Last week the Centers for Medicare & Medicaid Services approved AHCCCS’ request to begin reimbursing Community Health Workers for services provided to Medicaid members. CHWs are an integral and essential part of the health care delivery system, often at the front lines of the intersection between communities and health care providers.
CHWs often are also known by other names, such as Community Health Representatives, Patient Navigator, Promotores de Salud, Community Health Advisors, and Cultural Health Navigators, to name a few. Approval to reimburse CHWs for services is effective April 1, 2023.
Last week’s action brings full circle to the multi-year effort to build a reimbursement pathway for CHWs in Arizona. Way back in 2016 a group of stakeholders including AZPHA began pressing to give the ADHS the statutory responsibility to certify CHWs, a pre-requisite for reimbursement under Medicaid.
We succeeded in getting that authority in 2018 when the Arizona Legislature passed House Bill 2324, requiring ADHS to establish qualifications, a scope of practice, and core competencies for Certified Community Health Workers. That bill was successful due to the tenacious work be then Representative Heather Carter. See the ADHS Community Health Workers web page.
Starting April 1, 2023, AHCCCS and their contractors will be able to reimburse certified CHWs when their services are recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice.
Services must be documented in the member’s medical record and may include health system navigation and resource coordination, health education and training, and health promotion and coaching.
AHCCCS has three billing codes for CHW’s: 98960- patient education & training for 1 patient for 30 minutes; 98961- for a group of two to four patients; and 98962- or a group of five to eight patients.
CHW Certification Portal Now Open
Arizona’s Community Health Workers can apply for voluntary certification once they show they meet the standards and have successfully completed an approved training program. Here is the ADHS certification portal. ADHS is using a federal grant to temporarily bring the certification fee down to $1, but that will end when the grant funding ends. Applications are fully electronic and available at azhealth.gov/CHW.