[House Report 117-187]
[From the U.S. Government Publishing Office]


117th Congress    }                                     {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                     {      117-187

======================================================================



 
COLLECTING AND ANALYZING RESOURCES INTEGRAL AND NECESSARY FOR GUIDANCE 
                  FOR SOCIAL DETERMINANTS ACT OF 2021

                                _______
                                

 November 30, 2021.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3894]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3894) to require the Secretary of Health and 
Human Services to issue and disseminate guidance to States to 
clarify strategies to address social determinants of health 
under the Medicaid program and the Children's Health Insurance 
Program, and for other purposes, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                     Page
  I. Purpose and Summary..............................................  2
 II. Background and Need for the Legislation..........................  2
III. Committee Hearings...............................................  3
 IV. Committee Consideration..........................................  4
  V. Committee Votes..................................................  4
 VI. Oversight Findings...............................................  4
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures  5
VIII. Federal Mandates Statement......................................  5
 IX. Statement of General Performance Goals and Objectives............  5
  X. Duplication of Federal Programs..................................  5
 XI. Committee Cost Estimate..........................................  5
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......  5
XIII.Advisory Committee Statement.....................................  5
XIV. Applicability to Legislative Branch..............................  5
 XV. Section-by-Section Analysis of the Legislation...................  6
XVI. Changes in Existing Law Made by the Bill, as Reported............  6

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Collecting and Analyzing Resources 
Integral and Necessary for Guidance for Social Determinants Act of 
2021'' or the ``CARING for Social Determinants Act of 2021''.

SEC. 2. REQUIREMENT TO ISSUE GUIDANCE TO CLARIFY STRATEGIES TO ADDRESS 
                    SOCIAL DETERMINANTS OF HEALTH IN THE MEDICAID 
                    PROGRAM AND THE CHILDREN'S HEALTH INSURANCE 
                    PROGRAM.

  Not later than 3 years after the date of the enactment of this Act, 
and not less frequently than once every 3 years thereafter, the 
Secretary of Health and Human Services shall update the State Health 
Office letter 21-001, issued on January 7, 2021, to clarify strategies 
to address social determinants of health under the Medicaid program and 
the Children's Health Insurance Program. Such update shall include the 
following:
          (1) Guidance to State Medicaid agencies regarding the 
        strategies that States can implement under authorities in 
        existence as of such update under title XIX of the Social 
        Security Act, title XXI of such Act, or section 1115 of such 
        Act to address social determinants of health in the provision 
        of health care, including strategies specifically targeting 
        children receiving medical assistance under a State plan under 
        title XIX of such Act (or a waiver of such plan) or child 
        health assistance under a State child health plan under title 
        XXI of such Act.
          (2) Guidance on how States can encourage and incentivize 
        managed care entities to address social determinants of health 
        through contracts with such entities.
          (3) Updated examples from States with respect to how States 
        are addressing social determinants of health in the provision 
        of health care under the Medicaid program under title XIX of 
        the Social Security Act and the Children's Health Insurance 
        Program under title XXI of such Act, including through payment 
        models.

                         I. PURPOSE AND SUMMARY

    H.R. 3894, the ``Collecting and Analyzing Resources 
Integral and Necessary for Guidance for Social Determinants Act 
of 2021'' or the ``CARING for Social Determinants Act of 
2021,'' ensures that state Medicaid programs have current and 
accurate information on how they can use Medicaid to address 
social determinants of health.
    H.R. 3894 directs the Secretary of Health and Human 
Services (HHS) to update existing Medicaid guidance on 
strategies to address social determinants of health in the 
Medicaid program. It specifies that such guidance shall include 
information on provisions in Title XIX and Title XXI of the 
Social Security Act (SSA), as well as authorities under section 
1115 of such Act that states may use to address social 
determinants of health. It requires that the Secretary provide 
guidance on how states can encourage Medicaid managed care 
entities to address social determinants of health. It also 
requires that the guidance include examples of how states are 
currently using such authorities to address social determinants 
of health.

