224
uation, the grantee shall collect specific patient data 
recording navigation services provided to each pa-
tient served by the program and shall establish and 
implement procedures and protocols, consistent with 
applicable Federal and State laws (including 45 
C.F.R. 160 and 164) to ensure the confidentiality of 
all information shared by a participant in the pro-
gram, or their personal representative and their 
healthcare providers, group health plans, or health 
insurance insurers with the program. The patient 
navigator program may, consistent with applicable 
Federal and State confidentiality laws, collect, use or 
disclose aggregate information that is not individ-
ually identifiable (as defined in 45 C.F.R. 160 and 
164). With this data, the grantee shall submit an 
annual report to the Secretary that summarizes and 
analyzes these data, provides information on needs 
for navigation services, types of access difficulties re-
solved, sources of repeated resolution and flaws in 
the system of access, including insurance barriers. 
(4) APPLICATION FOR GRANT.—A grant may be 
made under paragraph (1) only if an application for 
the grant is submitted to the Secretary and the ap-
plication is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
225
formation as the Secretary determines to be nec-
essary to carry out this section. 
(5) EVALUATIONS.—
(A) IN GENERAL.—The Secretary, acting 
through the Director of the Indian Health Serv-
ice, shall, directly or through grants or con-
tracts, provide for evaluations to determine the 
effects of the services of patient navigators on 
the individuals of health disparity populations 
for whom the services were provided, taking 
into account the matters referred to in para-
graph (1)(C). 
(B) DISSEMINATION
OF
FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A). 
(6) COORDINATION WITH OTHER PROGRAMS.—
The Secretary shall coordinate the program under 
this subsection with the program under subsection 
(a) and with the program under section 417D. 
(c) REQUIREMENTS REGARDING FEES.—
(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that 
the program for which the grant is made have in ef-
fect—
226
(A) a schedule of fees or payments for the 
provision of its healthcare services related to 
the prevention and treatment of disease that is 
consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and 
(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or 
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
(2) RULE OF CONSTRUCTION.—Nothing in this 
section shall be construed to require payment for 
navigation services or to require payment for 
healthcare services in cases, such as with the Indian 
Health Service, where care is provided free of 
charge. 
(d) MODEL.—Not later than five years after the date 
of the enactment of this section, the Secretary shall de-
velop a peer-reviewed model of systems for the services 
provided by this section. The Secretary shall update such 
model as may be necessary to ensure that the best prac-
tices are being utilized. 
(e) DURATION OF GRANT.—The period during which 
payments are made to an entity from a grant under sub-
section (a)(1) or (b)(1) may not exceed five years. The
227
provision of such payments are subject to annual approval 
by the Secretary of the payments and subject to the avail-
ability of appropriations for the fiscal year involved to 
make the payments. This subsection may not be construed 
as establishing a limitation on the number of grants under 
such subsection that may be made to an entity. 
(f) DEFINITIONS.—For purposes of this section: 
(1) The term ‘‘culturally competent’’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
(2) The term ‘‘appropriate follow-up care’’ in-
cludes palliative and end-of-life care. 
(3) The term ‘‘health disparity population’’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
(A) racial and ethnic minority groups as 
defined in section 1707; and
228
(B) medically underserved groups, such as 
rural and low-income individuals and individ-
uals with low levels of literacy. 
(4)(A) The term ‘‘patient navigator’’ means an 
individual whose functions include—
(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
healthcare system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease, including pro-
viding information about clinical trials; and 
(ii) identifying, anticipating, and helping 
patients overcome barriers within the healthcare 
system to ensure prompt diagnostic and treat-
ment resolution of an abnormal finding of can-
cer or other chronic disease. 
(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
(g) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—
229
(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) (other than the 
purpose described in paragraph (2)(A)), there 
are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 
2005 through 2010. 
(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) (other than 
the purpose described in paragraph (2)(B)), 
there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal 
years 2005 through 2010. 
(C) BUREAU
OF
PRIMARY
HEALTH
CARE.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Bureau of Primary Health Care. 
(2) PROGRAMS IN RURAL AREAS.—
(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) by making grants 
under such subsection for model programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2005 through 2010. 
(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) by making
230
grants under such subsection for programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2005 through 2010. 
(C) OFFICE OF RURAL HEALTH POLICY.—
Amounts appropriated under subparagraph (A) 
or (B) shall be administered through the Office 
of Rural Health Policy. 
(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs 
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs. 
