110th CONGRESS
1st Session
S. 586
To amend the Public Health Service Act to provide grants to promote
positive health behaviors in women and children.
IN THE SENATE OF THE UNITED STATES
February 14, 2007
Mr. BINGAMAN introduced the following bill; which was read twice and referred
to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act to provide grants to promote
positive health behaviors in women and children.
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 `Community Health Workers Act of 2007'.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Chronic diseases, defined as any condition that requires regular medical
attention or medication, are the leading cause of death and disability
for women in the United States across racial and ethnic groups.
(2) According to the National Vital Statistics Report of 2001, the 5 leading
causes of death among Hispanic, American Indian, and African-American
women are heart disease, cancer, diabetes, cerebrovascular disease, and
unintentional injuries.
(3) Unhealthy behaviors alone lead to more than 50 percent of premature
deaths in the United States.
(4) Poor diet, physical inactivity, tobacco use, and alcohol and drug
abuse are the health risk behaviors that most often lead to disease, premature
death, and disability, and are particularly prevalent among many groups
of minority women.
(5) Over 60 percent of Hispanic and African-American women are classified
as overweight and over 30 percent are classified as obese. Over 60 percent
of American Indian women are classified as obese.
(6) American Indian women have the highest mortality rates related to
alcohol and drug use of all women in the United States.
(7) High poverty rates coupled with barriers to health preventive services
and medical care contribute to racial and ethnic disparities in health
factors, including premature death, life expectancy, risk factors associated
with major diseases, and the extent and severity of illnesses.
(8) There is increasing evidence that early life experiences are associated
with adult chronic disease and that prevention and intervention services
provided within the community and the home may lessen the impact of chronic
outcomes, while strengthening families and communities.
(9) Community health workers, who are primarily women, can be a critical
component in conducting health promotion and disease prevention efforts
in medically underserved populations.
(10) Recognizing the difficult barriers confronting medically underserved
communities (poverty, geographic isolation, language and cultural differences,
lack of transportation, low literacy, and lack of access to services),
community health workers are in a unique position to reduce preventable
morbidity and mortality, improve the quality of life, and increase the
utilization of available preventive health services for community members.
(11) Research has shown that community health workers have been effective
in significantly increasing health insurance coverage, screening and medical
follow-up visits among residents with limited access or underutilization
of health care services.
(12) States on the United States-Mexico border have high percentages of
impoverished and ethnic minority populations: border States accommodate
60 percent of the total Hispanic population and 23 percent of the total
population below 200 percent poverty in the United States.
SEC. 3. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et
seq.) is amended by adding at the end the following:
`SEC. 399S. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.
`(a) GRANTS AUTHORIZED- The Secretary, in collaboration with the Director
of the Centers for Disease Control and Prevention and other Federal officials
determined appropriate by the Secretary, is authorized to award grants to
States or local or tribal units, to promote positive health behaviors for
women and children in target populations, especially racial and ethnic minority
women and children in medically underserved communities.
`(b) USE OF FUNDS- Grants awarded pursuant to subsection (a) may be used
to support community health workers--
`(1) to educate, guide, and provide outreach in a community setting regarding
health problems prevalent among women and children and especially among
racial and ethnic minority women and children;
`(2) to educate, guide, and provide experiential learning opportunities
that target behavioral risk factors including--
`(B) physical inactivity;
`(C) being overweight or obese;
`(E) alcohol and substance use;
`(F) injury and violence;
`(G) risky sexual behavior; and
`(H) mental health problems;
`(3) to educate and guide regarding effective strategies to promote positive
health behaviors within the family;
`(4) to educate and provide outreach regarding enrollment in health insurance
including the State Children's Health Insurance Program under title XXI
of the Social Security Act, Medicare under title XVIII of such Act and
Medicaid under title XIX of such Act;
`(5) to promote community wellness and awareness; and
`(6) to educate and refer target populations to appropriate health care
agencies and community-based programs and organizations in order to increase
access to quality health care services, including preventive health services.
`(1) IN GENERAL- Each State or local or tribal unit (including federally
recognized tribes and Alaska native villages) that desires to receive
a grant under subsection (a) shall submit an application to the Secretary,
at such time, in such manner, and accompanied by such additional information
as the Secretary may require.
