[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4004 Introduced in House (IH)]

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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. Barragan, Mr. Engel, Mr. Butterfield, Mr. 
  Cardenas, Mr. Morelle, Mr. Fitzpatrick, Mr. Schrader, Mr. Soto, Mr. 
 Michael F. Doyle of Pennsylvania, and Ms. Blunt Rochester) introduced 
 the following bill; which was referred to the Committee 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Social Determinants Accelerator Act 
of 2019''.

SEC. 2. FINDINGS; PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) There is a significant body of evidence showing that 
        economic and social conditions have a powerful impact on 
        individual and population health outcomes and well-being, as 
        well as medical costs.
            (2) State, local, and Tribal governments and the service 
        delivery partners of such governments face significant 
        challenges in coordinating benefits and services delivered 
        through the Medicaid program and other social services programs 
        because of the fragmented and complex nature of Federal and 
        State funding and administrative requirements.
            (3) The Federal Government should prioritize and 
        proactively assist State and local governments to strengthen 
        the capacity of State and local governments to improve health 
        and social outcomes for individuals, thereby improving cost-
        effectiveness and return on investment.
    (b) Purposes.--The purposes of this Act are as follows:
            (1) To establish effective, coordinated Federal technical 
        assistance to help State and local governments to improve 
        outcomes and cost-effectiveness of, and return on investment 
        from, health and social services programs.
            (2) To build a pipeline of State and locally designed, 
        cross-sector interventions and strategies that generate 
        rigorous evidence about how to improve health and social 
        outcomes, and increase the cost-effectiveness of, and return on 
        investment from, Federal, State, local, and Tribal health and 
        social services programs.
            (3) To enlist State and local governments and the service 
        providers of such governments as partners in identifying 
        Federal statutory, regulatory, and administrative challenges in 
        improving the health and social outcomes of, cost-effectiveness 
        of, and return on investment from, Federal spending on 
        individuals enrolled in Medicaid.
            (4) To develop strategies to improve health and social 
        outcomes without denying services to, or restricting the 
        eligibility of, vulnerable populations.

SEC. 3. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.

