II 

116TH CONGRESS 

1ST SESSION S. 1323 

To amend titles XVIII and XIX of the Social Security Act to collect information under Medicare, Medicaid, and the Children’s Health Insurance 

Program related to social determinants of health, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 6, 2019 

Mr. PORTMAN (for himself and Mr. CASEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to collect information under Medicare, Medicaid, and the 

Children’s Health Insurance Program related to 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 ‘‘Utilizing National 

5 Data, Effectively Reforming Standards and Tools, to Ad6 dress Negative Determinates of Health Act’’ or the ‘‘UN7 DERSTAND Act’’. 


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1 SEC. 2. COLLECTION OF INFORMATION RELATED TO SO2 CIAL DETERMINANTS OF THE HEALTH OF 

3 MEDICARE BENEFICIARIES. 

4 (a) REPORTING OF INFORMATION.—Section 1809 of 

5 the Social Security Act (42 U.S.C. 1395b–10) is amended 

6 by adding at the end the following: 

7 ‘‘(d) COLLECTION OF INFORMATION RELATED TO

8 SOCIAL DETERMINANTS OF HEALTH.— 

9 ‘‘(1) PROPOSED RULE.— 

10 ‘‘(A) IN GENERAL.—Not later than Octo11 ber 1, 2020, the Secretary shall issue a pro12 posed rule so as to allow for the collection of in13 formation related to social determinants that 

14 may factor into the health of beneficiaries 

15 under this title. The proposed rule shall allow 

16 for the collection of such information from li17 censed health professionals (as defined in sec18 tion 1819(b)(5)(G)) and community health 

19 workers (as defined in section 2113(f)(4)). 

20 ‘‘(B) PHASED-IN IMPLEMENTATION; PUB21 LIC AVAILABILITY OF INFORMATION.—The Sec22 retary shall— 

23 ‘‘(i) phase-in implementation of the 

24 collection of information in accordance 

25 with subparagraph (A) over a 3-year pe26 riod, in such manner as the Secretary deVerDate Sep 11 2014 18:19 May 11, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1323.IS S1323

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1 termines appropriate in order to minimize 

2 any adverse impact on the licensed health 

3 professionals providing such information; 

4 and 

5 ‘‘(ii) make such information collected 

6 available to the public and updated at least 

7 annually during the phase-in period. 

8 ‘‘(2) SOCIAL DETERMINANTS OF HEALTH.—The 

9 information collected in accordance with paragraph 

10 (1) shall include (but is not limited to) the following 

11 possible social determinants of health, as identified 

12 in the ICD–10 diagnostic codes Z55 through Z65 

13 (or any such successor diagnostic codes): 

14 ‘‘(A) Problems related to education and lit15 eracy. 

16 ‘‘(B) Employment and unemployment. 

17 ‘‘(C) Occupations exposure risk factors. 

18 ‘‘(D) Problems related to housing and eco19 nomic circumstances. 

20 ‘‘(E) Problems related to social environ21 ments. 

22 ‘‘(F) Problems related to upbringing. 

23 ‘‘(G) Problems related to family cir24 cumstances, including primary support groups. 


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1 ‘‘(H) Psychosocial circumstances resulting 

2 from pregnancy. 

3 ‘‘(I) Conviction in civil or criminal pro4 ceedings.’’. 

5 (b) REPORT ON DATA ANALYSES.—Section 

6 1809(b)(2) of such Act (42 U.S.C. 1395b–10(b)(2)) is 

7 amended— 

8 (1) by striking ‘‘Not later than’’ and inserting 

9 the following: 

10 ‘‘(A) INITIAL REPORTS.—Not later than’’; 

11 and 

12 (2) by adding at the end the following: 

13 ‘‘(B) REPORTS ON COLLECTION OF INFOR14 MATION RELATED TO SOCIAL DETERMINANTS

15 OF HEALTH.—Not later than 5 years after the 

16 date of the enactment of this subparagraph, the 

17 Secretary shall submit to Congress a report 

18 that includes aggregate findings and trends 

19 across respective beneficiary populations for im20 proving the identification of health care dispari21 ties for beneficiaries under this title based on 

22 analyses of the data collected under subsection 

23 (d).’’. 


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1 SEC. 3. COLLECTION OF INFORMATION RELATED TO SO2 CIAL DETERMINANTS OF THE HEALTH OF 

3 MEDICAID AND CHIP BENEFICIARIES. 

4 (a) REPORTING OF INFORMATION.—Section 1946 of 

5 the Social Security Act (42 U.S.C. 1396w–5) is amended 

6 by adding at the end the following: 

7 ‘‘(d) COLLECTION OF INFORMATION RELATED TO

8 SOCIAL DETERMINANTS OF HEALTH.— 

9 ‘‘(1) DEVELOPMENT OF MODEL UNIFORM RE10 PORTING FIELD.— 

11 ‘‘(A) IN GENERAL.—Not later than Octo12 ber 1, 2020, the Secretary shall, in consultation 

13 with the States, develop and make available to 

14 the States a model uniform reporting field that 

15 States may use for purposes of reporting to the 

16 Secretary through the Transformed Medicaid 

17 Statistical Information System (T–MSIS) (or a 

18 successor system) information related to social 

19 determinants that may factor into the health of 

20 beneficiaries under this title and beneficiaries 

21 under title XXI and be collected from licensed 

22 health professionals (as defined in section 

23 1919(b)(5)(G)) and community health workers 

24 (as defined in section 2113(f)(4)). 


