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5313 - Grants to Promote the Community Health Workforce

 
Implementation Status 
Statutory Text 

Summary

Requires the CDC to award grants to public and nonprofit private entities (including states, hospitals, FQHCs, and others), to leverage community health workers in the promotion of positive health behaviors and outcomes for populations in medically underserved communities.  Community health workers are required to, among other things, educate and provide outreach regarding enrollment in health insurance, including Medicare, Medicaid, and CHIP.  Delineates certain specifications relative to funding prioritization.  Specifies details regarding collaboration with academic institutions and the “one-stop delivery system,” as well as an overall emphasis on evidence-based (outcome-oriented) interventions.  Authorizes to be appropriated (but does not delineate a separate Congressional appropriation) such sums as may be necessary for each of FYs 2010-2014.  As revised by section 10501(c) of the Senate Manager’s Amendment, delineates revisions to the use of funds and the definition of community health workers.

Implementation Status

 
Summary 
Statutory Text 

Due to the lack of appropriated funding, no grants have been made pursuant to this provision.  However, prior to January 2013, the CDC issued a brief acknowledging the authorization of this provision in the role of expanding the community health workforce.

2014

HHS announced the award of $35.7 million in Affordable Care Act funding to 147 health centers across 44 states, the District of Columbia, and Puerto Rico. The funding is intended support the construction of 21 new projects and 126 facility alterations for patient-centered medical homes. The full list of individual grants is available here.

On August 11, 2014 HRSA celebrated America’s health centers 45 years of care to underserved areas during National Health Center week. Specifically HRSA noted the “21.7 million patients receive health care services from the nearly 1,300 health centers operating more than 9,200 primary care sites across the nation.”

On Sept. 12, Secretary Sylvia M. Burwell announced Health Center Expanded Services awards of $295 million to 1,195 health centers. The press release noted that “the Expanded Services awardees are expected to increase access to comprehensive primary care services by hiring an estimated 4,750 new staff including new health care providers, staying open for longer hours, and expanding the care they provide to include new services such as oral health, behavioral health, pharmacy, and vision services.” See the full list here.

Sept. 10, 2014, the CDC released its Morbidity and Mortality Weekly Report (MMWR) Supplement (see press release here) emphasizing that millions of infants, children and adolescents do not receive key clinical preventive services. Clinical preventive services include important medical and dental care that facilitate healthy development in infants and children. The CDC report looks at 11 clinical services that prevent and help detect conditions and diseases in their earliest, most treatable stage to reduce illness, disability and expensive care.

The National Academy for State Health Policy published a report offering the first comprehensive look at the opportunities in the Affordable Care Act (ACA) to drive better outcomes for children and parents together.

October 1, 2014, Sen. Debbie Stabenow (D-MI), co-chair of the Senate Community Health Centers (CHC) Caucus, along with a bipartisan group of 65 senators sent a letter (here) urging Senate leaders to continue to support CHCs beyond the Fiscal Year (FY) 2015 budgetary window when the Affordable Care Act (ACA) mandatory Health Center Fund is set to expire.

On October 16, 2014, HRSA announced a roughly $100 million funding opportunity (additional details) soliciting applications under the Health Center Program’s Service Area Competition (SAC). Qualifying organizations “seeking a grant for operational support of an announced service area under the Health Center Program, including Community Health Center (CHC – section 330(e)), Migrant Health Center (MHC – section 330(g)), Health Care for the Homeless (HCH – section 330(h)), and/or Public Housing Primary Care (PHPC – section 330(i))” can apply before  Dec. 3, 2014.

In early Oct., Sen. Debbie Stabenow (D-MI), co-chair of the Senate Community Health Centers (CHC) Caucus, along with a bipartisan group of 65 senators sent a letter (here) urging Senate leaders to continue to support CHCs beyond the FY 15 budgetary window when the ACA mandatory Health Center Fund is set to expire.

On Nov. 6, HRSA announced $51.3 million in ACA funding to support 210 health centers to establish or expand behavioral health services for nearly 440,000 people.  With grants distributed among 47 states, the District of Columbia, and Puerto Rico, health centers use these new funds to hire new mental health professionals, add mental health and substance use disorder health services, and employ integrated models of primary care.  Earlier this year, the agency awarded $54.5 million in ACA funding for 223 other health centers to expand behavioral health services. A list of awardees is available here.

On Nov. 19, HRSA announced the availability of three separate grants to support the Health Center Program funding through a “variety of community-based and patient-directed public and private nonprofit organizations that serve an increasing number of the Nation’s underserved.” Various application deadlines are stipulated, though in general, are due Dec. 3, 2014 or Dec. 17, 2014.

