I 

117TH CONGRESS 

1ST SESSION H. R. 2503 

To direct the Secretary of Health and Human Services to establish an 

interagency council on social determinants of health, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 14, 2021 

Mrs. BUSTOS (for herself, Mr. COLE, Mr. MCGOVERN, Mr. MULLIN, Mr. 

WELCH, Ms. UNDERWOOD, Mr. MOOLENAAR, Ms. CLARKE of New York, 

Mr. FITZPATRICK, Mr. O’HALLERAN, Mr. CA ́RDENAS, Mr. CICILLINE, 

Mr. COHEN, Mr. BUTTERFIELD, Mr. MORELLE, Ms. LEE of California, 

Mr. MICHAEL F. DOYLE of Pennsylvania, Mrs. HAYES, Mrs. WALORSKI, 

Ms. KUSTER, Mr. RUSH, Ms. WILLIAMS of Georgia, and Mr. CARBAJAL) 

introduced the following bill; 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 health, 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 ‘‘Social Determinants 

5 Accelerator Act of 2021’’. 

6 SEC. 2. FINDINGS; PURPOSES. 

7 (a) FINDINGS.—Congress finds the following: 


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1 (1) There is a significant body of evidence 

2 showing that economic and social conditions have a 

3 powerful impact on individual and population health 

4 outcomes and well-being, as well as medical costs. 

5 (2) State, local, and Tribal governments and 

6 the service delivery partners of such governments 

7 face significant challenges in coordinating benefits 

8 and services delivered through the Medicaid program 

9 and other social services programs because of the 

10 fragmented and complex nature of Federal and 

11 State funding and administrative requirements. 

12 (3) The Federal Government should prioritize 

13 and proactively assist State and local governments 

14 to strengthen the capacity of State and local govern15 ments to improve health and social outcomes for in16 dividuals, thereby improving cost-effectiveness and 

17 return on investment. 

18 (b) PURPOSES.—The purposes of this Act are as fol19 lows: 

20 (1) To establish effective, coordinated Federal 

21 technical assistance to help State and local govern22 ments to improve outcomes and cost-effectiveness of, 

23 and return on investment from, health and social 

24 services programs. 


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1 (2) To build a pipeline of State and locally de2 signed, cross-sector interventions and strategies that 

3 generate rigorous evidence about how to improve 

4 health and social outcomes, and increase the cost-ef5 fectiveness of, and return on investment from, Fed6 eral, State, local, and Tribal health and social serv7 ices programs. 

8 (3) To enlist State and local governments and 

9 the service providers of such governments as part10 ners in identifying Federal statutory, regulatory, and 

11 administrative challenges in improving the health 

12 and social outcomes of, cost-effectiveness of, and re13 turn on investment from, Federal spending on indi14 viduals enrolled in Medicaid. 

15 (4) To develop strategies to improve health and 

16 social outcomes without denying services to, or re17 stricting the eligibility of, vulnerable populations. 

18 SEC. 3. SOCIAL DETERMINANTS ACCELERATOR COUNCIL. 

19 (a) ESTABLISHMENT.—The Secretary of Health and 

20 Human Services (referred to in this Act as the ‘‘Sec21 retary’’), in coordination with the Administrator of the 

22 Centers for Medicare & Medicaid Services (referred to in 

23 this Act as the ‘‘Administrator’’), shall establish an inter24 agency council, to be known as the Social Determinants 

25 Accelerator Interagency Council (referred to in this Act 


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1 as the ‘‘Council’’) to achieve the purposes listed in section 

2 2(b). 

3 (b) MEMBERSHIP.— 

4 (1) FEDERAL COMPOSITION.—The Council shall 

5 be composed of at least one designee from each of 

6 the following Federal agencies: 

7 (A) The Office of Management and Budg8 et. 

9 (B) The Department of Agriculture. 

10 (C) The Department of Education. 

11 (D) The Indian Health Service. 

12 (E) The Department of Housing and 

13 Urban Development. 

14 (F) The Department of Labor. 

15 (G) The Department of Transportation. 

16 (H) Any other Federal agency the Chair of 

17 the Council determines necessary. 

18 (2) DESIGNATION.— 

19 (A) IN GENERAL.—The head of each agen20 cy specified in paragraph (1) shall designate at 

21 least one employee described in subparagraph 

22 (B) to serve as a member of the Council. 

23 (B) RESPONSIBILITIES.—An employee de24 scribed in this subparagraph shall be a senior 

25 employee of the agency— 


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1 (i) whose responsibilities relate to au2 thorities, policies, and procedures with re3 spect to the health and well-being of indi4 viduals receiving medical assistance under 

5 a State plan (or a waiver of such plan) 

6 under title XIX of the Social Security Act 

7 (42 U.S.C. 1396 et seq.); or 

8 (ii) who has authority to implement 

9 and evaluate transformative initiatives that 

10 harness data or conducts rigorous evalua11 tion to improve the impact and cost-effec12 tiveness of federally funded services and 

13 benefits. 

