I

104TH CONGRESS

1ST SESSION H. R. 2245

To establish a national program of trained community health advisors to

assist the States in attaining the Healthy People 2000 Objectives.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 4, 1995

Mr. SANDERS (for himself and Mr. ROGERS) introduced the following bill;

which was referred to the Committee on Commerce

A BILL

To establish a national program of trained community health

advisors to assist the States in attaining the Healthy

People 2000 Objectives.

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 ‘‘National Community

5 Health Advisor Act’’.

6 SEC. 2. FINDINGS.

7 The Congress finds as follows:

8 (1) Communities across America have joined

9 forces with State health departments, academic in10 stitutions, and community-based public and non-
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1 profit organizations to improve the health of their

2 neighborhoods and help us as a Nation reach the

3 Healthy People 2000 objectives.

4 (2) Recognizing the difficult barriers confront5 ing their medically underserved communities—pov6 erty, geographic isolation, cultural differences, lack

7 of transportation, low literacy, and lack of access to

8 services—community leaders are becoming bridges

9 between their communities and local health and so10 cial service providers to break down these barriers.

11 (3) These community leaders, often referred to

12 as community health advisors, are uniquely knowl13 edgeable about their communities’ needs.

14 (4) Community health advisors can commu15 nicate to health and social service providers the

16 needs of community members, provide quality health

17 promotion and disease prevention information to the

18 community, and serve as the crucial link between

19 their community and service providers.

20 (5) Community health advisors can increase uti21 lization of available preventive health services, in22 crease the effectiveness of the health care delivery

23 system, reduce preventable morbidity and mortality,

24 and improve the quality of life of their neighbors.
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1 (6) Community health advisors can be a critical

2 part of our national challenge to meet the Healthy

3 People 2000 vision for the new century.

4 SEC. 3. DEFINITIONS.

5 For purposes of this Act:

6 (1) The term ‘‘authorized program services’’,

7 with respect to a community health advisor program,

8 means the services authorized in section 5(a) to be

9 included in a plan under such section.

10 (2) The term ‘‘community health advisor’’

11 means an individual—

12 (A) who has demonstrated the capacity to

13 carry out one or more of the authorized pro14 gram services;

15 (B) who, for not less than 1 year, has been

16 a resident of the community in which the com17 munity health advisor program involved is to be

18 operated; and

19 (C) is a member of the target population

20 to be served by the program.

21 (3) The term ‘‘community health advisor pro22 gram’’ means a program carried out in accordance

23 with a plan under section 5(a).
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1 (4) The term ‘‘financial assistance’’, with re2 spect to an award under section 4, means a grant,

3 cooperative agreement, or a contract.

4 (5) The term ‘‘Healthy People 2000 Objectives’’

5 means the objectives established by the Secretary to6 ward the goals of increasing the span of healthy life,

7 reducing health disparities among various popu8 lations, and providing access to preventive services,

9 which objectives apply to the health status of the

10 population of the United States for the year 2000.

11 (6) The term ‘‘medically underserved commu12 nity’’ means—

13 (A) a community that has a substantial

14 number of individuals who are members of a

15 medically underserved population, as defined in

16 section 330 of the Public Health Service Act; or

17 (B) a community a significant portion of

18 which is a health professional shortage area

19 designated under section 332 of such Act.

20 (7) The term ‘‘official poverty line’’ means the

21 official poverty line established by the Director of

22 the Office of Management and Budget and revised

23 by the Secretary in accordance with section 673(2)

24 of the Omnibus Budget Reconciliation Act of 1981,
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1 which poverty line is applicable the size of the family

2 involved.

3 (8) The term ‘‘Secretary’’ means the Secretary

4 of Health and Human Services.

5 (9) The term ‘‘State’’ means each of the several

6 States, the District of Columbia, and each of the

7 Commonwealth of Puerto Rico, American Samoa,

8 Guam, the Commonwealth of the Northern Mariana

9 Islands, the Virgin Islands, and the Trust Territory

10 of the Pacific Islands.

11 (10) The term ‘‘State involved’’, with respect to

12 an applicant for an award under section 4, means

13 the State in which the applicant is to carry out a

14 community health advisor program.

15 SEC. 4. FORMULA GRANTS REGARDING COMMUNITY

16 HEALTH ADVISOR PROGRAMS.

17 (a) FORMULA GRANTS.—In the case of each State

18 (or entity designated by a State under subsection (c)) that

19 submits to the Secretary a plan in accordance with section

20 5(a) for a fiscal year, the Secretary of Health and Human

21 Services, acting through the Director of the Centers for

22 Disease Control and Prevention and in coordination with

23 the heads of the agencies specified in subsection (b), shall

24 make an award of financial assistance to the State or en25 tity for the development and operation of community
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1 health advisor programs under the plan. The award shall

2 consist of the allotment determined under section 7 with

3 respect to the State, subject to section 11(b).

