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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

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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

 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

pportunities for preventive services by non-licensed

individuals.

Overview

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 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 Participant Criteria

 Certification by Missouri Credentialing Board  Certificate from an accredited institution of higher

education

 Grandfather Clause for current CHWs

Possible Provider Qualifications

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 No prior authorization needed  Referral from primary care provider  Services can be provided to an individual or a

group of up to 5 people.

Considerations for Accessing Services

 CDC Division for Heart Disease and Stroke Prevention. (2015)

Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach (2nd ed.). Available at: https://www.cdc.gov/dhdsp/docs/chw_brief.pdf