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