,i #aafth ,,congress #ast ,session ,h4 ,r4 #djjd ,,in ,,the ,,house ,,of ,,representatives ,july #be1 #bjai,mrs4 ,bustos 7for herself1 ,mr4 ,cole1 ,mr4 ,mc,govern1 ,mrs4 ,rodgers of ,washington1 ,mr4 ,rush1 ,ms4 ,barragn1 ,mr4 ,engel1 ,mr4 ,butterfield1 ,mr4 ,crdenas1 ,mr4 ,morelle1 ,mr4 ,fitzpatrick1 ,mr4 ,schrader1 ,mr4 ,soto1 ,mr4 ,michael ,f4 ,doyle of ,pennsylvania1 and ,ms4 ,blunt ,rochester7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to direct the ,secretary of ,health and ,human ,services to establish an interagency council on social determinants of health1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,social ,determinants ,accelerator ,act of #bjai4 #b4 ,findings2 purposes 7a7 ,findings ,congress finds the following3 7#a7 ,there is a significant body of evidence showing that economic and social conditions have a powerful impact on individual and population health outcomes and well-being1 as well as medical costs4 7#b7 ,state1 local1 and ,tribal governments and the service delivery partners of such governments face significant challenges in coordinating benefits and services delivered through the ,medicaid program and other social services programs because of the fragmented and complex nature of ,federal and ,state funding and administrative requirements4 7#c7 ,the ,federal ,government should prioritize and proactively assist ,state and local governments to strengthen the capacity of ,state and local governments to improve health and social outcomes for individuals1 thereby improving cost-effectiveness and return on investment4 7b7 ,purposes ,the purposes of this ,act are as follows3 7#a7 ,to establish effective1 coordinated ,federal technical assistance to help ,state and local governments to improve outcomes and cost-effectiveness of1 and return on investment from1 health and social services programs4 7#b7 ,to build a pipeline of ,state and locally designed1 cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes1 and increase the cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal health and social services programs4 7#c7 ,to enlist ,state and local governments and the service providers of such governments as partners in identifying ,federal statutory1 regulatory1 and administrative challenges in improving the health and social outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal spending on individuals enrolled in ,medicaid4 7#d7 ,to develop strategies to improve health and social outcomes without denying services to1 or restricting the eligibility of1 vulnerable populations4 #c4 ,social determinants accelerator council 7a7 ,establishment ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary71 in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this ,act as the ,administrator71 shall establish an interagency council1 to be known as the ,social ,determinants ,accelerator ,interagency ,council 7referred to in this ,act as the ,council7 to achieve the purposes listed in section #b7;b74 7b7 ,membership 7#a7 ,federal composition ,the ,council shall be composed of at least one designee from each of the following ,federal agencies3 7,a7 ,the ,office of ,management and ,budget4 7,b7 ,the ,department of ,agriculture4 7,c7 ,the ,department of ,education4 7,d7 ,the ,indian ,health ,service4 7,e7 ,the ,department of ,housing and ,urban ,development4 7,f7 ,the ,department of ,labor4 7,g7 ,the ,department of ,transportation4 7,h7 ,any other ,federal agency the ,chair of the ,council determines necessary4 7#b7 ,designation 7,a7 ,in general ,the head of each agency specified in paragraph 7#a7 shall designate at least one employee described in subparagraph 7,b7 to serve as a member of the ,council4 7,b7 ,responsibilities ,an employee described in this subparagraph shall be a senior employee of the agency-- 7i7 whose responsibilities relate to authorities1 policies1 and procedures with respect to the health and well-being of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7ii7 who has authority to implement and evaluate transformative initiatives that harness data or conducts rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits4 7#c7 ,,hhs representation ,in addition to the designees under paragraph 7#a71 the ,council shall include designees from at least three agencies within the ,department of ,health and ,human ,services1 including the ,centers for ,medicare ,medicaid ,services1 at least one of whom shall meet the criteria under paragraph 7#b77;,b74 7#d7 ,,omb role ,the ,director of the ,office of ,management and ,budget shall facilitate the timely resolution of ,governmentwide and multiagency issues to help the ,council achieve consensus recommendations described under subsection 7c77#a74 7#e7 ,non-,federal composition ,the ,comptroller ,general of the ,united ,states may designate up to #f ,council designees-- 7,a7 who have relevant subject matter expertise1 including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of ,federal ,government services2 and 7,b7 that each represent-- 7i7 ,state1 local1 and ,tribal health and human services agencies2 7ii7 public housing authorities or ,state housing finance agencies2 7iii7 ,state and local government budget offices2 7iv7 ,state ,medicaid agencies2 or 7v7 national consumer advocacy organizations4 7#f7 ,chair 7,a7 ,in general ,the ,secretary shall select the ,chair