II 

117TH CONGRESS 

2D SESSION S. 3479 

To amend the Public Health Service Act with respect to awards to support 

community health workers and community health. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 11 (legislative day, JANUARY 10), 2022 

Mr. CASEY (for himself, Mr. TILLIS, Ms. SMITH, and Ms. MURKOWSKI) 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 with respect to 

awards to support community health workers and community health. 

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 ‘‘Building a Sustainable 

5 Workforce for Healthy Communities Act’’. 

6 SEC. 2. AWARDS TO SUPPORT COMMUNITY HEALTH WORK7 ERS AND COMMUNITY HEALTH. 

8 Section 399V of the Public Health Service Act (42 

9 U.S.C. 280g–11) is amended— 


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1 (1) by amending the section heading to read as 

2 follows: ‘‘AWARDS TO SUPPORT COMMUNITY

3 HEALTH WORKERS AND COMMUNITY HEALTH’’; 

4 (2) by amending subsection (a) to read as fol5 lows: 

6 ‘‘(a) IN GENERAL.—The Secretary, acting through 

7 the Director of the Centers for Disease Control and Pre8 vention and in coordination with the Administrator of the 

9 Health Resources and Services Administration, shall 

10 award grants, contracts, or cooperative agreements to eli11 gible entities to promote positive health behaviors and out12 comes for populations in medically underserved commu13 nities through the use of community health workers, in14 cluding by addressing ongoing and longer-term community 

15 health needs, and by building the capacity of the commu16 nity health worker workforce. Such grants, contracts, and 

17 cooperative agreements shall be awarded in alignment and 

18 coordination with existing funding arrangements sup19 porting community health workers.’’; 

20 (3) in subsection (b)— 

21 (A) in the matter preceding paragraph 

22 (1)— 

23 (i) by striking ‘‘Grants awarded’’ and 

24 inserting ‘‘Subject to any requirements for 

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1 tification of a community health worker 

2 under applicable State law, grants, con3 tracts, and cooperative agreements award4 ed’’; and 

5 (ii) by striking ‘‘support community 

6 health workers’’; 

7 (B) by redesignating paragraphs (3) 

8 through (5) as paragraphs (4) through (6), re9 spectively; 

10 (C) by striking paragraphs (1) and (2) and 

11 inserting the following: 

12 ‘‘(1) recruit, hire, and train community health 

13 workers that reflect the needs of the community; 

14 ‘‘(2) support community health workers in pro15 viding education and outreach, in a community set16 ting, regarding— 

17 ‘‘(A) health conditions prevalent in— 

18 ‘‘(i) medically underserved commu19 nities (as defined in section 799B), par20 ticularly racial and ethnic minority popu21 lations; and 

22 ‘‘(ii) other such populations or geo23 graphic areas that may require additional 

24 support during public health emergencies, 

25 which may include counties identified by 


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1 the Secretary using applicable measures 

2 developed by the Centers for Disease Con3 trol and Prevention or other Federal agen4 cies; and 

5 ‘‘(B) addressing social determinants of 

6 health and eliminating health disparities, in7 cluding by— 

8 ‘‘(i) promoting awareness of services 

9 and resources to increase access to health 

10 care, mental health services, child services, 

11 technology, housing services, educational 

12 services, nutrition services, employment 

13 services, and other services; and 

14 ‘‘(ii) assisting in conducting individual 

15 and community needs assessments; 

16 ‘‘(3) educate community members, including re17 garding effective strategies to promote healthy be18 haviors;’’; 

19 (D) in paragraph (4), as so redesignated, 

20 by striking ‘‘to educate’’ and inserting ‘‘edu21 cate’’; 

22 (E) in paragraph (5), as so redesignated— 

23 (i) by striking ‘‘to identify’’ and in24 serting ‘‘identify’’; 


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1 (ii) by striking ‘‘healthcare agencies’’ 

2 and inserting ‘‘health care agencies’’; and 

3 (iii) by striking ‘‘healthcare services 

4 and to eliminate duplicative care; or’’ and 

5 inserting ‘‘health care services and to 

6 streamline care, including serving as a liai7 son between communities and health care 

8 agencies; and’’; and 

9 (F) in paragraph (6), as so redesignated— 

10 (i) by striking ‘‘to educate, guide, and 

11 provide’’ and inserting ‘‘support commu12 nity health workers in educating, guiding, 

13 or providing’’; and 

14 (ii) by striking ‘‘maternal health and 

15 prenatal care’’ and inserting ‘‘chronic dis16 eases, maternal health, prenatal, and 

17 postpartum care in order to improve ma18 ternal and infant health outcomes’’; 

19 (4) in subsection (c), by striking ‘‘Each eligible 

20 entity’’ and all that follows through ‘‘accompanied 

21 by’’ and inserting ‘‘To be eligible to receive an 

22 award under subsection (a), an entity shall prepare 

23 and submit to the Secretary an application at such 

24 time, in such manner, and containing’’; 

25 (5) in subsection (d)— 


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1 (A) in the matter preceding paragraph (1), 

2 by striking ‘‘grants’’ and inserting ‘‘awards’’; 

3 (B) by amending paragraph (1) to read as 

4 follows: 

5 ‘‘(1) propose to serve— 

6 ‘‘(A) areas with populations that have a 

7 high rate of chronic disease, infant mortality, or 

8 maternal morbidity and mortality; 

9 ‘‘(B) low-income populations, including 

10 medically underserved populations (as defined 

11 in section 330(b)(3)); 