    (a) Establishment.--The Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary''), in coordination with 
the Administrator of the Centers for Medicare & Medicaid Services 
(referred to in this Act as the ``Administrator''), shall establish an 
interagency council, to be known as the Social Determinants Accelerator 
Interagency Council (referred to in this Act as the ``Council'') to 
achieve the purposes listed in section 2(b).
    (b) Membership.--
            (1) Federal composition.--The Council shall be composed of 
        at least one designee from each of the following Federal 
        agencies:
                    (A) The Office of Management and Budget.
                    (B) The Department of Agriculture.
                    (C) The Department of Education.
                    (D) The Indian Health Service.
                    (E) The Department of Housing and Urban 
                Development.
                    (F) The Department of Labor.
                    (G) The Department of Transportation.
                    (H) Any other Federal agency the Chair of the 
                Council determines necessary.
            (2) Designation.--
                    (A) In general.--The head of each agency specified 
                in paragraph (1) shall designate at least one employee 
                described in subparagraph (B) to serve as a member of 
                the Council.
                    (B) Responsibilities.--An employee described in 
                this subparagraph shall be a senior employee of the 
                agency--
                            (i) whose responsibilities relate to 
                        authorities, policies, and procedures with 
                        respect to the health and well-being of 
                        individuals receiving medical assistance under 
                        a State plan (or a waiver of such plan) under 
                        title XIX of the Social Security Act (42 U.S.C. 
                        1396 et seq.); or
                            (ii) who has authority to implement and 
                        evaluate transformative initiatives that 
                        harness data or conducts rigorous evaluation to 
                        improve the impact and cost-effectiveness of 
                        federally funded services and benefits.
            (3) HHS representation.--In addition to the designees under 
        paragraph (1), the Council shall include designees from at 
        least three agencies within the Department of Health and Human 
        Services, including the Centers for Medicare & Medicaid 
        Services, at least one of whom shall meet the criteria under 
        paragraph (2)(B).
            (4) OMB role.--The Director of the Office of Management and 
        Budget shall facilitate the timely resolution of Governmentwide 
        and multiagency issues to help the Council achieve consensus 
        recommendations described under subsection (c)(1).
            (5) Non-federal composition.--The Comptroller General of 
        the United States may designate up to 6 Council designees--
                    (A) who have relevant subject matter expertise, 
                including expertise implementing and evaluating 
                transformative initiatives that harness data and 
                conduct evaluations to improve the impact and cost-
                effectiveness of Federal Government services; and
                    (B) that each represent--
                            (i) State, local, and Tribal health and 
                        human services agencies;
                            (ii) public housing authorities or State 
                        housing finance agencies;
                            (iii) State and local government budget 
                        offices;
                            (iv) State Medicaid agencies; or
                            (v) national consumer advocacy 
                        organizations.
            (6) Chair.--
                    (A) In general.--The Secretary shall select the 
                Chair of the Council from among the members of the 
                Council.
                    (B) Initiating guidance.--The Chair, on behalf of 
                the Council, shall identify and invite individuals from 
                diverse entities to provide the Council with advice and 
                information pertaining to addressing social 
                determinants of health, including--
                            (i) individuals from State and local 
                        government health and human services agencies;
                            (ii) individuals from State Medicaid 
                        agencies;
                            (iii) individuals from State and local 
                        government budget offices;
                            (iv) individuals from public housing 
                        authorities or State housing finance agencies;
                            (v) individuals from nonprofit 
                        organizations, small businesses, and 
                        philanthropic organizations;
                            (vi) advocates;
                            (vii) researchers; and
                            (viii) any other individuals the Chair 
                        determines to be appropriate.
    (c) Duties.--The duties of the Council are--
            (1) to make recommendations to the Secretary and the 
        Administrator regarding the criteria for making awards under 
        section 4;
            (2) to identify Federal authorities and opportunities for 
        use by States or local governments to improve coordination of 
        funding and administration of Federal programs, the 
        beneficiaries of whom include individuals described in section 
        2, and which may be unknown or underutilized and to make 
        information on such authorities and opportunities publicly 
        available;
            (3) to provide targeted technical assistance to States 
        developing a social determinants accelerator plan under section 
        4, including identifying potential statutory or regulatory 
        pathways for implementation of the plan and assisting in 
        identifying potential sources of funding to implement the plan;
            (4) to report to Congress annually on the subjects set 
        forth in subsection (e);
            (5) to develop and disseminate evaluation guidelines and 
        standards that can be used to reliably assess the impact of an 
        intervention or approach that may be implemented pursuant to 
        this Act on outcomes, cost-effectiveness of, and return on 
        investment from Federal, State, local, and Tribal governments, 
        and to facilitate technical assistance, where needed, to help 
        to improve State and local evaluation designs and 
        implementation;
            (6) to seek feedback from State, local, and Tribal 
        governments, including through an annual survey by an 
        independent third party, on how to improve the technical 
        assistance the Council provides to better equip State, local, 
        and Tribal governments to coordinate health and social service 
        programs;
            (7) to solicit applications for grants under section 4; and
            (8) to coordinate with other cross-agency initiatives 
        focused on improving the health and well-being of low-income 
        and at-risk populations in order to prevent unnecessary 
        duplication between agency initiatives.
    (d) Schedule.--Not later than 60 days after the date of the 
enactment of this Act, the Council shall convene to develop a schedule 
and plan for carrying out the duties described in subsection (c), 
including solicitation of applications for the grants under section 4.
    (e) Report to Congress.--The Council shall submit an annual report 
to Congress, which shall include--
            (1) a list of the Council members;
            (2) activities and expenditures of the Council;
            (3) summaries of the interventions and approaches that will 
        be supported by State, local, and Tribal governments that 
        received a grant under section 4, including--
                    (A) the best practices and evidence-based 
                approaches such governments plan to employ to achieve 
                the purposes listed in section 2(b); and
                    (B) a description of how the practices and 
                approaches will impact the outcomes, cost-effectiveness 
                of, and return on investment from, Federal, State, 
                local, and Tribal governments with respect to such 
                purposes;
            (4) the feedback received from State and local governments 
        on ways to improve the technical assistance of the Council, 
        including findings from a third-party survey and actions the 
        Council plans to take in response to such feedback; and
            (5) the major statutory, regulatory, and administrative 
        challenges identified by State, local, and Tribal governments 
        that received a grant under section 4, and the actions that 
        Federal agencies are taking to address such challenges.
    (f) FACA Applicability.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall not apply to the Council.
    (g) Council Procedures.--The Secretary, in consultation with the 
Comptroller General of the United States and the Director of the Office 
of Management and Budget, shall establish procedures for the Council 
to--
            (1) ensure that adequate resources are available to 
        effectively execute the responsibilities of the Council;
            (2) effectively coordinate with other relevant advisory 
        bodies and working groups to avoid unnecessary duplication;
            (3) create transparency to the public and Congress with 
        regard to Council membership, costs, and activities, including 
        through use of modern technology and social media to 
        disseminate information; and
            (4) avoid conflicts of interest that would jeopardize the 
        ability of the Council to make decisions and provide 
        recommendations.

SEC. 4. SOCIAL DETERMINANTS ACCELERATOR GRANTS TO STATES OR LOCAL 
              GOVERNMENTS.

