II 

111TH CONGRESS 

1ST SESSION S. 319 

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 

JANUARY 26, 2009 

Mr. BINGAMAN (for himself and Mr. DURBIN) 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 2009’’. 

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 

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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 

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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— 

14 (1) by redesignating the second section 399R 

15 (relating to the amyotrophic lateral sclerosis registry 

16 (42 U.S.C. 280g–7)) and the third section 399R (re17 lating to support for patients receiving a positive di18 agnosis of down syndrome or other prenatally or 

19 postnatally diagnosed conditions (42 U.S.C. 280g– 

20 8)) as sections 399S and 399T respectively; and 

21 (2) by adding at the end the following: 

22 ‘‘SEC. 399U. GRANTS TO PROMOTE POSITIVE HEALTH BE23 HAVIORS IN WOMEN. 

24 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col25 laboration with the Director of the Centers for Disease 


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1 Control and Prevention and other Federal officials deter2 mined appropriate by the Secretary, is authorized to 

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

4 positive health behaviors for women and children in target 

5 populations, especially racial and ethnic minority women 

6 and children in medically underserved communities. 

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

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

9 workers— 

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

11 a community setting regarding health problems prev12 alent among women and children and especially 

13 among racial and ethnic minority women and chil14 dren; 

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

16 learning opportunities that target behavioral risk 

17 factors including— 

18 ‘‘(A) poor nutrition; 

19 ‘‘(B) physical inactivity; 

20 ‘‘(C) being overweight or obese; 

21 ‘‘(D) tobacco use; 

22 ‘‘(E) alcohol and substance use; 

23 ‘‘(F) injury and violence; 

24 ‘‘(G) risky sexual behavior; and 

25 ‘‘(H) mental health problems; 


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

2 strategies to promote positive health behaviors with3 in the family; 

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

5 enrollment in health insurance including the State 

6 Children’s Health Insurance Program under title 

7 XXI of the Social Security Act, Medicare under title 

8 XVIII of such Act and Medicaid under title XIX of 

9 such Act; 

10 ‘‘(5) to promote community wellness and aware11 ness; and 

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

13 appropriate health care agencies and community14 based programs and organizations in order to in15 crease access to quality health care services, includ16 ing preventive health services. 

17 ‘‘(c) APPLICATION.— 

18 ‘‘(1) IN GENERAL.—Each State or local or trib19 al unit (including federally recognized tribes and 

20 Alaska native villages) that desires to receive a grant 

21 under subsection (a) shall submit an application to 

22 the Secretary, at such time, in such manner, and ac23 companied by such additional information as the 

24 Secretary may require. 


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

2 pursuant to paragraph (1) shall— 

3 ‘‘(A) describe the activities for which as4 sistance under this section is sought; 

5 ‘‘(B) contain an assurance that with re6 spect to each community health worker pro7 gram receiving funds under the grant awarded, 

8 such program provides training and supervision 

9 to community health workers to enable such 

10 workers to provide authorized program services; 

11 ‘‘(C) contain an assurance that the appli12 cant will evaluate the effectiveness of commu13 nity health worker programs receiving funds 

14 under the grant; 

15 ‘‘(D) contain an assurance that each com16 munity health worker program receiving funds 

17 under the grant will provide services in the cul18 tural context most appropriate for the individ19 uals served by the program; 

20 ‘‘(E) contain a plan to document and dis21 seminate project description and results to 

22 other States and organizations as identified by 

23 the Secretary; and 

24 ‘‘(F) describe plans to enhance the capac25 ity of individuals to utilize health services and 


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1 health-related social services under Federal, 

2 State, and local programs by— 

3 ‘‘(i) assisting individuals in estab4 lishing eligibility under the programs and 

5 in receiving the services or other benefits 

6 of the programs; and 

7 ‘‘(ii) providing other services as the 

8 Secretary determines to be appropriate, 

9 that may include transportation and trans10 lation services. 

11 ‘‘(d) PRIORITY.—In awarding grants under sub12 section (a), the Secretary shall give priority to those appli13 cants— 

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

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

16 who are eligible for health insurance but are 

17 uninsured or underinsured; 

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

19 whom English is not their primary language; 

20 and 

21 ‘‘(C) that encompass the United States22 Mexico border region; 

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

24 health-related social services to individuals who are 

25 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) MEDICALLY UNDERSERVED COMMUNITY.— 

24 The term ‘medically underserved community’ means 

25 a community identified by a State— 


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1 ‘‘(A) that has a substantial number of in2 dividuals who are members of a medically un3 derserved population, as defined by section 

4 330(b)(3); and 

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

6 health professional shortage area as designated 

7 under section 332. 

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

9 provision of training, supervision, and materials 

10 needed to effectively deliver the services described in 

11 subsection (b), reimbursement for services, and 

12 other benefits. 

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

14 population’ means women of reproductive age, re15 gardless of their current childbearing status and 

16 children under 21 years of age. 

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

18 are authorized to be appropriated to carry out this section 

19 $15,000,000 for each of fiscal years 2010, 2011, and 

20 2012.’’. 

Æ 


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