II 

116TH CONGRESS 

2D SESSION S. 4440 

To authorize the Director of the Centers for Disease Control and Prevention 

to carry out a Social Determinants of Health Program, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 5, 2020 

Ms. SMITH (for herself, Mr. MURPHY, Mr. KING, Mr. WHITEHOUSE, Ms. 

HARRIS, Mr. CARPER, and Mr. WYDEN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To authorize the Director of the Centers for Disease Control 

and Prevention to carry out a Social Determinants of 

Health Program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Social De5 terminants of Health Act of 2020’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Healthy People 2020 defines social deter2 minants of health as conditions in the environments 

3 in which people live, learn, work, play, worship, and 

4 age that affect a wide range of health, functioning, 

5 and quality-of-life outcomes and risks. 

6 (2) One of the overarching goals of Healthy 

7 People 2020 is to ‘‘create social and physical envi8 ronments that promote good health for all’’. 

9 (3) Healthy People 2020 developed a ‘‘place10 based’’ organizing framework, reflecting five key 

11 areas of social determinants of health namely— 

12 (A) economic stability; 

13 (B) education; 

14 (C) social and community context; 

15 (D) health and health care; and 

16 (E) neighborhood and built environment. 

17 (4) It is estimated that medical care accounts 

18 for only 10 to 20 percent of the modifiable contribu19 tors to healthy outcomes for a population. 

20 (5) The Centers for Medicare & Medicaid Serv21 ices has indicated the importance of the social deter22 minants in its work stating that, ‘‘As we seek to fos23 ter innovation, rethink rural health, find solutions to 

24 the opioid epidemic, and continue to put patients 


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1 first, we need to take into account social deter2 minants of health and recognize their importance.’’. 

3 (6) The Department of Health and Human 

4 Services’ Public Health 3.0 initiative recognizes the 

5 role of public health in working across sectors on so6 cial determinants of health, as well as the role of 

7 public health as chief health strategist in commu8 nities. 

9 (7) Through its Health Impact in 5 Years ini10 tiative, the Centers for Disease Control and Preven11 tion has highlighted nonclinical, community-wide ap12 proaches that show positive health impacts, results 

13 within five years, and cost effectiveness or cost sav14 ings over the lifetime of the population or earlier. 

15 (8) Health departments and the Centers for 

16 Disease Control and Prevention are not funded for 

17 such cross-cutting work. 

18 (9) Providing grants to public health depart19 ments and other eligible entities to coordinate cross20 sector collaboration will allow a community-wide, evi21 dence-based approach to address underlying social 

22 determinants of health. 

23 SEC. 3. SOCIAL DETERMINANTS OF HEALTH PROGRAM. 

24 (a) PROGRAM.—To the extent and in the amounts 

25 made available in advance in appropriations Acts, the SecVerDate Sep 11 2014 04:22 Aug 22, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4440.IS S4440

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1 retary of Health and Human Services, acting through the 

2 Director of the Centers for Disease Control and Preven3 tion (in this Act referred to as the ‘‘Director’’), shall carry 

4 out a program, to be known as the Social Determinants 

5 of Health Program (in this Act referred to as the ‘‘Pro6 gram’’), to achieve the following goals: 

7 (1) Improve health outcomes and reduce health 

8 inequities by coordinating social determinants of 

9 health activities across the Centers for Disease Con10 trol and Prevention. 

11 (2) Improve the capacity of public health agen12 cies and community organizations to address social 

13 determinants of health in communities. 

14 (b) ACTIVITIES.—To achieve the goals listed in sub15 section (a), the Director shall carry out activities including 

16 the following: 

17 (1) Coordinating across the Centers for Disease 

18 Control and Prevention to ensure that relevant pro19 grams consider and incorporate social determinants 

20 of health in grant awards and other activities. 

21 (2) Awarding grants under section 4 to State, 

22 local, territorial, and Tribal health departments and 

23 organizations, and to other eligible entities, to ad24 dress social determinants of health in target commu25 nities. 


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1 (3) Awarding grants under section 5 to non2 profit organizations and public or other nonprofit in3 stitutions of higher education— 

4 (A) to conduct research on best practices 

5 to improve social determinants of health; 

6 (B) to provide technical assistance, train7 ing, and evaluation assistance to grantees under 

8 section 4; and 

9 (C) to disseminate best practices to grant10 ees under section 4. 

11 (4) Coordinating, supporting, and aligning ac12 tivities of the Centers for Disease Control and Pre13 vention related to social determinants of health with 

14 activities of other Federal agencies related to social 

15 determinants of health, including such activities of 

16 agencies in the Department of Health and Human 

17 Services such as the Centers for Medicare & Med18 icaid Services. 

19 (5) Collecting and analyzing data related to the 

20 social determinants of health. 

21 SEC. 4. GRANTS TO ADDRESS SOCIAL DETERMINANTS OF 

22 HEALTH. 

23 (a) IN GENERAL.—The Director, as part of the Pro24 gram, shall award grants to eligible entities to address so25 cial determinants of health in their communities. 


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1 (b) ELIGIBILITY.—To be eligible to apply for a grant 

2 under this section, an entity shall be— 

3 (1) a State, local, territorial, or Tribal health 

4 agency or organization; 

5 (2) a qualified nongovernmental entity, as de6 fined by the Director; or 

7 (3) a consortium of entities that includes a 

8 State, local, territorial, or Tribal health agency or 

9 organization. 