of the ,council from among the members of the ,council4 7,b7 ,initiating guidance ,the ,chair1 on behalf of the ,council1 shall identify and invite individuals from diverse entities to provide the ,council with advice and information pertaining to addressing social determinants of health1 including-- 7i7 individuals from ,state and local government health and human services agencies2 7ii7 individuals from ,state ,medicaid agencies2 7iii7 individuals from ,state and local government budget offices2 7iv7 individuals from public housing authorities or ,state housing finance agencies2 7v7 individuals from nonprofit organizations1 small businesses1 and philanthropic organizations2 7vi7 advocates2 7vii7 researchers2 and 7viii7 any other individuals the ,chair determines to be appropriate4 7c7 ,duties ,the duties of the ,council are-- 7#a7 to make recommendations to the ,secretary and the ,administrator regarding the criteria for making awards under section #d2 7#b7 to identify ,federal authorities and opportunities for use by ,states or local governments to improve coordination of funding and administration of ,federal programs1 the beneficiaries of whom include individuals described in section #b1 and which may be unknown or underutilized and to make information on such authorities and opportunities publicly available2 7#c7 to provide targeted technical assistance to ,states developing a social determinants accelerator plan under section #d1 including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan2 7#d7 to report to ,congress annually on the subjects set forth in subsection 7e72 7#e7 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 ,act on outcomes1 cost-effectiveness of1 and return on investment from ,federal1 ,state1 local1 and ,tribal governments1 and to facilitate technical assistance1 where needed1 to help to improve ,state and local evaluation designs and implementation2 7#f7 to seek feedback from ,state1 local1 and ,tribal governments1 including through an annual survey by an independent third party1 on how to improve the technical assistance the ,council provides to better equip ,state1 local1 and ,tribal governments to coordinate health and social service programs2 7#g7 to solicit applications for grants under section #d2 and 7#h7 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 initiatives4 7d7 ,schedule ,not later than #fj days after the date of the enactment of this ,act1 the ,council shall convene to develop a schedule and plan for carrying out the duties described in subsection 7c71 including solicitation of applications for the grants under section #d4 7e7 ,report to ,congress ,the ,council shall submit an annual report to ,congress1 which shall include-- 7#a7 a list of the ,council members2 7#b7 activities and expenditures of the ,council2 7#c7 summaries of the interventions and approaches that will be supported by ,state1 local1 and ,tribal governments that received a grant under section #d1 including-- 7,a7 the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in section #b7;b72 and 7,b7 a description of how the practices and approaches will impact the outcomes1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments with respect to such purposes2 7#d7 the feedback received from ,state and local governments on ways to improve the technical assistance of the ,council1 including findings from a third-party survey and actions the ,council plans to take in response to such feedback2 and 7#e7 the major statutory1 regulatory1 and administrative challenges identified by ,state1 local1 and ,tribal governments that received a grant under section #d1 and the actions that ,federal agencies are taking to address such challenges4 7f7 ,,faca applicability ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,council4 7g7 ,council procedures ,the ,secretary1 in consultation with the ,comptroller ,general of the ,united ,states and the ,director of the ,office of ,management and ,budget1 shall establish procedures for the ,council to-- 7#a7 ensure that adequate resources are available to effectively execute the responsibilities of the ,council2 7#b7 effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication2 7#c7 create transparency to the public and ,congress with regard to ,council membership1 costs1 and activities1 including through use of modern technology and social media to disseminate information2 and 7#d7 avoid conflicts of interest that would jeopardize the ability of the ,council to make decisions and provide recommendations4 #d4 ,social determinants accelerator grants to ,states or local governments 7a7 ,grants to ,states1 local governments1 and tribes ,not later than #ahj days after the date of the enactment of this ,act1 the ,administrator1 in consultation with the ,secretary and the ,council1 shall award on a competitive basis not more than #be grants to eligible applicants described in subsection 7b71 for the development of social determinants accelerator plans1 as described in subsection 7f74 7b7 ,eligible applicant ,an eligible applicant described in this section is a ,state1 local1 or ,tribal health or human services agency that-- 7#a7 demonstrates the support of relevant parties across relevant ,state1 local1 or ,tribal jurisdictions2 and 7#b7 in the case of an applicant that is a local government agency1 