II 

117TH CONGRESS 

1ST SESSION S. 3039 

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 

OCTOBER 21, 2021 

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. 

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. SOCIAL DETERMINANTS ACCELERATOR COUNCIL. 

7 Title XI of the Social Security Act (42 U.S.C. 1301 

8 et seq.) is amended by adding at the end the following 

9 new part: 


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1 ‘‘PART E—SOCIAL DETERMINANTS OF HEALTH 

2 ‘‘SOCIAL DETERMINANTS ACCELERATOR COUNCIL

3 ‘‘SEC. 1191. (a) ESTABLISHMENT.—The Secretary, 

4 in consultation with the Administrator of the Centers for 

5 Medicare & Medicaid Services, the Administrator of the 

6 Health Resources and Services Administration, the Direc7 tor of the Centers for Disease Control and Prevention, the 

8 Director of the Agency for Healthcare Research and Qual9 ity, and the Director of the Indian Health Service, shall 

10 establish an interagency council, to be known as the Social 

11 Determinants Accelerator Interagency Council (referred to 

12 in this part as the ‘Council’) to achieve the purposes of— 

13 ‘‘(1) establishing effective, coordinated Federal 

14 technical assistance to help State and local govern15 ments to improve outcomes and cost-effectiveness of, 

16 and return on investment from, health and social 

17 services programs; 

18 ‘‘(2) building a pipeline of State and locally de19 signed, cross-sector interventions and strategies that 

20 generate rigorous evidence about how to improve 

21 health and social outcomes, and increase the cost-ef22 fectiveness of, and return on investment from, Fed23 eral, State, local, and Tribal health and social serv24 ices programs; 

25 ‘‘(3) enlisting State and local governments and 

26 the service providers of such governments as partVerDate Sep 11 2014 00:58 Oct 26, 2021 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3039.IS S3039

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1 ners in identifying Federal statutory, regulatory, and 

2 administrative challenges in improving the health 

3 and social outcomes of, cost-effectiveness of, and re4 turn on investment from, Federal spending on indi5 viduals receiving medical assistance under a State 

6 plan (or a waiver of such plan) under title XIX; and 

7 ‘‘(4) developing strategies to improve health 

8 and social outcomes without denying services to, or 

9 restricting the eligibility of, vulnerable populations. 

10 ‘‘(b) MEMBERSHIP.— 

11 ‘‘(1) FEDERAL MEMBERS.—The Council shall 

12 be composed of at least 1 designee from each of the 

13 following Federal agencies: 

14 ‘‘(A) The Office of Management and 

15 Budget. 

16 ‘‘(B) The Department of Agriculture. 

17 ‘‘(C) The Department of Education. 

18 ‘‘(D) The Department of Housing and 

19 Urban Development. 

20 ‘‘(E) The Department of Labor. 

21 ‘‘(F) The Department of Transportation. 

22 ‘‘(G) Any other Federal agency the Chair 

23 of the Council determines necessary. 

24 ‘‘(2) DESIGNATION.— 


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1 ‘‘(A) IN GENERAL.—The head of each 

2 agency specified in paragraph (1) shall des3 ignate at least 1 employee described in subpara4 graph (B) to serve as a member of the Council. 

5 ‘‘(B) RESPONSIBILITIES.—An employee 

6 described in this subparagraph shall be a senior 

7 employee of the agency— 

8 ‘‘(i) whose responsibilities relate to 

9 authorities, policies, and procedures with 

10 respect to the health and well-being of in11 dividuals receiving medical assistance 

12 under a State plan (or a waiver of such 

13 plan) under title XIX; or 

14 ‘‘(ii) who has authority to implement 

15 and evaluate transformative initiatives that 

16 harness data or who conducts rigorous 

17 evaluation to improve the impact and cost18 effectiveness of federally funded services 

19 and benefits. 

20 ‘‘(3) HHS REPRESENTATION.—In addition to 

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

22 include designees from agencies within the Depart23 ment of Health and Human Services, including the 

24 Centers for Medicare & Medicaid Services, the Agen25 cy for Healthcare Research and Quality, the Centers 


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1 for Disease Control and Prevention, the Health Re2 sources and Services Administration, and the Indian 

3 Health Service. The designees of each such agency 

4 shall include at least 1 designee who meets the cri5 teria under paragraph (2)(B). 