4 (b) COORDINATION WITH OTHER AGENCIES.—The

5 agencies referred to in subsection (a) regarding coordina6 tion are the Health Resources and Services Administra7 tion, the National Institutes of Health, and the Substance

8 Abuse and Mental Health Services Administration.

9 (c) DESIGNATED ENTITIES.—With respect to the

10 State involved, an entity other than the State may receive

11 an award under subsection (a) only if the entity—

12 (1) is a public or nonprofit private academic or13 ganization (or other public or nonprofit private en14 tity); and

15 (2) has been designated by the State to carry

16 out the purpose described in such subsection in the

17 State and to receive amounts under such subsection

18 in lieu of the State.

19 SEC. 5. STATE PLAN.

20 (a) IN GENERAL.—An applicant for an award under

21 section 4 for a fiscal year may receive such an award only

22 if the applicant submits to the Secretary a plan for such

23 year that is in such form, is made in such manner, and

24 is submitted at such time as the Secretary may require,

25 and that meets the following requirements:
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1 (1) The plan contains a description of how—

2 (A) if the applicant is a State, the award

3 will be administered by the State agency with

4 the principal responsibility for carrying out

5 public health programs; and

6 (B) if the applicant is an entity designated

7 under section 4, the award will be administered

8 in consultation with such State agency.

9 (2)(A) The plan contains a description of how

10 the applicant will—

11 (i) operate a clearinghouse to maintain and

12 disseminate information on community health

13 advisor programs (and similar programs) in the

14 State;

15 (ii) provide to community health advisor

16 programs in the State technical assistance in

17 training community health advisors; and

18 (iii) provide to community health advisor

19 programs in the State evaluation assistance in

20 evaluating their community health advisor pro21 grams and preparing the reports required in

22 paragraph (22); and

23 (B) The plan contains assurances that—

24 (i) not more than 15 percent of the award

25 will be expended in the aggregate for carrying
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1 out subparagraph (A) and for the expenses of

2 administering the award with respect to the

3 State involved; and

4 (ii) the remainder of the award will be pro5 vided directly to community health advisor pro6 grams in the State for carrying out the duties

7 of the programs pursuant to this subsection.

8 (3) The plan contains a description of how the

9 applicant will use the award, including the following:

10 (A) description of the criteria the applicant

11 will use to identify which community-based pub12 lic and private nonprofit entities will receive

13 funds from the award and how the funds will

14 be allocated among such public and private non15 profit entities.

16 (B) A description of how the award will as17 sist the State involved in attaining the Healthy

18 People 2000 Objectives.

19 (C) Assurances that for each community

20 health advisor program operated with the

21 award, a program is carried out to train com22 munity health advisors to provide the author23 ized program services.

24 (D) Assurances that, for each community

25 health advisor program operated with the
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1 award, a program of evaluation will be carried

2 out.

3 (E) A description of how the applicant will

4 identify and consider the needs of the commu5 nity involved for the authorized program serv6 ices.

7 (F) Assurances that each community

8 health advisor program operated with the award

9 will be provided in the cultural context most ap10 propriate for the individuals served by the pro11 gram.

12 (G) A description of how the applicant will

13 provide public education on health promotion

14 and disease prevention and facilitate the use of

15 available health services and health-related so16 cial services.

17 (H) A description of how the applicant will

18 provide health-related counseling.

19 (I) A description of how the applicant will

20 collaborate with and provide referrals for avail21 able health services and health-related social

22 services.

23 (J) Assurances that, with respect to the

24 purposes for the award is authorized to be ex25 pended, the State involved will maintain ex-
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1 penditures of non-Federal amounts for such

2 purposes at a level that is not less than the

3 level of such expenditures maintained by the

4 State for the fiscal year preceding the first fis5 cal year for which such an award is made with

6 respect to the State.

7 (K) Assurances that not more than 15 per8 cent of the award will be expended for the pro9 gram of training under subparagraph (C).

10 (L) Assurances that the applicant will not

11 provide amounts from the award to a commu12 nity-based public and private nonprofit entity to

13 operate a community health advisor program

14 unless the entity complies with section 6.

15 (M) Assurances that the applicant will

16 carry out community health advisor programs

17 in accordance with the guidelines established

18 under section 8.

19 (N) Such other information as the Sec20 retary may require.

21 (b) CERTAIN EXPENDITURES.—An award under sec22 tion 4 may be expended to provide compensation for the

23 services of community health advisors.
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1 SEC. 6. LOCAL PLAN.