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1 ‘‘(B) PHASED-IN IMPLEMENTATION; PUB2 LIC AVAILABILITY OF INFORMATION.—The Sec3 retary shall— 

4 ‘‘(i) phase-in implementation of the 

5 collection of information in accordance 

6 with subparagraph (A) over a 3-year pe7 riod, in such manner as the Secretary de8 termines appropriate in order to minimize 

9 any adverse impact on the licensed health 

10 professionals and community health work11 ers providing such information; and 

12 ‘‘(ii) make such information collected 

13 available to the public and updated at least 

14 annually during the phase-in period. 

15 ‘‘(2) SOCIAL DETERMINANTS OF HEALTH.—The 

16 information collected in accordance with paragraph 

17 (1) shall include (but is not limited to) the following 

18 possible social determinants of health, as identified 

19 in the ICD–10 diagnostic codes Z55 through Z65 

20 (or any such successor diagnostic codes): 

21 ‘‘(A) Problems related to education and lit22 eracy. 

23 ‘‘(B) Employment and unemployment. 

24 ‘‘(C) Occupations exposure risk factors. 


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1 ‘‘(D) Problems related to housing and eco2 nomic circumstances. 

3 ‘‘(E) Problems related to social environ4 ments. 

5 ‘‘(F) Problems related to upbringing and 

6 family circumstances including primary support 

7 groups. 

8 ‘‘(G) Psychosocial circumstances resulting 

9 from pregnancy. 

10 ‘‘(H) Conviction in civil or criminal pro11 ceedings.’’. 

12 (b) REPORT ON DATA ANALYSES.—Section 

13 1946(b)(2) of such Act (42 U.S.C. 1396w–5(b)(2)) is 

14 amended— 

15 (1) by striking ‘‘Not later than’’ and inserting 

16 the following: 

17 ‘‘(A) INITIAL REPORTS.—Not later than’’; 

18 and 

19 (2) by adding at the end the following: 

20 ‘‘(B) REPORTS ON COLLECTION OF INFOR21 MATION RELATED TO SOCIAL DETERMINANTS

22 OF HEALTH.—Not later than 5 years after the 

23 date of the enactment of this subparagraph, the 

24 Secretary shall submit to Congress a report 

25 that includes aggregate findings and trends 


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1 across respective beneficiary populations for im2 proving the identification of health care dispari3 ties for beneficiaries under this title and bene4 ficiaries under title XXI based on analyses of 

5 the data collected under subsection (d).’’. 

6 SEC. 4. COLLECTION OF INFORMATION RELATED TO SO7 CIAL DETERMINANTS OF THE HEALTH OF IN8 DIVIDUALS RECEIVING CARE THROUGH 

9 HEALTH CENTERS. 

10 Part A of title III of the Public Health Service Act 

11 (42 U.S.C. 241 et seq.) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 310B. COLLECTION OF INFORMATION RELATED TO 

14 SOCIAL DETERMINANTS OF HEALTH. 

15 ‘‘(a) IN GENERAL.— 

16 ‘‘(1) IN GENERAL.—Not later than October 1, 

17 2020, the Secretary, acting through the Adminis18 trator of the Health Resources and Services Admin19 istration, shall promulgate regulations to allow for 

20 the collection of information related to social deter21 minants that may factor into the health of individ22 uals receiving services at federally qualified health 

23 centers (as defined in section 1861(aa)(4) of the So24 cial Security Act). Such regulations shall allow for 

25 the collection of such information from licensed 


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1 health professionals (as defined in section 

2 1919(b)(5)(G) of the Social Security Act) and com3 munity health workers (as defined in section 

4 2113(f)(4) of the Social Security Act) providing 

5 services at such health centers. 

6 ‘‘(2) PHASED-IN IMPLEMENTATION; PUBLIC

7 AVAILABILITY OF INFORMATION.—The Secretary 

8 shall— 

9 ‘‘(A) phase-in implementation of the collec10 tion of information in accordance with para11 graph (1) over a 3-year period, in such manner 

12 as the Secretary determines appropriate in 

13 order to minimize any adverse impact on the li14 censed health professionals and community 

15 health workers providing such information; and 

16 ‘‘(B) make such information collected 

17 available to the public and updated at least an18 nually during the phase-in period. 

19 ‘‘(b) SOCIAL DETERMINANTS OF HEALTH.—The in20 formation collected in accordance with subsection (a) shall 

21 include (but is not limited to) the following possible social 

22 determinants of health, as identified in the ICD–10 diag23 nostic codes Z55 through Z65 (or any such successor diag24 nostic codes): 

25 ‘‘(1) Problems related to education and literacy. 


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1 ‘‘(2) Employment and unemployment. 

2 ‘‘(3) Occupations exposure risk factors. 

3 ‘‘(4) Problems related to housing and economic 

4 circumstances. 

5 ‘‘(5) Problems related to social environments. 

6 ‘‘(6) Problems related to upbringing. 

7 ‘‘(7) Problems related to family circumstances, 

8 including primary support groups. 

9 ‘‘(8) Psychosocial circumstances resulting from 

10 pregnancy. 

11 ‘‘(9) Conviction in civil or criminal proceedings. 

12 ‘‘(c) REPORTS ON COLLECTION OF INFORMATION

13 RELATED TO SOCIAL DETERMINANTS OF HEALTH.—Not 

14 later than 5 years after the date of the enactment of this 

15 section, the Secretary shall submit to Congress a report 

16 that includes aggregate findings and trends across respec17 tive patient populations for improving the identification of 

18 health care disparities for individuals receiving health 

19 services at federally qualified health centers based on anal20 yses of the data collected under subsection (a).’’. 

Æ 


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