C.R.S.
Section 25.5-5-334
Community health worker services
- federal authorization
- reporting
- rules
- definition
(1)
As used in this section, unless the context otherwise requires, “community health worker” means a frontline public health worker who serves as a liaison between health-care providers or social service providers and community members in order to facilitate access to physical, behavioral, or dental health-related services, or services to address social determinants of health, and who improves the quality and cultural responsiveness of health-related service delivery.(2)
No later than July 1, 2024, the state department shall seek federal authorization from the centers for medicare and medicaid services to provide reimbursement for community health worker services including, but not limited to, the delivery of preventive services, group and individual health education and health coaching, health navigation, transitions of care supports, screening and assessment for nonclinical and social needs, and individual support and health advocacy.(3)
Prior to seeking federal authorization, the state department shall hold at least four public stakeholder meetings to facilitate public engagement and solicit input from relevant stakeholders on the development of the required elements for federal authorization. Relevant stakeholders include, but are not limited to, community health workers, representatives from a statewide group representing community health workers, consumer advocates, local public health agencies, public health nonprofits and institutes, representatives from Colorado department of public health and environment-recognized training programs for health navigators and community health workers, health-care providers, managed care entities, representatives from schools and school-based health centers, and the Colorado department of public health and environment. At a minimum, the state department shall seek input from stakeholders regarding:(a)
Ways to ensure community health workers serve to reduce health disparities and increase health equity;(b)
Minimum qualifications for community health workers, such as training and skills-based experience requirements;(c)
Methods for minimizing the burden of entering into the community health workforce;(d)
A patient safety monitoring responsibilities and grievance process;(e)
What services provided by a community health worker will be considered covered services and noncovered services;(f)
Processes and requirements regarding provider types, provider enrollment, billing codes, places of service, and any other operational component necessary for implementation in the medicaid management information system;(g)
Reimbursement using the fee-for-service managed care or values-based payment models for community health workers with consideration of the use of alternative payment methodologies in the future;(h)
New provider types that could facilitate community health worker services outside of traditional health-care settings, such as community-based organizations; and(i)
Clarification on community health workers’ role and scope of practice as part of a delivery system that may include case management, care management, and care coordination services provided by managed care entities, community-centered boards, single entry points, behavioral health administrative service organizations, case management agencies, and health-care providers.(4)
In consideration of opportunities for future expansion of the community health worker workforce, the Colorado department of public health and environment is encouraged to partner with the state department and stakeholders to make recommendations for training and competency standards related to specialization that would enable community health workers to specialize their work with different populations and health conditions.(5)
Costs associated with services provided by community health workers through a federally qualified health center, as defined in the federal “Social Security Act”, 42 U.S.C. sec. 1395x (aa)(4), are considered allowable costs for the purposes of a federally qualified health center’s cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in federally qualified health centers’ cost reports.(6)
Costs associated with services provided by community health workers through a rural health clinic, as defined in the federal “Social Security Act”, 42 U.S.C. sec. 1395x (aa)(2), are considered allowable costs for the purposes of a rural health clinic’s cost report. The state department shall work with stakeholders to determine how services provided by community health workers will be captured in rural health centers’ cost reports.(7)
The state department shall consult with the Colorado department of public health and environment in promulgating rules concerning the voluntary competency-based community health worker registry managed by the Colorado department of public health and environment and any additional criteria or standards that may be necessary.(8)
For purposes of medicaid reimbursement, a community health worker shall:(a)
Work under the supervision of a clinician or within a licensed or otherwise approved and medicaid-enrolled health provider agency; and(b)
Meet the minimum qualifications and credentialing requirements of the voluntary competency-based community health worker registry as defined in section 25-20.5-112.(9)
The state department shall ensure that reimbursement policies and federal authorities for existing unlicensed health workers, such as peer support professionals, recovery professionals, managed care navigation staff, and others, are aligned and incorporated with the community health worker payment models.(10)
On or before January 31, 2026, the state department shall report on ways community health workers are being utilized through the state medical assistance program and include available data or any identified costs or savings associated with community health worker services and considerations for the general assembly to expand community health worker services in community-based organizations that are outside of the traditional health-care setting in its presentation to the joint budget committee of the general assembly and in its presentation to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of the “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act”.
Source:
Section 25.5-5-334 — Community health worker services - federal authorization - reporting - rules - definition, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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