Posted on: 13 February 2014 By: Joel.RAMP

I'm hoping to hear more information about how exactly any Community Health Workers were funded using Medicaid dollars. On the call the presenter from Oregon mentioned that billing rates were established which suggests fee for service. I'd appreciate hearing more details. For example: 

-- On a fee for service basis, did the CHW program bill the state and/or did it bill managed care organizations? 

-- Do managed care organizations provide CHW services as part of the managed care funding they receive from the states (i.e., non-fee for service)? 

Thanks!

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deirdras


Thu, 02/13/2014 - 15:29

There are a few different ways CHWs have been or could be reimbursed. Previous to the new rule, if a state licensed CHWs, they could be reimbursed as "other licensed practitioners." (Minnesota) If a state has a SPA approved to cover preventive services provided by other qualified providers per the rule discussed today, those providers could be reimbursed for providing the services either as fee for service or through managed care depending on the state's Medicaid structure. The details will vary by state. 

Joel.RAMP


Thu, 02/13/2014 - 15:32

Thanks for the response. 

You wrote that "providers could be reimbursed for providing the services either as fee for service or through managed care depending on the state's Medicaid structure."

I would really appreciate additional information or examples about CHWs being supported via managed care. Do you have anything more you can share? Additional details, case studies, other to talk to...anything would be helpful. 

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