[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4440 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4440

   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 SENATE OF THE UNITED STATES

                             August 5, 2020

   Ms. Smith (for herself, Mr. Murphy, Mr. King, Mr. Whitehouse, Ms. 
Harris, Mr. Carper, and Mr. Wyden) introduced the following bill; which 
  was read twice and referred to the Committee on Health, Education, 
                          Labor, and Pensions

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Social Determinants of 
Health Act of 2020''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Healthy People 2020 defines social determinants of 
        health as conditions in the environments in which people live, 
        learn, work, play, worship, and age that affect a wide range of 
        health, functioning, and quality-of-life outcomes and risks.
            (2) One of the overarching goals of Healthy People 2020 is 
        to ``create social and physical environments that promote good 
        health for all''.
            (3) Healthy People 2020 developed a ``place-based'' 
        organizing framework, reflecting five key areas of social 
        determinants of health namely--
                    (A) economic stability;
                    (B) education;
                    (C) social and community context;
                    (D) health and health care; and
                    (E) neighborhood and built environment.
            (4) It is estimated that medical care accounts for only 10 
        to 20 percent of the modifiable contributors to healthy 
        outcomes for a population.
            (5) The Centers for Medicare & Medicaid Services has 
        indicated the importance of the social determinants in its work 
        stating that, ``As we seek to foster innovation, rethink rural 
        health, find solutions to the opioid epidemic, and continue to 
        put patients first, we need to take into account social 
        determinants of health and recognize their importance.''.
            (6) The Department of Health and Human Services' Public 
        Health 3.0 initiative recognizes the role of public health in 
        working across sectors on social determinants of health, as 
        well as the role of public health as chief health strategist in 
        communities.
            (7) Through its Health Impact in 5 Years initiative, the 
        Centers for Disease Control and Prevention has highlighted 
        nonclinical, community-wide approaches that show positive 
        health impacts, results within five years, and cost 
        effectiveness or cost savings over the lifetime of the 
        population or earlier.
            (8) Health departments and the Centers for Disease Control 
        and Prevention are not funded for such cross-cutting work.
            (9) Providing grants to public health departments and other 
        eligible entities to coordinate cross-sector collaboration will 
        allow a community-wide, evidence-based approach to address 
        underlying social determinants of health.

SEC. 3. SOCIAL DETERMINANTS OF HEALTH PROGRAM.

    (a) Program.--To the extent and in the amounts made available in 
advance in appropriations Acts, the Secretary of Health and Human 
Services, acting through the Director of the Centers for Disease 
Control and Prevention (in this Act referred to as the ``Director''), 
shall carry out a program, to be known as the Social Determinants of 
Health Program (in this Act referred to as the ``Program''), to achieve 
the following goals:
            (1) Improve health outcomes and reduce health inequities by 
        coordinating social determinants of health activities across 
        the Centers for Disease Control and Prevention.
            (2) Improve the capacity of public health agencies and 
        community organizations to address social determinants of 
        health in communities.
    (b) Activities.--To achieve the goals listed in subsection (a), the 
Director shall carry out activities including the following:
            (1) Coordinating across the Centers for Disease Control and 
        Prevention to ensure that relevant programs consider and 
        incorporate social determinants of health in grant awards and 
        other activities.
            (2) Awarding grants under section 4 to State, local, 
        territorial, and Tribal health departments and organizations, 
        and to other eligible entities, to address social determinants 
        of health in target communities.
            (3) Awarding grants under section 5 to nonprofit 
        organizations and public or other nonprofit institutions of 
        higher education--
                    (A) to conduct research on best practices to 
                improve social determinants of health;
                    (B) to provide technical assistance, training, and 
                evaluation assistance to grantees under section 4; and
                    (C) to disseminate best practices to grantees under 
                section 4.
            (4) Coordinating, supporting, and aligning activities of 
        the Centers for Disease Control and Prevention related to 
        social determinants of health with activities of other Federal 
        agencies related to social determinants of health, including 
        such activities of agencies in the Department of Health and 
        Human Services such as the Centers for Medicare & Medicaid 
        Services.
            (5) Collecting and analyzing data related to the social 
        determinants of health.

SEC. 4. GRANTS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH.

