 20 Sciences, Engineering, and Medicine (or other ap- 21 propriate entity), not later than 18 months after en- 22 tering into such arrangement, to finalize the report 23 prepared pursuant to such arrangement and submit 24 such report to the Committees on Energy and Com- 25 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 9 •HR 5246 IH merce and Ways and Means of the House of Rep- 1 resentatives and the Committees on Finance and 2 Health, Education, Labor, and Pensions of the Sen- 3 ate. 4 (c) DEFINITIONS.—In this section: 5 (1) The term ‘‘health equity’’ means a state 6 where all people are able to attain their full health 7 potential and no one is hindered from achieving this 8 potential due to social position or another socially 9 determined circumstance. 10 (2) The term ‘‘middle-income Medicare bene- 11 ficiaries’’ means individuals entitled to part A of 12 XVIII of the Social Security Act and enrolled under 13 part B of such title who have an income that is not 14 below 125 percent of the poverty line applicable to 15 a family of the size involved, but not more than 400 16 percent of the poverty line so applicable. 17 (3) The term ‘‘Medicare-Medicaid dual eligi- 18 bles’’ means individuals who are dually eligible for 19 benefits under title XVIII of the Social Security Act 20 and title XIX of such Act. 21 (4) The term ‘‘social determinants of health’’ 22 refers to the conditions in the environments in which 23 people live, learn, work, play, worship, and age that 24 VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS 10 •HR 5246 IH affect a wide range of health, functioning, and qual- 1 ity-of-life outcomes and risks. 2 Æ VerDate Sep 11 2014 04:08 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H5246.IH H5246 kjohnson on DSK79L0C42 with BILLS