A community health worker (CHW) is a trained health educator who works with MHCP recipients who may have difficulty understanding providers due to cultural or language barriers. CHWs extend the reach of providers into underserved communities, reducing health disparities, enhancing provider communication, and improving health outcomes and overall quality measures. Working in conjunction with primary care providers, CHWs can bridge gaps in communication and instill lasting health knowledge.
CHW services are a diagnosis-related medical intervention, not a social service.
CHWs providing diagnosis-related patient education services to enrollees of managed care organizations (MCOs) must contact the MCOs for enrollment requirements and coverage policies.
CHW services providing patient education for health promotion and disease management are covered if provided under the supervision of a physician, dentist, advanced practice registered nurse (APRN), certified public health nurse (PHN) or mental health professional.
Providers must have a valid certificate from the Minnesota State Colleges and Universities (MnSCU) demonstrating that the applicant has completed an approved community health worker curriculum.
MHCP requires CHW enrollment so they are represented on a claim as the provider who provided the services.
CHWs interested in enrolling must submit the following signed and completed forms:
Attach a copy of your MnSCU CHW certification to the application form.
Submit all signed and completed forms to MHCP at one of the following:
FAX to (preferred): 651-431-7462
DHS-MHCP Provider Enrollment
PO Box 64987
St. Paul, MN 55164-0987
Currently enrolled CHWs must inform DHS of their affiliation with dentists, ARPNs, certified PHNs or mental health professionals by submitting a signed and completed Individual Practitioner MHCP Provider Information Change Form (DHS-3535) (PDF).
MHCP Provider Enrollment will notify applicants of the status of their application within 30 days of receiving the signed and completed application, agreement, and applicant assurance statement.
Enrolled CHWs are considered a non-pay-to provider. An eligible MHCP enrolled billing provider must bill for services for the CHW to receive payment.
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MHCP recipients of the Medical Assistance (MA) and MinnesotaCare programs are eligible to receive education services provided by a CHW.
MHCP recipients enrolled in the Minnesota Family Planning Program (MFPP) are not eligible to receive CHW services.
MHCP will cover diagnosis-related patient education services, including diabetes prevention and pediatric obesity treatment provided by a CHW with the following criteria:
MHCP does not cover social services such as enrollment assistance, case management, or advocacy delivered by a CHW
The CHW education service is based on units of time. Include the following in the recipient’s record:
The billing provider must meet the same documentation requirements listed above. The documentation must support the number of units billed.
Federally qualified health center (FQHC) and rural health clinic (RHC): Bill using appropriate electronic claim format.
Providers must bill the enrollee’s appropriate MCO for patient education services provided by a community health worker.
Community health representative (CHR): Community-based health care providers who provide health promotion and disease prevention services in their communities and have completed an Indian Health Service (IHS) funded, tribally contracted or granted and directed program of training.
Community health worker (CHW): A health worker who is a trusted member of or has an unusually close understanding of the community served, which enables the person to provide information about health issues that affect the community and link individuals with the health and social services they need to achieve wellness.
Minnesota Statutes 256B.0625, subd. 49 (Community health worker)
Minnesota Statutes 245.462, subd. 18 (Mental health professional)
Minnesota Statutes 245.4871, subd. 27 (Mental health professional)