II 

109TH CONGRESS 

2D SESSION S. 3975 

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 

SEPTEMBER 28, 2006 

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 2006’’. 

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 


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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 07:29 Sep 30, 2006 Jkt 049196 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3975.IS S3975

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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 07:29 Sep 30, 2006 Jkt 049196 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3975.IS S3975

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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. 399P. 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 in target populations, 

23 especially racial and ethnic minority women in medically 

24 underserved communities. 


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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 especially among racial and 

7 ethnic minority women; 

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

9 learning opportunities that target behavioral risk 

10 factors including— 

11 ‘‘(A) poor nutrition; 

12 ‘‘(B) physical inactivity; 

13 ‘‘(C) being overweight or obese; 

14 ‘‘(D) tobacco use; 

15 ‘‘(E) alcohol and substance use; 

16 ‘‘(F) injury and violence; 

17 ‘‘(G) risky sexual behavior; and 

18 ‘‘(H) mental health problems; 

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

20 strategies to promote positive health behaviors with21 in the family; 

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

23 enrollment in health insurance including the State 

24 Children’s Health Insurance Program under title 

25 XXI of the Social Security Act, Medicare under title 


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1 XVIII of such Act and Medicaid under title XIX of 

2 such Act; 

3 ‘‘(5) to promote community wellness and aware4 ness; and 

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

6 appropriate health care agencies and community7 based programs and organizations in order to in8 crease access to quality health care services, includ9 ing preventive health services. 

10 ‘‘(c) APPLICATION.— 

11 ‘‘(1) IN GENERAL.—Each State or local or trib12 al unit (including federally recognized tribes and 

13 Alaska native villages) that desires to receive a grant 

14 under subsection (a) shall submit an application to 

15 the Secretary, at such time, in such manner, and ac16 companied by such additional information as the 

17 Secretary may require. 

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

19 pursuant to paragraph (1) shall— 

20 ‘‘(A) describe the activities for which as21 sistance under this section is sought; 

22 ‘‘(B) contain an assurance that with re23 spect to each community health worker pro24 gram receiving funds under the grant awarded, 

25 such program provides training and supervision 


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1 to community health workers to enable such 

2 workers to provide authorized program services; 

3 ‘‘(C) contain an assurance that the appli4 cant will evaluate the effectiveness of commu5 nity health worker programs receiving funds 

6 under the grant; 

7 ‘‘(D) contain an assurance that each com8 munity health worker program receiving funds 

9 under the grant will provide services in the cul10 tural context most appropriate for the individ11 uals served by the program; 

12 ‘‘(E) contain a plan to document and dis13 seminate project description and results to 

14 other States and organizations as identified by 

15 the Secretary; and 

16 ‘‘(F) describe plans to enhance the capac17 ity of individuals to utilize health services and 

18 health-related social services under Federal, 

19 State, and local programs by— 

20 ‘‘(i) assisting individuals in estab21 lishing eligibility under the programs and 

22 in receiving the services or other benefits 

23 of the programs; and 

24 ‘‘(ii) providing other services as the 

25 Secretary determines to be appropriate, 


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1 that may include transportation and trans2 lation services. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Secretary shall give priority to those appli5 cants— 

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

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

8 who are eligible for health insurance but are 

9 uninsured or underinsured; 

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

11 whom English is not their primary language; 

12 and 

13 ‘‘(C) that encompass the United States14 Mexico border region; 

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

16 health-related social services to individuals who are 

17 underserved with respect to such services; and 

18 ‘‘(3) with documented community activity and 

19 experience with community health workers. 

20 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU21 TIONS.—The Secretary shall encourage community health 

22 worker programs receiving funds under this section to col23 laborate with academic institutions. Nothing in this sec24 tion shall be construed to require such collaboration. 


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1 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE2 NESS.—The Secretary shall establish guidelines for assur3 ing the quality of the training and supervision of commu4 nity health workers under the programs funded under this 

5 section and for assuring the cost-effectiveness of such pro6 grams. 

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

8 community health worker programs identified in approved 

9 applications and shall determine whether such programs 

10 are in compliance with the guidelines established under 

11 subsection (f). 

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

13 provide technical assistance to community health worker 

14 programs identified in approved applications with respect 

15 to planning, developing, and operating programs under the 

16 grant. 

17 ‘‘(i) REPORT TO CONGRESS.— 

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

19 after the date on which the Secretary first awards 

20 grants under subsection (a), the Secretary shall sub21 mit to Congress a report regarding the grant 

22 project. 

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

24 paragraph (1) shall include the following: 


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

2 which grant funds were used. 

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

4 ‘‘(C) An evaluation of— 

5 ‘‘(i) the effectiveness of these pro6 grams; 

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

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

9 health outcomes of the community resi10 dents. 

11 ‘‘(D) Recommendations for sustaining the 

12 community health worker programs developed 

13 or assisted under this section. 

14 ‘‘(E) Recommendations regarding training 

15 to enhance career opportunities for community 

16 health workers. 

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

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

19 ‘community health worker’ means an individual who 

20 promotes health or nutrition within the community 

21 in which the individual resides— 

22 ‘‘(A) by serving as a liaison between com23 munities and health care agencies; 

24 ‘‘(B) by providing guidance and social as25 sistance to community residents; 


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1 ‘‘(C) by enhancing community residents’ 

2 ability to effectively communicate with health 

3 care providers; 

4 ‘‘(D) by providing culturally and linguis5 tically appropriate health or nutrition edu6 cation; 

7 ‘‘(E) by advocating for individual and com8 munity health or nutrition needs; and 

9 ‘‘(F) by providing referral and followup 

10 services. 

11 ‘‘(2) COMMUNITY SETTING.—The term ‘commu12 nity setting’ means a home or a community organi13 zation located in the neighborhood in which a partic14 ipant resides. 

15 ‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.— 

16 The term ‘medically underserved community’ means 

17 a community identified by a State— 

18 ‘‘(A) that has a substantial number of in19 dividuals who are members of a medically un20 derserved population, as defined by section 

21 330(b)(3); and 

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

23 health professional shortage area as designated 

24 under section 332. 


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

2 provision of training, supervision, and materials 

3 needed to effectively deliver the services described in 

4 subsection (b), reimbursement for services, and 

5 other benefits. 

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

7 population’ means women of reproductive age, re8 gardless of their current childbearing status. 

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

10 are authorized to be appropriated to carry out this section 

11 $15,000,000 for each of fiscal years 2007, 2008, and 

12 2009.’’. 

Æ 


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