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I
116TH CONGRESS
2D SESSION
H. R. 6561
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
APRIL 21, 2020
Ms. BARRAGA´N (for herself, Mr. BUTTERFIELD, Ms. BLUNT ROCHESTER, Mr.
LUJA´N, Mr. CA´RDENAS, Mr. SOTO, Ms. JACKSON LEE, Ms. VELA´ZQUEZ,
Ms. NORTON, Ms. MOORE, Mr. COHEN, Ms. GARCIA of Texas, Mrs.
NAPOLITANO, Mr. GRIJALVA, Ms. TLAIB, Mr. KILDEE, Mr. MORELLE,
Mr. DANNY K. DAVIS of Illinois, and Mr. HIGGINS of New York) intro-
duced 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 2020’’.
5
SEC. 2. FINDINGS.
6
Congress finds the following:
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(1) Healthy People 2020 defines social deter-
1
minants of health as conditions in the environments
2
in which people live, learn, work, play, worship, and
3
age that affect a wide range of health, functioning,
4
and quality-of-life outcomes and risks.
5
(2) One of the overarching goals of Healthy
6
People 2020 is to ‘‘create social and physical envi-
7
ronments that promote good health for all’’.
8
(3) Healthy People 2020 developed a ‘‘place-
9
based’’ organizing framework, reflecting five key
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areas of social determinants of health namely—
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(A) economic stability;
12
(B) education;
13
(C) social and community context;
14
(D) health and health care; and
15
(E) neighborhood and built environment.
16
(4) It is estimated that medical care accounts
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for only 10 to 20 percent of the modifiable contribu-
18
tors to healthy outcomes for a population.
19
(5) The Centers for Medicare & Medicaid Serv-
20
ices has indicated the importance of the social deter-
21
minants in its work stating that, ‘‘As we seek to fos-
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ter innovation, rethink rural health, find solutions to
23
the opioid epidemic, and continue to put patients
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•HR 6561 IH
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-
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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
(9) Providing grants to public health depart-
18
ments and other eligible entities to coordinate cross-
19
sector collaboration will allow a community-wide, evi-
20
dence-based approach to address underlying social
21
determinants of health.
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SEC. 3. SOCIAL DETERMINANTS OF HEALTH PROGRAM.
23
(a) PROGRAM.—To the extent and in the amounts
24
made available in advance in appropriations Acts, the Di-
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•HR 6561 IH
rector of the Centers for Disease Control and Prevention
1
(in this Act referred to as the ‘‘Director’’) shall carry out
2
a program, to be known as the Social Determinants of
3
Health Program (in this Act referred to as the ‘‘Pro-
4
gram’’), to achieve the following goals:
5
(1) Improve health outcomes and reduce health
6
inequities by coordinating social determinants of
7
health activities across the Centers for Disease Con-
8
trol and Prevention.
9
(2) Improve the capacity of public health agen-
10
cies and community organizations to address social
11
determinants of health in communities.
12
(b) ACTIVITIES.—To achieve the goals listed in sub-
13
section (a), the Director shall carry out activities including
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the following:
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(1) Coordinating across the Centers for Disease
16
Control and Prevention to ensure that relevant pro-
17
grams consider and incorporate social determinants
18
of health in grant awards and other activities.
19
(2) Awarding grants under section 4 to State,
20
local, territorial, and Tribal health agencies and or-
21
ganizations, and to other eligible entities, to address
22
social determinants of health in target communities.
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(3) Awarding grants under section 5 to non-
1
profit organizations and public or other nonprofit in-
2
stitutions of 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.
10
(4) Coordinating, supporting, and aligning ac-
11
tivities of the Centers for Disease Control and Pre-
12
vention related to social determinants of health with
13
activities of other Federal agencies related to social
14
determinants of health, including such activities of
15
agencies in the Department of Health and Human
16
Services such as the Centers for Medicare & Med-
17
icaid Services.
18
(5) Collecting and analyzing data related to the
19
social determinants of health.
20
SEC. 4. GRANTS TO ADDRESS SOCIAL DETERMINANTS OF
21
HEALTH.
22
(a) IN GENERAL.—The Director, as part of the Pro-
23
gram, shall award grants to eligible entities to address so-
24
cial determinants of health in their communities.
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(b) ELIGIBILITY.—To be eligible to apply for a grant
1
under this section, an entity shall be—
2
(1) a State, local, territorial, or Tribal health
3
agency or organization;
4
(2) a qualified nongovernmental entity, as de-
5
fined by the Director; or
6
(3) a consortium of entities that includes a
7
State, local, territorial, or Tribal health agency or
8
organization.
9
(c) USE OF FUNDS.—
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(1) IN GENERAL.—A grant under this section
11
shall be used to address social determinants of
12
health in a target community by designing and im-
13
plementing innovative, evidence-based, cross-sector
14
strategies.