10 (c) USE OF FUNDS.— 

11 (1) IN GENERAL.—A grant under this section 

12 shall be used to address social determinants of 

13 health in a target community by designing and im14 plementing innovative, evidence-based, cross-sector 

15 strategies. 

16 (2) TARGET COMMUNITY.—For purposes of this 

17 section, a target community shall be a State, county, 

18 city, Tribe, or other municipality. 

19 (d) PRIORITY AND SET ASIDE.— 

20 (1) PRIORITY.—In awarding grants under this 

21 section, the Director shall prioritize applicants pro22 posing to serve target communities with significant 

23 unmet health and social needs, as defined by the Di24 rector. 


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1 (2) SET ASIDE.—The Director shall set aside 5 

2 percent of amounts appropriated to carry out this 

3 section in each fiscal year to award grants to Indian 

4 Tribes and Tribal organizations. 

5 (e) APPLICATION.—To seek a grant under this sec6 tion, an eligible entity shall— 

7 (1) submit an application at such time, in such 

8 manner, and containing such information as the Di9 rector may require; 

10 (2) propose a set of activities to address social 

11 determinants of health through evidence-based, 

12 cross-sector strategies, which activities may in13 clude— 

14 (A) collecting quantifiable data from health 

15 care, social services, and other entities regard16 ing the most significant gaps in health-pro17 moting social, economic, and environmental 

18 needs; 

19 (B) identifying evidence-based approaches 

20 to meeting the nonmedical, social needs of pop21 ulations identified by data collection described 

22 in subparagraph (A), such as unstable housing 

23 or inadequate food; 


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1 (C) developing scalable methods to meet 

2 patients’ social needs identified in clinical set3 tings or other sites; 

4 (D) convening entities such as local and 

5 State governmental and nongovernmental orga6 nizations, health systems, payors, and commu7 nity-based organizations to review, plan, and 

8 implement community-wide interventions and 

9 strategies to advance health-promoting social 

10 conditions; 

11 (E) monitoring and evaluating the impact 

12 of activities funded through the grant on the 

13 health and well-being of the residents of the 

14 target community and on the cost of health 

15 care; and 

16 (F) such other activities as may be speci17 fied by the Director; 

18 (3) demonstrate how the eligible entity will col19 laborate with— 

20 (A) health systems; 

21 (B) payors, including, as appropriate, Med22 icaid managed care organizations (as defined in 

23 section 1903(m)(1)(A) of the Social Security 

24 Act (42 U.S.C. 1396b(m)(1)(A))), Medicare 

25 Advantage plans under part C of title XVIII of 


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1 such Act (42 U.S.C. 1395w–21 et seq.), and 

2 health insurance issuers and group health plans 

3 (as such terms are defined in section 2791 of 

4 the Public Health Service Act); 

5 (C) other relevant stakeholders and initia6 tives in areas of need, such as the Accountable 

7 Health Communities Model of the Centers for 

8 Medicare & Medicaid Services, health homes 

9 under the Medicaid program under title XIX of 

10 the Social Security Act (42 U.S.C. 1396 et 

11 seq.), community-based organizations, and 

12 human services organizations; 

13 (D) other non-health care sector organiza14 tions, including organizations focusing on trans15 portation, housing, or food access; and 

16 (E) local employers; and 

17 (4) identify key health inequities in the target 

18 community and demonstrate how the proposed ef19 forts of the eligible entity would address such inequi20 ties. 

21 (f) MONITORING AND EVALUATION.—As a condition 

22 of receipt of a grant under this section, a grantee shall 

23 agree to submit an annual report to the Director describ24 ing the activities carried out through the grant and the 

25 outcomes of such activities. 


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1 (g) INDEPENDENT NATIONAL EVALUATION.— 

2 (1) IN GENERAL.—Not later than 5 years after 

3 the first grants are awarded under this section, the 

4 Director shall provide for the commencement of an 

5 independent national evaluation of the Program 

6 under this section. 

7 (2) REPORT TO CONGRESS.—Not later than 60 

8 days after receiving the results of such independent 

9 national evaluation, the Director shall report such 

10 results to the Committee on Health, Education, 

11 Labor, and Pensions of the Senate and the Com12 mittee on Energy and Commerce of the House of 

13 Representatives. 

14 SEC. 5. RESEARCH AND TRAINING. 

15 The Director, as part of the Program— 

16 (1) shall award grants to nonprofit organiza17 tions and public or other nonprofit institutions of 

18 higher education— 

19 (A) to conduct research on best practices 

20 to improve social determinants of health; 

21 (B) to provide technical assistance, train22 ing, and evaluation assistance to grantees under 

23 section 4; and 

24 (C) to disseminate best practices to grant25 ees under section 4; and 


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1 (2) may require a grantee under paragraph (1) 

2 to provide technical assistance and capacity building 

3 to entities that are eligible entities under section 4 

4 but not receiving funds through such section. 

5 SEC. 6. FUNDING. 

6 (a) IN GENERAL.—There is authorized to be appro7 priated to carry out this Act, $50,000,000 for each of fis8 cal years 2021 through 2026. 

9 (b) ALLOCATION.—Of the amount made available to 

10 carry out this Act for a fiscal year, not less than 75 per11 cent shall be used for grants under sections 4 and 5. 

Æ 


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