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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5474 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5474

     To amend 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 11, 2024

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 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 2024''.

SEC. 2. SOCIAL DETERMINANTS ACCELERATOR COUNCIL.

    Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is 
amended by adding at the end the following new part:

                ``PART F--SOCIAL DETERMINANTS OF HEALTH

               ``social determinants accelerator council

    ``Sec. 1191.  (a) Establishment.--The Secretary, in consultation 
with the Administrator of the Centers for Medicare & Medicaid Services, 
the Administrator of the Health Resources and Services Administration, 
the Director of the Centers for Disease Control and Prevention, the 
Director of the Agency for Healthcare Research and Quality, and the 
Director of the Indian Health Service, shall establish an interagency 
council, to be known as the Social Determinants Accelerator Interagency 
Council (referred to in this part as the `Council') to achieve the 
purposes of--
            ``(1) establishing effective, coordinated Federal technical 
        assistance to help State and local governments to improve 
        outcomes and cost-effectiveness of, and return on investment 
        from, health and social services programs;
            ``(2) building a pipeline of State and locally designed, 
        cross-sector interventions and strategies that generate 
        rigorous evidence about how to improve health and social 
        outcomes, and increase the cost-effectiveness of, and return on 
        investment from, Federal, State, local, and Tribal health and 
        social services programs;
            ``(3) enlisting State and local governments and the service 
        providers of such governments as partners in identifying 
        Federal statutory, regulatory, and administrative challenges in 
        improving the health and social outcomes of, cost-effectiveness 
        of, and return on investment from, Federal spending on 
        individuals receiving medical assistance under a State plan (or 
        a waiver of such plan) under title XIX; and
            ``(4) developing strategies to improve health and social 
        outcomes without denying services to, or restricting the 
        eligibility of, vulnerable populations.
    ``(b) Membership.--
            ``(1) Federal members.--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 Department of Housing and Urban 
                Development.
                    ``(E) The Department of Labor.
                    ``(F) The Department of Transportation.
                    ``(G) 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 1 
                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 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 transformative initiatives that 
                        harness data or who 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 
        agencies within the Department of Health and Human Services, 
        including the Centers for Medicare & Medicaid Services, the 
        Agency for Healthcare Research and Quality, the Centers for 
        Disease Control and Prevention, the Health Resources and 
        Services Administration, and the Indian Health Service. The 
        designees of each such agency shall include at least 1 designee 
        who meets the criteria under paragraph (2)(B).
            ``(4) Non-federal members.--The Council shall include at 
        least 9 non-Federal members, to be designated by the Secretary, 
        with experience in improving the impact and cost-effectiveness 
        of Federal Government health and social services, of which--
                    ``(A) at least 1 such member shall be a director of 
                a State or local human services agency;
                    ``(B) at least 1 such member shall be a director of 
                a Tribal health authority;
                    ``(C) at least 1 such member shall be a director of 
                a public housing authority or State housing finance 
                agency;
                    ``(D) at least 1 such member shall be a director of 
                a State or local government budget office;
                    ``(E) at least 1 such member shall be a State 
                Medicaid program director;
                    ``(F) at least 1 such member shall be from a State 
                office of rural health;
                    ``(G) at least 1 such member shall be a 
                representative from a national consumer or patient 
                advocacy organization;
                    ``(H) at least 1 such member shall be a primary 
                care provider with clinical experience working in 
                medically underserved populations; and
                    ``(I) at least 1 such member shall be a 
                representative from a commercial health plan.
            ``(5) Chair.--The Secretary shall select the Chair of the 
        Council from among the members of the Council.
    ``(c) Duties.--The duties of the Council are--
            ``(1) to make recommendations to the Secretary regarding 
        the criteria for making awards under section 1192;
            ``(2) to identify Federal authorities and opportunities for 
        use by States or local governments to improve coordination of 
        funding and administration of Federal programs that serve 
        individuals with significant unmet health and social needs, as 
        defined by the Secretary, and for whom coordinated health and 
        social interventions may be unknown or underutilized;
            ``(3) to make information on such authorities and 
        opportunities publicly available;
            ``(4) to provide targeted technical assistance to States 
        developing social determinants of health interventions;
            ``(5) to report to Congress annually in accordance with 
        subsection (e);
            ``(6) solicit feedback from State, local, and Tribal 
        governments on best practices for addressing social 
        determinants of health and for coordinating health and social 
        service programs;
            ``(7) to develop and disseminate such best practices;
            ``(8) to develop and disseminate performance measures to 
        reliably assess the impact of local interventions or 
        approaches;
            ``(9) 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; and
            ``(10) to draft and make publicly available a report on 
        Federal cross-agency opportunities to address social 
        determinants of health, which shall include the benefits of 
        grants to State, local, or Tribal jurisdictions.
    ``(d) Schedule.--Not later than 90 days after the date of the 
enactment of the Social Determinants Accelerator Act of 2024, 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 section 1192.
    ``(e) Report to Congress.--The Council shall submit an annual 
report to Congress, which shall include--
            ``(1) a list of the Council members;
            ``(2) summaries of the activities and expenditures of the 
        Council;
            ``(3) summaries of the interventions and approaches that 
        will be supported by State, local, and Tribal governments that 
        received a grant under section 1192, including evidence-based 
        best practices and approaches grantees have employed to improve 
        health outcomes, and improve the cost-effectiveness of, and 
        return on investment from, Federal, State, local, and Tribal 
        governments;
            ``(4) the feedback received from State and local 
        governments on ways to improve the technical assistance of the 
        Council, and actions the Council plans to take in response to 
        such feedback; and
            ``(5) the major statutory, regulatory, and administrative 
        challenges identified by State, local, and Tribal governments 
        that received a grant under section 1192, and the actions that 
        Federal agencies are taking to address such challenges.
    ``(f) FACA Applicability.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall not apply to the Council.
    ``(g) Council Procedures.--The Secretary, in consultation with the 
Comptroller General of the United States and the Director of the Office 
of Management and Budget, 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, including 
        through use of modern technology and social media to 
        disseminate information; and
            ``(4) avoid conflicts of interest that would jeopardize the 
        ability of the Council to make decisions and provide 
        recommendations.