CHAPTER 5—COMMUNITY HEALTH 
WORKERS
SEC. 431. SHORT TITLE. 
This chapter may be cited as the ‘‘Community Health 
Workers Act of 2003’’. 
SEC. 432. 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:
231
‘‘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; 
‘‘(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
232
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,
233
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
234
‘‘(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-
236
‘‘(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;
237
‘‘(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 followup 
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 by section 
330(b)(3); and
238
‘‘(B) a significant portion of which is a 
health professional shortage area as 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 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010.’’. 
CHAPTER 6—HEALTH EMPOWERMENT 
ZONES 
SEC. 440. HEALTH EMPOWERMENT ZONES. 
(a) HEALTH EMPOWERMENT ZONE PROGRAMS.—
(1) GRANTS.—The Secretary, acting through 
the Administrator of the Health Resources and Serv-
ices Administration and the Director of the Office of 
Minority Health, and in cooperation with the Direc-
tor of the Office of Community Services and the Di-
rector of the National Center for Minority Health
239
and Health Disparities, shall make grants to part-
nerships of private and public entities to establish 
health empowerment zone programs in communities 
that disproportionately experience disparities in 
health status and healthcare for the purpose de-
scribed in paragraph (2). 
(2) USE OF FUNDS.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the purpose of a health empower-
ment zone program under this section shall be 
to assist individuals, businesses, schools, minor-
ity health associations, non-profit organizations, 
community-based 
organizations, 
hospitals, 
healthcare clinics, foundations, and other enti-
ties in communities that disproportionately ex-
perience disparities in health status and 
healthcare which are seeking—
(i) to improve the health or environ-
ment of minority individuals in the com-
munity and to reduce disparities in health 
status and healthcare by assisting individ-
uals in accessing Federal programs; and 
(ii) to coordinate the efforts of gov-
ernmental and private entities regarding
240
the elimination of racial and ethnic dispari-
ties in health status and healthcare. 
(B) MEDICARE AND MEDICAID.—A health 
empowerment zone program under this section 
shall not provide any assistance (other than re-
ferral and follow-up services) that is duplicative 
of programs under title XVIII or XIX of the 
Social Security Act (42 U.S.C. 1395 and 1396 
et seq.). 
(3) DISTRIBUTION.—The Secretary shall make 
at least 1 grant under this section to a partnership 
for a health empowerment zone program in commu-
nities that disproportionately experience disparities 
in health status and healthcare that is located in a 
territory or possession of the United States. 
(4) APPLICATION.—To obtain a grant under 
this section, a partnership shall submit to the Sec-
retary an application in such form and in such man-
ner as the Secretary may require. An application 
under this paragraph shall—
(A) demonstrate that the communities to 
be served by the health empowerment zone pro-
gram are those that disproportionately experi-
ence disparities in health status and healthcare;
241
(B) set forth a strategic plan for accom-
plishing the purpose described in paragraph (2), 
by—
(i) describing the coordinated health, 
economic, human, community, and physical 
development plan and related activities 
proposed for the community; 
(ii) describing the extent to which 
local institutions and organizations have 
contributed and will contribute to the plan-
ning process and implementation; 
(iii) identifying the projected amount 
of Federal, State, local, and private re-
sources that will be available in the area 
and the private and public partnerships to 
be used (including any participation by or 
cooperation 
with 
universities, 
colleges, 
foundations, non-profit organizations, med-
ical centers, hospitals, health clinics, school 
districts, or other private and public enti-
ties); 
(iv) identifying the funding requested 
under any Federal program in support of 
the proposed activities;
242
(v) identifying benchmarks for meas-
uring the success of carrying out the stra-
tegic plan; 
(vi) demonstrating the ability to reach 
and service the targeted underserved mi-
nority community populations in a cul-
turally appropriate and linguistically re-
sponsive manner; and 
(vii) demonstrating a capacity and in-
frastructure to provide long-term commu-
nity response that is culturally appropriate 
and linguistically responsive to commu-
nities that disproportionately experience 
disparities in health and healthcare; and 
(C) include such other information as the 
Secretary may require. 
(5) PREFERENCE.—In awarding grants under 
this subsection, the Secretary shall give preference 
to proposals from indigenous community entities 
that have an expertise in providing culturally appro-
priate and linguistically responsive services to com-
munities that disproportionately experience dispari-
ties in health and health care. 
(b) FEDERAL ASSISTANCE FOR HEALTH EMPOWER-
MENT ZONE GRANT PROGRAMS.—The Secretary, the Ad-