14 (3) HHS REPRESENTATION.—In addition to 

15 the designees under paragraph (1), the Council shall 

16 include designees from at least three agencies within 

17 the Department of Health and Human Services, in18 cluding the Centers for Medicare & Medicaid Serv19 ices, at least one of whom shall meet the criteria 

20 under paragraph (2)(B). 

21 (4) OMB ROLE.—The Director of the Office of 

22 Management and Budget shall facilitate the timely 

23 resolution of governmentwide and multiagency issues 

24 to help the Council achieve consensus recommenda25 tions described under subsection (c)(1). 


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1 (5) NON-FEDERAL COMPOSITION.—The Sec2 retary may designate up to 6 Council designees— 

3 (A) who have relevant subject matter ex4 pertise, including expertise implementing and 

5 evaluating transformative initiatives that har6 ness data and conduct evaluations to improve 

7 the impact and cost-effectiveness of Federal 

8 Government services; and 

9 (B) that each represent— 

10 (i) State, local, and Tribal health and 

11 human services agencies; 

12 (ii) public housing authorities or State 

13 housing finance agencies; 

14 (iii) State and local government budg15 et offices; 

16 (iv) State Medicaid agencies; or 

17 (v) national consumer advocacy orga18 nizations. 

19 (6) CHAIR.— 

20 (A) IN GENERAL.—The Secretary shall se21 lect the Chair of the Council from among the 

22 members of the Council. 

23 (B) INITIATING GUIDANCE.—The Chair, 

24 on behalf of the Council, shall identify and in25 vite individuals from diverse entities to provide 


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1 the Council with advice and information per2 taining to addressing social determinants of 

3 health, including— 

4 (i) individuals from State and local 

5 government health and human services 

6 agencies; 

7 (ii) individuals from State Medicaid 

8 agencies; 

9 (iii) individuals from State and local 

10 government budget offices; 

11 (iv) individuals from public housing 

12 authorities or State housing finance agen13 cies; 

14 (v) individuals from nonprofit organi15 zations, small businesses, and philan16 thropic organizations; 

17 (vi) advocates; 

18 (vii) researchers; and 

19 (viii) any other individuals the Chair 

20 determines to be appropriate. 

21 (c) DUTIES.—The duties of the Council are— 

22 (1) to make recommendations to the Secretary 

23 and the Administrator regarding the criteria for 

24 making awards under section 4; 


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1 (2) to identify Federal authorities and opportu2 nities for use by States or local governments to im3 prove coordination of funding and administration of 

4 Federal programs, the beneficiaries of whom include 

5 individuals described in section 2, and which may be 

6 unknown or underutilized and to make information 

7 on such authorities and opportunities publicly avail8 able; 

9 (3) to provide targeted technical assistance to 

10 States developing a social determinants accelerator 

11 plan under section 4, including identifying potential 

12 statutory or regulatory pathways for implementation 

13 of the plan and assisting in identifying potential 

14 sources of funding to implement the plan; 

15 (4) to report to Congress annually on the sub16 jects set forth in subsection (e); 

17 (5) to develop and disseminate evaluation guide18 lines and standards that can be used to reliably as19 sess the impact of an intervention or approach that 

20 may be implemented pursuant to this Act on out21 comes, cost-effectiveness of, and return on invest22 ment from Federal, State, local, and Tribal govern23 ments, and to facilitate technical assistance, where 

24 needed, to help to improve State and local evaluation 

25 designs and implementation; 


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1 (6) to seek feedback from State, local, and 

2 Tribal governments, including through an annual 

3 survey by an independent third party, on how to im4 prove the technical assistance the Council provides 

5 to better equip State, local, and Tribal governments 

6 to coordinate health and social service programs; 

7 (7) to solicit applications for grants under sec8 tion 4; 

9 (8) to coordinate with other cross-agency initia10 tives focused on improving the health and well-being 

11 of low-income and at-risk populations in order to 

12 prevent unnecessary duplication between agency ini13 tiatives; 

14 (9) to draft and make publically available a re15 port on Federal cross-agency opportunities to ad16 dress social determinants of health, which shall in17 clude the benefits of grants to State, local, or Tribal 

18 jurisdictions; and 

19 (10) to provide technical assistance to State, 

20 local, and Tribal jurisdictions seeking to develop so21 cial determinants accelerator plans described in sec22 tion 4(f), including such plans associated with any 

23 new pilot program carried out by the Center for Dis24 ease Control and Prevention. 


