State Community Health Worker Legislation Current Practices Across the United States

NCSL “Incorporating Community Health workers into State Health Care Systems: options for Policymakers” August 2015 Page 6

State Community Health Worker Legislative Action and Policy Considerations

Community Health Worker Regulation Professional Title Authorization or Credentialing Defined Scope of Practice Establish Core Credentials for Education Standards of Practice Authorized Reimbursement

Ohio Revised Code 4723.81 Certification of community health workers program. 4723.82 Community health worker certificate. 4723.83 Application for certificate. 4723.84 Eligibility for certificate. 4723.85 Review and renewal of application. 4723.86 Denial, revocation or suspension of certificate. 4723.87 Community health worker training programs. 4723.88 Community health worker standards and procedures.

Ohio Administrative Code 4723-26-01 Definition of terms. 4723-26-02 Community health worker certification. 4723-26-03 [Rescinded] Procedures for obtaining a certificate to practice as a community health worker by endorsement. 4723-26-04 Renewal of community health worker certificate. 4723-26-05 Continuing education requirements. 4723-26-06 Nurse delegation to community health workers. 4723-26-07 Prohibitions on delegation. 4723-26-08 Criteria and standards for a registered nurse delegating to a community health worker. 4723-26-09 Supervision of the performance of a nursing task performed by a community health worker. 4723-26-10 Standards of safe care provided by the community health worker. 4723-26-11 Disciplinary actions against certified community health workers; investigations. 4723-26-12 Standards for community health worker training programs. 4723-26-13 Standard curriculum for community health worker training programs. 4723-26-14 Procedures for obtaining approval or reapproval of community health worker training programs.

Workforce Development Establish state-level standards for education and training Encourage the development of training programs in various state agencies Require specific education and training for specific jobs Encourage CHW training to be part of health care teams Allocate funding authorization for CHW workforce development

CHWs’ Effect on Quality and Cost Potential to improve quality and control or decrease cost Role of CHW aligns with goals of community care teams, primary care providers and patient-centered medical homes Strengthen understanding of community health needs Enhanced cultural competence and improved communication between providers and patients

Financing Mechanisms Reimbursement considerations often begin with establishing credentialing Encourage supportive state Medicaid payment options Consider state and federal grants (establish pilot programs) Work with managed care organizations and private payers on reimbursement models Add CHWs to health care teams focused on integrated and patient-centered care Support data collection and research on cost benefits (limited cost savings research to date)

State Community Health Worker Program Examples

Oregon Patient Centered Medical Home Program covers services provided by certified CHWs Key Funding—Medicaid State Plan Amendment Example of CHW Services—Ensure patients regularly see their health care provider and receive chronic disease management (e.g., home visits to manage asthma treatment)

Kentucky Kentucky Homeplace, established in 1994 Employs CHWs in underserved and rural communities Housed within the University of Kentucky (UK) Center for Excellence in Rural Health Key Funding—Kentucky Department for Public Health contracts with UK Center for Rural Health (GRF funding) Helps patients access health resources, including food, eyeglasses and dentures

South Carolina South Carolina Department of Health and Human Services’ (SCDHHS) Health Access at the Right Time (HeART) initiative Includes CHWs in primary care practices as community liaisons Key Funding—Eligible primary care physician practices receive a grant from the SCDHHS Two billing codes available for CHW services

Sustainable Financing Post 2016 Election What is the future of the Affordable Care Act (ACA)? How will ACA changes effect health policy on the state and federal level? What is the future of CHWs and program funding?

Resources www.nursing.ohio.gov http://www.ncsl.org/Portals/1/Documents/Health/CHWbrief2015.pdf http://www.cdc.gov/dhdsp/pubs/docs/chw_state_laws.pdf http://www.nashp.org/state-community-health-worker-models/ http://www.astho.org/Community-Health-Workers/

Contact Information Tom Dilling Legislative Liaison/Adjudication Coordinator Ohio Board of Nursing 17 S. High St., Suite 400 Columbus, OH 43215-7410 E-mail: tdilling@nursing.ohio.gov Tel: (614) 644-5689 Fax: (614) 995-3686