[House Report 117-187]
[From the U.S. Government Publishing Office]
117th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 117-187
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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\
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\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).
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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\
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\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).
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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.
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\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).
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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.
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