`(2) CONTENTS- Each application submitted pursuant to paragraph (1) shall--
`(A) describe the activities for which assistance under this section
is sought;
`(B) contain an assurance that with respect to each community health
worker program receiving funds under the grant awarded, such program
provides training and supervision to community health workers to enable
such workers to provide authorized program services;
`(C) contain an assurance that the applicant will evaluate the effectiveness
of community health worker programs receiving funds under the grant;
`(D) contain an assurance that each community health worker program
receiving funds under the grant will provide services in the cultural
context most appropriate for the individuals served by the program;
`(E) contain a plan to document and disseminate project description
and results to other States and organizations as identified by the Secretary;
and
`(F) describe plans to enhance the capacity of individuals to utilize
health services and health-related social services under Federal, State,
and local programs by--
`(i) assisting individuals in establishing eligibility under the programs
and in receiving the services or other benefits of the programs; and
`(ii) providing other services as the Secretary determines to be appropriate,
that may include transportation and translation services.
`(d) PRIORITY- In awarding grants under subsection (a), the Secretary shall
give priority to those applicants--
`(1) who propose to target geographic areas--
`(A) with a high percentage of residents who are eligible for health
insurance but are uninsured or underinsured;
`(B) with a high percentage of families for whom English is not their
primary language; and
`(C) that encompass the United States-Mexico border region;
`(2) with experience in providing health or health-related social services
to individuals who are underserved with respect to such services; and
`(3) with documented community activity and experience with community
health workers.
`(e) COLLABORATION WITH ACADEMIC INSTITUTIONS- The Secretary shall encourage
community health worker programs receiving funds under this section to collaborate
with academic institutions. Nothing in this section shall be construed to
require such collaboration.
`(f) QUALITY ASSURANCE AND COST-EFFECTIVENESS- The Secretary shall establish
guidelines for assuring the quality of the training and supervision of community
health workers under the programs funded under this section and for assuring
the cost-effectiveness of such programs.
`(g) MONITORING- The Secretary shall monitor community health worker programs
identified in approved applications and shall determine whether such programs
are in compliance with the guidelines established under subsection (f).
`(h) TECHNICAL ASSISTANCE- The Secretary may provide technical assistance
to community health worker programs identified in approved applications
with respect to planning, developing, and operating programs under the grant.
`(1) IN GENERAL- Not later than 4 years after the date on which the Secretary
first awards grants under subsection (a), the Secretary shall submit to
Congress a report regarding the grant project.
`(2) CONTENTS- The report required under paragraph (1) shall include the
following:
`(A) A description of the programs for which grant funds were used.
`(B) The number of individuals served.
`(i) the effectiveness of these programs;
`(ii) the cost of these programs; and
`(iii) the impact of the project on the health outcomes of the community
residents.
`(D) Recommendations for sustaining the community health worker programs
developed or assisted under this section.
`(E) Recommendations regarding training to enhance career opportunities
for community health workers.
`(j) DEFINITIONS- In this section:
`(1) COMMUNITY HEALTH WORKER- The term `community health worker' means
an individual who promotes health or nutrition within the community in
which the individual resides--
`(A) by serving as a liaison between communities and health care agencies;
`(B) by providing guidance and social assistance to community residents;
`(C) by enhancing community residents' ability to effectively communicate
with health care providers;
`(D) by providing culturally and linguistically appropriate health or
nutrition education;
`(E) by advocating for individual and community health or nutrition
needs; and
`(F) by providing referral and followup services.
`(2) COMMUNITY SETTING- The term `community setting' means a home or a
community organization located in the neighborhood in which a participant
resides.
`(3) MEDICALLY UNDERSERVED COMMUNITY- The term `medically underserved
community' means a community identified by a State--
`(A) that has a substantial number of individuals who are members of
a medically underserved population, as defined by section 330(b)(3);
and
`(B) a significant portion of which is a health professional shortage
area as designated under section 332.
`(4) SUPPORT- The term `support' means the provision of training, supervision,
and materials needed to effectively deliver the services described in
subsection (b), reimbursement for services, and other benefits.
`(5) TARGET POPULATION- The term `target population' means women of reproductive
age, regardless of their current childbearing status and children under
21 years of age.
`(k) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
to carry out this section $15,000,000 for each of fiscal years 2008, 2009,
and 2010.'.
END
