II 118th CONGRESS 2d Session S. 5182 IN THE SENATE OF THE UNITED STATES September 25, 2024 Mr. Sullivan (for himself and Ms. Cortez Masto ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to require the collection of information regarding social determinants of health, and for other purposes.

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 . 2. 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 uniform reporting field (A) In general Not later than 18 months after the date of enactment of this subsection, the Secretary, in consultation with the States, shall develop a model uniform reporting field through the transformed Medicaid Statistical Information System (T–MSIS), as approved by the Secretary, for collecting standardized and aggregated State-level information related to social determinants that may factor into the health of beneficiaries under this title who are eligible for medical assistance for which Federal financial participation is available and beneficiaries under title XXI who are eligible for child health assistance for which Federal financial participation is available which the States, notwithstanding section 1902(a)(7) and as a condition for meeting the requirements of section 1902(a)(6) and section 2107(b)(1), shall use to annually report such information. (B) Implementation In carrying out the requirements of subparagraph (A), the Secretary shall— (i) determine the appropriate providers and frequency with which such providers may submit standardized information to States to be used to complete the uniform reporting field developed under such subparagraph; (ii) issue guidance for ensuring compliance with applicable laws regarding beneficiary informed consent, privacy, and anonymity with respect to the information collected through the uniform reporting field; (iii) with respect to the collection of information relating to beneficiaries who are children, issue guidance on the collection of such information from a parent, legal guardian, or any other person who is legally authorized to share such information on behalf of the child when the direct collection of such information from children may not otherwise be feasible or appropriate; and (iv) issue guidance on how to reduce duplicative screenings of beneficiaries, or to ensure that information collected from a screening is entered into a beneficiary's health record so that other providers who treat that beneficiary can see that a screening has been conducted for that beneficiary. (2) Social determinants of health defined (A) In general For purposes of this title and title XXI, the term social determinants of health means the standardized definitions developed in accordance with paragraph (1) for identifying social determinants of health needs identified in the ICD–10 diagnostic codes Z55 through Z63, Z65, and Z75 (as in effect on the date of enactment of this subsection). (B) Incorporation measures of relative severity The Secretary shall issue guidance relating to incorporating measures for quantifying, with respect to an individual, the relative severity of a social determinant of health need of the individual as identified by a diagnostic code referred to in subparagraph (A). (3) Rules of construction (A) Federal privacy requirements Nothing in this subsection shall be construed to supersede any Federal privacy or confidentiality requirement, including the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and section 543 of the Public Health Service Act and any regulations promulgated thereunder. (B) No requirement for the provision of medical assistance Nothing in this subsection shall be construed as allowing for medical assistance for items and services for which Federal financial participation is not permitted under this title. (4) State requirement to collect information from providers As a condition for meeting the requirements of section 1902(a)(6) and section 2107(b)(1), a State shall ensure that the providers identified by the Secretary under paragraph (1)(B)(i) are conducting screenings for social needs and submitting standardized information with appropriate frequency (as identified by the Secretary under such paragraph). (5) Application to territories (A) In general To the extent that the Secretary determines that it is not practicable for a State specified in subparagraph (B) to report information in accordance with the uniform reporting field made available under paragraph (1), this subsection shall not apply with respect to such State. (B) Territories specified The States specified in this subparagraph are Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. . (b) Report 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) Report on collection of information related to social determinants of health Not later than 4 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 social determinants of health for beneficiaries under this title who are eligible for medical assistance for which Federal financial participation is available and beneficiaries under title XXI who are eligible for child health assistance for which Federal financial participation is available based on analyses of the data collected under subsection (d). .