15
(2) TARGET COMMUNITY.—For purposes of this
16
section, a target community shall be a State, county,
17
city, or other municipality.
18
(d) PRIORITY.—In awarding grants under this sec-
19
tion, the Director shall prioritize applicants proposing to
20
serve target communities with significant unmet health
21
and social needs, as defined by the Director.
22
(e) APPLICATION.—To seek a grant under this sec-
23
tion, an eligible entity shall—
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•HR 6561 IH
(1) submit an application at such time, in such
1
manner, and containing such information as the Di-
2
rector may require;
3
(2) propose a set of activities to address social
4
determinants of health through evidence-based,
5
cross-sector strategies, which activities may in-
6
clude—
7
(A) collecting quantifiable data from health
8
care, social services, and other entities regard-
9
ing the most significant gaps in health-pro-
10
moting social, economic, and environmental
11
needs;
12
(B) identifying evidence-based approaches
13
to meeting the nonmedical, social needs of pop-
14
ulations identified by data collection described
15
in subparagraph (A), such as unstable housing
16
or inadequate food;
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(C) developing scalable methods to meet
18
patients’ social needs identified in clinical set-
19
tings or other sites;
20
(D) convening entities such as local and
21
State governmental and nongovernmental orga-
22
nizations, health systems, payors, and commu-
23
nity-based organizations to review, plan, and
24
implement community-wide interventions and
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•HR 6561 IH
strategies to advance health-promoting social
1
conditions;
2
(E) monitoring and evaluating the impact
3
of activities funded through the grant on the
4
health and well-being of the residents of the
5
target community and on the cost of health
6
care; and
7
(F) such other activities as may be speci-
8
fied by the Director;
9
(3) demonstrate how the eligible entity will col-
10
laborate with—
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(A) health systems;
12
(B) payors, including, as appropriate, med-
13
icaid managed care organizations (as defined in
14
section 1903(m)(1)(A) of the Social Security
15
Act (42 U.S.C. 1396b(m)(1)(A))), Medicare
16
Advantage plans under part C of title XVIII of
17
such Act (42 U.S.C. 1395w–21 et seq.), and
18
health insurance issuers and group health plans
19
(as such terms are defined in section 2791 of
20
the Public Health Service Act);
21
(C) other relevant stakeholders and initia-
22
tives in areas of need, such as the Accountable
23
Health Communities Model of the Centers for
24
Medicare & Medicaid Services, health homes
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•HR 6561 IH
under the Medicaid program under title XIX of
1
the Social Security Act (42 U.S.C. 1396 et
2
seq.),
community-based
organizations,
and
3
human services organizations;
4
(D) other non-health care sector organiza-
5
tions, including organizations focusing on trans-
6
portation, housing, or food access; and
7
(E) local employers; and
8
(4) identify key health inequities in the target
9
community and demonstrate how the proposed ef-
10
forts of the eligible entity would address such inequi-
11
ties.
12
(f) MONITORING AND EVALUATION.—As a condition
13
of receipt of a grant under this section, a grantee shall
14
agree to submit an annual report to the Director describ-
15
ing the activities carried out through the grant and the
16
outcomes of such activities.
17
(g) INDEPENDENT NATIONAL EVALUATION.—
18
(1) IN GENERAL.—Not later than 5 years after
19
the first grants are awarded under this section, the
20
Director shall provide for the commencement of an
21
independent national evaluation of the Program
22
under this section.
23
(2) REPORT TO CONGRESS.—Not later than 60
24
days after receiving the results of such independent
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•HR 6561 IH
national evaluation, the Director shall report such
1
results to the Congress.
2
SEC. 5. RESEARCH AND TRAINING.
3
The Director, as part of the Program—
4
(1) shall award grants to nonprofit organiza-
5
tions and public or other nonprofit institutions of
6
higher education—
7
(A) to conduct research on best practices
8
to improve social determinants of health;
9
(B) to provide technical assistance, train-
10
ing, and evaluation assistance to grantees under
11
section 4; and
12
(C) to disseminate best practices to grant-
13
ees under section 4; and
14
(2) may require a grantee under paragraph (1)
15
to provide technical assistance and capacity building
16
to entities that are eligible entities under section 4
17
but not receiving funds through such section.
18
SEC. 6. FUNDING.
19
(a) IN GENERAL.—There is authorized to be appro-
20
priated to carry out this Act, $50,000,000 for each of fis-
21
cal years 2021 through 2026.
22
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•HR 6561 IH
(b) ALLOCATION.—Of the amount made available to
1
carry out this Act for a fiscal year, not less than 75 per-
2
cent shall be used for grants under sections 4 and 5.
3
Æ
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