[Congressional Record Volume 155, Number 15 (Monday, January 26, 2009)]
[Senate]
[Pages S836-S838]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mr. Durbin):
  S. 319. A bill to amend the Public Health Service Act to provide 
grants to promote positive health behaviors in women and children; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today, 
entitled the Community Health Workers Act of 2009, will help improve 
access to health education and outreach services to women and children 
in medically underserved areas, including the U.S. border region along 
New Mexico.
  Lack of access to adequate health care and health education is a 
significant problem on the southern New Mexico border. While the 
problem of access is in part due to a lack of insurance, it is also 
attributable to non-financial barriers such as a shortage of 
physicians, hospitals, and other health professionals; inadequate 
transportation; a lack of bilingual health information and health 
providers; and a culturally insensitive system of care.
  This legislation would help overcome these impediments by providing 
$15 million in grants annually for a 3 year period to State, local, and 
tribal organizations, including community health centers and public 
health departments, for the purpose of hiring community health workers 
to provide health education, outreach, and referrals to women and 
families who otherwise would have little or no contact with health care 
services.
  Factors such as poverty, language, and cultural differences impede 
access to health care in medically underserved populations; hence, 
community health workers are in a unique position to improve health 
outcomes and quality of care for groups that have traditionally lacked 
access to adequate services. They often serve as ``community 
specialists'' and are members of the communities in which they work. As 
such they can effectively serve hard-to-reach populations.
  In a shining example of how community health workers serve their 
communities, a group of so-called ``Promotoras'', community health 
workers, in Dona Ana County were quickly mobilized during a recent 
flood emergency in rural New Mexico. These community health workers 
assisted in the disaster recovery efforts by partnering with the 
Federal Emergency Management Agency, FEMA, to find, inform and register 
flood victims for Federal disaster assistance. Their personal networks 
and knowledge of the local culture, language, needs, assets, and 
barriers greatly enhanced FEMA's community outreach efforts. The 
Promotoras of Dona Ana County demonstrate the important role community 
health workers could play in communities across the Nation, including 
increasing the effectiveness of new initiatives in homeland security 
and emergency preparedness, and in implementing risk communication 
strategies.
  The positive benefits of the community health worker model also have 
been documented in research studies. Research has shown that community 
health workers have been effective in increasing the utilization of 
health preventive services such as cancer screenings and medical follow 
up for elevated blood pressure and improving enrollment in publicly 
funded health insurance programs. In the case of uninsured children, a 
study by Dr. Glenn Flores, ``Community-Based Case Management in 
Insuring Uninsured Latino Children,'' published in the December 2005 
issue of Pediatrics found that uninsured children who received 
community-based case management were eight times more likely to obtain 
health insurance coverage than other children involved in the study 
because case workers were employed to address typical barriers to 
access, including insufficient knowledge about application processes 
and eligibility criteria, language barriers and family mobility issues, 
among others. This study confirms that community health workers could 
be highly effective in reducing the numbers of uninsured children, 
especially those who are at greatest risk for being uninsured. 
Preliminary investigation of a community health workers project in New 
Mexico similarly suggests that community health workers could be useful 
in improving enrollment in Medicaid and the State Children's Health 
Insurance Program.
  According to a 2003 Institute of Medicine, IOM, report entitled, 
``Unequal Treatment: Confronting Racial and Ethnic Disparities in 
Healthcare,'' community health workers offer promise as a community-
based resource to increase racial and ethnic minorities' access to 
health care and to serve as a liaison between healthcare providers and 
the communities they serve.
  Although the community health worker model is valued in the New 
Mexico border region as well as other parts of the country that 
encounter challenges of meeting the health care needs of medically 
underserved populations, these programs often have difficulty securing 
adequate financial resources to maintain and expand upon their 
services. As a result, many of these programs are significantly limited 
in their ability to meet the ongoing and emerging health demands of 
their communities.
  The IOM report also noted that ``programs to support the use of 
community health workers . . .  especially among medically underserved 
and racial and ethnic minority populations, should be expanded, 
evaluated, and replicated.''
  I am introducing this legislation to increase resources for a model 
that has shown significant promise for increasing access to quality 
health care and health education for families in medically underserved 
communities.
  Mr. President, I ask unanimous consent that this statement and the 
text of the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 319

       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 2009''.

     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

[[Page S837]]

     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 health insurance 
     coverage, screening and medical follow-up 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--
       (1) by redesignating the second section 399R (relating to 
     the amyotrophic lateral sclerosis registry (42 U.S.C. 280g-
     7)) and the third section 399R (relating to support for 
     patients receiving a positive diagnosis of down syndrome or 
     other prenatally or postnatally diagnosed conditions (42 
     U.S.C. 280g-8)) as sections 399S and 399T respectively; and
       (2) by adding at the end the following:

     ``SEC. 399U. 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 and children in target populations, especially 
     racial and ethnic minority women and children 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 children and especially among racial and ethnic 
     minority women and children;
       ``(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 (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 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--

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       ``(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 and children under 21 years of age.
       ``(k) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $15,000,000 for each of fiscal years 2010, 2011, and 2012.''.
                                 ______