6 ‘‘(4) NON-FEDERAL MEMBERS.—The Council 

7 shall include at least 9 non-Federal members, to be 

8 designated by the Secretary, with experience in im9 proving the impact and cost-effectiveness of Federal 

10 Government health and social services, of which— 

11 ‘‘(A) at least 1 such member shall be a di12 rector of a State or local human services agen13 cy; 

14 ‘‘(B) at least 1 such member shall be a di15 rector of a Tribal health authority; 

16 ‘‘(C) at least 1 such member shall be a di17 rector of a public housing authority or State 

18 housing finance agency; 

19 ‘‘(D) at least 1 such member shall be a di20 rector of a State or local government budget of21 fice; 

22 ‘‘(E) at least 1 such member shall be a 

23 State Medicaid program director; 

24 ‘‘(F) at least 1 such member shall be from 

25 a State office of rural health; 


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1 ‘‘(G) at least 1 such member shall be a 

2 representative from a national consumer or pa3 tient advocacy organization; 

4 ‘‘(H) at least 1 such member shall be a 

5 primary care provider with clinical experience 

6 working in medically underserved populations; 

7 and 

8 ‘‘(I) at least 1 such member shall be a rep9 resentative from a commercial health plan. 

10 ‘‘(5) CHAIR.—The Secretary shall select the 

11 Chair of the Council from among the members of 

12 the Council. 

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

14 ‘‘(1) to make recommendations to the Secretary 

15 regarding the criteria for making awards under sec16 tion 1192; 

17 ‘‘(2) to identify Federal authorities and oppor18 tunities for use by States or local governments to 

19 improve coordination of funding and administration 

20 of Federal programs that serve individuals with sig21 nificant unmet health and social needs, as defined by 

22 the Secretary, and for whom coordinated health and 

23 social interventions may be unknown or underuti24 lized; 


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1 ‘‘(3) to make information on such authorities 

2 and opportunities publicly available; 

3 ‘‘(4) to provide targeted technical assistance to 

4 States developing social determinants of health 

5 interventions; 

6 ‘‘(5) to report to Congress annually in accord7 ance with subsection (e); 

8 ‘‘(6) solicit feedback from State, local, and 

9 Tribal governments on best practices for addressing 

10 social determinants of health and for coordinating 

11 health and social service programs; 

12 ‘‘(7) to develop and disseminate such best prac13 tices; 

14 ‘‘(8) to develop and disseminate performance 

15 measures to reliably assess the impact of local inter16 ventions or approaches; 

17 ‘‘(9) to coordinate with other cross-agency ini18 tiatives focused on improving the health and well19 being of low-income and at-risk populations in order 

20 to prevent unnecessary duplication between agency 

21 initiatives; and 

22 ‘‘(10) to draft and make publicly available a re23 port on Federal cross-agency opportunities to ad24 dress social determinants of health, which shall inVerDate Sep 11 2014 00:58 Oct 26, 2021 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3039.IS S3039

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1 clude the benefits of grants to State, local, or Tribal 

2 jurisdictions. 

3 ‘‘(d) SCHEDULE.—Not later than 90 days after the 

4 date of the enactment of the Social Determinants Accel5 erator Act of 2021, the Council shall convene to develop 

6 a schedule and plan for carrying out the duties described 

7 in subsection (c), including solicitation of applications for 

8 the grants under section 1192. 

