On this page, we share NASDOH’s policy engagements with the most recent activity summarized first. For information on recent federal efforts to address SDOH we are aware of, see HHS SDOH policy activity.
In the response, NASDOH agrees with the need for a multi-sector effort to improve care coordination, health, and well-being. NASDOH also welcomes the Playbook’s focus on multi-sector partnerships and flexible funding. See the full response here.
NASDOH submitted a letter of support to Senator Sherrod Brown (D-OH) and Senator Bill Cassidy (R-LA) for introducing the Supplemental Security Income (SSI) Savings Penalty Elimination Act (S.2767), which would update SSI’s asset limits for the first time since the 1980s to ensure disabled and elderly Americans are able to prepare themselves for a financial emergency without putting the benefits they rely on at risk. See the full letter here.
In the response, NASDOH discusses how addressing health disparities in rural communities needs to include a focus on addressing health-related social needs and the underlying drivers of health outcomes. The NASDOH response also discusses the use of community health workers in rural communities and highlights the work and resources of several NASDOH members to support rural communities. See the full response here.
NASDOH specifically commented on CMS’ proposals to add (1) new payment options for SDOH screening and risk assessment, (2) codes specifically designed to describe services involving community health workers (CHWs), and (3) the Connection to Community Service Provider quality measure to the Merit-Based Incentive Payment System (MIPS) program and auxiliary personnel. See the full comment letter here.
NASDOH responded to the National Institutes of Health’s (NIH) recent request for information on Food is Medicine research opportunities. In the response, NASDOH highlights alliance members’ commitment to addressing hunger and Food is Medicine research and NASDOH’s recently released principles for SDOH research and offers suggestions on relevant research questions to prioritize. See the full response here.
NASDOH encourages CMS to avoid placing restrictions or administrative burdens on the pathway that would discourage the use of In Lieu of Services (ILOS) to address SDOH. NASDOH also requests CMS conduct a learning collaborative to provide clarity about how to appropriately count investments in infrastructure to coordinate social care in the numerator of the Medical Loss Ratio (MLR). See the full comment letter here.
NASDOH expresses support for the requirement to include beneficiaries, community-based organizations, and other organizations on the Medicaid Advisory Committee, and encourages CMS to consider any costs a Beneficiary Advisory Group member may experience to attend meetings. NASDOH also encourages CMS to allow for reimbursements of costs beneficiaries incur to participate and to ensure financial compensation for such costs would not impact an individual’s eligibility for Federal benefits programs, including Medicaid. See the full comment letter here.
NASDOH submitted a comment letter on the CMS FY 2024 Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Proposed Rule. In the comment letter, NASDOH expresses support for adding quality measures on equity and social needs screening to additional CMS programs. See the full comment letter here.
NASDOH submitted a letter of support to Congresswomen Alma Adams (D-NC) and Lauren Underwood (D-IL) and Senator Cory Booker (D-NJ) for recently reintroducing the Black Maternal Health Momnibus Act (H.R. 3305/S. 1606) historic legislation to save moms’ lives and address every driver of maternal mortality, morbidity, and disparities in the U.S. See the full letter here.
NASDOH offered comments highlighting links between clinician burnout and the ability to address patients’ social needs, utilizing community health workers as one strategy to ensure care is culturally and linguistically congruent, and the crucial need to build up and sustain the public health workforce. See the full response here.
Similar to the response sent to the House Energy and Commerce Committee, NASDOH offered comments, focusing on ways to improve coordination and strengthen local response, as well as data infrastructure and partnerships needed for a robust response. See the full response here.
NASDOH offered comments, focusing on ways to improve coordination and strengthen local response, as well as data infrastructure and partnerships needed for a robust response. See the full response here.
In the response, NASDOH expressed support for proposals around: 1) revised language for MA plans to provide culturally competent care and expand the list of underserved populations that MA plans must provide culturally competent care to; 2) a requirement for MA plans to offer digital health education to improve telehealth access; 3) the addition of behavioral health services to the list of required providers part of care coordination plans; and, 4) a new health equity index (HEI) reward in Star Ratings. See NASDOH’s full comments here.
The letter highlights that the guidance supports additional efforts for addressing social needs and will be of benefit to the individuals enrolled in Medicaid and improve outcomes in the Medicaid program. See NASDOH’s letter here.
NASDOH specifically commented on the addition of two proposed structural measures, Screening for Social Drivers of Health and Screen Positive Rate for Social Drivers of Health in quality payment programs. NASDOH also suggested CMS provide guidance on standardized screening for SDOH for all patients across programs. See the full comment letter here.
Specifically, NASDOH commented on overarching principles to measure healthcare quality disparities across CMS quality programs and on potential quality measures for health equity in rural and rural emergency settings. See the full comment letter here.
