[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2245 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 2245

To establish a national program of trained community health advisors to 
   assist the States in attaining the Healthy People 2000 Objectives.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 1995

Mr. Sanders (for himself and Mr. Rogers) introduced the following bill; 
            which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
To establish a national program of trained community health advisors to 
   assist the States in attaining the Healthy People 2000 Objectives.
    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``National Community Health Advisor 
Act''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Communities across America have joined forces with 
        State health departments, academic institutions, and community-
        based public and nonprofit organizations to improve the health 
        of their neighborhoods and help us as a Nation reach the 
        Healthy People 2000 objectives.
            (2) Recognizing the difficult barriers confronting their 
        medically underserved communities--poverty, geographic 
        isolation, cultural differences, lack of transportation, low 
        literacy, and lack of access to services--community leaders are 
        becoming bridges between their communities and local health and 
        social service providers to break down these barriers.
            (3) These community leaders, often referred to as community 
        health advisors, are uniquely knowledgeable about their 
        communities' needs.
            (4) Community health advisors can communicate to health and 
        social service providers the needs of community members, 
        provide quality health promotion and disease prevention 
        information to the community, and serve as the crucial link 
        between their community and service providers.
            (5) Community health advisors can increase utilization of 
        available preventive health services, increase the 
        effectiveness of the health care delivery system, reduce 
        preventable morbidity and mortality, and improve the quality of 
        life of their neighbors.
            (6) Community health advisors can be a critical part of our 
        national challenge to meet the Healthy People 2000 vision for 
        the new century.

SEC. 3. DEFINITIONS.

    For purposes of this Act:
            (1) The term ``authorized program services'', with respect 
        to a community health advisor program, means the services 
        authorized in section 5(a) to be included in a plan under such 
        section.
            (2) The term ``community health advisor'' means an 
        individual--
                    (A) who has demonstrated the capacity to carry out 
                one or more of the authorized program services;
                    (B) who, for not less than 1 year, has been a 
                resident of the community in which the community health 
                advisor program involved is to be operated; and
                    (C) is a member of the target population to be 
                served by the program.
            (3) The term ``community health advisor program'' means a 
        program carried out in accordance with a plan under section 
        5(a).
            (4) The term ``financial assistance'', with respect to an 
        award under section 4, means a grant, cooperative agreement, or 
        a contract.
            (5) The term ``Healthy People 2000 Objectives'' means the 
        objectives established by the Secretary toward the goals of 
        increasing the span of healthy life, reducing health 
        disparities among various populations, and providing access to 
        preventive services, which objectives apply to the health 
        status of the population of the United States for the year 
        2000.
            (6) The term ``medically underserved community'' means--
                    (A) a community that has a substantial number of 
                individuals who are members of a medically underserved 
                population, as defined in section 330 of the Public 
                Health Service Act; or
                    (B) a community a significant portion of which is a 
                health professional shortage area designated under 
                section 332 of such Act.
            (7) The term ``official poverty line'' means the official 
        poverty line established by the Director of the Office of 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981, which poverty line is applicable 
        the size of the family involved.
            (8) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (9) The term ``State'' means each of the several States, 
        the District of Columbia, and each of the Commonwealth of 
        Puerto Rico, American Samoa, Guam, the Commonwealth of the 
        Northern Mariana Islands, the Virgin Islands, and the Trust 
        Territory of the Pacific Islands.
            (10) The term ``State involved'', with respect to an 
        applicant for an award under section 4, means the State in 
        which the applicant is to carry out a community health advisor 
        program.

SEC. 4. FORMULA GRANTS REGARDING COMMUNITY HEALTH ADVISOR PROGRAMS.

