Title: UNDERSTAND Act
Policy area: Health

Summary:
Utilizing National Data, Effectively Reforming Standards and Tools, to Address Negative Determinates [sic] of Health Act or the UNDERSTAND Act
This bill requires the collection and reporting of social determinants of health that may affect Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries and individuals who receive services at federally qualified health centers. Social determinants of health include educational, employment, housing, and family circumstances.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1323 Introduced in Senate (IS)]

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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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Utilizing National Data, Effectively 
Reforming Standards and Tools, to Address Negative Determinates of 
Health Act'' or the ``UNDERSTAND Act''.

SEC. 2. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF THE 
              HEALTH OF MEDICARE BENEFICIARIES.

    (a) Reporting of Information.--Section 1809 of the Social Security 
Act (42 U.S.C. 1395b-10) is amended by adding at the end the following:
    ``(d) Collection of Information Related to Social Determinants of 
Health.--
            ``(1) Proposed rule.--
                    ``(A) In general.--Not later than October 1, 2020, 
                the Secretary shall issue a proposed rule so as to 
                allow for the collection of information related to 
                social determinants that may factor into the health of 
                beneficiaries under this title. The proposed rule shall 
                allow for the collection of such information from 
                licensed health professionals (as defined in section 
                1819(b)(5)(G)) and community health workers (as defined 
                in section 2113(f)(4)).
                    ``(B) Phased-in implementation; public availability 
                of information.--The Secretary shall--
                            ``(i) phase-in implementation of the 
                        collection of information in accordance with 
                        subparagraph (A) over a 3-year period, in such 
                        manner as the Secretary determines appropriate 
                        in order to minimize any adverse impact on the 
                        licensed health professionals providing such 
                        information; and
                            ``(ii) make such information collected 
                        available to the public and updated at least 
                        annually during the phase-in period.
            ``(2) Social determinants of health.--The information 
        collected in accordance with paragraph (1) shall include (but 
        is not limited to) the following possible social determinants 
        of health, as identified in the ICD-10 diagnostic codes Z55 
        through Z65 (or any such successor diagnostic codes):
                    ``(A) Problems related to education and literacy.
                    ``(B) Employment and unemployment.
                    ``(C) Occupations exposure risk factors.
                    ``(D) Problems related to housing and economic 
                circumstances.
                    ``(E) Problems related to social environments.
                    ``(F) Problems related to upbringing.
                    ``(G) Problems related to family circumstances, 
                including primary support groups.
                    ``(H) Psychosocial circumstances resulting from 
                pregnancy.
                    ``(I) Conviction in civil or criminal 
                proceedings.''.
    (b) Report on Data Analyses.--Section 1809(b)(2) of such Act (42 
U.S.C. 1395b-10(b)(2)) is amended--
            (1) by striking ``Not later than'' and inserting the 
        following:
                    ``(A) Initial reports.--Not later than''; and
            (2) by adding at the end the following:
                    ``(B) Reports on collection of information related 
                to social determinants of health.--Not later than 5 
                years after the date of the enactment of this 
                subparagraph, the Secretary shall submit to Congress a 
                report that includes aggregate findings and trends 
                across respective beneficiary populations for improving 
                the identification of health care disparities for 
                beneficiaries under this title based on analyses of the 
                data collected under subsection (d).''.

SEC. 3. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF THE 
              HEALTH OF MEDICAID AND CHIP BENEFICIARIES.