In the comment letter, NASDOH expressed its appreciation for CMS’s Vision for Medicare putting the person at the center of care and its commitment to embedding health equity in its work. We are particularly grateful to see this RFI, demonstrating that CMS is not just supportive of health equity, but also willing to take the necessary steps to modify and update its own programs to ensure health inequities are identified and meaningfully addressed. In the letter, NASDOH commented on methods for screening for SDOH, approaches for partnership between community-based organizations (CBOs) and MA plans, and the use of algorithms and analytics to promote care management and coordination. See the full letter here.
Ahead of the September 2022 White House Conference on Hunger, Nutrition, and Health, NASDOH offered ideas based on members’ experiences providing services to address people’s social needs and SDOH as they relate to hunger, nutrition, and health. See NASDOH’s full comment letter here.
NASDOH offered comments specifically on the Hospital Commitment to Health Equity measure, Screening for Social Drivers of Health measures, and two requests for information on reporting of SDOH diagnosis codes and using measurement and stratification tools to address health equity. See the full comments here.
NASDOH focused our comments on SDOH-related provisions, including the proposal to require all SNPs to include one or more standardized questions on the topics of housing stability, food security, and access to transportation as part of their health risk assessments (HRAs). See the full NASDOH letter here.
NASDOH continues to be appreciative of CMS’s commitment to ensuring that MA plans have flexibility to offer Special Supplemental Benefits for the Chronically Ill (SSBCI) that meet the unique, nonuniform needs of their plan populations, including providing coverage of benefits that are not primarily health related and that address the SDOH. In its comment letter, NASDOH supported CMS’ efforts to codify SSBCI policies on “not primarily health related” benefits previously outlined, to expand its list of eligible chronic conditions for SSBCI benefits, and provides flexibility around the Medical Loss Ratio.
To view the letter, please click here.
NASDOH is excited to see that the Centers for Medicare and Medicaid Services (CMS) has taken the approach in the 2020 Medicare Advantage Call Letter that would allow plans to “vary, or target, [Special Supplemental Benefits for the Chronically Ill] SSBCI as they relate to the individual enrollee’s specific medical condition and needs.”
In response to the Draft Call Letter, NASDOH provided recommendations on two requests for comments around flexibility to determine what is a chronic condition that meets statutory standard and the limits of supplemental benefits for chronically ill enrollees.
Please read our comment letter here.
In the RFI response, NASDOH offered comments to CMS Administrator Chiquita Brooks LaSure underscoring that the RFI can inform a comprehensive access strategy for Medicaid and CHIP. NASDOH focused its response on five key questions in the RFI, which align with NASDOH’s previous recommendations on addressing social needs in the Medicaid program. NASDOH commented on access and eligibility requirements in Medicaid, care coordination and covering social care in Medicaid, and assessment of payment policies through the development of a Medicaid learning collaborative. See the full response here.
NASDOH offers comments with a social needs and SDOH frame specifically related to accessing health care, understanding provider experiences, advancing health equity, and learning from the impact of COVID-19 waivers and flexibilities. See the full response here.
In the memo, NASDOH calls the existing Medicaid and CHIP model be used to address health-related social needs. NASDOH strongly encourages the enhancement of CMS efforts to promote cross-state learning, including the creation of a learning collaborative focused specifically on strategies to address social needs in Medicaid. See the full memo here.
NASDOH appreciates the leadership from the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and the Center for Medicare & Medicaid Services (CMS) Administrator Seema Verma in highlighting the critical role that social determinants play in health. NASDOH encourages CMS to further encourage state Medicaid programs to address the social determinants of health without undermining its core purpose.
Please see here a letter addressed to Administrator Verma that highlights NASDOH’s recommendations to accelerate the work of states and providers.
In addition, NASDOH has developed a one-pager that highlights the importance, as well as the opportunities, of supporting state innovation and policies that address social determinants of health in the Medicaid environment (see one-pager here).
NASDOH sent the set of proposed principles for addressing social needs and SDOH in future CMMI payment models to CMMI Director Dr. Dora Hughes. In the principles, NASDOH notes CMMI’s recent strategy refresh focusing on health equity and emphasizes that screening for and referring or providing services to beneficiaries with health-related social needs is a vital component of addressing equity. Therefore, NASDOH asserts that social needs considerations should be incorporated into all future CMMI payment models and offers principles for CMMI to consider.
NASDOH commends the Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) for their efforts to improve the quality of care and health outcomes for Medicare beneficiaries. In particular, NASDOH is encouraged by the inclusion of social determinants of health in the Geographic Population Based Payment model, which provides direct contract entities (DCEs) the opportunity to assume total cost of care (TCOC) risk for Medicare fee-for-service beneficiaries in a specific geographic area. NASDOH drafted a response to CMS’s request for information (RFI) on Direct Contracting – Geographic Population-Based Payment Model Option. Our response offers several elements that we believe should be taken into consideration to help DCEs and community partners work together to accomplish the goals of the Geographic PBP model.
