MN COMMUNITY HEALTH WORKER AND COMMUNITY PARAMEDIC OVERVIEW Health Care Alliance Quarterly Meeting February 6, 2015 Kay Herzfeld Emerging Professions Coordinator Office of Rural Health & Primary Care Minnesota Department of Health Community Health Workers • American Public Health Association Definition: A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competency of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. CHW Job Titles CHWs work under many different job titles, depending on where they live and work, including: • promotores de salud/promatora • community health representative • community advisor • , outreach worker • peer educator, • patient navigator In January 2010, CHWs were officially recognized by the Department of Labor, Bureau of Labor Statistics, as Standard Occupational Classification 21-1094 CHW Education and Training Minnesota is currently the only state in the United States that offers a CHW curriculum in higher education. • Curriculum includes: • Core Competencies: 9 credits • Role, Advocacy and Outreach – 2 • Organization and Resources – 1 • Teaching and Capacity Building – 2 • Legal and Ethical Responsibilities – 1 • Coordination and Documentation - 1 • Communication and Cultural Competency - 2 • Health Promotion Competencies: 3 credits • Practice Competencies – Internship: 2 credits CHW Education and Training Seven schools offer the certificate program: • Minneapolis Community and Technical College, Minneapolis • Normandale Community College • Northwest Technical College, Bemidji (hybrid: online/in-person) • Rochester Community and Technical College, Rochester (as needed) • St. Catherine University, St. Paul • South Central College, Mankato (online) • Summit Academy OIC, Minneapolis • In order to enter the program, a CHW must have a high school diploma or completed a GED. • To date, 614 students completed the certification curriculum. CHW Employers Of the 614 students who completed the CHW certificate program, 267 are known to be working as a CHW. CHW Employers: • • • • • • • Community-based Nonprofits Clinics and Hospitals Federally Qualified Health Centers Public Health Departments Dental Clinics Community Mental Health Centers Faith-based Networks CHWs by County, 2015 2007 Minnesota Statute (MS 256B.0625, Subd. 49) CHW Payment and Reimbursement Supervision • MHCP requires general supervision of CHW by an MHCP enrolled (ordering provider): • Physician • Advanced Practice Registered Nurse • Certified Public Health Nurse • Dentist • Mental Health Professional MHCP Enrollment • MHCP requires CHW enrollment so they are represented on a claim as the rendering provider. • As of Jan. 2015 only 53 CHWs enrolled. CHW Payment and Reimbursement Covered Services • Educating patients on how to effectively self-manage their physical, oral and mental health. • CHW services are provided face-to-face with recipients (either individually or in a group) in their home, outpatient clinic, or other community setting. Non-covered services: • Enrollment assistance • Case management • Advocacy CHW Payment and Reimbursement Bill in 30 minute units • Limited to 4 units per 24 hours • No more than 8 units per calendar month • No more than 8 recipients can present for the service at a given time. Billing Codes and Rates • 98960 - self-management education and training face to face; 1 patient . Rate is $19.44 per unit. • 98961- self-management education and training face to face; 2-4 patients. Rate is $9.09 per unit. • 98962 - self-management education and training face to face; 5 8 patients . Rate is $6.56 per unit. Rates as of Dec. 2014, and are subject to change. Community Paramedics In 2007, as a means of addressing the sustainability of rural ambulance services and primary care workforce shortages, Minnesota funded a pilot program to educate skilled paramedics to increase their role in providing primary care to the uninsured, underinsured and medically underserved communities. A “Flex Grant” was provided by the Minnesota Department of Health, Office of Rural Health, to train 10 paramedics to this role. The Community Paramedic model was based on best practices of similar initiatives around the world, including the Alaska Community Health Aide, the Nova Scotia Community Paramedic model and the Australia Rural and Remote Paramedic Program. Pilot test 2011 Education and Training • CP concept grew from the traditional career ladder of Emergency Medical Technicians (EMTs) . • Certified First Responder • Emergency Medical Technician – Basic (EMT-B) • Emergency Medical Technician – Intermediate (EMT-I). • Eventually, EMTs can obtain a certification to become an Emergency Technician – Paramedic (EMT-P). • The Community Paramedic certification offers career Paramedics another level of training and a new way to contribute their skills. • Program consists of 114 didactic hours and 196 clinical hours which leads to the attainment of 14 credits toward a degree. Training Schools • Hennepin Technical College • • • • First CP certification program in U.S. 2012 first graduating class Trains students all over the country Virtual / ITV – for non-clinical hours • Inver Hills Community College • Program started 2014 • 110 Total Minnesota CPs trained to date. Certification • EMS Regulatory Board • Must be currently certified as a paramedic and have two years of full-time service as a paramedic or it’s part-time equivalent. • Successfully complete a community paramedic education program through an accredited college or university. • Practice under the supervision of an ambulance services medical director • Recertification every 2 years • 88 Certified CPs to date. Supervision • Works under the direction of an ambulance services Medical Director in coordination with patient’s primary care physician. Scope of Practice / Services Provided • Health assessments • Chronic disease monitoring and education • Medication compliance • Immunizations and vaccinations • Laboratory specimen collection • Hospital discharge follow-up care • Minor medical procedures approved by the Ambulance Medical Director CP Payment and Reimbursement • 2012 MN first state in U.S. to provide MA reimbursement for CPs. • Billed under an enrolled MHCP Ambulance Services Medical Director • Services part of a care plan ordered by a primary care provider (physician, advanced practice RN, physicians assistant) • “Face to face” time with patient covered only (approx. $60.00 per/hour) • Not covered: • Travel Time • Mileage • Facility Fee • Services related to hospital acquired conditions or treatments Essentia Ada North Memorial Hennepin Cty Med Ctr Scott County Operating Planned Park Rapids Allina HealthEast Shakopee Mdewakaton Tribe Lakewood Health System NorthBrainerd Ringdahl Tri County Hospital/EMS CPs included in Medicaid ACOs 2014: It’s official – there are savings!