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1 (d) SCHEDULE.—Not later than 60 days after the 

2 date of the enactment of this Act, the Council shall con3 vene to develop a schedule and plan for carrying out the 

4 duties described in subsection (c), including solicitation of 

5 applications for the grants under section 4. 

6 (e) REPORT TO CONGRESS.—The Council shall sub7 mit an annual report to Congress, which shall include— 

8 (1) a list of the Council members; 

9 (2) activities and expenditures of the Council; 

10 (3) summaries of the interventions and ap11 proaches that will be supported by State, local, and 

12 Tribal governments that received a grant under sec13 tion 4, including— 

14 (A) the best practices and evidence-based 

15 approaches such governments plan to employ to 

16 achieve the purposes listed in section 2(b); and 

17 (B) a description of how the practices and 

18 approaches will impact the outcomes, cost-effec19 tiveness of, and return on investment from, 

20 Federal, State, local, and Tribal governments 

21 with respect to such purposes; 

22 (4) the feedback received from State and local 

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1 party survey and actions the Council plans to take 

2 in response to such feedback; and 

3 (5) the major statutory, regulatory, and admin4 istrative challenges identified by State, local, and 

5 Tribal governments that received a grant under sec6 tion 4, and the actions that Federal agencies are 

7 taking to address such challenges. 

8 (f) FACA APPLICABILITY.—The Federal Advisory 

9 Committee Act (5 U.S.C. App.) shall not apply to the 

10 Council. 

11 (g) COUNCIL PROCEDURES.—The Secretary, in con12 sultation with the Comptroller General of the United 

13 States and the Director of the Office of Management and 

14 Budget, shall establish procedures for the Council to— 

15 (1) ensure that adequate resources are available 

16 to effectively execute the responsibilities of the 

17 Council; 

18 (2) effectively coordinate with other relevant ad19 visory bodies and working groups to avoid unneces20 sary duplication; 

21 (3) create transparency to the public and Con22 gress with regard to Council membership, costs, and 

23 activities, including through use of modern tech24 nology and social media to disseminate information; 

25 and 


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1 (4) avoid conflicts of interest that would jeop2 ardize the ability of the Council to make decisions 

3 and provide recommendations. 

4 SEC. 4. SOCIAL DETERMINANTS ACCELERATOR GRANTS TO 

5 STATES OR LOCAL GOVERNMENTS. 

6 (a) GRANTS TO STATES, LOCAL GOVERNMENTS, AND

7 TRIBES.—Not later than 180 days after the date of the 

8 enactment of this Act, the Administrator, in consultation 

9 with the Secretary and the Council, shall award on a com10 petitive basis not more than 25 grants to eligible appli11 cants described in subsection (b), for the development of 

12 social determinants accelerator plans, as described in sub13 section (f). 

14 (b) ELIGIBLE APPLICANT.—An eligible applicant de15 scribed in this section is a State, local, or Tribal health 

16 or human services agency that— 

17 (1) demonstrates the support of relevant parties 

18 across relevant State, local, or Tribal jurisdictions; 

19 and 

20 (2) in the case of an applicant that is a local 

21 government agency, provides to the Secretary a let22 ter of support from the lead State health or human 

23 services agency for the State in which the local gov24 ernment is located. 


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1 (c) AMOUNT OF GRANT.—The Administrator, in co2 ordination with the Council, shall determine the total 

3 amount that the Administrator will make available to each 

4 grantee under this section. 

5 (d) APPLICATION.—An eligible applicant seeking a 

6 grant under this section shall include in the application 

7 the following information: 

8 (1) The target population (or populations) that 

9 would benefit from implementation of the social de10 terminants accelerator plan proposed to be developed 

11 by the applicant. 

12 (2) A description of the objective or objectives 

13 and outcome goals of such proposed plan, which 

14 shall include at least one health outcome and at 

15 least one other important social outcome. 

16 (3) The sources and scope of inefficiencies that, 

17 if addressed by the plan, could result in improved 

18 cost-effectiveness of or return on investment from 

19 Federal, State, local, and Tribal governments. 

20 (4) A description of potential interventions that 

21 could be designed or enabled using such proposed 

22 plan. 

23 (5) The State, local, Tribal, academic, non24 profit, community-based organizations, and other 

25 private sector partners that would participate in the 


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1 development of the proposed plan and subsequent 

2 implementation of programs or initiatives included 

3 in such proposed plan. 

4 (6) Such other information as the Adminis5 trator, in consultation with the Secretary and the 

6 Council, determines necessary to achieve the pur7 poses of this Act. 

8 (e) USE OF FUNDS.—A recipient of a grant under 

9 this section may use funds received through the grant for 

10 the following purposes: 

11 (1) To convene and coordinate with relevant 

12 government entities and other stakeholders across 

13 sectors to assist in the development of a social deter14 minant accelerator plan. 