Please read our comment letter here.
NASDOH wrote to Senator Murray (D-WA), Chair of the Senate HELP Committee, and Senator Burr (R-NC), Ranking Member of the Senate HELP Committee, offering comments on the draft legislation Prepare for and Response to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act). In the letter, NASDOH underscores the importance of addressing SDOH as part of preparing for and responding to future emergencies and comments on specific provisions related to SDOH. Check out the full letter here.
NASDOH applauds Representative Cheri Bustos (D-IL), Representative Tom Cole (R-OK), Representative G.K. Butterfield (D-NC), and Representative Markwayne Mullin (R-OK) for launching the Congressional Social Determinants of Health (SDOH) Caucus in 2021 to explore opportunities to improve the impact of efforts to address SDOH with federal support. In the letter, NASDOH offers eight recommendations to the Congressional SDOH Caucus, outlines areas of opportunity for the caucus to promote a coordinated federal approach to investment in SDOH, reviews several SDOH-related legislative proposals that NASDOH supports, and details several NASDOH members’ examples of engaging in SDOH programs on the ground. Please see the full response here.
NASDOH thanks Representatives Bustos, Cole, Butterfield, and Mullin for launching the Congressional Social Determinants of Health (SDOH) Caucus to explore opportunities to improve the impact of efforts to address SDOH with federal support. NASDOH appreciates their leadership in bringing together members of Congress to coordinate across SDOH-related jurisdictions in order to improve health outcomes and optimize federal funding. Read the July, 2021 letter here.
NASDOH supports a package of bills intended to improve Black maternal health outcomes, including bills S.346 / H.R.959 – The Black Maternal Health Momnibus Act of 2021, which would direct multi-agency efforts to improve maternal health, particularly among racial and ethnic minority groups, veterans, and other vulnerable populations, and address issues of maternal health related to the COVID-19 pandemic. Read the July, 2021 letter here.
Introduced by Rep. Nanette Diaz-Barragán (D-CA) and Senator Tina Smith (D-MN)
NASDOH supports The Improving Social Determinants Act of 2021. The bill would authorize $50 million for CDC’s SDOH activities, including grants to state, local, territorial and tribal health agencies and organizations to address SDOH in target communities; grants to nonprofits and institutions of higher education to conduct research and provide technical assistance; data collection and analysis; and federal coordination.
Introduced by Reps. Cheri Bustos (D-IL), Jim McGovern (D-MA), Rom Cole (R-OK), Markwayne Mullin (R-OK)
NASDOH supports The Social Determinants Accelerator Act of 2021. The bill would direct the Secretary of HHS to establish an interagency council on social determinants of health and make $25 million available to state, local, and tribal governments to develop plans to target social determinants that are negatively impacting high need patients.
Introduced by Senators Dan Sullivan (R-AK) and Chris Murphy (D-CT)
NASDOH supports Leveraging Integrated Networks in Communities (LINC) to Address Social Needs Act of 2021. The bill would authorize $150 million to HHS to award competitive grants to States (working through public-private partnerships) to establish or enhance technology platforms to refer and connect people to food, housing, child development, job training, and transportation supports and services.
Introduced by Senator Patty Murray (D-WA)
NASDOH supports Public Health Infrastructure Saves Lives Act (PHISLA). The bill would establish a new core public health infrastructure program, specifically providing $4.5 billion in annual funding to bolster the nation’s efforts to fight the COVID-19 pandemic and strengthen its ability to respond to other public health challenges going forward.
NASDOH was encouraged by the inclusion of the social determinants of health in the Committee and Task Force’s approach to improving health outcomes in rural or underserved communities. In our comment letter we provided responses to specific questions related to the social determinant of health and provided links to additional resources that might be useful to the Committee and the Task Force. We look forward to the opportunity to engage in further dialogue on these issues and welcome any questions or request for additional information.
Please read our comment letter here.
In the January 2022 letter, NASDOH urges HHS to issue guidance to states outlining how public health entities should modernize their data systems in light of lessons learned during the COVID-19 pandemic. Check out the full letter here.
NASDOH submitted comments to the White House Office of Science and Technology Policy (OSTP) request for information (RFI) on Strengthening Community Health through Technology. In the letter, NASDOH offered comments on the “digital health technologies” terminology, underscoring the importance of qualitative and quantitative data as well as data generated by the community. With examples from members, NASDOH outlined successful models of community health providers using digital health technology, raised barriers faced by organizations in community-based settings; and, reviewed trends in digital health technology use from the pandemic. See NASDOH’s comment letter here.