9 ‘‘(e) REPORT TO CONGRESS.—The Council shall sub10 mit an annual report to Congress, which shall include— 

11 ‘‘(1) a list of the Council members; 

12 ‘‘(2) summaries of the activities and expendi13 tures of the Council; 

14 ‘‘(3) summaries of the interventions and ap15 proaches that will be supported by State, local, and 

16 Tribal governments that received a grant under sec17 tion 1192, including evidence-based best practices 

18 and approaches grantees have employed to improve 

19 health outcomes, and improve the cost-effectiveness 

20 of, and return on investment from, Federal, State, 

21 local, and Tribal governments; 

22 ‘‘(4) the feedback received from State and local 

23 governments on ways to improve the technical assist24 ance of the Council, and actions the Council plans 

25 to take in response to such feedback; and 


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1 ‘‘(5) the major statutory, regulatory, and ad2 ministrative challenges identified by State, local, and 

3 Tribal governments that received a grant under sec4 tion 1192, and the actions that Federal agencies are 

5 taking to address such challenges. 

6 ‘‘(f) FACA APPLICABILITY.—The Federal Advisory 

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

8 Council. 

9 ‘‘(g) COUNCIL PROCEDURES.—The Secretary, in con10 sultation with the Comptroller General of the United 

11 States and the Director of the Office of Management and 

12 Budget, shall establish procedures for the Council to— 

13 ‘‘(1) ensure that adequate resources are avail14 able to effectively execute the responsibilities of the 

15 Council; 

16 ‘‘(2) effectively coordinate with other relevant 

17 advisory bodies and working groups to avoid unnec18 essary duplication; 

19 ‘‘(3) create transparency to the public and Con20 gress with regard to Council membership, costs, and 

21 activities, including through use of modern tech22 nology and social media to disseminate information; 

23 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 ‘‘GRANTS TO ADDRESS SOCIAL DETERMINANTS OF

5 HEALTH

6 ‘‘SEC. 1192. (a) GRANTS TO STATES, LOCAL GOV7 ERNMENTS, AND TRIBES.— 

8 ‘‘The Secretary, in consultation with the Coun9 cil, shall award on a competitive basis up to 25 

10 grants to eligible applicants described in subsection 

11 (b) for addressing social determinants of health in 

12 underserved populations. Not later than 180 days 

13 after the date of the enactment of the Social Deter14 minants Accelerator Act of 2021, the Secretary shall 

15 award all such grants. 

16 ‘‘(b) ELIGIBLE APPLICANT.—In order to be eligible 

17 to apply for a grant under this section, an entity shall 

18 be— 

19 ‘‘(1) a State, local, territorial, or Tribal health 

20 agency or organization; 

21 ‘‘(2) a qualified nongovernmental entity, as de22 fined by Secretary; or 

23 ‘‘(3) a consortium of entities that includes a 

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

25 organization. 


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1 ‘‘(c) AMOUNT OF GRANT.—The Secretary, in coordi2 nation with the Council, shall determine the total amount 

3 that the Secretary will make available to each grantee 

4 under this section. 

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

6 grant under this section shall submit an application at 

7 such time, in such manner, and containing such informa8 tion as the Secretary may require, and submit a proposed 

9 process for developing a social determinants accelerator 

10 plan in accordance with subsection (e). 

11 ‘‘(e) USE OF FUNDS.—A grant under this section 

12 shall be used— 

13 ‘‘(1) to engage qualified research experts to ad14 vise on research relevant to, and to design, a pro15 posed social determinants accelerator plan, in ac16 cordance with standards and guidelines issued by 

17 the Secretary; 

18 ‘‘(2) to collaborate with the Council to support 

19 the development of a social determinants accelerator 

20 plan; 

21 ‘‘(3) to prepare and submit a final social deter22 minants accelerator plan to the Secretary; and 

23 ‘‘(4) to address social determinants of health in 

24 a target community in a State, county, city, or other 

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1 tive, evidence-based, cross-sector strategies to im2 prove the health and well-being of individuals in 

3 such community through the implementation of the 

4 final social determinants accelerator plan. 

5 ‘‘(f) PRIORITY.—In awarding grants under this sec6 tion, the Secretary shall prioritize applicants proposing to 

7 serve target communities with significant unmet health 

8 and social needs, as defined by the Secretary. 

9 ‘‘(g) CONTENTS OF PLANS.—A social determinants 

10 accelerator plan developed through a grant under this sec11 tion shall include the following: 

12 ‘‘(1) A description of the population (or popu13 lations) in the target community that would benefit 

14 from implementation of the social determinants ac15 celerator plan, including an analysis describing the 

16 projected impact on the well-being of individuals de17 scribed in subsection (e)(4). 