                II. BACKGROUND AND NEED FOR LEGISLATION

    Social determinants of health impact the quality of 
everyone's life and are the primary drivers of health outcomes, 
along with health behaviors like smoking, diet, and 
exercise.\1\\2\ Generally, social determinants of health are 
defined as the medical, economic, educational, environmental, 
and social conditions affecting individuals as they live and 
age.\3\ Examples of social determinants of health include 
income, housing, transportation, safety, literacy, language, 
hunger, access to clean water and nutritional food, civic 
engagement, and access to and quality of health care.\4\ 
Although these markers are important indicators of health-
related risks, individual-level social determinants of health 
are not routinely collected or systematically used by 
healthcare providers to allocate resources or supports to 
individuals most in need.\5\
---------------------------------------------------------------------------
    \1\Health.gov, Social Determinants of Health (health.gov/
healthypeople/objectives-and-data/social-determinants-health) (Accessed 
June 11, 2021).
    \2\Kaiser Family Foundation, Beyond Healthcare: The Role of Social 
Determinants (www.kff.org/racial-equity-and-health-policy/issue-brief/
beyond-health-care-the-role-of-social-determinants-in-promoting-health-
and-health-equity/) (May 10, 2018).
    \3\de Beaumont Foundation, Driving Public Health in the Fast Lane 
(debeaumont.org/wp-content/uploads/2019/09/DSI-White-Paper_v15-
Spreads.pdf) (Accessed June 14, 2021).
    \4\Centers for Disease Control and Prevention, Morbidity and 
Mortality Weekly Report (MMWR): Ten Great Public Health Achievements--
United States, 1900 1999 (www.cdc.gov/mmwr/preview/mmwrhtml/
00056796.htm) (Accessed June 14, 2021).
    \5\Centers for Disease Control and Prevention, Agency for Toxic 
Substances and Disease Registry, Fact Sheet: What is Social 
Vulnerability? (www.atsdr.cdc.gov/placeandhealth/svi/fact_sheet/
fact_sheet.html) (Accessed June 14, 2021).
---------------------------------------------------------------------------
    In order to address social determinant needs, states have 
deployed a broad array of approaches across their Medicaid 
programs to better support the broader needs of their Medicaid 
populations. For example, the State of Washington uses 
flexibilities in a section 1115 demonstration to partner with 
Federally Qualified Health Centers that administer the Health 
Care for the Homeless program to help provide supportive 
housing and supported employment opportunities for those 
enrolled in the program.\6\ Additionally, the State of 
Minnesota, through its section 1915(i) State Plan Amendment 
covers certain housing stabilization services for people with 
disabilities that either have mental illness or substance use 
disorders or are at risk of experiencing homelessness.\7\
---------------------------------------------------------------------------
    \6\Letter from Anne Marie Costello, Acting Center Director and 
Deputy Administrator, Centers for Medicare and Medicaid Servies, to 
MaryAnne Lindeblad, Medicaid Director, Health Care Authority 
(www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/
1115/downloads/wa/wa-medicaid-transformation-ca.pdf) (Nov. 6, 2020).
    \7\State Plan Amendment #18-0008 and enclosed transmittal 
documents, State of Minnesota (www.medicaid.gov/sites/default/files/
State-resource-center/Medicaid-State-Plan-Amendments/Downloads/MN/MN-
18-08.pdf) (Aug. 1, 2019).
---------------------------------------------------------------------------
    Medicaid has significant flexibility to allow for state 
innovation and for other states to take up models that other 
states have demonstrated. On January 7, 2021, the Centers for 
Medicare & Medicaid Services (CMS) released guidance that 
described current flexibilities under the law and highlighted 
successful pilots and demonstrations that states have taken to 
use these flexibilities to address social determinants of 
health.\8\ H.R. 3894 would continue these efforts by requiring 
regular updates to the guidance so that states can remain up to 
date on the latest flexibilities and successes in supporting 
social determinants of health in Medicaid.
---------------------------------------------------------------------------
    \8\Letter from Anne Marie Costello, Acting Deputy Administrator and 
Director, Centers for Medicare and Medicaid Services, to State Health 
Officials (www.medicaid.gov/federal-policy-guidance/downloads/
sho21001.pdf) (Jan. 7, 2021).
---------------------------------------------------------------------------

