,,ii  #aafth ,,congress  #b;d ,session  
,s4 #dddj  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,august #e1    
#bjbj,ms4 ,smith 7for herself1 ,mr4     
,murphy1 ,mr4 ,king1 ,mr4 ,whitehouse1  
,ms4 ,harris1 ,mr4 ,carper1 and ,mr4    
,wyden7 introduced the following bill2  
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
authorize the ,director of the ,centers 
for ,disease ,control and ,prevention to
 carry out a ,social ,determinants of   
,health ,program1 and for other         
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,improving ,social  
,determinants of ,health ,act of #bjbj4 
#b4 ,findings ,congress finds the       
following3 7#a7 ,healthy ,people #bjbj  
defines social determinants of health as
 conditions in the environments in which
 people live1 learn1 work1 play1        
worship1 and age that affect a wide     
range of health1 functioning1 and       
quality-of-life outcomes and risks4     

7#b7 ,one of the overarching goals of   
,healthy ,people #bjbj is to create     
social and physical environments that   
promote good health for all4  7#c7      
,healthy ,people #bjbj developed a      
place-based organizing framework1       
reflecting five key areas of social     
determinants of health namely-- 7,a7    
economic stability2  7,b7 education2    
7,c7 social and community context2  7,d7
 health and health care2 and  7,e7      
neighborhood and built environment4     
7#d7 ,it is estimated that medical care 
accounts for only #aj to #bj percent of 
the modifiable contributors to healthy  
outcomes for a population4  7#e7 ,the   
,centers for ,medicare  ,medicaid       
,services has indicated the importance  
of the social determinants in its work  
stating that1 ,as we seek to foster     
innovation1 rethink rural health1 find  
solutions to the opioid epidemic1 and   
continue to put patients first1 we need 
to take into account social determinants
 of health and recognize their          

importance44  7#f7 ,the ,department of  
,health and ,human ,services' ,public   
,health #c4j initiative recognizes the  
role of public health in working across 
sectors on social determinants of       
health1 as well as the role of public   
health as chief health strategist in    
communities4  7#g7 ,through its ,health 
,impact in #e ,years initiative1 the    
,centers for ,disease ,control and      
,prevention has highlighted nonclinical1
 community-wide approaches that show    
positive health impacts1 results within 
five years1 and cost effectiveness or   
cost savings over the lifetime of the   
population or earlier4  7#h7 ,health    
departments and the ,centers for        
,disease ,control and ,prevention are   
not funded for such cross-cutting work4 
7#i7 ,providing grants to public health 
departments and other eligible entities 
to coordinate cross-sector collaboration
 will allow a community-wide1           
evidence-based approach to address      
underlying social determinants of       

health4  #c4 ,social ,determinants of   
,health ,program  7a7 ,program ,to the  
extent and in the amounts made available
 in advance in appropriations ,acts1 the
 ,secretary of ,health and ,human       
,services1 acting through the ,director 
of the ,centers for ,disease ,control   
and ,prevention 7in this ,act referred  
to as the ,director71 shall carry out a 
program1 to be known as the ,social     
,determinants of ,health ,program 7in   
this ,act referred to as the ,program71 
to achieve the following goals3 7#a7    
,improve health outcomes and reduce     
health inequities by coordinating social
 determinants of health activities      
across the ,centers for ,disease        
,control and ,prevention4  7#b7 ,improve
 the capacity of public health agencies 
and community organizations to address  
social determinants of health in        
communities4  7b7 ,activities ,to       
achieve the goals listed in subsection  
7a71 the ,director shall carry out      
activities including the following3 7#a7

 ,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        
activities4  7#b7 ,awarding grants under
 section #d to ,state1 local1           
territorial1 and ,tribal health         
departments and organizations1 and to   
other eligible entities1 to address     
social determinants of health in target 
communities4  7#c7 ,awarding grants     
under section #e to nonprofit           
organizations and public or other       
nonprofit institutions of higher        
education-- 7,a7 to conduct research on 
best practices to improve social        
determinants of health2  7,b7 to provide
 technical assistance1 training1 and    
evaluation assistance to grantees under 
section #d2 and  7,c7 to disseminate    
best practices to grantees under section
 #d4  7#d7 ,coordinating1 supporting1   
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 health1 including such activities of 
agencies in the ,department of ,health  
and ,human ,services such as the        
,centers for ,medicare  ,medicaid       
,services4  7#e7 ,collecting and        
analyzing data related to the social    
determinants of health4  #d4 ,grants to 
address social determinants of health   
7a7 ,in general ,the ,director1 as part 
of the ,program1 shall award grants to  
eligible entities to address social     
determinants of health in their         
communities4  7b7 ,eligibility ,to be   
eligible to apply for a grant under this
 section1 an entity shall be-- 7#a7 a   
,state1 local1 territorial1 or ,tribal  
health agency or organization2  7#b7 a  
qualified nongovernmental entity1 as    
defined by the ,director2 or  7#c7 a    
consortium of entities that includes a  
,state1 local1 territorial1 or ,tribal  
health agency or organization4  7c7 ,use

