Overview MO HealthNet is evaluating the potential to provide - PDF document

04/16/2018 COMMUNITY HEALTH WORKER STATE PLAN AMENDMENT Elizabeth Sissom, RN, MSN Timothy Kling, MD, FACOG Missouri Department of Social Services MO HealthNet Division April 19, 2018 Overview  MO HealthNet is evaluating the potential to provide coverage and reimbursement for preventive services provided by a Community Health Worker (CHW).  CMS rule from 2014 allows for payment opportunities for preventive services by non-licensed individuals. 1

04/16/2018 Possible Participant Criteria  Must be a member of a Health Home or a Medical Home  Identified as a High Utilizer, or  Have one of the following:  Diabetes  Lung Disease  Heart Disease  HIV/AIDS  Substance Use Disorder/Opioid Use Disorder  Obesity (children only) Possible Provider Qualifications  Certification by Missouri Credentialing Board  Certificate from an accredited institution of higher education  Grandfather Clause for current CHWs 2

04/16/2018 Considerations for Accessing Services  No prior authorization needed  Referral from primary care provider  Services can be provided to an individual or a group of up to 5 people. Resources  CDC Division for Heart Disease and Stroke Prevention. (2015) Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach (2 nd ed.). Available at: https://www.cdc.gov/dhdsp/docs/chw_brief.pdf 3