15 (2) To identify populations of individuals receiv16 ing medical assistance under a State plan (or a 

17 waiver of such plan) under title XIX of the Social 

18 Security Act (42 U.S.C. 1396 et seq.) who may ben19 efit from the proposed approaches to improving the 

20 health and well-being of such individuals through the 

21 implementation of the proposed social determinants 

22 accelerator plan. 

23 (3) To engage qualified research experts to ad24 vise on relevant research and to design a proposed 


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1 evaluation plan, in accordance with the standards 

2 and guidelines issued by the Administrator. 

3 (4) To collaborate with the Council to support 

4 the development of social determinants accelerator 

5 plans. 

6 (5) To prepare and submit a final social deter7 minants accelerator plan to the Council. 

8 (f) CONTENTS OF PLANS.—A social determinant ac9 celerator plan developed under this section shall include 

10 the following: 

11 (1) A description of the target population (or 

12 populations) that would benefit from implementation 

13 of the social determinants accelerator plan, including 

14 an analysis describing the projected impact on the 

15 well-being of individuals described in subsection 

16 (e)(2). 

17 (2) A description of the interventions or ap18 proaches designed under the social determinants ac19 celerator plan and the evidence for selecting such 

20 interventions or approaches. 

21 (3) The objectives and outcome goals of such 

22 interventions or approaches, including at least one 

23 health outcome and at least one other important so24 cial outcome. 


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1 (4) A plan for accessing and linking relevant 

2 data to enable coordinated benefits and services for 

3 the jurisdictions described in subsection (b)(1) and 

4 an evaluation of the proposed interventions and ap5 proaches. 

6 (5) A description of the State, local, Tribal, 

7 academic, nonprofit, or community-based organiza8 tions, or any other private sector organizations that 

9 would participate in implementing the proposed 

10 interventions or approaches, and the role each would 

11 play to contribute to the success of the proposed 

12 interventions or approaches. 

13 (6) The identification of the funding sources 

14 that would be used to finance the proposed interven15 tions or approaches. 

16 (7) A description of any financial incentives 

17 that may be provided, including outcome-focused 

18 contracting approaches to encourage service pro19 viders and other partners to improve outcomes of, 

20 cost-effectiveness of, and return on investment from, 

21 Federal, State, local, or Tribal government spending. 

22 (8) The identification of the applicable Federal, 

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1 aged to implement the proposed interventions or ap2 proaches. 

3 (9) A description of potential considerations 

4 that would enhance the impact, scalability, or sus5 tainability of the proposed interventions or ap6 proaches and the actions the grant awardee would 

7 take to address such considerations. 

8 (10) A proposed evaluation plan, to be carried 

9 out by an independent evaluator, to measure the im10 pact of the proposed interventions or approaches on 

11 the outcomes of, cost-effectiveness of, and return on 

12 investment from, Federal, State, local, and Tribal 

13 governments. 

14 (11) Precautions for ensuring that vulnerable 

15 populations will not be denied access to Medicaid or 

16 other essential services as a result of implementing 

17 the proposed plan. 

18 SEC. 5. FUNDING. 

19 (a) AUTHORIZATION OF APPROPRIATIONS.— 

20 (1) IN GENERAL.—There is authorized to be 

21 appropriated to the Secretary $25,000,000 for fiscal 

22 years 2022 through 2026 to carry out the require23 ments of this Act. 

24 (2) SOCIAL DETERMINANTS COUNCIL.—Of the 

25 funds made available under paragraph (1), 


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1 $5,000,000 may be used each fiscal year to carry 

2 out section 3. 

3 (b) RESERVATION OF FUNDS.— 

4 (1) IN GENERAL.—Of the funds made available 

5 under subsection (a), the Secretary shall reserve not 

6 less than 20 percent to award grants to eligible ap7 plicants for the development of social determinants 

8 accelerator plans under section 4 intended to serve 

9 rural populations. 

10 (2) EXCEPTION.—In the case of a fiscal year 

11 for which the Secretary determines that there are 

12 not sufficient eligible applicants to award up to 25 

13 grants under section 4 that are intended to serve 

14 rural populations and the Secretary cannot satisfy 

15 the 20-percent requirement, the Secretary may re16 serve an amount that is less than 20 percent of 

17 amounts made available under subsection (a) to 

18 award grants for such purpose. 

19 (c) RULE OF CONSTRUCTION.—Nothing in this Act 

20 shall prevent Federal agencies represented on the Council 

21 from contributing additional funding from other sources 

22 to support activities to improve the effectiveness of the 

23 Council. 

Æ 


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