I 
109TH CONGRESS 
1ST SESSION H. R. 4469 
To amend the Public Health Service Act to provide grants to promote positive 
health behaviors in women. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 7, 2005 
Ms. SOLIS introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to provide grants 
to promote positive health behaviors in women. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Community Health 
Workers Act of 2005’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Chronic diseases, defined as any condition 
that requires regular medical attention or medica-
tion, are the leading cause of death and disability for
women in the United States across racial and ethnic 
groups. 
(2) According to the National Vital Statistics 
Report of 2001, the 5 leading causes of death 
among Hispanic, American Indian, and African- 
American women are heart disease, cancer, diabetes, 
cerebrovascular disease, and unintentional injuries. 
(3) Unhealthy behaviors alone lead to more 
than 50 percent of premature deaths in the United 
States. 
(4) Poor diet, physical inactivity, tobacco use, 
and alcohol and drug abuse are the health risk be-
haviors that most often lead to disease, premature 
death, and disability, and are particularly prevalent 
among many groups of minority women. 
(5) Over 60 percent of Hispanic and African- 
American women are classified as overweight and 
over 30 percent are classified as obese. Over 60 per-
cent of American Indian women are classified as 
obese. 
(6) American Indian women have the highest 
mortality rates related to alcohol and drug use of all 
women in the United States. 
(7) High poverty rates coupled with barriers to 
health preventive services and medical care con-
tribute to racial and ethnic disparities in health fac-
tors, including premature death, life expectancy, risk 
factors associated with major diseases, and the ex-
tent and severity of illnesses. 
(8) There is increasing evidence that early life 
experiences are associated with adult chronic disease 
and that prevention and intervention services pro-
vided within the community and the home may less-
en the impact of chronic outcomes, while strength-
ening families and communities. 
(9) Community health workers, who are pri-
marily women, can be a critical component in con-
ducting health promotion and disease prevention ef-
forts in medically underserved populations. 
(10) Recognizing the difficult barriers con-
fronting medically underserved communities (pov-
erty, geographic isolation, language and cultural dif-
ferences, lack of transportation, low literacy, and 
lack of access to services), community health work-
ers are in a unique position to reduce preventable 
morbidity and mortality, improve the quality of life, 
and increase the utilization of available preventive 
health services for community members. 
(11) Research has shown that community 
health workers have been effective in significantly in-
creasing screening and medical follow-up visits 
among residents with limited access or underutiliza-
tion of health care services. 
(12) States on the United States-Mexico border 
have high percentages of impoverished and ethnic 
minority populations: border States accommodate 60 
percent of the total Hispanic population and 23 per-
cent of the total population below 200 percent pov-
erty in the United States. 
SEC. 3. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV-
IORS IN WOMEN. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BE-
HAVIORS IN WOMEN. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Director of the Centers for Disease 
Control and Prevention and other Federal officials deter-
mined appropriate by the Secretary, is authorized to 
award grants to States or local or tribal units, to promote 
positive health behaviors for women in target populations, 
especially racial and ethnic minority women in medically 
underserved communities.
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support community health 
workers— 
‘‘(1) to educate, guide, and provide outreach in 
a community setting regarding health problems prev-
alent among women and especially among racial and 
ethnic minority women; 
‘‘(2) to educate, guide, and provide experiential 
learning opportunities that target behavioral risk 
factors including— 
‘‘(A) poor nutrition; 
‘‘(B) physical inactivity; 
‘‘(C) being overweight or obese; 
‘‘(D) tobacco use; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) risky sexual behavior; and 
‘‘(H) mental health problems; 
‘‘(3) to educate and guide regarding effective 
strategies to promote positive health behaviors with-
in the family; 
‘‘(4) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, medicare under title
XVIII of such Act, and medicaid under title XIX of 
such Act; 
‘‘(5) to promote community wellness and aware-
ness; and 
‘‘(6) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN GENERAL.—Each State or local or trib-
al unit (including federally recognized tribes and 
Alaska native villages) that desires to receive a grant 
under subsection (a) shall submit an application to 
the Secretary, at such time, in such manner, and ac-
companied by such additional information as the 
Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides training and supervision
to community health workers to enable such 
workers to provide authorized program services; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide services in the cul-
tural context most appropriate for the individ-
uals served by the program; 
‘‘(E) contain a plan to document and dis-
seminate project description and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services as the 
Secretary determines to be appropriate,
that may include transportation and trans-
lation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas— 
‘‘(A) with a high percentage of residents 
who are eligible for health insurance but are 
uninsured or underinsured; 
‘‘(B) with a high percentage of families for 
whom English is not their primary language; 
and 
‘‘(C) that encompass the United States- 
Mexico border region; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions. Nothing in this sec-
tion shall be construed to require such collaboration.
‘‘(f) QUALITY ASSURANCE
AND COST-EFFECTIVE-
NESS.—The Secretary shall establish guidelines for assur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for assuring the cost-effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following:
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of the project on the 
health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents;
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health or nutrition needs; and 
‘‘(F) by providing referral and follow-up 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation located in the neighborhood in which a partic-
ipant resides. 
‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community identified by a State— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
derserved population, as defined in section 
330(b)(3); and 
‘‘(B) a significant portion of which is a 
health professional shortage area designated 
under section 332.
‘‘(4) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(5) TARGET POPULATION.—The term ‘target 
population’ means women of reproductive age, re-
gardless of their current childbearing status. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2003, 2004, and 
2005.’’. 
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