982 
(I) whose responsibilities relate 
to authorities, policies, and procedures 
with respect to the health and well- 
being of individuals receiving medical 
assistance under a State plan (or a 
waiver of such plan) under title XIX 
of the Social Security Act (42 U.S.C. 
1396 et seq.); or 
(II) who has authority to imple-
ment and evaluate transformative ini-
tiatives that harness data or conducts 
rigorous evaluation to improve the im-
pact and cost-effectiveness of federally 
funded services and benefits. 
(C) HHS REPRESENTATION.—In addition 
to the designees under subparagraph (A), the 
Council shall include designees from at least 
three agencies within the Department of Health 
and Human Services, including the Centers for 
Medicare & Medicaid Services, at least one of 
whom shall meet the criteria under this section. 
(D) OMB ROLE.—The Director of the Of-
fice of Management and Budget shall facilitate 
the timely resolution of Governmentwide and 
multiagency issues to help the Council achieve 
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consensus recommendations described under 
this section. 
(E) NON-FEDERAL
COMPOSITION.—The 
Comptroller General of the United States may 
designate up to 6 Council designees— 
(i) who have relevant subject matter 
expertise, including expertise implementing 
and evaluating transformative initiatives 
that harness data and conduct evaluations 
to improve the impact and cost-effective-
ness of Federal Government services; and 
(ii) that each represent— 
(I) State, local, and Tribal health 
and human services agencies; 
(II) public housing authorities or 
State housing finance agencies; 
(III) State and local government 
budget offices; 
(IV) State Medicaid agencies; or 
(V) national consumer advocacy 
organizations. 
(F) CHAIR.— 
(i) IN GENERAL.—The Secretary shall 
select the Chair of the Council from among 
the members of the Council. 
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(ii) 
INITIATING
GUIDANCE.—The 
Chair, on behalf of the Council, shall iden-
tify and invite individuals from diverse en-
tities to provide the Council with advice 
and information pertaining to addressing 
social determinants of health, including— 
(I) individuals from State and 
local government health and human 
services agencies; 
(II) individuals from State Med-
icaid agencies; 
(III) individuals from State and 
local government budget offices; 
(IV) 
individuals 
from 
public 
housing authorities or State housing 
finance agencies; 
(V) individuals from nonprofit or-
ganizations, small businesses, and 
philanthropic organizations; 
(VI) advocates; 
(VII) researchers; and 
(VIII) any other individuals the 
Chair determines to be appropriate. 
(3) DUTIES.—The duties of the Council are— 
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(A) to make recommendations to the Sec-
retary and the Administrator regarding the cri-
teria for making awards under this section; 
(B) to identify Federal authorities and op-
portunities for use by States or local govern-
ments to improve coordination of funding and 
administration of Federal programs, the bene-
ficiaries of whom include individuals, and which 
may be unknown or underutilized and to make 
information on such authorities and opportuni-
ties publicly available; 
(C) to provide targeted technical assistance 
to States developing a social determinants ac-
celerator plan under this section, including 
identifying potential statutory or regulatory 
pathways for implementation of the plan and 
assisting in identifying potential sources of 
funding to implement the plan; 
(D) to report to Congress annually on the 
subjects set forth in this section; 
(E) to develop and disseminate evaluation 
guidelines and standards that can be used to 
reliably assess the impact of an intervention or 
approach that may be implemented pursuant to 
this Act on outcomes, cost-effectiveness of, and 
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986 
return on investment from Federal, State, local, 
and Tribal governments, and to facilitate tech-
nical assistance, where needed, to help to im-
prove State and local evaluation designs and 
implementation; 
(F) to seek feedback from State, local, and 
Tribal governments, including through an an-
nual survey by an independent third party, on 
how to improve the technical assistance the 
Council provides to better equip State, local, 
and Tribal governments to coordinate health 
and social service programs; 
(G) to solicit applications for grants under 
this section; and 
(H) to coordinate with other cross-agency 
initiatives focused on improving the health and 
well-being of low-income and at-risk populations 
in order to prevent unnecessary duplication be-
tween agency initiatives. 