    (a) Formula Grants.--In the case of each State (or entity 
designated by a State under subsection (c)) that submits to the 
Secretary a plan in accordance with section 5(a) for a fiscal year, the 
Secretary of Health and Human
 Services, acting through the Director of the Centers for Disease 
Control and Prevention and in coordination with the heads of the 
agencies specified in subsection (b), shall make an award of financial 
assistance to the State or entity for the development and operation of 
community health advisor programs under the plan. The award shall 
consist of the allotment determined under section 7 with respect to the 
State, subject to section 11(b).
    (b) Coordination With Other Agencies.--The agencies referred to in 
subsection (a) regarding coordination are the Health Resources and 
Services Administration, the National Institutes of Health, and the 
Substance Abuse and Mental Health Services Administration.
    (c) Designated Entities.--With respect to the State involved, an 
entity other than the State may receive an award under subsection (a) 
only if the entity--
            (1) is a public or nonprofit private academic organization 
        (or other public or nonprofit private entity); and
            (2) has been designated by the State to carry out the 
        purpose described in such subsection in the State and to 
        receive amounts under such subsection in lieu of the State.

SEC. 5. STATE PLAN.

    (a) In General.--An applicant for an award under section 4 for a 
fiscal year may receive such an award only if the applicant submits to 
the Secretary a plan for such year that is in such form, is made in 
such manner, and is submitted at such time as the Secretary may 
require, and that meets the following requirements:
            (1) The plan contains a description of how--
                    (A) if the applicant is a State, the award will be 
                administered by the State agency with the principal 
                responsibility for carrying out public health programs; 
                and
                    (B) if the applicant is an entity designated under 
                section 4, the award will be administered in 
                consultation with such State agency.
            (2)(A) The plan contains a description of how the applicant 
        will--
                    (i) operate a clearinghouse to maintain and 
                disseminate information on community health advisor 
                programs (and similar programs) in the State;
                    (ii) provide to community health advisor programs 
                in the State technical assistance in training community 
                health advisors; and
                    (iii) provide to community health advisor programs 
                in the State evaluation assistance in evaluating their 
                community health advisor programs and preparing the 
                reports required in paragraph (22); and
            (B) The plan contains assurances that--
                    (i) not more than 15 percent of the award will be 
                expended in the aggregate for carrying out subparagraph 
                (A) and for the expenses of administering the award 
                with respect to the State involved; and
                    (ii) the remainder of the award will be provided 
                directly to community health advisor programs in the 
                State for carrying out the duties of the programs 
                pursuant to this subsection.
            (3) The plan contains a description of how the applicant 
        will use the award, including the following:
                    (A) description of the criteria the applicant will 
                use to identify which community-based public and 
                private nonprofit entities will receive funds from the 
                award and how the funds will be allocated among such 
                public and private nonprofit entities.
                    (B) A description of how the award will assist the 
                State involved in attaining the Healthy People 2000 
                Objectives.
                    (C) Assurances that for each community health 
                advisor program operated with the award, a program is 
                carried out to train community health advisors to 
                provide the authorized program services.
                    (D) Assurances that, for each community health 
                advisor program operated with the award, a program of 
                evaluation will be carried out.
                    (E) A description of how the applicant will 
                identify and consider the needs of the community 
                involved for the authorized program services.
                    (F) Assurances that each community health advisor 
                program operated with the award will be provided in the 
                cultural context most appropriate for the individuals 
                served by the program.
                    (G) A description of how the applicant will provide 
                public education on health promotion and disease 
                prevention and facilitate the use of available health 
                services and health-related social services.
                    (H) A description of how the applicant will provide 
                health-related counseling.
                    (I) A description of how the applicant will 
                collaborate with and provide referrals for available 
                health services and health-related social services.
                    (J) Assurances that, with respect to the purposes 
                for the award is authorized to be expended, the State 
                involved will maintain expenditures of non-Federal 
                amounts for such purposes at a level that is not less 
                than the level of such expenditures maintained by the 
                State for the fiscal year preceding the first fiscal 
                year for which such an award is made with respect to 
                the State.
                    (K) Assurances that not more than 15 percent of the 
                award will be expended for the program of training 
                under subparagraph (C).
                    (L) Assurances that the applicant will not provide 
                amounts from the award to a community-based public and 
                private nonprofit entity to operate a community health 
                advisor program unless the entity complies with section 
                6.
                    (M) Assurances that the applicant will carry out 
                community health advisor programs in accordance with 
                the guidelines established under section 8.
                    (N) Such other information as the Secretary may 
                require.
    (b) Certain Expenditures.--An award under section 4 may be expended 
to provide compensation for the services of community health advisors.

SEC. 6. LOCAL PLAN.