 of funds  7#a7 ,in general ,a grant    
under this section shall be used to     
address social determinants of health in
 a target community by designing and    
implementing innovative1 evidence-based1
 cross-sector strategies4  7#b7 ,target 
community ,for purposes of this section1
 a target community shall be a ,state1  
county1 city1 ,tribe1 or other          
municipality4  7d7 ,priority and set    
aside  7#a7 ,priority ,in awarding      
grants under this section1 the ,director
 shall prioritize applicants proposing  
to serve target communities with        
significant unmet health and social     
needs1 as defined by the ,director4     
7#b7 ,set aside ,the ,director shall set
 aside #e percent of amounts            
appropriated to carry out this section  
in each fiscal year to award grants to  
,indian ,tribes and ,tribal             
organizations4  7e7 ,application ,to    
seek a grant under this section1 an     
eligible entity shall-- 7#a7 submit an  
application at such time1 in such       

manner1 and containing such information 
as the ,director may require2  7#b7     
propose a set of activities to address  
social determinants of health through   
evidence-based1 cross-sector strategies1
 which activities may include-- 7,a7    
collecting quantifiable data from health
 care1 social services1 and other       
entities regarding the most significant 
gaps in health-promoting social1        
economic1 and environmental needs2  7,b7
 identifying evidence-based approaches  
to meeting the nonmedical1 social needs 
of populations identified by data       
collection described in subparagraph    
7,a71 such as unstable housing or       
inadequate food2  7,c7 developing       
scalable methods to meet patients'      
social needs identified in clinical     
settings or other sites2  7,d7 convening
 entities such as local and ,state      
governmental and nongovernmental        
organizations1 health systems1 payors1  
and community-based organizations to    
review1 plan1 and implement             

community-wide interventions and        
strategies to advance health-promoting  
social conditions2  7,e7 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 care2 and  7,f7 such other       
activities as may be specified by the   
,director2  7#c7 demonstrate how the    
eligible entity will collaborate with-- 
7,a7 health systems2  7,b7 payors1      
including1 as appropriate1 ,medicaid    
managed care organizations 7as defined  
in section #aijc7m77#a77;,a7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7m77#a77;,a7771 ,medicare        
,advantage plans under part ,c of title 
,,xviii of such ,act 7#db ,u4,s4,c4     
#aciew-#ba et seq471 and health         
insurance issuers and group health plans
 7as such terms are defined in section  
#bgia of the ,public ,health ,service   
,act72  7,c7 other relevant stakeholders
 and initiatives in areas of need1 such 

as the ,accountable ,health ,communities
 ,model of the ,centers for ,medicare   
,medicaid ,services1 health homes under 
the ,medicaid program under title ,,xix 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acif et seq471               
community-based organizations1 and human
 services organizations2  7,d7 other    
non-health care sector organizations1   
including organizations focusing on     
transportation1 housing1 or food access2
 and  7,e7 local employers2 and  7#d7   
identify key health inequities in the   
target community and demonstrate how the
 proposed efforts of the eligible entity
 would address such inequities4  7f7    
,monitoring and evaluation ,as a        
condition of receipt of a grant under   
this section1 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 activities4  7g7 ,independent      
national evaluation  7#a7 ,in general   
,not later than #e years after the first

 grants are awarded under this section1 
the ,director shall provide for the     
commencement of an independent national 
evaluation of the ,program under this   
section4  7#b7 ,report to ,congress ,not
 later than #fj days after receiving the
 results of such independent national   
evaluation1 the ,director shall report  
such results to the ,committee on       
,health1 ,education1 ,labor1 and        
,pensions of the ,senate and the        
,committee on ,energy and ,commerce of  
the ,house of ,representatives4  #e4    
,research and training ,the ,director1  
as part of the ,program-- 7#a7 shall    
award grants to nonprofit organizations 
and public or other nonprofit           
institutions of higher education-- 7,a7 
to conduct research on best practices to
 improve social determinants of health2 
7,b7 to provide technical assistance1   
training1 and evaluation assistance to  
grantees under section #d2 and  7,c7 to 
disseminate best practices to grantees  
under section #d2 and  7#b7 may require 

a grantee under paragraph 7#a7 to       
provide technical assistance and        
capacity building to entities that are  
eligible entities under section #d but  
not receiving funds through such        
section4  #f4 ,funding  7a7 ,in general 
,there is authorized to be appropriated 
to carry out this ,act1 #ej1jjj1jjj for 
each of fiscal years #bjba through      
#bjbf4  7b7 ,allocation ,of the amount  
made available to carry out this ,act   
for a fiscal year1 not less than #ge    
percent shall be used for grants under  
sections #d and #e4