    (a) Reporting of Information.--Section 1946 of the Social Security 
Act (42 U.S.C. 1396w-5) is amended by adding at the end the following:
    ``(d) Collection of Information Related to Social Determinants of 
Health.--
            ``(1) Development of model uniform reporting field.--
                    ``(A) In general.--Not later than October 1, 2020, 
                the Secretary shall, in consultation with the States, 
                develop and make available to the States a model 
                uniform reporting field that States may use for 
                purposes of reporting to the Secretary through the 
                Transformed Medicaid Statistical Information System (T-
                MSIS) (or a successor system) information related to 
                social determinants that may factor into the health of 
                beneficiaries under this title and beneficiaries under 
                title XXI and be collected from licensed health 
                professionals (as defined in section 1919(b)(5)(G)) and 
                community health workers (as defined in section 
                2113(f)(4)).
                    ``(B) Phased-in implementation; public availability 
                of information.--The Secretary shall--
                            ``(i) phase-in implementation of the 
                        collection of information in accordance with 
                        subparagraph (A) over a 3-year period, in such 
                        manner as the Secretary determines appropriate 
                        in order to minimize any adverse impact on the 
                        licensed health professionals and community 
                        health workers providing such information; and
                            ``(ii) make such information collected 
                        available to the public and updated at least 
                        annually during the phase-in period.
            ``(2) Social determinants of health.--The information 
        collected in accordance with paragraph (1) shall include (but 
        is not limited to) the following possible social determinants 
        of health, as identified in the ICD-10 diagnostic codes Z55 
        through Z65 (or any such successor diagnostic codes):
                    ``(A) Problems related to education and literacy.
                    ``(B) Employment and unemployment.
                    ``(C) Occupations exposure risk factors.
                    ``(D) Problems related to housing and economic 
                circumstances.
                    ``(E) Problems related to social environments.
                    ``(F) Problems related to upbringing and family 
                circumstances including primary support groups.
                    ``(G) Psychosocial circumstances resulting from 
                pregnancy.
                    ``(H) Conviction in civil or criminal 
                proceedings.''.
    (b) Report on Data Analyses.--Section 1946(b)(2) of such Act (42 
U.S.C. 1396w-5(b)(2)) is amended--
            (1) by striking ``Not later than'' and inserting the 
        following:
                    ``(A) Initial reports.--Not later than''; and
            (2) by adding at the end the following:
                    ``(B) Reports on collection of information related 
                to social determinants of health.--Not later than 5 
                years after the date of the enactment of this 
                subparagraph, the Secretary shall submit to Congress a 
                report that includes aggregate findings and trends 
                across respective beneficiary populations for improving 
                the identification of health care disparities for 
                beneficiaries under this title and beneficiaries under 
                title XXI based on analyses of the data collected under 
                subsection (d).''.

SEC. 4. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF THE 
              HEALTH OF INDIVIDUALS RECEIVING CARE THROUGH HEALTH 
              CENTERS.

    Part A of title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) is amended by adding at the end the following:

``SEC. 310B. COLLECTION OF INFORMATION RELATED TO SOCIAL DETERMINANTS 
              OF HEALTH.

    ``(a) In General.--
            ``(1) In general.--Not later than October 1, 2020, the 
        Secretary, acting through the Administrator of the Health 
        Resources and Services Administration, shall promulgate 
        regulations to allow for the collection of information related 
        to social determinants that may factor into the health of 
        individuals receiving services at federally qualified health 
        centers (as defined in section 1861(aa)(4) of the Social 
        Security Act). Such regulations shall allow for the collection 
        of such information from licensed health professionals (as 
        defined in section 1919(b)(5)(G) of the Social Security Act) 
        and community health workers (as defined in section 2113(f)(4) 
        of the Social Security Act) providing services at such health 
        centers.
            ``(2) Phased-in implementation; public availability of 
        information.--The Secretary shall--
                    ``(A) phase-in implementation of the collection of 
                information in accordance with paragraph (1) over a 3-
                year period, in such manner as the Secretary determines 
                appropriate in order to minimize any adverse impact on 
                the licensed health professionals and community health 
                workers providing such information; and
                    ``(B) make such information collected available to 
                the public and updated at least annually during the 
                phase-in period.
    ``(b) Social Determinants of Health.--The information collected in 
accordance with subsection (a) shall include (but is not limited to) 
the following possible social determinants of health, as identified in 
the ICD-10 diagnostic codes Z55 through Z65 (or any such successor 
diagnostic codes):
            ``(1) Problems related to education and literacy.
            ``(2) Employment and unemployment.
            ``(3) Occupations exposure risk factors.
            ``(4) Problems related to housing and economic 
        circumstances.
            ``(5) Problems related to social environments.
            ``(6) Problems related to upbringing.
            ``(7) Problems related to family circumstances, including 
        primary support groups.
            ``(8) Psychosocial circumstances resulting from pregnancy.
            ``(9) Conviction in civil or criminal proceedings.
    ``(c) Reports on Collection of Information Related to Social 
Determinants of Health.--Not later than 5 years after the date of the 
enactment of this section, the Secretary shall submit to Congress a 
report that includes aggregate findings and trends across respective 
patient populations for improving the identification of health care 
disparities for individuals receiving health services at federally 
qualified health centers based on analyses of the data collected under 
subsection (a).''.
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