1. “Community Health Workers (CHWs) work in association with the local health care system (hospitals, doctors, clinics) in both urban and rural environments to bridge the gap between providers and underserved populations in need of care. They are members of the community who share ethnicity, language, socioeconomic status and life experiences with those they serve. CHWs provide culturally appropriate health education and information in order to assist people in receiving the care they need. They can give informal counseling and guidance on health behaviors; advocate for individual and community health needs; and provide some direct health services, like first aid and blood pressure screening.” http://www.abcardio.org/articles/cms_rule.html

3. 45 CFR Parts 155 and 156 [CMS–2334–F] RIN 0938–AR04 Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule. SUMMARY: This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act).

4. Comment: One commenter urged HHS to clarify that § 440.130 of the proposed regulation does not dictate who can provide preventive services; it merely dictates what providers can recommend them, consistent with the totality of the statute. Response: The proposed regulation does not dictate who can provide preventive services; it defines who can recommend such services. States will have discretion to determine which providers will provide the service using the state plan amendment process.

5. PART 440—SERVICES: GENERAL PROVISIONS ■ 35. Section 440.130 is amended by revising paragraph (c) to read as follows: § 440.130 Diagnostic, screening, preventive, 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— (1) Prevent disease, disability, and other health conditions or their progression; (2) Prolong life; and (3) Promote physical and mental health and efficiency.

6. 160 Hours of Training Communication Skills – Listening – Use language confidently and appropriately – Ability to read and write well enough to document activities Interpersonal Skills – Counseling – Relationship-building – Ability to work as a team member – Ability to work appropriately with diverse groups of people Service Coordination Skills – Ability to identify and access resources – Ability to network and build coalitions – Ability to provide follow-up Capacity-Building Skills – “ Empowerment” - Ability to identify problems and resources to help clients solve problems themselves – Leadership – Ability to strategize – Ability to motivate

7. Advocacy Skills – Ability to speak up for individuals or communities and withstand intimidation – Ability to use language appropriately – Ability to overcome barriers Teaching Skills – Ability to share information one-on-one – Ability to master information, plan and lead classes, and collect and use information from community people Organizational Skills – Ability to set goals and plan – Ability to juggle priorities and manage time Knowledge Base on Specific Health Issues – Broad knowledge about the community – Knowledge about specific health issues – Knowledge of health and social service systems – Ability to find information

8. From a Local University Medical School: “I am the PI on the RWJF grant to pilot the clinical curriculum that she and I and our Patient Care Team developed for the grant application. Our clinical curriculum we designed is intended to elevate the typical CHW to serve as a CMS-reimbursable Patient Health Advisor in a clinic setting rather than only in the home/community setting. This is an additional 40-hour clinical module (in addition to the general 160-hour CHW course) that would train students to measure vital signs conduct urine and saliva tests to detect a variety of disorders and/or diseases. Biomarkers such as proteins, glucose, ketones, hemoglobin, bilirubin, urobilinogen, acetone, nitrite and leucocytes as well as testing of pH and specific gravity as well as illicit drugs, pregnancy, and strep A will be taught as well as obtaining blood samples to check for cholesterol, A1C and some medications. This is just a snippet of the additional clinical education they will receive.”

9. EMS MIH-CP Implications Certify EMT’s as CHW? – Already a reimbursable service under some state essential benefit plans Will CHW’s be a better alternative to EMS personnel – The ‘value’ questions What “space” does EMS ‘own’ – …….