    (a) In General.--The Director, as part of the Program, shall award 
grants to eligible entities to address social determinants of health in 
their communities.
    (b) Eligibility.--To be eligible to apply for a grant under this 
section, an entity shall be--
            (1) a State, local, territorial, or Tribal health agency or 
        organization;
            (2) a qualified nongovernmental entity, as defined by the 
        Director; or
            (3) a consortium of entities that includes a State, local, 
        territorial, or Tribal health agency or organization.
    (c) Use of Funds.--
            (1) In general.--A grant under this section shall be used 
        to address social determinants of health in a target community 
        by designing and implementing innovative, evidence-based, 
        cross-sector strategies.
            (2) Target community.--For purposes of this section, a 
        target community shall be a State, county, city, Tribe, or 
        other municipality.
    (d) Priority and Set Aside.--
            (1) Priority.--In awarding grants under this section, the 
        Director shall prioritize applicants proposing to serve target 
        communities with significant unmet health and social needs, as 
        defined by the Director.
            (2) Set aside.--The Director shall set aside 5 percent of 
        amounts appropriated to carry out this section in each fiscal 
        year to award grants to Indian Tribes and Tribal organizations.
    (e) Application.--To seek a grant under this section, an eligible 
entity shall--
            (1) submit an application at such time, in such manner, and 
        containing such information as the Director may require;
            (2) propose a set of activities to address social 
        determinants of health through evidence-based, cross-sector 
        strategies, which activities may include--
                    (A) collecting quantifiable data from health care, 
                social services, and other entities regarding the most 
                significant gaps in health-promoting social, economic, 
                and environmental needs;
                    (B) identifying evidence-based approaches to 
                meeting the nonmedical, social needs of populations 
                identified by data collection described in subparagraph 
                (A), such as unstable housing or inadequate food;
                    (C) developing scalable methods to meet patients' 
                social needs identified in clinical settings or other 
                sites;
                    (D) convening entities such as local and State 
                governmental and nongovernmental organizations, health 
                systems, payors, and community-based organizations to 
                review, plan, and implement community-wide 
                interventions and strategies to advance health-
                promoting social conditions;
                    (E) monitoring and evaluating the impact of 
                activities funded through the grant on the health and 
                well-being of the residents of the target community and 
                on the cost of health care; and
                    (F) such other activities as may be specified by 
                the Director;
            (3) demonstrate how the eligible entity will collaborate 
        with--
                    (A) health systems;
                    (B) payors, including, as appropriate, Medicaid 
                managed care organizations (as defined in section 
                1903(m)(1)(A) of the Social Security Act (42 U.S.C. 
                1396b(m)(1)(A))), Medicare Advantage plans under part C 
                of title XVIII of such Act (42 U.S.C. 1395w-21 et 
                seq.), and health insurance issuers and group health 
                plans (as such terms are defined in section 2791 of the 
                Public Health Service Act);
                    (C) other relevant stakeholders and initiatives in 
                areas of need, such as the Accountable Health 
                Communities Model of the Centers for Medicare & 
                Medicaid Services, health homes under the Medicaid 
                program under title XIX of the Social Security Act (42 
                U.S.C. 1396 et seq.), community-based organizations, 
                and human services organizations;
                    (D) other non-health care sector organizations, 
                including organizations focusing on transportation, 
                housing, or food access; and
                    (E) local employers; and
            (4) identify key health inequities in the target community 
        and demonstrate how the proposed efforts of the eligible entity 
        would address such inequities.
    (f) Monitoring and Evaluation.--As a condition of receipt of a 
grant under this section, a grantee shall agree to submit an annual 
report to the Director describing the activities carried out through 
the grant and the outcomes of such activities.
    (g) Independent National Evaluation.--
            (1) In general.--Not later than 5 years after the first 
        grants are awarded under this section, the Director shall 
        provide for the commencement of an independent national 
        evaluation of the Program under this section.
            (2) Report to congress.--Not later than 60 days after 
        receiving the results of such independent national evaluation, 
        the Director shall report such results to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives.

SEC. 5. RESEARCH AND TRAINING.

    The Director, as part of the Program--
            (1) shall award grants to nonprofit organizations and 
        public or other nonprofit institutions of higher education--
                    (A) to conduct research on best practices to 
                improve social determinants of health;
                    (B) to provide technical assistance, training, and 
                evaluation assistance to grantees under section 4; and
                    (C) to disseminate best practices to grantees under 
                section 4; and
            (2) may require a grantee under paragraph (1) to provide 
        technical assistance and capacity building to entities that are 
        eligible entities under section 4 but not receiving funds 
        through such section.

SEC. 6. FUNDING.

    (a) In General.--There is authorized to be appropriated to carry 
out this Act, $50,000,000 for each of fiscal years 2021 through 2026.
    (b) Allocation.--Of the amount made available to carry out this Act 
for a fiscal year, not less than 75 percent shall be used for grants 
under sections 4 and 5.
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