1. MN community Health Worker and Community Paramedic Overview
Health Care Alliance Quarterly Meeting
February 6, 2015
Kay Herzfeld
Emerging Professions Coordinator Office of Rural Health & Primary Care
Minnesota Department of Health

2. Community Health Workers
American Public Health Association Definition:
A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competency of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

3. CHW Job Titles
CHWs work under many different job titles, depending on where they live and work, including:
promotores de salud/promatora
community health representative
community advisor
, outreach worker
peer educator,
patient navigator
In January 2010, CHWs were officially recognized by the Department of Labor, Bureau of Labor Statistics, as Standard Occupational Classification

4. CHW Education and Training
Minnesota is currently the only state in the United States that offers a CHW curriculum in higher education.
Curriculum includes:
Core Competencies: 9 credits
Role, Advocacy and Outreach – 2
Organization and Resources – 1
Teaching and Capacity Building – 2
Legal and Ethical Responsibilities – 1
Coordination and Documentation - 1
Communication and Cultural Competency - 2
Health Promotion Competencies: 3 credits
Practice Competencies – Internship: 2 credits

5. CHW Education and Training
Seven schools offer the certificate program:
Minneapolis Community and Technical College, Minneapolis
Normandale Community College
Northwest Technical College, Bemidji (hybrid: online/in-person)
Rochester Community and Technical College, Rochester (as needed)
St. Catherine University, St. Paul
South Central College, Mankato (online)
Summit Academy OIC, Minneapolis
In order to enter the program, a CHW must have a high school diploma or completed a GED.
To date, 614  students completed the certification curriculum.

6. CHW Employers
Of the 614 students who completed the CHW certificate program, 267 are known to be working as a CHW. CHW Employers:
Community-based Nonprofits
Clinics and Hospitals
Federally Qualified Health Centers
Public Health Departments
Dental Clinics
Community Mental Health Centers
Faith-based Networks

7. CHWs by County, 2015

8. 2007 Minnesota Statute (MS 256B.0625, Subd. 49)

9. CHW Payment and Reimbursement
Supervision
MHCP requires general supervision of CHW by an MHCP enrolled (ordering provider):
Physician
Advanced Practice Registered Nurse
Certified Public Health Nurse
Dentist
Mental Health Professional
MHCP Enrollment
MHCP requires CHW enrollment so they are represented on a claim as the rendering provider.
As of Jan only 53 CHWs enrolled.

10. CHW Payment and Reimbursement
Covered Services
Educating patients on how to effectively self-manage their physical, oral and mental health.
CHW services are provided face-to-face with recipients (either individually or in a group) in their home, outpatient clinic, or other community setting.
Non-covered services:
Enrollment assistance
Case management
Advocacy

11. CHW Payment and Reimbursement
Bill in 30 minute units
Limited to 4 units per 24 hours
No more than 8 units per calendar month
No more than 8 recipients can present for the service at a given time.
Billing Codes and Rates
self-management education and training face to face; 1 patient . Rate is $19.44 per unit.
self-management education and training face to face; 2-4 patients. Rate is $9.09 per unit.
self-management education and training face to face; 5 8 patients . Rate is $6.56 per unit.
Rates as of Dec. 2014, and are subject to change.

12. Community Paramedics

14. In 2007, as a means of addressing the sustainability of rural ambulance services and primary care workforce shortages, Minnesota funded a pilot program to educate skilled paramedics to increase their role in providing primary care to the uninsured, underinsured and medically underserved communities.
A “Flex Grant” was provided by the Minnesota Department of Health, Office of Rural Health, to train 10 paramedics to this role.
The Community Paramedic model was based on best practices of similar initiatives around the world, including the Alaska Community Health Aide, the Nova Scotia Community Paramedic model and the Australia Rural and Remote Paramedic Program.

15. Pilot test

16. 2011

17. Education and Training
CP concept grew from the traditional career ladder of Emergency Medical Technicians (EMTs) .
Certified First Responder
Emergency Medical Technician – Basic (EMT-B)
Emergency Medical Technician – Intermediate (EMT-I).
Eventually, EMTs can obtain a certification to become an Emergency Technician – Paramedic (EMT-P).
The Community Paramedic certification offers career Paramedics another level of training and a new way to contribute their skills.
Program consists of 114 didactic hours and 196 clinical hours which leads to the attainment of 14 credits toward a degree.

18. Training Schools
Hennepin Technical College
First CP certification program in U.S.
2012 first graduating class
Trains students all over the country
Virtual / ITV – for non-clinical hours
Inver Hills Community College
Program started 2014
110 Total Minnesota CPs trained to date.

19. Certification EMS Regulatory Board
Must be currently certified as a paramedic and have two years of full-time service as a paramedic or it’s part-time equivalent.
Successfully complete a community paramedic education program through an accredited college or university.
Practice under the supervision of an ambulance services medical director
Recertification every 2 years
88 Certified CPs to date.

20. Scope of Practice / Services Provided
Supervision
Works under the direction of an ambulance services Medical Director in coordination with patient’s primary care physician.
Scope of Practice / Services Provided
Health assessments
Chronic disease monitoring and education
Medication compliance
Immunizations and vaccinations
Laboratory specimen collection
Hospital discharge follow-up care
Minor medical procedures approved by the Ambulance Medical Director

21. CP Payment and Reimbursement
2012 MN first state in U.S. to provide MA reimbursement for CPs.
Billed under an enrolled MHCP Ambulance Services Medical Director
Services part of a care plan ordered by a primary care provider (physician, advanced practice RN, physicians assistant)
“Face to face” time with patient covered only (approx. $60.00 per/hour)
Not covered:
Travel Time
Mileage
Facility Fee
Services related to hospital acquired conditions or treatments

22. Essentia Ada
North Memorial
Park Rapids
Allina
Lakewood Health System
HealthEast
North-Brainerd
Hennepin Cty Med Ctr
Ringdahl
Tri County Hospital/EMS
Shakopee Mdewakaton Tribe
Scott County
Operating
Planned

23. CPs included in Medicaid ACOs
2014: It’s official – there are savings!