    A community-based public or private nonprofit entity may receive 
funds from an award under section 4 for a fiscal year to operate a 
community health advisor program only if the entity submits to the 
recipient of such award a plan for such year that is in such form, is 
made in such manner, and is submitted at such time as the recipient may 
require.

SEC. 7. DETERMINATION OF AMOUNT OF ALLOTMENT.

    (a) In General.--For purposes of section 4(a), the allotment under 
this section with respect to a State for a fiscal year is the greater 
of--
            (1) the sum of the respective amounts determined for the 
        State under subsection (b) and subsection (c); and
            (2) $500,000.
    (b) Amount Relating to Population.--For purposes of subsection (a), 
the amount determined under this subsection is the product of--
            (1) an amount equal to 50 percent of the amount 
        appropriated under section 11 for the fiscal year and available 
        for awards under section 4; and
            (2) the percentage constituted by the ratio of--
                    (A) the number of individuals residing in the State 
                involved; to
                    (B) the sum of the respective amounts determined 
                for each State under subparagraph (A).
    (c) Amount Relating to Poverty Level.--For purposes of subsection 
(a), the amount determined under this subsection is the product of--
            (1) the amount determined under subsection (b)(1); and
            (2) the percentage constituted by the ratio of--
                    (A) the number of individuals residing in the State 
                whose income is at or below an amount equal to 200 
                percent of the official poverty line; to
                    (B) the sum of the respective amounts determined 
                for each State under subparagraph (A).

SEC. 8. QUALITY ASSURANCE; COST-EFFECTIVENESS.

    The Secretary shall establish guidelines for assuring the quality 
of community health advisor programs (including quality in the training 
of community health advisors) and for assuring the cost-effectiveness 
of the programs.

SEC. 9. EVALUATIONS; TECHNICAL ASSISTANCE.

    (a) Evaluations.--The Secretary shall conduct evaluations of 
community health advisor programs, and disseminate information 
developed as a result of the evaluations. In conducting such 
evaluations, the Secretary shall determine whether the programs are in 
compliance with the guidelines established under section 8.
    (b) Technical Assistance.--The Secretary may provide technical 
assistance to recipients of awards under section 4 with respect to the 
planning, development, and operation of community health advisor 
programs.
    (c) Grants and Contracts.--The Secretary may carry out this section 
directly or through grants, cooperative agreements, or contracts.
    (d) Limitation on Expenditures.--Of the amounts appropriated under 
section 11 for a fiscal year, the Secretary may reserve not more than 5 
percent for carrying out this section.

SEC. 10. RULE OF CONSTRUCTION REGARDING PROGRAMS OF INDIAN HEALTH 
              SERVICE.

    This Act may not be construed as requiring the Secretary to modify 
or terminate the program carried out by the Director of the Indian 
Health Service and designated by such Director as the Community Health 
Representative Program. The Secretary shall ensure that support for 
such Program is not supplanted by awards under section 4. In 
communities in which both such Program and a community health advisor 
program are being carried out, the Secretary shall ensure that the 
community health advisor program works in cooperation with, and as a 
complement to, the Community Health Representative Program.

SEC. 11. FUNDING.

    (a) Authorization of Appropriations.--For the purpose of carrying 
out this Act, there are authorized to be appropriated such sums as may 
be necessary for each of the fiscal years 1996 through 2001.
    (b) Effect of Insufficient Appropriations for Minimum Allotments.--
            (1) In general.--If the amounts made available under 
        subsection (a) for a fiscal year are insufficient for providing 
        each State (or entity designated by the State pursuant to 
        section 4, as the case may be) with an award under section 4 in 
        an amount equal to or greater than the amount specified in 
        section 7(a)(2), the Secretary shall, from such amounts as are 
        made available under subsection (a), make such awards on a 
        discretionary basis.
            (2) Rule of construction.--For purposes of paragraph (1), 
        awards under section 4 are made on a discretionary basis if the 
        Secretary determines which States (or entities designated by 
        States pursuant to such section, as the case may be) are to 
        receive such awards, subject to meeting the requirements of 
        this subtitle for such an award, and the Secretary determines 
        the amount of such awards.
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