I 

116TH CONGRESS 

1ST SESSION H. R. 4621 

To require the Secretary of Health and Human Services to issue and disseminate guidance to States to clarify strategies to address social determinants of health under the Medicaid program and the Children’s Health 

Insurance Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 8, 2019 

Ms. BLUNT ROCHESTER (for herself and Mr. BILIRAKIS) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To require the Secretary of Health and Human Services 

to issue and disseminate guidance to States to clarify 

strategies to address social determinants of health under 

the Medicaid program and the Children’s Health Insurance 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 ‘‘Collecting and Ana5 lyzing Resources Integral and Necessary for Guidance for 

6 Social Determinants Act of 2019’’ or the ‘‘CARING for 

7 Social Determinants Act of 2019’’. 


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1 SEC. 2. FINDINGS; PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) Social determinants of health are the condi5 tions in which people are born, grow, live, play, work 

6 and age; they include factors like socioeconomic sta7 tus, education, housing, transportation, nutrition 

8 and literacy. 

9 (2) Research has shown that addressing social 

10 determinants of health is important for improving 

11 overall health and reducing health inequities. 

12 (3) Social determinants that negatively impact 

13 health can have harmful neurodevelopmental and bi14 ological consequences that develop in childhood and 

15 manifest in adulthood. 

16 (4) There is a growing body of evidence sug17 gesting that policies that specifically address social 

18 needs, including policies targeting children and fami19 lies, can improve community health outcomes and 

20 have the potential to reduce health care spending. 

21 (5) Some State Medicaid programs have begun 

22 testing innovative delivery and payment models de23 signed to improve health outcomes and reduce costs 

24 by implementing strategies to address social deter25 minants of health under existing Medicaid authori26 ties as well as through the use of waivers, though 


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1 payment incentives linked to social determinant of 

2 health are not common. 

3 (6) Despite a growing focus on social deter4 minants of health in State managed care contracts, 

5 most States do not provide necessary guidance for 

6 managed care organizations as to how they may use 

7 existing authority under Federal law to provide pa8 tients with services that can improve health by ad9 dressing social determinants. 

10 (7) Centers for Medicare & Medicaid Services 

11 guidance and technical assistance are critical tools 

12 that could increase adoption of strategies to address 

13 social determinants of health among State Medicaid 

14 agencies. 

15 (b) PURPOSES.—It is the purpose of this Act to pro16 vide States with additional operational clarity and exam17 ples of the strategies they can leverage through existing 

18 authority and waivers to address social determinants of 

19 health for the Medicaid population. 


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1 SEC. 3. REQUIREMENT TO ISSUE GUIDANCE TO CLARIFY 

2 STRATEGIES TO ADDRESS SOCIAL DETER3 MINANTS OF HEALTH IN THE MEDICAID PRO4 GRAM AND THE CHILDREN’S HEALTH INSUR5 ANCE PROGRAM. 

6 Not later than 2 years after the date of the enact7 ment of this Act, the Secretary of Health and Human 

8 Services shall issue and disseminate guidance to States to 

9 clarify strategies to address social determinants of health 

10 under the Medicaid program and the Children’s Health 

11 Insurance Program. Such guidance shall include the fol12 lowing: 

13 (1) Guidance and technical assistance to State 

14 Medicaid agencies regarding the strategies that 

15 States can implement under existing authorities 

16 under title XI, XIX, or XXI of the Social Security 

17 Act, or through waivers, to address social deter18 minants of health in the provision of health care, in19 cluding strategies specifically targeting the pediatric 

20 population. 

21 (2) Guidance and technical assistance on how 

22 States can encourage and incentivize managed care 

23 organizations to address social determinants of 

24 health through contracts with such organizations. 

25 (3) A compendium of examples from States 

26 with respect to how States are currently addressing 


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1 social determinants of health in the provision of 

2 health care under the Medicaid program and the 

3 Children’s Health Insurance Program, including 

4 through payment models. 

Æ 


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