(4) SCHEDULE.—Not later than 60 days after 
the date of the enactment of this Act, the Council 
shall convene to develop a schedule and plan for car-
rying out the duties described in this section, includ-
ing solicitation of applications for the grants under 
this section. 
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987 
(5) REPORT TO CONGRESS.—The Council shall 
submit an annual report to Congress, which shall in-
clude— 
(A) a list of the Council members; 
(B) activities and expenditures of the 
Council; 
(C) summaries of the interventions and ap-
proaches that will be supported by State, local, 
and Tribal governments that received a grant 
under this section, including— 
(i) the best practices and evidence- 
based approaches such governments plan 
to employ to achieve the purposes listed in 
this section; and 
(ii) a description of how the practices 
and approaches will impact the outcomes, 
cost-effectiveness of, and return on invest-
ment from, Federal, State, local, and Trib-
al governments with respect to such pur-
poses; 
(D) the feedback received from State and 
local governments on ways to improve the tech-
nical assistance of the Council, including find-
ings from a third-party survey and actions the 
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988 
Council plans to take in response to such feed-
back; and 
(E) the major statutory, regulatory, and 
administrative challenges identified by State, 
local, and Tribal governments that received a 
grant under subsection (d), and the actions that 
Federal agencies are taking to address such 
challenges. 
(6) FACA APPLICABILITY.—The Federal Advi-
sory Committee Act (5 U.S.C. App.) shall not apply 
to the Council. 
(7) COUNCIL PROCEDURES.—The Secretary, in 
consultation with the Comptroller General of the 
United States and the Director of the Office of Man-
agement and Budget, shall establish procedures for 
the Council to— 
(A) ensure that adequate resources are 
available to effectively execute the responsibil-
ities of the Council; 
(B) effectively coordinate with other rel-
evant advisory bodies and working groups to 
avoid unnecessary duplication; 
(C) create transparency to the public and 
Congress with regard to Council membership, 
costs, and activities, including through use of 
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989 
modern technology and social media to dissemi-
nate information; and 
(D) avoid conflicts of interest that would 
jeopardize the ability of the Council to make de-
cisions and provide recommendations. 
(d) SOCIAL DETERMINANTS ACCELERATOR GRANTS 
TO STATES OR LOCAL GOVERNMENTS.— 
(1) GRANTS TO STATES, LOCAL GOVERNMENTS, 
AND TRIBES.—Not later than 180 days after the 
date of the enactment of this Act, the Administrator, 
in consultation with the Secretary and the Council, 
shall award on a competitive basis not more than 25 
grants to eligible applicants described in this section, 
for the development of social determinants accel-
erator plans, as described in this section. 
(2) ELIGIBLE
APPLICANT.—An eligible appli-
cant described in this section is a State, local, or 
Tribal health or human services agency that— 
(A) demonstrates the support of relevant 
parties across relevant State, local, or Tribal ju-
risdictions; and 
(B) in the case of an applicant that is a 
local government agency, provides to the Sec-
retary a letter of support from the lead State 
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990 
health or human services agency for the State 
in which the local government is located. 
(3) AMOUNT OF GRANT.—The Administrator, 
in coordination with the Council, shall determine the 
total amount that the Administrator will make avail-
able to each grantee under this section. 
(4) APPLICATION.—An eligible applicant seek-
ing a grant under this section shall include in the 
application the following information: 
(A) The target population (or populations) 
that would benefit from implementation of the 
social determinants accelerator plan proposed to 
be developed by the applicant. 
(B) A description of the objective or objec-
tives and outcome goals of such proposed plan, 
which shall include at least one health outcome 
and at least one other important social out-
come. 
(C) The sources and scope of inefficiencies 
that, if addressed by the plan, could result in 
improved cost-effectiveness of or return on in-
vestment from Federal, State, local, and Tribal 
governments. 
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991 
(D) A description of potential interventions 
that could be designed or enabled using such 
proposed plan. 
