I 

116TH CONGRESS 

1ST SESSION H. R. 4004 

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 

JULY 25, 2019 

Mrs. BUSTOS (for herself, Mr. COLE, Mr. MCGOVERN, Mrs. RODGERS of 

Washington, Mr. RUSH, Ms. BARRAGA ́N, Mr. ENGEL, Mr. BUTTERFIELD, 

Mr. CA ́RDENAS, Mr. MORELLE, Mr. FITZPATRICK, Mr. SCHRADER, Mr. 

SOTO, Mr. MICHAEL F. DOYLE of Pennsylvania, and Ms. BLUNT ROCHESTER) 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 2019’’. 

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 

24 issues to help the Council achieve consensus rec25 ommendations described under subsection (c)(1). 


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1 (5) NON-FEDERAL COMPOSITION.—The Comp2 troller General of the United States may designate 

3 up to 6 Council designees— 

4 (A) who have relevant subject matter ex5 pertise, including expertise implementing and 

6 evaluating transformative initiatives that har7 ness data and conduct evaluations to improve 

8 the impact and cost-effectiveness of Federal 

9 Government services; and 

10 (B) that each represent— 

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

12 human services agencies; 

13 (ii) public housing authorities or State 

14 housing finance agencies; 

15 (iii) State and local government budg16 et offices; 

17 (iv) State Medicaid agencies; or 

18 (v) national consumer advocacy orga19 nizations. 

20 (6) CHAIR.— 

21 (A) IN GENERAL.—The Secretary shall se22 lect the Chair of the Council from among the 

23 members of the Council. 

24 (B) INITIATING GUIDANCE.—The Chair, 

25 on behalf of the Council, shall identify and inVerDate Sep 11 2014 02:51 Aug 13, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4004.IH H4004

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1 vite individuals from diverse entities to provide 

2 the Council with advice and information per3 taining to addressing social determinants of 

4 health, including— 

5 (i) individuals from State and local 

6 government health and human services 

7 agencies; 

8 (ii) individuals from State Medicaid 

9 agencies; 

10 (iii) individuals from State and local 

11 government budget offices; 

12 (iv) individuals from public housing 

13 authorities or State housing finance agen14 cies; 

15 (v) individuals from nonprofit organi16 zations, small businesses, and philan17 thropic organizations; 

18 (vi) advocates; 

19 (vii) researchers; and 

20 (viii) any other individuals the Chair 

21 determines to be appropriate. 

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

23 (1) to make recommendations to the Secretary 

24 and the Administrator regarding the criteria for 

25 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; and 

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

15 date of the enactment of this Act, the Council shall con16 vene to develop a schedule and plan for carrying out the 

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

18 applications for the grants under section 4. 

19 (e) REPORT TO CONGRESS.—The Council shall sub20 mit an annual report to Congress, which shall include— 

21 (1) a list of the Council members; 

22 (2) activities and expenditures of the Council; 

23 (3) summaries of the interventions and ap24 proaches that will be supported by State, local, and 


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1 Tribal governments that received a grant under sec2 tion 4, including— 

3 (A) the best practices and evidence-based 

4 approaches such governments plan to employ to 

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

6 (B) a description of how the practices and 

7 approaches will impact the outcomes, cost-effec8 tiveness of, and return on investment from, 

9 Federal, State, local, and Tribal governments 

10 with respect to such purposes; 

11 (4) the feedback received from State and local 

12 governments on ways to improve the technical assist13 ance of the Council, including findings from a third14 party survey and actions the Council plans to take 

15 in response to such feedback; and 

16 (5) the major statutory, regulatory, and admin17 istrative challenges identified by State, local, and 

18 Tribal governments that received a grant under sec19 tion 4, and the actions that Federal agencies are 

20 taking to address such challenges. 

21 (f) FACA APPLICABILITY.—The Federal Advisory 

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

23 Council. 

24 (g) COUNCIL PROCEDURES.—The Secretary, in con25 sultation with the Comptroller General of the United 


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1 States and the Director of the Office of Management and 

2 Budget, shall establish procedures for the Council to— 

3 (1) ensure that adequate resources are available 

4 to effectively execute the responsibilities of the 

5 Council; 

6 (2) effectively coordinate with other relevant ad7 visory bodies and working groups to avoid unneces8 sary duplication; 

9 (3) create transparency to the public and Con10 gress with regard to Council membership, costs, and 

11 activities, including through use of modern tech12 nology and social media to disseminate information; 

13 and 

14 (4) avoid conflicts of interest that would jeop15 ardize the ability of the Council to make decisions 

16 and provide recommendations. 

17 SEC. 4. SOCIAL DETERMINANTS ACCELERATOR GRANTS TO 

18 STATES OR LOCAL GOVERNMENTS. 

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

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

21 enactment of this Act, the Administrator, in consultation 

22 with the Secretary and the Council, shall award on a com23 petitive basis not more than 25 grants to eligible appli24 cants described in subsection (b), for the development of 


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1 social determinants accelerator plans, as described in sub2 section (f). 

3 (b) ELIGIBLE APPLICANT.—An eligible applicant de4 scribed in this section is a State, local, or Tribal health 

5 or human services agency that— 

6 (1) demonstrates the support of relevant parties 

7 across relevant State, local, or Tribal jurisdictions; 

8 and 

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

10 government agency, provides to the Secretary a let11 ter of support from the lead State health or human 

12 services agency for the State in which the local gov13 ernment is located. 