In the 2021 letter, NASDOH offers support for the findings as well as the recommendations for potential HHS actions that can help build the overall evidence base for SDOH and follows with a set of recommended areas for emphasis. See the full response here.
In our 2021 letter to Ambassador Susan Rice (Director, Domestic Policy Council), Secretary Xavier Becerra, (U.S. Department of Health & Human Services), and Mr. Gene Sperling (American Rescue Plan Coordinator), NASDOH encouraged the federal government to take proactive steps to ensure that federal funding, such as that appropriated in the American Rescue Plan Act (ARPA) and other new funding initiatives, is prioritized toward long-term investment in public health, social determinants of health (SDOH), and equity. We included 5 recommendations and highlighted the opportunity to use funding to support multi-sector partnerships to advance SDOH.
NASDOH believes this RFI can yield important input into how federal policies and actions can equitably serve all eligible individuals and communities. Achieving equity and addressing adverse social determinants of health are interconnected aims, and we offer our perspective on how these goals can be accomplished through the administration of federal programs. Read the July, 2021 letter here.
NASDOH appreciates the opportunity to provide our collective comments on how the Health Insurance Portability and Accountability Act (HIPAA) Rules could better promote coordinated and value-based health care, particularly as it relates to the ability of covered entities to disclose protected health information (PHI) to social service and other third-party agencies that provide health-related services.
Please see here for NASDOH’s letter to HHS with recommendations on questions posed in the proposed rule related to adding a new subsection 164.506(c)(6) which would expressly permit covered entities to disclose PHI without obtaining a valid authorization from the individual to social service agencies, community-based organizations, HCBS providers, and other similar third parties that provide health-related services to specific individuals for individual-level care coordination and case management.
NASDOH commended HHS for addressing the social determinants of health (SDOH) in the Regulatory Sprint to Coordinated Care. We were pleased to provide comments on the Office of Inspector General (OIG)’s proposed rule to revise the safe harbor protections under the Federal antikickback statute. We believe that inclusion of safe harbors that have the potential to protect interventions to address the social determinants of health from violations under the Federal anti-kickback statute is an important next step.
Please see our full comments in the letter here.
NASDOH commends the Office of the Chief Technology Officer (CTO) for his efforts to catalyze the shift towards a value-based health care system focused on rewarding and improving patient outcomes and scaling and deployment of effective prevention strategies in the social and economic environment. We appreciated the opportunity to provide comments on the PreventionX RFI and provided a multi-sectoral perspective on the importance of addressing social determinants of health as part of chronic disease prevention strategy, and to support transformation to value-based care.
Please read our comment letter here.
One of the largest problems on the journey to better address the social determinants of health is the fragmented coordination process between community-based organizations and health care entities. NASDOH submitted a letter on March 4th, 2019 to the Chief Data Officer (CDO) at the U.S. Department of Health and Human Services (HHS) that outlines several use cases and associated case studies. The letter is intended to inform the CDO on potential actions to promote transparency of, access to, aggregation of, and integration and sharing of, appropriate data and technology across sectors to assess and address social determinants of health at the individual and community level.
Please click here to view the letter.
NASDOH members recently met with the U.S. Department of Health and Human Services (HHS) Deputy Secretary to discuss federal statutory and regulatory barriers to implementing a value-based framework that sustains social determinants of health efforts and that addresses care for the whole person. In follow up to this conversation, NASDOH provided a letter that includes evidence for specific social determinants of health interventions that may deliver consistent return on investment (ROI).
Please view the letter here.
NASDOH is grateful for the opportunity to provide our collective comments on how the Health Insurance Portability and Accountability Act (HIPAA) Rules could better promote coordinated and value-based health care, particularly as it relates to the ability of covered entities to disclose protected health information (PHI) to social service agencies.
Please click here to view NASDOH’s comment letter.
NASDOH appreciates the Surgeon General for his efforts to highlight the importance of community health and vitality through his interest in soliciting comments on the upcoming Surgeon General’s Call to Action document, “Community Health and Prosperity.” NASDOH provides an overview of multi-sectoral alliance efforts to achieve similar goals, including several examples of local, successful efforts on the part of our members.
Please click here to view.
On November 14, 2018, Intermountain Healthcare and the Hatch Center for Civility and Solutions hosted a symposium titled The Root of the Issue: America’s Social Determinants of Health. Many health care leaders and policy makers attended the symposium to discuss the impact of “upstream” factors such as housing instability and chronic hunger on the health of people in Utah and across the nation. U.S. Secretary of Health and Human Services, Alex Azar, provided remarks on the ongoing Departmental policy efforts to address the social determinants of health (SDOH). NASDOH appreciates Secretary Azar’s remarks in a letter submitted in early December 2018 that highlights the Department’s efforts and commitment.
Please see the comment letter here .