(E) The State, local, Tribal, academic, 
nonprofit, community-based organizations, and 
other private sector partners that would partici-
pate in the development of the proposed plan 
and subsequent implementation of programs or 
initiatives included in such proposed plan. 
(F) Such other information as the Admin-
istrator, in consultation with the Secretary and 
the Council, determines necessary to achieve the 
purposes of this Act. 
(5) USE OF FUNDS.—A recipient of a grant 
under this section may use funds received through 
the grant for the following purposes: 
(A) To convene and coordinate with rel-
evant government entities and other stake-
holders across sectors to assist in the develop-
ment of a social determinant accelerator plan. 
(B) To identify populations of individuals 
receiving medical assistance under a State plan 
(or a waiver of such plan) under title XIX of 
the Social Security Act (42 U.S.C. 1396 et 
seq.) who may benefit from the proposed ap-
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992 
proaches to improving the health and well-being 
of such individuals through the implementation 
of the proposed social determinants accelerator 
plan. 
(C) To engage qualified research experts to 
advise on relevant research and to design a pro-
posed evaluation plan, in accordance with the 
standards and guidelines issued by the Admin-
istrator. 
(D) To collaborate with the Council to sup-
port the development of social determinants ac-
celerator plans. 
(E) To prepare and submit a final social 
determinants accelerator plan to the Council. 
(6) CONTENTS
OF
PLANS.—A social deter-
minant accelerator plan developed under this section 
shall include the following: 
(A) A description of the target population 
(or populations) that would benefit from imple-
mentation of the social determinants accelerator 
plan, including an analysis describing the pro-
jected impact on the well-being of individuals 
described in paragraph (5)(B). 
(B) A description of the interventions or 
approaches designed under the social deter-
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993 
minants accelerator plan and the evidence for 
selecting such interventions or approaches. 
(C) The objectives and outcome goals of 
such interventions or approaches, including at 
least one health outcome and at least one other 
important social outcome. 
(D) A plan for accessing and linking rel-
evant data to enable coordinated benefits and 
services for the jurisdictions described in this 
section and an evaluation of the proposed inter-
ventions and approaches. 
(E) A description of the State, local, Trib-
al, academic, nonprofit, or community-based or-
ganizations, or any other private sector organi-
zations that would participate in implementing 
the proposed interventions or approaches, and 
the role each would play to contribute to the 
success of the proposed interventions or ap-
proaches. 
(F) The identification of the funding 
sources that would be used to finance the pro-
posed interventions or approaches. 
(G) A description of any financial incen-
tives that may be provided, including outcome- 
focused contracting approaches to encourage 
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994 
service providers and other partners to improve 
outcomes of, cost-effectiveness of, and return on 
investment from, Federal, State, local, or Tribal 
government spending. 
(H) The identification of the applicable 
Federal, State, local, or Tribal statutory and 
regulatory authorities, including waiver authori-
ties, to be leveraged to implement the proposed 
interventions or approaches. 
(I) A description of potential consider-
ations 
that 
would 
enhance 
the 
impact, 
scalability, or sustainability of the proposed 
interventions or approaches and the actions the 
grant awardee would take to address such con-
siderations. 
(J) A proposed evaluation plan, to be car-
ried out by an independent evaluator, to meas-
ure the impact of the proposed interventions or 
approaches on the outcomes of, cost-effective-
ness of, and return on investment from, Fed-
eral, State, local, and Tribal governments. 
(K) Precautions for ensuring that vulner-
able populations will not be denied access to 
Medicaid or other essential services as a result 
of implementing the proposed plan. 
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995 
(e) FUNDING.— 
(1) IN GENERAL.—Out of any money in the 
Treasury not otherwise appropriated, there is appro-
priated to carry out this Act $25,000,000, of which 
up to $5,000,000 may be used to carry out this Act, 
to remain available for obligation until the date that 
is 5 years after the date of enactment of this Act. 
