II 

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. 

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) Chronic diseases, defined as any condition 

9 that requires regular medical attention or medica10 tion, are the leading cause of death and disability for 


jcorcoran on PROD1PC62 with BILLS
2 

•S 586 IS 

1 women in the United States across racial and ethnic 

2 groups. 

3 (2) According to the National Vital Statistics 

4 Report of 2001, the 5 leading causes of death 

5 among Hispanic, American Indian, and African6 American women are heart disease, cancer, diabetes, 

7 cerebrovascular disease, and unintentional injuries. 

8 (3) Unhealthy behaviors alone lead to more 

9 than 50 percent of premature deaths in the United 

10 States. 

11 (4) Poor diet, physical inactivity, tobacco use, 

12 and alcohol and drug abuse are the health risk be13 haviors that most often lead to disease, premature 

14 death, and disability, and are particularly prevalent 

15 among many groups of minority women. 

16 (5) Over 60 percent of Hispanic and African17 American women are classified as overweight and 

18 over 30 percent are classified as obese. Over 60 per19 cent of American Indian women are classified as 

20 obese. 

21 (6) American Indian women have the highest 

22 mortality rates related to alcohol and drug use of all 

23 women in the United States. 

24 (7) High poverty rates coupled with barriers to 

25 health preventive services and medical care conVerDate Aug 31 2005 04:37 Feb 18, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586

jcorcoran on PROD1PC62 with BILLS
3 

•S 586 IS 

1 tribute to racial and ethnic disparities in health fac2 tors, including premature death, life expectancy, risk 

3 factors associated with major diseases, and the ex4 tent and severity of illnesses. 

5 (8) There is increasing evidence that early life 

6 experiences are associated with adult chronic disease 

7 and that prevention and intervention services pro8 vided within the community and the home may less9 en the impact of chronic outcomes, while strength10 ening families and communities. 

11 (9) Community health workers, who are pri12 marily women, can be a critical component in con13 ducting health promotion and disease prevention ef14 forts in medically underserved populations. 

15 (10) Recognizing the difficult barriers con16 fronting medically underserved communities (pov17 erty, geographic isolation, language and cultural dif18 ferences, lack of transportation, low literacy, and 

19 lack of access to services), community health work20 ers are in a unique position to reduce preventable 

21 morbidity and mortality, improve the quality of life, 

22 and increase the utilization of available preventive 

23 health services for community members. 

24 (11) Research has shown that community 

25 health workers have been effective in significantly inVerDate Aug 31 2005 04:37 Feb 18, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586

jcorcoran on PROD1PC62 with BILLS
4 

•S 586 IS 

1 creasing health insurance coverage, screening and 

2 medical follow-up visits among residents with limited 

3 access or underutilization of health care services. 

4 (12) States on the United States-Mexico border 

5 have high percentages of impoverished and ethnic 

6 minority populations: border States accommodate 60 

7 percent of the total Hispanic population and 23 per8 cent of the total population below 200 percent pov9 erty in the United States. 

10 SEC. 3. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV11 IORS IN WOMEN. 

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

13 (42 U.S.C. 280g et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 399S. GRANTS TO PROMOTE POSITIVE HEALTH BE16 HAVIORS IN WOMEN. 

17 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col18 laboration with the Director of the Centers for Disease 

19 Control and Prevention and other Federal officials deter20 mined appropriate by the Secretary, is authorized to 

21 award grants to States or local or tribal units, to promote 

22 positive health behaviors for women and children in target 

23 populations, especially racial and ethnic minority women 

24 and children in medically underserved communities. 


jcorcoran on PROD1PC62 with BILLS
5 

•S 586 IS 

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

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

3 workers— 

4 ‘‘(1) to educate, guide, and provide outreach in 

5 a community setting regarding health problems prev6 alent among women and children and especially 

7 among racial and ethnic minority women and chil8 dren; 

9 ‘‘(2) to educate, guide, and provide experiential 

10 learning opportunities that target behavioral risk 

11 factors including— 

12 ‘‘(A) poor nutrition; 

13 ‘‘(B) physical inactivity; 

14 ‘‘(C) being overweight or obese; 

15 ‘‘(D) tobacco use; 

16 ‘‘(E) alcohol and substance use; 

17 ‘‘(F) injury and violence; 

18 ‘‘(G) risky sexual behavior; and 

19 ‘‘(H) mental health problems; 

20 ‘‘(3) to educate and guide regarding effective 

21 strategies to promote positive health behaviors with22 in the family; 

23 ‘‘(4) to educate and provide outreach regarding 

24 enrollment in health insurance including the State 

25 Children’s Health Insurance Program under title 


jcorcoran on PROD1PC62 with BILLS
6 

•S 586 IS 

1 XXI of the Social Security Act, Medicare under title 

2 XVIII of such Act and Medicaid under title XIX of 

3 such Act; 

4 ‘‘(5) to promote community wellness and aware5 ness; and 

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

7 appropriate health care agencies and community8 based programs and organizations in order to in9 crease access to quality health care services, includ10 ing preventive health services. 