On Nov. 24, HRSA announced the availability of roughly $1.1M to fund health centers working to improve the health of underserved communities and vulnerable populations. These grants “support a variety of community-based and patient-directed public and private nonprofit organizations that serve an increasing number of the Nation’s underserved.” Applications are due Jan 7, 2015.

 

Statutory Text

 
Implementation Status 
Summary 

SEC. 5313. GRANTS TO PROMOTE THE COMMUNITY HEALTH
WORKFORCE.
(a) IN GENERAL.—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. 399V. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND
OUTCOMES.
‘‘(a) GRANTS AUTHORIZED.—The Director of the Centers for Disease Control and Prevention, in collaboration with the Secretary,
shall award grants to eligible entities to promote positive health
behaviors and outcomes for populations in medically underserved
communities through the use of community health workers.
‘‘(b) USE OF FUNDS.—Grants awarded under subsection (a) shall
be used to support community health workers—
‘‘(1) to educate, guide, and provide outreach in a community
setting regarding health problems prevalent in medically underserved communities, particularly racial and ethnic minority
populations;
‘‘(2) to educate and provide guidance regarding effective
strategies to promote positive health behaviors and discourage
risky health behaviors;
‘‘(3) to educate and provide outreach regarding enrollment
in health insurance including the 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;
‘‘(4) to identify, educate, refer, and enroll underserved populations to appropriate healthcare agencies and communitybased programs and organizations in order to increase access
to quality healthcare services and to eliminate duplicative care;
or
‘‘(5) to educate, guide, and provide home visitation services
regarding maternal health and prenatal care.
‘‘(c) APPLICATION.—Each eligible entity 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 information as the Secretary may require.
‘‘(d) PRIORITY.—In awarding grants under subsection (a), the
Secretary shall give priority to applicants that—
‘‘(1) 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 residents who suffer
from chronic diseases; or
‘‘(C) with a high infant mortality rate;
‘‘(2) have experience in providing health or health-related
social services to individuals who are underserved with respect
to such services; and
‘‘(3) have documented community activity and experience
with community health workers.
‘‘(e) COLLABORATION WITH ACADEMIC INSTITUTIONS AND THE
ONE-STOP DELIVERY SYSTEM.—The Secretary shall encourage
community health worker programs receiving funds under this section to collaborate with academic institutions and one-stop delivery
systems under section 134(c) of the Workforce Investment Act of
1998. Nothing in this section shall be construed to require such
collaboration.
‘‘(f) EVIDENCE-BASED INTERVENTIONS.—The Secretary shall
encourage community health worker programs receiving funding
under this section to implement a process or an outcome-based

payment system that rewards community health workers for connecting underserved populations with the most appropriate services
at the most appropriate time. Nothing in this section shall be
construed to require such a payment.
‘‘(g) 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 costeffectiveness of such programs.
‘‘(h) MONITORING.—The Secretary shall monitor community
health worker programs identified in approved applications under
this section and shall determine whether such programs are in
compliance with the guidelines established under subsection (g).
‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may provide technical assistance to community health worker programs identified
in approved applications under this section with respect to planning,
developing, and operating programs under the grant.
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated, such sums as may be necessary to carry out
this section for each of fiscal years 2010 through 2014.
‘‘(k) DEFINITIONS.—In this section:
‘‘(1) COMMUNITY HEALTH WORKER.—The term ‘community
health worker’, as defined by the Department of Labor as
Standard Occupational Classification [21–1094] 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
healthcare agencies;
‘‘(B) by providing guidance and social assistance to
community residents;
‘‘(C) by enhancing community residents’ ability to effectively communicate with healthcare providers;
‘‘(D) by providing culturally and linguistically appropriate health or nutrition education;
‘‘(E) by advocating for individual and community
health;
‘‘(F) by providing referral and follow-up services or
otherwise coordinating care; and
‘‘(G) by proactively identifying and enrolling eligible
individuals in Federal, State, local, private or nonprofit
health and human services programs.
‘‘(2) COMMUNITY SETTING.—The term ‘community setting’
means a home or a community organization located in the
neighborhood in which a participant in the program under
this section resides.
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible entity’ means a
public or nonprofit private entity (including a State or public
subdivision of a State, a public health department, a free health
clinic, a hospital, or a Federally-qualified health center (as
defined in section 1861(aa) of the Social Security Act)), or
a consortium of any such entities.
‘‘(4) 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.’’.

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