                        III. COMMITTEE HEARINGS

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 3894:
    The Subcommittee on Health held a hearing on June 24, 2021, 
entitled ``Empowered by Data: Legislation to Advance Equity and 
Public Health''. The Subcommittee received testimony from the 
following witnesses:
           Romilla Batra, M.D., M.B.A., Chief Medical 
        Officer, SCAN Health Plan;
           Beth Blauer, Executive Director, Johns 
        Hopkins University Centers for Civic Impact;
           Karen DeSalvo, M.D., M.P.H, M.Sc., Chief 
        Health Officer, Google Health;
           Faisel Syed, M.D., National Director of 
        Primary Care, ChenMed; and
           Kara Odom Walker, M.D., M.P.H., M.S.H.S., 
        Executive Vice President and Chief Population Health 
        Officer, Nemours Childrens Health System.

                      IV. COMMITTEE CONSIDERATION

    H.R. 3894, the ``Collecting and Analyzing Resources 
Integral and Necessary for Guidance for Social Determinants Act 
of 2021'' or the ``CARING for Social Determinants Act of 
2021,'' was introduced on June 15, 2021, by Representatives 
Lisa Blunt Rochester (D-DE) and Gus Bilirakis (R-FL), which was 
referred to the Committee on Energy and Commerce. Subsequently, 
on June 16, 2021, H.R. 3894 was referred to the Subcommittee on 
Health. A legislative hearing was held on the bill on June 24, 
2021.
    On July 15, 2021, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 3894 and 
18 other bills. During consideration of the bill, an amendment 
offered by Representative Blunt Rochester was agreed to by a 
voice vote. Upon conclusion of consideration of the bill, the 
Subcommittee agreed to a motion on final passage offered by 
Representative Eshoo (D-CA), Chairwoman of the Subcommittee, to 
order H.R. 3894 reported favorably to the full Committee, 
amended, by a voice vote.
    On July 21, 2021, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 3894 and 23 other 
bills. During consideration of the bill, an amendment offered 
by Representative Blunt Rochester was agreed to by a voice 
vote. Upon conclusion of consideration of the bill, the full 
Committee agreed to a motion on final passage offered by 
Representative Pallone (D-NJ), Chairman of the Committee, to 
order H.R. 3894 reported favorably to the House, amended, by a 
voice vote.

                           V. COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
3894, including a motion by Mr. Pallone ordering H.R. 3894 
favorably reported to the House, amended.

                         VI. OVERSIGHT FINDINGS

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to ensure 
state Medicaid programs have regularly updated guidance on what 
authorities in Medicaid and CHIP can be used to address social 
determinants of health.

                   X. DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3894 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. COMMITTEE COST ESTIMATE

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. EARMARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3894 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. ADVISORY COMMITTEE STATEMENT

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``Collecting and Analyzing Resources Integral and Necessary 
for Guidance for Social Determinants Act of 2021'' or the 
``CARING for Social Determinants Act of 2021.''

Sec. 2. Requirement to issue guidance to clarify strategies to address 
        social determinants of health in the Medicaid Program and the 
        Children's Health Insurance Program

    Section 2 directs the Secretary of HHS to update State 
Health Office letter 21-001, issued on January 7, 2021, no 
later than three years after the date of enactment, and no less 
frequently than every three years after that.
    Subsection (1) requires that the guidance include updates 
to the authorities under the Medicaid program, CHIP program, 
and section 1115 of the Social Security Act that states can use 
to address social determinants of health.
    Subsection (2) requires that the guidance include guidance 
on how states can encourage and incentivize Medicaid managed 
care entities to address social determinants of health.
    Subsection (3) requires that the guidance include updated 
examples of how states are addressing social determinants of 
health through Medicaid and CHIP, including examples of payment 
models.

       XVI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    There are no changes to existing law made by the bill H.R. 
3894.

                                  [all]