    (a) Grants to States, Local Governments, and Tribes.--Not later 
than 180 days after the date of the enactment of this Act, the 
Administrator, in consultation with the Secretary and the Council, 
shall award on a competitive basis not more than 25 grants to eligible 
applicants described in subsection (b), for the development of social 
determinants accelerator plans, as described in subsection (f).
    (b) Eligible Applicant.--An eligible applicant described in this 
section is a State, local, or Tribal health or human services agency 
that--
            (1) demonstrates the support of relevant parties across 
        relevant State, local, or Tribal jurisdictions; and
            (2) in the case of an applicant that is a local government 
        agency, provides to the Secretary a letter of support from the 
        lead State health or human services agency for the State in 
        which the local government is located.
    (c) Amount of Grant.--The Administrator, in coordination with the 
Council, shall determine the total amount that the Administrator will 
make available to each grantee under this section.
    (d) Application.--An eligible applicant seeking a grant under this 
section shall include in the application the following information:
            (1) The target population (or populations) that would 
        benefit from implementation of the social determinants 
        accelerator plan proposed to be developed by the applicant.
            (2) A description of the objective or objectives and 
        outcome goals of such proposed plan, which shall include at 
        least one health outcome and at least one other important 
        social outcome.
            (3) The sources and scope of inefficiencies that, if 
        addressed by the plan, could result in improved cost-
        effectiveness of or return on investment from Federal, State, 
        local, and Tribal governments.
            (4) A description of potential interventions that could be 
        designed or enabled using such proposed plan.
            (5) The State, local, Tribal, academic, nonprofit, 
        community-based organizations, and other private sector 
        partners that would participate in the development of the 
        proposed plan and subsequent implementation of programs or 
        initiatives included in such proposed plan.
            (6) Such other information as the Administrator, in 
        consultation with the Secretary and the Council, determines 
        necessary to achieve the purposes of this Act.
    (e) Use of Funds.--A recipient of a grant under this section may 
use funds received through the grant for the following purposes:
            (1) To convene and coordinate with relevant government 
        entities and other stakeholders across sectors to assist in the 
        development of a social determinant accelerator plan.
            (2) To identify populations of individuals receiving 
        medical assistance under a State plan (or a waiver of such 
        plan) under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.) who may benefit from the proposed approaches to 
        improving the health and well-being of such individuals through 
        the implementation of the proposed social determinants 
        accelerator plan.
            (3) To engage qualified research experts to advise on 
        relevant research and to design a proposed evaluation plan, in 
        accordance with the standards and guidelines issued by the 
        Administrator.
            (4) To collaborate with the Council to support the 
        development of social determinants accelerator plans.
            (5) To prepare and submit a final social determinants 
        accelerator plan to the Council.
    (f) Contents of Plans.--A social determinant accelerator plan 
developed under this section shall include the following:
            (1) A description of the target population (or populations) 
        that would benefit from implementation of the social 
        determinants accelerator plan, including an analysis describing 
        the projected impact on the well-being of individuals described 
        in subsection (e)(2).
            (2) A description of the interventions or approaches 
        designed under the social determinants accelerator plan and the 
        evidence for selecting such interventions or approaches.
            (3) The objectives and outcome goals of such interventions 
        or approaches, including at least one health outcome and at 
        least one other important social outcome.
            (4) A plan for accessing and linking relevant data to 
        enable coordinated benefits and services for the jurisdictions 
        described in subsection (b)(1) and an evaluation of the 
        proposed interventions and approaches.
            (5) A description of the State, local, Tribal, academic, 
        nonprofit, or community-based organizations, or any other 
        private sector organizations that would participate in 
        implementing the proposed interventions or approaches, and the 
        role each would play to contribute to the success of the 
        proposed interventions or approaches.
            (6) The identification of the funding sources that would be 
        used to finance the proposed interventions or approaches.
            (7) A description of any financial incentives that may be 
        provided, including outcome-focused contracting approaches to 
        encourage service providers and other partners to improve 
        outcomes of, cost-effectiveness of, and return on investment 
        from, Federal, State, local, or Tribal government spending.
            (8) The identification of the applicable Federal, State, 
        local, or Tribal statutory and regulatory authorities, 
        including waiver authorities, to be leveraged to implement the 
        proposed interventions or approaches.
            (9) A description of potential considerations that would 
        enhance the impact, scalability, or sustainability of the 
        proposed interventions or approaches and the actions the grant 
        awardee would take to address such considerations.
            (10) A proposed evaluation plan, to be carried out by an 
        independent evaluator, to measure the impact of the proposed 
        interventions or approaches on the outcomes of, cost-
        effectiveness of, and return on investment from, Federal, 
        State, local, and Tribal governments.
            (11) Precautions for ensuring that vulnerable populations 
        will not be denied access to Medicaid or other essential 
        services as a result of implementing the proposed plan.

SEC. 5. FUNDING.

    (a) In General.--Out of any money in the Treasury not otherwise 
appropriated, there is appropriated to carry out this Act $25,000,000, 
of which up to $5,000,000 may be used to carry out this Act, to remain 
available for obligation until the date that is 5 years after the date 
of enactment of this Act.
    (b) Reservation of Funds.--
            (1) In general.--Of the funds made available under 
        subsection (a), the Secretary shall reserve not less than 20 
        percent to award grants to eligible applicants for the 
        development of social determinants accelerator plans under 
        section 4 intended to serve rural populations.
            (2) Exception.--In the case of a fiscal year for which the 
        Secretary determines that there are not sufficient eligible 
        applicants to award up to 25 grants under section 4 that are 
        intended to serve rural populations and the Secretary cannot 
        satisfy the 20-percent requirement, the Secretary may reserve 
        an amount that is less than 20 percent of amounts made 
        available under subsection (a) to award grants for such 
        purpose.
    (c) Rule of Construction.--Nothing in this Act shall prevent 
Federal agencies represented on the Council from contributing 
additional funding from other sources to support activities to improve 
the effectiveness of the Council.
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