1. CHW workforce strategy meeting January 14, 2014Community Health Workers: National Update Carl H. Rush, MRP University of TexasHouston Institute for Health Policy

2. This session Review:what is distinctive about CHWs?Currentnational initiatives around CHWsOpportunities Whatsin Medicaid rule changeshappening in the states 3. Whats your definition of CHW?3 4. Community Health Worker Definition American Public Health Association (1) The CHW is a frontline public health workerwho is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW toserve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. 4 5. Community Health Worker Definition - APHA (2) The CHW also builds individual and communitycapacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informalcounseling, social support and advocacy. APHA Policy Statement 2009-1, November 20095 6. What Is Distinctive About CHWs? (1) Do not provide clinical careGenerally do not hold another professional licenseExpertise is based on shared life experience (and often culture) with people served6 7. What Is Distinctive About CHWs? (2) Rely on relationships and trust more than on clinical expertiseRelate to community members as peers rather than purely as clientsCan achieve certain results that other professionals cant7 8. Current national CHW initiatives (1) CDC CHW policy e-learning seriesOWH CHW leadership trainingDOL apprenticeable tradeOMH Promotora/CHW initiativeDOL occupational definitionNAO-APHA-UT curriculum guidelines project8 9. Current national CHW initiatives (2) HHS working group on CHWs: awareness campaign?HUD CHW InitiativesCMS Center for Innovation Grantee learning collaborative on CHWsState Innovation Models Rockefeller Foundation/Urban Institute study 9 10. Promoting Policy and Syste ms Change to Expand Employment of Community Health Workers (CHWs)Course DescriptionThis course is designed to provide state programs and other stakeholders with basic knowledge about Community Health Workers (CHWs), such as official definitions of CHWs, workforce development, and other topic areas. In addition, the course covers how states can become engaged in policy and systems change efforts to establish sustainability for the work of CHWs, including examples of states that have proven success in this arena.The six-session course covers CHWs roles and functions Current status of the CHW occupation Areas of public policy affecting CHWs Credentialing CHWs Sustainable funding for CHW positions Examples of states successful in moving policy and systems change forwardThe course sessions are self-paced. Completion time for each session is between 3045 minutes. The user does not have to take each session in succession. 11. Link to CDC E-learninghttp://1.usa.gov/Z0nNw8g11 12. Medicaid Breakthru: Preventive Services 78 FR 135 p. 42306: 7/15/13 (effective Jan. 2014) 440.130 Diagnostic, screening, preventive, and rehabilitative service Preventive services means services recommended by a physicianor other licensed practitioner (previously read provided by) Brings rules into conformance with ACA Commentary clearly reflects interest in funding services by CHWsand other nonlicensed providers Payment for CHW services will no longer need to be treated asadmin costs 13. Requirements to Take Advantage of Medicaid Rule Change State must file Medicaid State Plan Amendment (in a fewstates this requires legislative authorization) Must specify what non-licensed occupations are coveredand qualifications (skill requirements) not necessarily certification Must specify what services will be paid for (CPT codes) Must specify rates of payment and payment mechanism(FFS, MCO, bundled payment etc.) 14. Surge in state-level interest In addition to established initiatives in AK, FL, IN, MA, MN, NJ, NY, OH, TX: New movements in AZ, CO, IL, MS, NE, NM, OR, RI, SC, WIRecent State investigations in AR, CA, DE, GA, IA, LA, MD, MO, ND, PA, UT, VA,WA, WV 15. Updated 1/8/14 2014 Community Resources LLC 16. Common Elements In State Initiatives Gathering workforce dataConvening leadership and champions General education/awarenessCHW professional association/network Agreement on standards andcredentialing Strategies for susrainable CHW roles 17. Recent state/local innovations with CHWs Delaware Health AmbassadorsSeattle-King County CHW studyMedicaid 1115 waiver in TexasOregon CCO legislationSouth Carolina Medicaid pilotAkron OH Accountable Care CommunityNevada pooled funds pilot 18. CONTACT INFO Carl H. Rush, MRP Project on CHW Policy and Practice U. of Texas Institute for Health Policy PO Box 5533 San Antonio, TX 78201-0533 (210) 775-2709 (210) 241-3983 mobile carl.h.rush@uth.tmc.edu