I 

110TH CONGRESS 

1ST SESSION H. R. 1968 

To amend the Public Health Service Act to provide grants to promote positive 

health behaviors in women and children. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 19, 2007 

Ms. SOLIS (for herself and Mr. WYNN) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to provide grants 

to promote positive health behaviors in women and children. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Community Health 

5 Workers Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Over 9,000,000 children in the United 

9 States remain uninsured, although two-thirds of un10 insured children are eligible for public programs 

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1 such as Medicaid and the State Children’s Health 

2 Insurance Program. 

3 (2) Language, cultural barriers, and lack of in4 formation may delay or block enrollment in public 

5 programs. 

6 (3) Community health workers are effective in 

7 significantly increasing health insurance coverage, 

8 screening, and medical follow-up visits among resi9 dents with limited access or underutilization of 

10 health care services. 

11 (4) A study published in the ‘‘Journal of the 

12 American Academy of Pediatrics’’ found that fami13 lies who interacted with community health workers 

14 are 8 times more likely to obtain health insurance 

15 for their children. Almost 96 percent of children who 

16 worked with community health workers obtained 

17 health insurance, and 78 percent were insured con18 tinuously. 

19 (5) Chronic diseases, defined as any condition 

20 that requires regular medical attention or medica21 tion, are the leading cause of death and disability for 

22 women in the United States across racial and ethnic 

23 groups. 

24 (6) According to the National Vital Statistics 

25 Report of 2001, the 5 leading causes of death 

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1 among Hispanic, American Indian, and African2 American women are heart disease, cancer, diabetes, 

3 cerebrovascular disease, and unintentional injuries. 

4 (7) Unhealthy behaviors alone lead to more 

5 than 50 percent of premature deaths in the United 

6 States. 

7 (8) Poor diet, physical inactivity, tobacco use, 

8 and alcohol and drug abuse are the health risk be9 haviors that most often lead to disease, premature 

10 death, and disability, and are particularly prevalent 

11 among many groups of minority women. 

12 (9) Over 60 percent of Hispanic and African13 American women are classified as overweight, and 

14 over 30 percent are classified as obese. Over 60 per15 cent of American Indian women are classified as 

16 obese. 

17 (10) American Indian women have the highest 

18 mortality rates related to alcohol and drug use of all 

19 women in the United States. 

20 (11) High poverty rates coupled with barriers 

21 to health preventive services and medical care con22 tribute to racial and ethnic disparities in health fac23 tors, including premature death, life expectancy, risk 

24 factors associated with major diseases, and the ex25 tent and severity of illnesses. 

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1 (12) There is increasing evidence that early life 

2 experiences are associated with adult chronic disease 

3 and that prevention and intervention services pro4 vided within the community and the home may less5 en the impact of chronic outcomes, while strength6 ening families and communities. 

7 (13) Community health workers, who are pri8 marily women, can be a critical component in con9 ducting health promotion and disease prevention ef10 forts in medically underserved populations. 

11 (14) Recognizing the difficult barriers con12 fronting medically underserved communities (pov13 erty, geographic isolation, language and cultural dif14 ferences, lack of transportation, low literacy, and 

15 lack of access to services), community health work16 ers are in a unique position to reduce preventable 

17 morbidity and mortality, improve the quality of life, 

18 and increase the utilization of available preventive 

19 health services for community members. 

20 SEC. 3. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV21 IORS IN WOMEN. 

22 Part P of title III of the Public Health Service Act 

23 (42 U.S.C. 280g et seq.) is amended by adding at the end 

24 the following: 

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1 ‘‘SEC. 399R. GRANTS TO PROMOTE POSITIVE HEALTH BE2 HAVIORS IN WOMEN AND CHILDREN. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col4 laboration with the Director of the Centers for Disease 

5 Control and Prevention and other Federal officials deter6 mined appropriate by the Secretary, is authorized to 

7 award grants to eligible entities to promote positive health 

8 behaviors for women and children in target populations, 

9 especially racial and ethnic minority women and children 

10 in medically underserved communities. 

11 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

12 subsection (a) may be used to support community health 

13 workers— 

14 ‘‘(1) to educate and provide outreach regarding 

15 enrollment in health insurance including the State 

16 Children’s Health Insurance Program under title 

17 XXI of the Social Security Act, Medicare under title 

18 XVIII of such Act, and Medicaid under title XIX of 

19 such Act; 

20 ‘‘(2) to educate, guide, and provide outreach in 

21 a community setting regarding health problems prev22 alent among women and children and especially 

23 among racial and ethnic minority women and chil24 dren; 

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1 ‘‘(3) to educate, guide, and provide experiential 

2 learning opportunities that target behavioral risk 

3 factors including— 

4 ‘‘(A) poor nutrition; 

5 ‘‘(B) physical inactivity; 

6 ‘‘(C) being overweight or obese; 

7 ‘‘(D) tobacco use; 

8 ‘‘(E) alcohol and substance use; 

9 ‘‘(F) injury and violence; 

10 ‘‘(G) risky sexual behavior; and 

11 ‘‘(H) mental health problems; 

12 ‘‘(4) to educate and guide regarding effective 

13 strategies to promote positive health behaviors with14 in the family; 

15 ‘‘(5) to promote community wellness and aware16 ness; and 

17 ‘‘(6) to educate and refer target populations to 

18 appropriate health care agencies and community19 based programs and organizations in order to in20 crease access to quality health care services, includ21 ing preventive health services. 

22 ‘‘(c) APPLICATION.— 

23 ‘‘(1) IN GENERAL.—Each eligible entity that 

24 desires to receive a grant under subsection (a) shall 

25 submit an application to the Secretary, at such time, 

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1 in such manner, and accompanied by such additional 

2 information as the Secretary may require. 

