Covered CHW Services

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Two CHWs talking at a conference table.CHWs may provide patient education and care coordination and must:

  • Be supervised by a Medicaid-enrolled provider
  • Have order signed by authorized professional
  • Work under a documented care plan
  • Provide services face-to-face
  • Use an “established health education curriculum”

[SPEAKER]

After receiving CMS approval, the Minnesota Department of Human Services published regulations governing the reimbursement process. One essential provision is that, although a CHW must apply for registration as a Medicaid provider and receive a Medicaid provider number, the CHW may not bill the Minnesota health care plan or the Medicaid fee- for-service program directly. Billing is controlled by the supervising provider.

Under this policy, billable services are limited to diagnosis-related patient education support, and they may be provided only on the basis of an order signed by an authorized clinical professional as part of a documented plan of care. Only face¬to-face services are covered, but they may be provided in a group setting as well as individually. The definition of the procedure code used requires that CHWs use an established curriculum in delivering health education, but in practice the State requires simply that the health education be “grounded in” established health education materials, which may be developed by the supervising provider, and the CHW may conduct a variety of education and support activities with the patient.