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 located4 7c7 ,amount of grant ,the ,administrator1 in coordination with the ,council1 shall determine the total amount that the ,administrator will make available to each grantee under this section4 7d7 ,application ,an eligible applicant seeking a grant under this section shall include in the application the following information3 7#a7 ,the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant4 7#b7 ,a description of the objective or objectives and outcome goals of such proposed plan1 which shall include at least one health outcome and at least one other important social outcome4 7#c7 ,the sources and scope of inefficiencies that1 if addressed by the plan1 could result in improved cost-effectiveness of or return on investment from ,federal1 ,state1 local1 and ,tribal governments4 7#d7 ,a description of potential interventions that could be designed or enabled using such proposed plan4 7#e7 ,the ,state1 local1 ,tribal1 academic1 nonprofit1 community-based organizations1 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 plan4 7#f7 ,such other information as the ,administrator1 in consultation with the ,secretary and the ,council1 determines necessary to achieve the purposes of this ,act4 7e7 ,use of funds ,a recipient of a grant under this section may use funds received through the grant for the following purposes3 7#a7 ,to convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinant accelerator plan4 7#b7 ,to identify populations of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan4 7#c7 ,to engage qualified research experts to advise on relevant research and to design a proposed evaluation plan1 in accordance with the standards and guidelines issued by the ,administrator4 7#d7 ,to collaborate with the ,council to support the development of social determinants accelerator plans4 7#e7 ,to prepare and submit a final social determinants accelerator plan to the ,council4 7f7 ,contents of plans ,a social determinant accelerator plan developed under this section shall include the following3 7#a7 ,a description of the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan1 including an analysis describing the projected impact on the well-being of individuals described in subsection 7e77#b74 7#b7 ,a description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches4 7#c7 ,the objectives and outcome goals of such interventions or approaches1 including at least one health outcome and at least one other important social outcome4 7#d7 ,a plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in subsection 7b77#a7 and an evaluation of the proposed interventions and approaches4 7#e7 ,a description of the ,state1 local1 ,tribal1 academic1 nonprofit1 or community-based organizations1 or any other private sector organizations that would participate in implementing the proposed interventions or approaches1 and the role each would play to contribute to the success of the proposed interventions or approaches4 7#f7 ,the identification of the funding sources that would be used to finance the proposed interventions or approaches4 7#g7 ,a description of any financial incentives that may be provided1 including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 or ,tribal government spending4 7#h7 ,the identification of the applicable ,federal1 ,state1 local1 or ,tribal statutory and regulatory authorities1 including waiver authorities1 to be leveraged to implement the proposed interventions or approaches4 7#i7 ,a description of potential considerations that would enhance the impact1 scalability1 or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations4 7#aj7 ,a proposed evaluation plan1 to be carried out by an independent evaluator1 to measure the impact of the proposed interventions or approaches on the outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments4 7#aa7 ,precautions for ensuring that vulnerable populations will not be denied access to ,medicaid or other essential services as a result of implementing the proposed plan4 #e4 ,funding 7a7 ,in general ,out of any money in the ,treasury not otherwise appropriated1 there is appropriated to carry out this ,act #be1jjj1jjj1 of which up to #e1jjj1jjj may be used to carry out this ,act1 to remain available for obligation until the date that is #e years after the date of enactment of this ,act4 7b7 ,reservation of funds 7#a7 ,in general ,of the funds made available under subsection 7a71 the ,secretary shall reserve not less than #bj percent to award grants to eligible applicants for the development of social determinants accelerator plans under section #d intended to serve rural populations4 7#b7 ,exception ,in the case of a fiscal year for which the ,secretary determines that there are not sufficient eligible applicants to award up to #be grants under section #d that are intended to serve rural populations and the ,secretary cannot satisfy the #bj-percent requirement1 the ,secretary may reserve an amount that is less than #bj percent of amounts made available under subsection 7a7 to award grants for such purpose4 7c7 ,rule of construction ,nothing in this ,act shall prevent ,federal agencies represented on the ,council from contributing additional funding from other sources to support activities to improve the effectiveness of the ,council4