[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2986 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 2986

To amend part A of title XI of the Social Security Act to establish an 
  interagency council on social determinants of health, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 5, 2019

Mr. Young (for himself and Ms. Stabenow) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend part A of title XI of the Social Security Act 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. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.

    Part A of title XI of the Social Security Act (42 U.S.C. 1301 et 
seq.) is amended by inserting after section 1139B, the following new 
section:

``SEC. 1139C. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.

    ``(a) Establishment.--There is established an interagency council 
to be known as the Social Determinants Accelerator Interagency Council 
(referred to in this section as the `Council').
    ``(b) Membership.--
            ``(1) Federal composition.--The Council shall be composed 
        of at least 1 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) The Department of Justice.
                    ``(I) 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 leadership 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; or
                            ``(ii) who has authority to implement and 
                        evaluate 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 3 agencies within the Department of Health and Human 
        Services, including the Centers for Medicare & Medicaid 
        Services, who shall meet the criteria under paragraph (2)(B).
            ``(4) 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 
                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.
            ``(5) Chair.--
                    ``(A) In general.--The Chair of the Council shall 
                be the representative from the Office of Management and 
                Budget to--
                            ``(i) ensure a government-wide and multi-
                        agency response, when applicable; and
                            ``(ii) facilitate the timely resolution of 
                        government-wide and multi-agency issues to help 
                        the Council achieve consensus recommendations 
                        described under subsection (c)(1).
                    ``(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 regarding 
        the criteria for making awards under subsection (g);
            ``(2) to identify Federal authorities and opportunities for 
        use by States or local governments to improve coordination of 
        funding and administration of Federal programs, and which may 
        be unknown to or underutilized by State or local governments 
        and to make information on such authorities and opportunities 
        publicly available;
            ``(3) to provide targeted technical assistance to States 
        developing models focused on case management of individuals 
        receiving services administered by State or local health and 
        social services agencies, including by identifying potential 
        statutory or regulatory pathways for implementation of the 
        models and assisting in identifying potential sources of 
        funding to implement the models;
            ``(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 section 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 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 subsection 
        (g); 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 section, 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 
subsection (g).
    ``(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 approaches that will be supported by 
        State, local, and Tribal governments that received a grant 
        under subsection (g) including--
                    ``(A) evidence-based approaches such governments 
                plan to employ to, at a minimum, address the economic, 
                social, and health needs of the affected populations; 
                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; and
            ``(4) the major barriers identified by State, local, and 
        Tribal governments that received a grant under subsection (g), 
        and the actions that Federal agencies are taking to address 
        such challenges.
    ``(f) Council Procedures.--The Director of the Office of Management 
and Budget, in consultation with the Comptroller General of the United 
States, 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 to 
        disseminate information; and
            ``(4) avoid conflicts of interest that would jeopardize the 
        ability of the Council to make decisions and provide 
        recommendations.
    ``(g) Social Determinants Accelerator Grants to States or Local 
Governments.--
            ``(1) Grants to states, local governments, and tribes.--Not 
        later than 180 days after the date of the enactment of this 
        section, the Secretary, in consultation with the Council, shall 
        award on a competitive basis not more than 25 grants to 
        eligible applicants described in paragraph (2), for the 
        development of social determinants accelerator plans, as 
        described in paragraph (6).
            ``(2) Eligible applicant.--An eligible applicant described 
        in this paragraph is a State, local, or Tribal health or human 
        services agency that--
                    ``(A) demonstrates the support of relevant parties 
                across relevant State, local, or Tribal jurisdictions; 
                and
                    ``(B) 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.
            ``(3) Amount of grant.--The Secretary, in coordination with 
        the Council, shall determine the total amount that the 
        Secretary will make available to each grantee under this 
        subsection.
            ``(4) Application.--An eligible applicant seeking a grant 
        under this subsection shall include in the application the 
        following information:
                    ``(A) The target population (or populations) that 
                would benefit from implementation of the social 
                determinants accelerator plan proposed to be developed 
                by the applicant.
                    ``(B) A description of the objective or objectives 
                and outcome goals of such proposed plan, which shall 
                include at least 1 health outcome and at least 1 other 
                important social outcome.
                    ``(C) 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.
                    ``(D) A description of potential interventions that 
                could be designed or enabled using such proposed plan.
                    ``(E) 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.
                    ``(F) Such other information as the Secretary, in 
                consultation with the Council, determines necessary to 
                achieve the purposes of this section.
            ``(5) Use of funds.--A recipient of a grant under this 
        subsection may use funds received through the grant for the 
        following purposes:
                    ``(A) To convene and coordinate with relevant 
                government entities and other stakeholders across 
                sectors to assist in the development of a social 
                determinant accelerator plan.
                    ``(B) To identify approaches to improving the 
                health and well-being of individuals receiving medical 
                assistance under a State plan (or a waiver of such 
                plan) under title XIX through the implementation of the 
                proposed social determinants accelerator plan.
                    ``(C) 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 Secretary.
                    ``(D) To collaborate with the Council to support 
                the development of social determinants accelerator 
                plans.
                    ``(E) To prepare and submit a final social 
                determinants accelerator plan to the Council.
            ``(6) Contents of plans.--A social determinant accelerator 
        plan developed with a grant made under this subsection shall 
        include the following:
                    ``(A) 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 paragraph (5)(B).
                    ``(B) A description of the interventions or 
                approaches designed under the social determinants 
                accelerator plan and the evidence for selecting such 
                interventions or approaches.
                    ``(C) The objectives and outcome goals of such 
                interventions or approaches, including at least 1 
                health outcome and at least 1 other important social 
                outcome.
                    ``(D) A plan for accessing and linking relevant 
                data to enable coordinated benefits and services for 
                the jurisdictions described in paragraph (2)(A) and an 
                evaluation of the proposed interventions and 
                approaches.
                    ``(E) 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.
                    ``(F) The identification of the funding sources 
                that would be used to finance the proposed 
                interventions or approaches.
                    ``(G) 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.
                    ``(H) 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.
                    ``(I) 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.
                    ``(J) A proposed rigorous 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.
                    ``(K) Precautions for ensuring that vulnerable 
                populations will not be denied access to Medicaid or 
                other essential services as a result of implementing 
                the proposed social determinants accelerator plan.
    ``(h) Funding.--
            ``(1) In general.--Out of any money in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        section $20,000,000, of which up to $5,000,000 may be used for 
        administrative expenses to carry out this section, to remain 
        available for obligation until the date that is 5 years after 
        the date of enactment of this section.
            ``(2) Reservation of funds.--
                    ``(A) In general.--Of the funds made available 
                under paragraph (1), the Secretary shall reserve not 
                less than 20 percent to award grants to eligible 
                applicants for the development of social determinants 
                accelerator plans under subsection (g) intended to 
                serve rural populations.
                    ``(B) 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 subsection (g) 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 paragraph (1) to award grants for such 
                purpose.
            ``(3) Rule of construction.--Nothing in this section 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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