[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2139 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2139

  To amend the Public Health Service Act to provide grants to promote 
                  positive health behaviors in women.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 17, 2002

 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.

    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 ``Community Health Workers Act of 
2002''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Chronic diseases, defined as any condition that 
        requires regular medical attention or medication, 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 behaviors 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 percent 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 contribute to racial and 
        ethnic disparities in health factors, including premature 
        death, life expectancy, risk factors associated with major 
        diseases, and the extent 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 provided within the 
        community and the home may lessen the impact of chronic 
        outcomes, while strengthening families and communities.
            (9) Community health workers, who are primarily women, can 
        be a critical component in conducting health promotion and 
        disease prevention efforts in medically underserved 
        populations.
            (10) Recognizing the difficult barriers confronting 
        medically underserved communities (poverty, geographic 
        isolation, language and cultural differences, lack of 
        transportation, low literacy, and lack of access to services), 
        community health workers 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 increasing screening and 
        medical followup visits among residents with limited access or 
        underutilization 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 percent of the total population below 200 
        percent poverty in the United States.

SEC. 3. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS 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 BEHAVIORS IN WOMEN.

    ``(a) Grants Authorized.--The Secretary, in collaboration with the 
Director of the Centers for Disease Control and Prevention and other 
Federal officials determined 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 prevalent 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 within 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 awareness; and
            ``(6) to educate and refer target populations to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to quality health 
        care services, including preventive health services.
    ``(c) Application.--
            ``(1) In general.--Each State or local or tribal 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 accompanied 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 assistance 
                under this section is sought;
                    ``(B) contain an assurance that with respect to 
                each community health worker program 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 applicant will 
                evaluate the effectiveness of community health worker 
                programs receiving funds under the grant;
                    ``(D) contain an assurance that each community 
                health worker program receiving funds under the grant 
                will provide services in the cultural context most 
                appropriate for the individuals served by the program;
                    ``(E) contain a plan to document and disseminate 
                project description and results to other States and 
                organizations as identified by the Secretary; and
                    ``(F) describe plans to enhance the capacity of 
                individuals to utilize health services and health-
                related social services under Federal, State, and local 
                programs by--
                            ``(i) assisting individuals in establishing 
                        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 translation 
                        services.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to those applicants--
            ``(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 Institutions.--The Secretary 
shall encourage community health worker programs receiving funds under 
this section to collaborate with academic institutions. Nothing in this 
section shall be construed to require such collaboration.
    ``(f) Quality Assurance and Cost-Effectiveness.--The Secretary 
shall establish guidelines for assuring the quality of the training and 
supervision of community health workers under the programs funded under 
this section and for assuring the cost-effectiveness of such programs.
    ``(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 (e).
    ``(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 submit 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 programs;
                            ``(ii) the cost of these programs; and
                            ``(iii) the impact of the project on the 
                        health outcomes of the community residents.
                    ``(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 communities 
                and health care agencies;
                    ``(B) by providing guidance and social assistance 
                to community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with health care providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health or nutrition needs; and
                    ``(F) by providing referral and followup services.
            ``(2) Community setting.--The term `community setting' 
        means a home or a community organization located in the 
        neighborhood in which a participant resides.
            ``(3) Medically underserved community.--The term `medically 
        underserved community' means a community identified by a 
        State--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved population, 
                as defined by section 330(b)(3); and
                    ``(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, regardless of their current 
        childbearing status.
    ``(k) Authorization of Appropriations.--There are 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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