Sec. 12. Collection of information related to social determinants of the health of Medicaid and CHIP beneficiaries
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Not later than 2 years after the date of enactment of this Act, the Secretary shall submit a report to Congress that includes a description of whether and how information related to the social determinants of health for individuals eligible for medical assistance under Medicaid or child health assistance or pregnancy-related assistance under CHIP may be captured under the data systems for such programs as in effect on the date such report is submitted, including— a description of whether and how ICD–10 codes (or successor codes) may be used to identify social determinants of health in programs such as Medicaid and CHIP, and whether other claims file or demographic information may be employed; and a description of whether existing data systems under Medicaid and CHIP could be employed to capture such information, whether program or system changes would be required, how privacy and confidentiality as required under applicable law and regulations would be maintained, and the resources and timeframes at the Federal and State levels that would be needed to make such changes.
The Secretary shall issue detailed guidance for States concurrent with the submission of the report to Congress under paragraph (1). Such guidance shall address— whether and how information related to the social determinants of health for individuals eligible for medical assistance under Medicaid or child health assistance or pregnancy-related assistance under CHIP could be captured employing existing systems under such programs; and implementation considerations for capturing such information, including whether program or system changes would be required, whether additional steps would be needed to maintain privacy and confidentiality as required under relevant laws and regulations, and the resources and timeframes at that would be needed to make such changes.
The Secretary shall develop the report required under paragraph
(1)and the guidance required under paragraph
(2)with the input of relevant stakeholders, such as State Medicaid directors, medicaid managed care organizations, and other relevant Federal agencies such as the Centers for Disease Control and Prevention, the Health Resources Services Administration, and the Agency for Healthcare Research and Quality. If the Secretary determines in the report required under paragraph
(1)that information related to the social determinants of health for individuals eligible for medical assistance under Medicaid or child health assistance or pregnancy-related assistance under CHIP cannot be captured under the data systems for such programs as in effect on the date such report is submitted, then, not later than 6 months after such date, the Secretary shall submit a second report to Congress that contains an action plan for implementing the program or data systems changes needed in order for such information to be collected while maintaining privacy and confidentiality as required under relevant laws and regulations. The action plan should be prepared so as to be implemented by the Federal Government and States not later than 2 years after the date on which the report required under this paragraph is submitted is submitted to Congress. The Secretary shall revise and reissue the guidance for States required under paragraph
(2)to take into account the action plan included in the report submitted to Congress under subparagraph (A). There are authorized to be appropriated to the Secretary, $40,000,000 for purposes of preparing the reports required under this subsection and implementing the collection of information related to the social determinants of health for individuals eligible for medical assistance under Medicaid or child health assistance or pregnancy-related assistance under CHIP. There are authorized to be appropriated to the Secretary, $50,000,000 for purposes of making payments to States in accordance with a methodology established by the Secretary for State expenditures attributable to planning for and implementing the collection of such information in accordance with subsection
(d)of section 1946 of the Social Security Act ( 42 U.S.C. 1396w–5 ) (as added by subsection (b)). Section 1946 of the Social Security Act ( 42 U.S.C. 1396w–5 ) is amended by adding at the end the following: Subject to paragraph (5), the Secretary, in consultation with the States, shall develop a method for collecting standardized and aggregated State-level information related to social determinants that may factor into the health of beneficiaries under this title and beneficiaries under title XXI 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: A model uniform reporting field through the transformed Medicaid Statistical Information System (T–MSIS) (or a successor system) or another appropriate reporting platform, as approved by the Secretary. A model uniform questionnaire or survey (which may be included as part of an existing survey, questionnaire, or form administered by the Secretary), for purposes of the State or the Secretary collecting such information by administering regularly but not less than annually a questionnaire or survey of beneficiaries under this title and beneficiaries under title XXI. A model uniform form to be adapted for inclusion in the Medicaid and CHIP Scorecard developed by the Centers for Medicare & Medicaid Services, for purposes of the Secretary collecting such information. An alternative method identified by the Secretary for collecting such information. In carrying out the requirements of subparagraph (A), the Secretary shall— for purposes of the method described in clause
(i)of such subparagraph, determine the appropriate providers and frequency with which such providers shall complete the reporting field identified and report the information to the State; for purposes of the method described in clause
(ii)of such subparagraph, identify the means and frequency (which shall be no less frequent than once per year) with which a questionnaire or survey of beneficiaries is to be conducted; with respect to any method described in such subparagraph, issue guidance for ensuring compliance with applicable laws regarding beneficiary informed consent, privacy, and anonymity with respect to the information collected under such method; 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 regularly evaluate the method under such subparagraph and the information reported using such method, and, as needed, make updates to the method and the information reported. The information collected in accordance with the method made available under paragraph
(1)shall, to the extent practicable, include standardized definitions for identifying social determinants of health needs identified in the ICD–10 diagnostic codes Z55 through Z65 (or any such successor diagnostic codes), as defined by the Healthy People 2020 and related initiatives of the Office of Disease Prevention and Health Promotion of the Department of Health and Human Services, or any other standardized set of definitions for social determinants of health identified by the Secretary. Such definitions shall incorporate measures for quantifying the relative severity of any such social determinant of health need identified in an individual. 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. 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 method made available under paragraph (1), this subsection shall not apply with respect to such State. The States specified in this subparagraph are Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Subject to subparagraph (B), the requirement for a State to collect information in accordance with the method made available under paragraph
(1)shall not apply to the State before the date that is 4 years after the date of enactment of this subsection. If an action plan is submitted to Congress under section 13(a)(4) of the Healthy Moms and Babies Act , in lieu of the date described in subparagraph (A), the requirement for a State to collect information in accordance with the method made available under paragraph
(1)shall not apply to the State before the date specified in such action plan. There is appropriated to the Secretary for fiscal year 2023 and each fiscal year thereafter $1,000,000 to carry out the provisions of this section and subsection (b)(2)(B). . Section 1946(b)(2) of such Act ( 42 U.S.C. 1396w–5(b)(2) ) is amended— by striking Not later than and inserting the following: Not later than ; and by adding at the end the following: Not later than 5 years after the date on which the requirement to collect information under subsection
(d)is first applicable to States, 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 and beneficiaries under title XXI based on analyses of the data collected under subsection (d). Not later than 3 years after the date of enactment of this subparagraph, the Secretary shall submit to Congress an interim report on progress in developing, implementing, and utilizing the method selected by the Secretary under subsection (d)(1) along with any available, preliminary information that has been collected using such method. . Section 2107(e)(1) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1) ) is amended by adding at the end the following: Section 1946 (relating to addressing health care disparities). .
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- 42 USC 1396w–5
- 42 USC 1396w–5(b)(2)
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Sec. 12
Collection of information related to social determinants of the health of Medicaid and CHIP beneficiaries
Cite42 USC 1396w–5
Cite42 USC 1396w–5(b)(2)
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