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
• 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
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
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
• Eventually, EMTs can obtain a certification to
become an Emergency Technician – Paramedic
• 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.
• 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
• Successfully complete a community paramedic
education program through an accredited college or
• Practice under the supervision of an ambulance services
medical director
• Recertification every 2 years
• 88 Certified CPs to date.
• 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
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
Cty Med Ctr
Scott County
Park Rapids
Ringdahl Tri County
CPs included in Medicaid ACOs
2014: It’s official –
there are savings!

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