2 A community-based public or private nonprofit entity

3 may receive funds from an award under section 4 for a

4 fiscal year to operate a community health advisor program

5 only if the entity submits to the recipient of such award

6 a plan for such year that is in such form, is made in such

7 manner, and is submitted at such time as the recipient

8 may require.

9 SEC. 7. DETERMINATION OF AMOUNT OF ALLOTMENT.

10 (a) IN GENERAL.—For purposes of section 4(a), the

11 allotment under this section with respect to a State for

12 a fiscal year is the greater of—

13 (1) the sum of the respective amounts deter14 mined for the State under subsection (b) and sub15 section (c); and

16 (2) $500,000.

17 (b) AMOUNT RELATING TO POPULATION.—For pur18 poses of subsection (a), the amount determined under this

19 subsection is the product of—

20 (1) an amount equal to 50 percent of the

21 amount appropriated under section 11 for the fiscal

22 year and available for awards under section 4; and

23 (2) the percentage constituted by the ratio of—

24 (A) the number of individuals residing in

25 the State involved; to
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1 (B) the sum of the respective amounts de2 termined for each State under subparagraph

3 (A).

4 (c) AMOUNT RELATING TO POVERTY LEVEL.—For

5 purposes of subsection (a), the amount determined under

6 this subsection is the product of—

7 (1) the amount determined under subsection

8 (b)(1); and

9 (2) the percentage constituted by the ratio of—

10 (A) the number of individuals residing in

11 the State whose income is at or below an

12 amount equal to 200 percent of the official pov13 erty line; to

14 (B) the sum of the respective amounts de15 termined for each State under subparagraph

16 (A).

17 SEC. 8. QUALITY ASSURANCE; COST-EFFECTIVENESS.

18 The Secretary shall establish guidelines for assuring

19 the quality of community health advisor programs (includ20 ing quality in the training of community health advisors)

21 and for assuring the cost-effectiveness of the programs.

22 SEC. 9. EVALUATIONS; TECHNICAL ASSISTANCE.

23 (a) EVALUATIONS.—The Secretary shall conduct

24 evaluations of community health advisor programs, and

25 disseminate information developed as a result of the eval-
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1 uations. In conducting such evaluations, the Secretary

2 shall determine whether the programs are in compliance

3 with the guidelines established under section 8.

4 (b) TECHNICAL ASSISTANCE.—The Secretary may

5 provide technical assistance to recipients of awards under

6 section 4 with respect to the planning, development, and

7 operation of community health advisor programs.

8 (c) GRANTS AND CONTRACTS.—The Secretary may

9 carry out this section directly or through grants, coopera10 tive agreements, or contracts.

11 (d) LIMITATION ON EXPENDITURES.—Of the

12 amounts appropriated under section 11 for a fiscal year,

13 the Secretary may reserve not more than 5 percent for

14 carrying out this section.

15 SEC. 10. RULE OF CONSTRUCTION REGARDING PROGRAMS

16 OF INDIAN HEALTH SERVICE.

17 This Act may not be construed as requiring the Sec18 retary to modify or terminate the program carried out by

19 the Director of the Indian Health Service and designated

20 by such Director as the Community Health Representative

21 Program. The Secretary shall ensure that support for such

22 Program is not supplanted by awards under section 4. In

23 communities in which both such Program and a commu24 nity health advisor program are being carried out, the Sec25 retary shall ensure that the community health advisor pro-
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1 gram works in cooperation with, and as a complement to,

2 the Community Health Representative Program.

3 SEC. 11. FUNDING.

4 (a) AUTHORIZATION OF APPROPRIATIONS.—For the

5 purpose of carrying out this Act, there are authorized to

6 be appropriated such sums as may be necessary for each

7 of the fiscal years 1996 through 2001.

8 (b) EFFECT OF INSUFFICIENT APPROPRIATIONS FOR

9 MINIMUM ALLOTMENTS.—

10 (1) IN GENERAL.—If the amounts made avail11 able under subsection (a) for a fiscal year are insuf12 ficient for providing each State (or entity designated

13 by the State pursuant to section 4, as the case may

14 be) with an award under section 4 in an amount

15 equal to or greater than the amount specified in sec16 tion 7(a)(2), the Secretary shall, from such amounts

17 as are made available under subsection (a), make

18 such awards on a discretionary basis.

19 (2) RULE OF CONSTRUCTION.—For purposes of

20 paragraph (1), awards under section 4 are made on

21 a discretionary basis if the Secretary determines

22 which States (or entities designated by States pursu23 ant to such section, as the case may be) are to re24 ceive such awards, subject to meeting the require-
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1 ments of this subtitle for such an award, and the

2 Secretary determines the amount of such awards.

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