(2) RESERVATION OF FUNDS.— 
(A) IN
GENERAL.—Of the funds made 
available under paragraph (1), the Secretary 
shall reserve not less than 20 percent to award 
grants to eligible applicants for the development 
of social determinants accelerator plans under 
this section intended to serve rural populations. 
(B) EXCEPTION.—In the case of a fiscal 
year for which the Secretary determines that 
there are not sufficient eligible applicants to 
award up to 25 grants under section 4 that are 
intended to serve rural populations and the Sec-
retary cannot satisfy the 20-percent require-
ment, the Secretary may reserve an amount 
that is less than 20 percent of amounts made 
available under paragraph (1) to award grants 
for such purpose. 
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996 
(3) RULE OF CONSTRUCTION.—Nothing in this 
Act shall prevent Federal agencies represented on 
the Council from contributing additional funding 
from other sources to support activities to improve 
the effectiveness of the Council. 
SEC. 
1010. 
CORRECTING 
HURTFUL 
AND 
ALIENATING 
NAMES 
IN 
GOVERNMENT 
EXPRESSION 
(CHANGE). 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Correcting Hurtful and Alienating Names in Government 
Expression (CHANGE) Act’’. 
(b) MODERNIZATION OF LANGUAGE REFERRING TO 
INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF 
THE UNITED STATES.—An Executive agency (as defined 
in section 105 of title 5, United States Code) shall not 
use the following terms in any proposed or final rule, regu-
lation, interpretation, publication, other document, dis-
play, or sign issued by the agency after the date of the 
enactment of this Act, except to the extent that the term 
is used in quoting or reproducing text written by a source 
other than an officer (as defined in section 2104 of title 
5, United States Code) or employee (as defined in section 
2105 of title 5, United States Code) of the agency: 
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997 
(1) The term ‘‘alien’’, when used to refer to an 
individual who is not a citizen or national of the 
United States. 
(2) The term ‘‘illegal alien’’ when used to refer 
to an individual who is unlawfully present in the 
United States or who lacks a lawful immigration 
status in the United States. 
(c) UNIFORM DEFINITION.— 
(1) IN GENERAL.—Chapter 1 of title 1, United 
States Code, is amended by adding at the end the 
following: 
‘‘§ 9. Definition of ‘foreign national’ 
‘‘In determining the meaning of any Act of Congress, 
or of any ruling, regulation, or interpretation of various 
administrative bureaus and agencies of the United States, 
the term ‘foreign national’ means any individual other 
than an individual— 
‘‘(1) who is a citizen of the United States; or 
‘‘(2) though not a citizen of the United States, 
who owes permanent allegiance to the United 
States.’’. 
(2) TECHNICAL
AMENDMENT.—The table of 
sections for chapter 1 of title 1, United States Code, 
is amended by adding at the end the following: 
‘‘9. Definition of ‘foreign national’.’’. 
(d) REFERENCES.— 
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998 
(1) IN GENERAL.—Any reference in any Fed-
eral statute, rule, regulation, Executive order, publi-
cation, or other document of the United States— 
(A) to the term ‘‘alien’’, when used to refer 
to an individual who is not a citizen or national 
of the United States, is deemed to refer to the 
term ‘‘foreign national’’; and 
(B) to the term ‘‘illegal alien’’, when used 
to refer to an individual who is unlawfully 
present in the United States or who lacks a 
lawful immigration status in the United States, 
is deemed to refer to the term ‘‘undocumented 
foreign national’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 421(5)(A)(ii)(II) of the Con-
gressional Budget and Impoundment Control 
Act of 1974 (2 U.S.C. 658(5)(A)(ii)(II)) is 
amended by striking ‘‘illegal aliens’’ and insert-
ing ‘‘undocumented foreign nationals’’. 
(B) Section 432(e) of the Homeland Secu-
rity Act of 2002 (6 U.S.C. 240(e)) is amended 
by striking ‘‘illegal alien’’ and inserting ‘‘un-
documented foreign national’’. 
(C) Section 439 of the Antiterrorism and 
Effective Death Penalty Act of 1996 (8 U.S.C. 
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