14 (c) AMOUNT OF GRANT.—The Administrator, in co15 ordination with the Council, shall determine the total 

16 amount that the Administrator will make available to each 

17 grantee under this section. 

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

19 grant under this section shall include in the application 

20 the following information: 

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

22 would benefit from implementation of the social de23 terminants accelerator plan proposed to be developed 

24 by the applicant. 


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1 (2) A description of the objective or objectives 

2 and outcome goals of such proposed plan, which 

3 shall include at least one health outcome and at 

4 least one other important social outcome. 

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

6 if addressed by the plan, could result in improved 

7 cost-effectiveness of or return on investment from 

8 Federal, State, local, and Tribal governments. 

9 (4) A description of potential interventions that 

10 could be designed or enabled using such proposed 

11 plan. 

12 (5) The State, local, Tribal, academic, non13 profit, community-based organizations, and other 

14 private sector partners that would participate in the 

15 development of the proposed plan and subsequent 

16 implementation of programs or initiatives included 

17 in such proposed plan. 

18 (6) Such other information as the Adminis19 trator, in consultation with the Secretary and the 

20 Council, determines necessary to achieve the pur21 poses of this Act. 

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

23 this section may use funds received through the grant for 

24 the following purposes: 


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1 (1) To convene and coordinate with relevant 

2 government entities and other stakeholders across 

3 sectors to assist in the development of a social deter4 minant accelerator plan. 

5 (2) To identify populations of individuals receiv6 ing medical assistance under a State plan (or a 

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

8 Security Act (42 U.S.C. 1396 et seq.) who may ben9 efit from the proposed approaches to improving the 

10 health and well-being of such individuals through the 

11 implementation of the proposed social determinants 

12 accelerator plan. 

13 (3) To engage qualified research experts to ad14 vise on relevant research and to design a proposed 

15 evaluation plan, in accordance with the standards 

16 and guidelines issued by the Administrator. 

17 (4) To collaborate with the Council to support 

18 the development of social determinants accelerator 

19 plans. 

20 (5) To prepare and submit a final social deter21 minants accelerator plan to the Council. 

22 (f) CONTENTS OF PLANS.—A social determinant ac23 celerator plan developed under this section shall include 

24 the following: 


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

2 populations) that would benefit from implementation 

3 of the social determinants accelerator plan, including 

4 an analysis describing the projected impact on the 

5 well-being of individuals described in subsection 

6 (e)(2). 

7 (2) A description of the interventions or ap8 proaches designed under the social determinants ac9 celerator plan and the evidence for selecting such 

10 interventions or approaches. 

11 (3) The objectives and outcome goals of such 

12 interventions or approaches, including at least one 

13 health outcome and at least one other important so14 cial outcome. 

15 (4) A plan for accessing and linking relevant 

16 data to enable coordinated benefits and services for 

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

18 an evaluation of the proposed interventions and ap19 proaches. 

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

21 academic, nonprofit, or community-based organiza22 tions, or any other private sector organizations that 

23 would participate in implementing the proposed 

24 interventions or approaches, and the role each would 


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1 play to contribute to the success of the proposed 

2 interventions or approaches. 

3 (6) The identification of the funding sources 

4 that would be used to finance the proposed interven5 tions or approaches. 

6 (7) A description of any financial incentives 

7 that may be provided, including outcome-focused 

8 contracting approaches to encourage service pro9 viders and other partners to improve outcomes of, 

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

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

12 (8) The identification of the applicable Federal, 

13 State, local, or Tribal statutory and regulatory au14 thorities, including waiver authorities, to be lever15 aged to implement the proposed interventions or ap16 proaches. 

17 (9) A description of potential considerations 

18 that would enhance the impact, scalability, or sus19 tainability of the proposed interventions or ap20 proaches and the actions the grant awardee would 

21 take to address such considerations. 

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

23 out by an independent evaluator, to measure the im24 pact of the proposed interventions or approaches on 

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


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

2 governments. 

3 (11) Precautions for ensuring that vulnerable 

4 populations will not be denied access to Medicaid or 

5 other essential services as a result of implementing 

6 the proposed plan. 

7 SEC. 5. FUNDING. 

8 (a) IN GENERAL.—Out of any money in the Treasury 

9 not otherwise appropriated, there is appropriated to carry 

10 out this Act $25,000,000, of which up to $5,000,000 may 

11 be used to carry out this Act, to remain available for obli12 gation until the date that is 5 years after the date of en13 actment of this Act. 

14 (b) RESERVATION OF FUNDS.— 

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

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

17 less than 20 percent to award grants to eligible ap18 plicants for the development of social determinants 

19 accelerator plans under section 4 intended to serve 

20 rural populations. 

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

22 for which the Secretary determines that there are 

23 not sufficient eligible applicants to award up to 25 

24 grants under section 4 that are intended to serve 

25 rural populations and the Secretary cannot satisfy 


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1 the 20-percent requirement, the Secretary may re2 serve an amount that is less than 20 percent of 

3 amounts made available under subsection (a) to 

4 award grants for such purpose. 

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

6 shall prevent Federal agencies represented on the Council 

7 from contributing additional funding from other sources 

8 to support activities to improve the effectiveness of the 

9 Council. 

Æ 


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