3 ‘‘(2) CONTENTS.—Each application submitted 

4 pursuant to paragraph (1) shall— 

5 ‘‘(A) describe the activities for which as6 sistance under this section is sought; 

7 ‘‘(B) contain an assurance that with re8 spect to each community health worker pro9 gram receiving funds under the grant awarded, 

10 such program provides training and supervision 

11 to community health workers to enable such 

12 workers to provide authorized program services; 

13 ‘‘(C) contain an assurance that the appli14 cant will evaluate the effectiveness of commu15 nity health worker programs receiving funds 

16 under the grant; 

17 ‘‘(D) contain an assurance that each com18 munity health worker program receiving funds 

19 under the grant will provide services in the cul20 tural context most appropriate for the individ21 uals served by the program; 

22 ‘‘(E) contain a plan to document and dis23 seminate project description and results to 

24 other States and organizations as identified by 

25 the Secretary; and 

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1 ‘‘(F) describe plans to enhance the capac2 ity of individuals to utilize health services and 

3 health-related social services under Federal, 

4 State, and local programs by— 

5 ‘‘(i) assisting individuals in estab6 lishing eligibility under the programs and 

7 in receiving the services or other benefits 

8 of the programs; and 

9 ‘‘(ii) providing other services as the 

10 Secretary determines to be appropriate, 

11 that may include transportation and trans12 lation services. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Secretary shall give priority to those appli15 cants— 

16 ‘‘(1) who propose to target geographic areas— 

17 ‘‘(A) with a high percentage of residents 

18 who are eligible for health insurance but are 

19 uninsured or underinsured; and 

20 ‘‘(B) with a high percentage of families for 

21 whom English is not their primary language. 

22 ‘‘(2) with experience in providing health or 

23 health-related social services to individuals who are 

24 underserved with respect to such services; and 

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1 ‘‘(3) with documented community activity and 

2 experience with community health workers. 

3 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU4 TIONS.—The Secretary shall encourage community health 

5 worker programs receiving funds under this section to col6 laborate with academic institutions. Nothing in this sec7 tion shall be construed to require such collaboration. 

8 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE9 NESS.—The Secretary shall establish guidelines for assur10 ing the quality of the training and supervision of commu11 nity health workers under the programs funded under this 

12 section and for assuring the cost-effectiveness of such pro13 grams. 

14 ‘‘(g) MONITORING.—The Secretary shall monitor 

15 community health worker programs identified in approved 

16 applications and shall determine whether such programs 

17 are in compliance with the guidelines established under 

18 subsection (f). 

19 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

20 provide technical assistance to community health worker 

21 programs identified in approved applications with respect 

22 to planning, developing, and operating programs under the 

23 grant. 

24 ‘‘(i) REPORT TO CONGRESS.— 

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1 ‘‘(1) IN GENERAL.—Not later than 4 years 

2 after the date on which the Secretary first awards 

3 grants under subsection (a), the Secretary shall sub4 mit to Congress a report regarding the grant 

5 project. 

6 ‘‘(2) CONTENTS.—The report required under 

7 paragraph (1) shall include the following: 

8 ‘‘(A) A description of the programs for 

9 which grant funds were used. 

10 ‘‘(B) The number of individuals served. 

11 ‘‘(C) An evaluation of— 

12 ‘‘(i) the effectiveness of these pro13 grams; 

14 ‘‘(ii) the cost of these programs; and 

15 ‘‘(iii) the impact of the project on the 

16 health outcomes of the community resi17 dents. 

18 ‘‘(D) Recommendations for sustaining the 

19 community health worker programs developed 

20 or assisted under this section. 

21 ‘‘(E) Recommendations regarding training 

22 to enhance career opportunities for community 

23 health workers. 

24 ‘‘(j) DEFINITIONS.—In this section: 

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1 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

2 ‘community health worker’ means an individual who 

3 promotes health or nutrition within the community 

4 in which the individual resides— 

5 ‘‘(A) by serving as a liaison between com6 munities and health care agencies; 

7 ‘‘(B) by providing guidance and social as8 sistance to community residents; 

9 ‘‘(C) by enhancing community residents’ 

10 ability to effectively communicate with health 

11 care providers; 

12 ‘‘(D) by providing culturally and linguis13 tically appropriate health or nutrition edu14 cation; 

15 ‘‘(E) by advocating for individual and com16 munity health or nutrition needs; and 

17 ‘‘(F) by providing referral and followup 

18 services. 

19 ‘‘(2) COMMUNITY SETTING.—The term ‘commu20 nity setting’ means a home or a community organi21 zation located in the neighborhood in which a partic22 ipant resides. 

23 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en24 tity’ means— 

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1 ‘‘(A) a unit of State, local or tribal govern2 ment (including a federally recognized tribe or 

3 Alaska native villages); or 

4 ‘‘(B) a community-based organization. 

5 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

6 The term ‘medically underserved community’ means 

7 a community— 

8 ‘‘(A) that has a substantial number of in9 dividuals who are members of a medically un10 derserved population, as defined by section 

11 330(b)(3); and 

12 ‘‘(B) a significant portion of which is a 

13 health professional shortage area as designated 

14 under section 332. 

15 ‘‘(5) SUPPORT.—The term ‘support’ means the 

16 provision of training, supervision, and materials 

17 needed to effectively deliver the services described in 

18 subsection (b), reimbursement for services, and 

19 other benefits. 

20 ‘‘(6) TARGET POPULATION.—The term ‘target 

21 population’ means women of reproductive age, re22 gardless of their current childbearing status and 

23 children under 21 years of age. 

24 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 

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1 $15,000,000 for each of fiscal years 2008, 2009, 2010, 

2 2011, and 2012.’’. 

Æ 

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