           ``grants to address social determinants of health

    ``Sec. 1192.  (a) Grants to States, Local Governments, and 
Tribes.--
            ``The Secretary, in consultation with the Council, shall 
        award on a competitive basis up to 25 grants to eligible 
        applicants described in subsection (b) for addressing social 
        determinants of health in underserved populations. Not later 
        than 180 days after the date of the enactment of the Social 
        Determinants Accelerator Act of 2024, the Secretary shall award 
        all such grants.
    ``(b) Eligible Applicant.--In order to be eligible to apply for a 
grant under this section, an entity shall be--
            ``(1) a State, local, territorial, or Tribal health agency 
        or organization;
            ``(2) a qualified nongovernmental entity, as defined by 
        Secretary; or
            ``(3) a consortium of entities that includes a State, 
        local, territorial, or Tribal health agency or organization.
    ``(c) 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 section.
    ``(d) Application.--An eligible applicant seeking a grant under 
this section shall submit an application at such time, in such manner, 
and containing such information as the Secretary may require, and 
submit a proposed process for developing a social determinants 
accelerator plan in accordance with subsection (e).
    ``(e) Use of Funds.--A grant under this section shall be used--
            ``(1) to engage qualified research experts to advise on 
        research relevant to, and to design, a proposed social 
        determinants accelerator plan, in accordance with standards and 
        guidelines issued by the Secretary;
            ``(2) to collaborate with the Council to support the 
        development of a social determinants accelerator plan;
            ``(3) to prepare and submit a final social determinants 
        accelerator plan to the Secretary; and
            ``(4) to address social determinants of health in a target 
        community in a State, county, city, or other municipality, by 
        designing and implementing innovative, evidence-based, cross-
        sector strategies to improve the health and well-being of 
        individuals in such community through the implementation of the 
        final social determinants accelerator plan.
    ``(f) Priority.--In awarding grants under this section, the 
Secretary shall prioritize applicants proposing to serve target 
communities with significant unmet health and social needs, as defined 
by the Secretary.
    ``(g) Contents of Plans.--A social determinants accelerator plan 
developed through a grant under this section shall include the 
following:
            ``(1) A description of the population (or populations) in 
        the target community 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 subsection (e)(4).
            ``(2) A description of the interventions or approaches 
        designed under the social determinants accelerator plan and the 
        evidence for selecting such interventions or approaches.
            ``(3) The objectives and outcome goals of such 
        interventions or approaches, including at least 1 health 
        outcome and at least 1 other important social outcome.
            ``(4) A plan for accessing and linking relevant data to 
        enable coordinated benefits and services for the relevant 
        jurisdictions and an evaluation of the proposed interventions 
        and approaches.
            ``(5) 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. Such entities may 
        include--
                    ``(A) health systems;
                    ``(B) payors, including, as appropriate, medicaid 
                managed care entities (as defined in section 
                1903(m)(1)(A)), Medicare Advantage plans under part C 
                of title XVIII, and health insurance issuers and group 
                health plans (as such terms are defined in section 2791 
                of the Public Health Service Act);
                    ``(C) other relevant stakeholders and initiatives 
                in areas of need, such as the Accountable Health 
                Communities Model of the Centers for Medicare & 
                Medicaid Services, health homes under the Medicaid 
                program under title XIX, community-based organizations, 
                and human services organizations;
                    ``(D) other non-health care sector organizations, 
                including organizations focusing on transportation, 
                housing, or food access; and
                    ``(E) local employers.
            ``(6) The identification of any supplemental funding 
        sources that would be used to finance the proposed 
        interventions or approaches.
            ``(7) 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.
            ``(8) 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.
            ``(9) 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.
            ``(10) A 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.
            ``(11) Precautions for ensuring that vulnerable populations 
        will not be denied access to the Medicaid program under title 
        XIX or other essential services as a result of implementing the 
        social determinants accelerator plan.
    ``(h) Monitoring and Evaluation.--As a condition of receipt of a 
grant under this section, a grantee shall agree to submit an annual 
report to the Secretary describing the activities carried out through 
the grant and the outcomes of such activities.
    ``(i) Independent National Evaluation.--
            ``(1) In general.--Not later than 3 years after the first 
        grants are awarded under this section, the Secretary shall 
        provide for the commencement of an independent national 
        evaluation of the program under this section.
            ``(2) Report to congress.--Not later than 90 days after 
        receiving the results of such independent national evaluation, 
        the Secretary shall report such results to the Congress.
    ``(j) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to the Secretary $10,000,000 for each of fiscal years 2025 
        through 2029 to carry out this section.
            ``(2) Reservation.--Of the funds made available to carry 
        out this section, the Secretary shall reserve not less than 20 
        percent to award grants to eligible applicants for the 
        development of social determinants accelerator plans under this 
        section intended to serve rural populations.''.
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