18 ‘‘(2) A description of the interventions or ap19 proaches designed under the social determinants ac20 celerator plan and the evidence for selecting such 

21 interventions or approaches. 

22 ‘‘(3) The objectives and outcome goals of such 

23 interventions or approaches, including at least 1 

24 health outcome and at least 1 other important social 

25 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 relevant jurisdictions and an evaluation of the 

4 proposed interventions and approaches. 

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

6 academic, nonprofit, or community-based organiza7 tions, or any other private sector organizations that 

8 would participate in implementing the proposed 

9 interventions or approaches, and the role each would 

10 play to contribute to the success of the proposed 

11 interventions or approaches. Such entities may in12 clude— 

13 ‘‘(A) health systems; 

14 ‘‘(B) payors, including, as appropriate, 

15 medicaid managed care entities (as defined in 

16 section 1903(m)(1)(A)), Medicare Advantage 

17 plans under part C of title XVIII, and health 

18 insurance issuers and group health plans (as 

19 such terms are defined in section 2791 of the 

20 Public Health Service Act); 

21 ‘‘(C) other relevant stakeholders and initia22 tives in areas of need, such as the Accountable 

23 Health Communities Model of the Centers for 

24 Medicare & Medicaid Services, health homes 

25 under the Medicaid program under title XIX, 


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1 community-based organizations, and human 

2 services organizations; 

3 ‘‘(D) other non-health care sector organi4 zations, including organizations focusing on 

5 transportation, housing, or food access; and 

6 ‘‘(E) local employers. 

7 ‘‘(6) The identification of any supplemental 

8 funding sources that would be used to finance the 

9 proposed interventions or approaches. 

10 ‘‘(7) A description of any financial incentives 

11 that may be provided, including outcome-focused 

12 contracting approaches to encourage service pro13 viders and other partners to improve outcomes of, 

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

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

16 ‘‘(8) The identification of the applicable Fed17 eral, State, local, or Tribal statutory and regulatory 

18 authorities, including waiver authorities, to be lever19 aged to implement the proposed interventions or ap20 proaches. 

21 ‘‘(9) A description of potential considerations 

22 that would enhance the impact, scalability, or sus23 tainability of the proposed interventions or ap24 proaches and the actions the grant awardee would 

25 take to address such considerations. 


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1 ‘‘(10) A evaluation plan, to be carried out by an 

2 independent evaluator, to measure the impact of the 

3 proposed interventions or approaches on the out4 comes of, cost-effectiveness of, and return on invest5 ment from, Federal, State, local, and Tribal govern6 ments. 

7 ‘‘(11) Precautions for ensuring that vulnerable 

8 populations will not be denied access to the Medicaid 

9 program under title XIX or other essential services 

10 as a result of implementing the social determinants 

11 accelerator plan. 

12 ‘‘(h) MONITORING AND EVALUATION.—As a condi13 tion of receipt of a grant under this section, a grantee 

14 shall agree to submit an annual report to the Secretary 

15 describing the activities carried out through the grant and 

16 the outcomes of such activities. 

17 ‘‘(i) INDEPENDENT NATIONAL EVALUATION.— 

18 ‘‘(1) IN GENERAL.—Not later than 3 years 

19 after the first grants are awarded under this section, 

20 the Secretary shall provide for the commencement of 

21 an independent national evaluation of the program 

22 under this section. 

23 ‘‘(2) REPORT TO CONGRESS.—Not later than 

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1 pendent national evaluation, the Secretary shall re2 port such results to the Congress. 

3 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.— 

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

5 appropriated to the Secretary $10,000,000 for each 

6 of fiscal years 2022 through 2026 to carry out this 

7 section. 

8 ‘‘(2) RESERVATION.—Of the funds made avail9 able to carry out this section, the Secretary shall re10 serve not less than 20 percent to award grants to el11 igible applicants for the development of social deter12 minants accelerator plans under this section in13 tended to serve rural populations.’’. 

Æ 


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