CDC Policy Evidence Assessment Report
The CDC released a policy evidence assessment report on CHWs in late 2014. The report discusses policy components, which are discrete activities that could be part of public health policy. The CDC identified 14 CHW policy components to assess using the Quality and Impact Component (QuIC) Evidence Assessment method, which categorizes policies on a continuum of Emerging, Promising Impact, Promising Quality, and Best. Of the 14 policies assessed by the CDC, 8 were categorized as “Best” in the Evidence Strength Assessment.
Read more about the best practices in the full report on CDC’s website. You can also learn about how MiCHWA is using this report by reviewing our June 2011 stakeholder forum slides. Learn more about our series of stakeholder forums here.
SPAs, Waivers, & Beyond
We get asked about other states and Medicaid — a lot. More coming soon on what we know!
Federal Register Ruling: Vol. 78, No. 135, July 15, 2013
The Federal Register is a daily publication of the US federal government that issues proposed and final administrative regulations of federal agencies. On page 42306, the following ruling is cited:
§440.130 — Diagnostic, screening, preventative, and rehabilitative services.
“(c) Preventive services means services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law to —
- Prevent disease, disability, and other health conditions or their progression
- Prolong life
- Promote physical and mental health and efficiency. “
Per the register, this final rule “does not dictate who can provide preventive services; it defines who can recommend such services.” As long as preventive services are prescribed by a physician or licensed practitioner, the person actually providing preventive services can be a community health worker or other non-credentialed professional. The register indicates that “States will have discretion to determine which providers will provide the service using the state plan amendment process.” If CHWs and advocates see this as an opportunity for CHW integration into health and human service systems, advocates need to know the current Medicaid state plan, whether an amendment process is underway regarding this ruling, and, if it exists, when it is expected to be submitted to CMS for review. CHWs need to have the majority voice for drafting recommendations concerning their profession in this process.
Patient Protection & Affordable Care Act of 2010 (H.R. 3590)
The Patient Protection and Affordable Care Act of 2010 (PPACA) specifically cites the use of CHWs as an effective way of improving health outcomes as part of a health care team while containing costs.1 The law lists “community health worker” as a member of the health care workforce and as a health professional2; the law also authorizes the Centers for Disease Control and Prevention to fund agencies who train health care team members, including CHWs, and to direct intervention grants “to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.” 3
The law defines community health worker as “an individual who promotes health or nutrition within the community in which the individual resides.” 3
You can read more about the law, including its text in full, here.
For more about CHWs and the PPACA, MiCHWA recommends a 2011 article from the American Journal of Public Health titled “Transforming the delivery of care in the post-health reform era: what role will community health workers play?”
Citation: Martinez J, Ro M, Villa NM, Powell W, Knickman JR. Transforming the delivery of care in the post-health reform era: what role will community health workers play? American Journal of Public Health. 2011;101(12):e1-e5.
1 Patient Protection and Affordable Care Act, 42 USCA §18001 (2010).
2 Patient Protection and Affordable Care Act, 42 USCA §294q (2010).
3 Patient Protection and Affordable Care Act, 42 USCA §280g-11 (2010).
Patient Protection & Affordable Care Act of 2010 (H.R. 3590): Text By Section
§5101 — National Health Care Workforce CommissionCHWs are listed as a health care provider under the “health care workforce” and are defined as health professionals.
§5313 — Grants to Promote the Community Health Workforce
The CDC “awards grants to eligible entities that promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.” Grants are used to support CHWs and their roles for education and outreach in the following areas:
- Prevalent health problems in medically underserved communities, particularly racial and ethnic minority populations
- Promotion of health behaviors and discouragement of risky health behaviors
- Enrollment in health insurance
- Identify and referring individuals to healthcare agencies and social services to increase access and eliminate duplicative care
- Provide home visitation services for maternal health and prenatal care
§5403 — Interdisciplinary, Community-based, LinkagesThe Secretary shall award grants to Area Health Education Centers to “Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers, public and allied health professionals, or other health professionals, as practicable.”
Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
In 2009, Congress reauthorized the Children’s Health Insurance Program (CHIP). CHIP provides insurance coverage to many low-income children who are otherwise uninsured. As part of this program, “the law makes explicit that CHIP outreach funds can be used for activities conducted by community health workers” according to a summary of the law by Georgetown University. You can read more about what CHIPRA does through the Kaiser Family Foundation’s CHIPRA page. CHWs are currently working as part of CHIPRA in Michigan.