12 ‘‘(C) populations residing in health profes13 sional shortage areas (as defined in section 

14 332(a)); 

15 ‘‘(D) populations residing in maternity 

16 care health professional target areas identified 

17 under section 332(k); or 

18 ‘‘(E) rural or traditionally underserved 

19 populations, including racial and ethnic minor20 ity populations or low-income populations;’’; 

21 (C) in paragraph (2), by striking ‘‘; and’’ 

22 and inserting ‘‘, including rural populations and 

23 racial and ethnic minority populations;’’; 

24 (D) in paragraph (3), by striking ‘‘with 

25 community health workers.’’ and inserting ‘‘and 


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1 established relationships with community health 

2 workers in the communities expected to be 

3 served by the program; or’’ and 

4 (E) by adding at the end the following: 

5 ‘‘(4) develop a plan for providing services to the 

6 extent practicable, in the language and cultural con7 text most appropriate to individuals expected to be 

8 served by the program.’’; 

9 (6) in subsection (e)— 

10 (A) by striking ‘‘community health worker 

11 programs’’ and inserting ‘‘eligible entities’’; and 

12 (B) by striking ‘‘and one-stop delivery sys13 tems under section 121(e)’’ and inserting ‘‘, 

14 health professions schools, minority-serving in15 stitutions (defined, for purposes of this sub16 section, as institutions and programs described 

17 in section 326(e)(1) of the Higher Education 

18 Act of 1965 and institutions described in sec19 tion 371(a) of such Act), area health education 

20 centers under section 751 of this Act, and one21 stop delivery systems under section 121’’; 

22 (7) by striking subsections (f), (g), (h), (i), and 

23 (j) and inserting the following: 

24 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary may 

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1 section (a) technical assistance with respect to planning, 

2 development, and operation of community health worker 

3 programs authorized or supported under this section. 

4 ‘‘(g) DISSEMINATION OF BEST PRACTICES.—Not 

5 later than 4 years after the date of enactment of the 

6 Building a Sustainable Workforce for Healthy Commu7 nities Act, the Secretary shall, based on activities carried 

8 out under this section and in consultation with relevant 

9 stakeholders, identify and disseminate evidence-based or 

10 evidence-informed practices regarding recruitment and re11 tention of community health workers and paraprofes12 sionals to address ongoing public health and community 

13 health needs, and to prepare for, and respond to, future 

14 public health emergencies. 

15 ‘‘(h) REPORT TO CONGRESS.—Not later than 4 years 

16 after the date of enactment of the Building a Sustainable 

17 Workforce for Healthy Communities Act, the Secretary 

18 shall submit to the Committee on Health, Education, 

19 Labor, and Pensions of the Senate and the Committee on 

20 Energy and Commerce of the House of Representatives 

21 a report concerning the effectiveness of the program under 

22 this section in addressing ongoing public health and com23 munity health needs. Such report shall include rec24 ommendations regarding any improvements to such pro25 gram, including recommendations for how to improve reVerDate Sep 11 2014 02:59 Jan 12, 2022 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3479.IS S3479

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1 cruitment, training, and retention of the community 

2 health workforce. 

3 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For 

4 purposes of carrying out this section, there are authorized 

5 to be appropriated such sums as may be necessary for 

6 each of fiscal years 2023 through 2027.’’; 

7 (8) by redesignating subsection (k) as sub8 section (j); and 

9 (9) in subsection (j), as so redesignated— 

10 (A) by striking paragraphs (1), (2), and 

11 (4); 

12 (B) by redesignating paragraph (3) as 

13 paragraph (1); 

14 (C) in paragraph (1), as so redesignated— 

15 (i) by striking ‘‘entity (including a 

16 State or public subdivision of a State’’ and 

17 inserting ‘‘entity, including a State or po18 litical subdivision of a State, an Indian 

19 Tribe or Tribal organization, an urban In20 dian organization, a community-based or21 ganization’’; and 

22 (ii) by striking ‘‘as defined in section 

23 1861(aa) of the Social Security Act))’’ and 

24 inserting ‘‘(as described in section 


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1 1861(aa)(4)(B) of the Social Security 

2 Act)’’; and 

3 (D) by adding at the end the following: 

4 ‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

5 The terms ‘Indian Tribe’ and ‘Tribal organization’ 

6 have the meanings given the terms ‘Indian tribe’ and 

7 ‘tribal organization’, respectively, in section 4 of the 

8 Indian Self-Determination and Education Assistance 

9 Act. 

10 ‘‘(3) URBAN INDIAN ORGANIZATION.—The term 

11 ‘urban Indian organization’ has the meaning given 

12 such term in section 4 of the Indian Health Care 

13 Improvement Act.’’. 

14 SEC. 3. GAO STUDY AND REPORT. 

15 Not later than 4 years after the date of enactment 

16 of this Act, the Comptroller General of the United States 

17 shall submit to the Committee on Health, Education, 

18 Labor, and Pensions of the Senate and the Committee on 

19 Energy and Commerce of the House of Representatives 

20 a report on the program authorized under section 399V 

21 of the Public Health Service Act (42 U.S.C. 280g–11) (as 

22 amended by section 2), including a review of the outcomes 

23 and effectiveness of the program and coordination with ap24 plicable programs of the Health Resources and Services 


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1 Administration to ensure there is no unnecessary duplica2 tion of efforts among such programs. 

Æ 


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