11 ‘‘(c) APPLICATION.— 

12 ‘‘(1) IN GENERAL.—Each State or local or trib13 al unit (including federally recognized tribes and 

14 Alaska native villages) that desires to receive a grant 

15 under subsection (a) shall submit an application to 

16 the Secretary, at such time, in such manner, and ac17 companied by such additional information as the 

18 Secretary may require. 

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

20 pursuant to paragraph (1) shall— 

21 ‘‘(A) describe the activities for which as22 sistance under this section is sought; 

23 ‘‘(B) contain an assurance that with re24 spect to each community health worker pro25 gram receiving funds under the grant awarded, 


jcorcoran on PROD1PC62 with BILLS
7 

•S 586 IS 

1 such program provides training and supervision 

2 to community health workers to enable such 

3 workers to provide authorized program services; 

4 ‘‘(C) contain an assurance that the appli5 cant will evaluate the effectiveness of commu6 nity health worker programs receiving funds 

7 under the grant; 

8 ‘‘(D) contain an assurance that each com9 munity health worker program receiving funds 

10 under the grant will provide services in the cul11 tural context most appropriate for the individ12 uals served by the program; 

13 ‘‘(E) contain a plan to document and dis14 seminate project description and results to 

15 other States and organizations as identified by 

16 the Secretary; and 

17 ‘‘(F) describe plans to enhance the capac18 ity of individuals to utilize health services and 

19 health-related social services under Federal, 

20 State, and local programs by— 

21 ‘‘(i) assisting individuals in estab22 lishing eligibility under the programs and 

23 in receiving the services or other benefits 

24 of the programs; and 


jcorcoran on PROD1PC62 with BILLS
8 

•S 586 IS 

1 ‘‘(ii) providing other services as the 

2 Secretary determines to be appropriate, 

3 that may include transportation and trans4 lation services. 

5 ‘‘(d) PRIORITY.—In awarding grants under sub6 section (a), the Secretary shall give priority to those appli7 cants— 

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

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

10 who are eligible for health insurance but are 

11 uninsured or underinsured; 

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

13 whom English is not their primary language; 

14 and 

15 ‘‘(C) that encompass the United States16 Mexico border region; 

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

18 health-related social services to individuals who are 

19 underserved with respect to such services; and 

20 ‘‘(3) with documented community activity and 

21 experience with community health workers. 

22 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU23 TIONS.—The Secretary shall encourage community health 

24 worker programs receiving funds under this section to colVerDate Aug 31 2005 04:37 Feb 18, 2007 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S586.IS S586

jcorcoran on PROD1PC62 with BILLS
9 

•S 586 IS 

1 laborate with academic institutions. Nothing in this sec2 tion shall be construed to require such collaboration. 

3 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE4 NESS.—The Secretary shall establish guidelines for assur5 ing the quality of the training and supervision of commu6 nity health workers under the programs funded under this 

7 section and for assuring the cost-effectiveness of such pro8 grams. 

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

10 community health worker programs identified in approved 

11 applications and shall determine whether such programs 

12 are in compliance with the guidelines established under 

13 subsection (f). 

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

15 provide technical assistance to community health worker 

16 programs identified in approved applications with respect 

17 to planning, developing, and operating programs under the 

18 grant. 

19 ‘‘(i) REPORT TO CONGRESS.— 

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

21 after the date on which the Secretary first awards 

22 grants under subsection (a), the Secretary shall sub23 mit to Congress a report regarding the grant 

24 project. 


jcorcoran on PROD1PC62 with BILLS
10 

•S 586 IS 

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

2 paragraph (1) shall include the following: 

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

4 which grant funds were used. 

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

6 ‘‘(C) An evaluation of— 

7 ‘‘(i) the effectiveness of these pro8 grams; 

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

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

11 health outcomes of the community resi12 dents. 

13 ‘‘(D) Recommendations for sustaining the 

14 community health worker programs developed 

15 or assisted under this section. 

16 ‘‘(E) Recommendations regarding training 

17 to enhance career opportunities for community 

18 health workers. 

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

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

21 ‘community health worker’ means an individual who 

22 promotes health or nutrition within the community 

23 in which the individual resides— 

24 ‘‘(A) by serving as a liaison between com25 munities and health care agencies; 


jcorcoran on PROD1PC62 with BILLS
11 

•S 586 IS 

1 ‘‘(B) by providing guidance and social as2 sistance to community residents; 

3 ‘‘(C) by enhancing community residents’ 

4 ability to effectively communicate with health 

5 care providers; 

6 ‘‘(D) by providing culturally and linguis7 tically appropriate health or nutrition edu8 cation; 

9 ‘‘(E) by advocating for individual and com10 munity health or nutrition needs; and 

11 ‘‘(F) by providing referral and followup 

12 services. 

13 ‘‘(2) COMMUNITY SETTING.—The term ‘commu14 nity setting’ means a home or a community organi15 zation located in the neighborhood in which a partic16 ipant resides. 

17 ‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.— 

18 The term ‘medically underserved community’ means 

19 a community identified by a State— 

20 ‘‘(A) that has a substantial number of in21 dividuals who are members of a medically un22 derserved population, as defined by section 

23 330(b)(3); and 


jcorcoran on PROD1PC62 with BILLS
12 

•S 586 IS 

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

2 health professional shortage area as designated 

3 under section 332. 

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

5 provision of training, supervision, and materials 

6 needed to effectively deliver the services described in 

7 subsection (b), reimbursement for services, and 

8 other benefits. 

9 ‘‘(5) TARGET POPULATION.—The term ‘target 

10 population’ means women of reproductive age, re11 gardless of their current childbearing status and 

12 children under 21 years of age. 

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

14 are authorized to be appropriated to carry out this section 

15 $15,000,000 for each of fiscal years 2008, 2009, and 

16 2010.’’. 

Æ 


jcorcoran on PROD1PC62 with BILLS