A community health worker (CHW) is a trained health educator who works with Minnesota Health Care Programs (MHCP) recipients who may have difficulty understanding providers due to cultural or language barriers. CHWs extend the reach of providers into underserved communities, reduce health disparities, enhance provider communication, and improve 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 that provide 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), mental health professional or registered nurse.
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. CHW providers must enroll and be screened following the MHCP provider screening requirements at the time of enrollment and once within every five years to maintain their enrollment.
MHCP requires CHWs to enroll so they are represented on a claim as the provider who provided the services. During the enrollment process, Provider Enrollment will assign the CHW worker a Unique Minnesota Provider Identifier (UMPI) if the CHW does not have a National Provider Identifier (NPI).
CHWs interested in enrolling must submit the following signed and completed forms:
Attach a copy of your MnSCU CHW certification to the application form. Fax all signed and completed forms to MHCP at: 651-431-7462.
Currently enrolled CHWs must inform DHS of their affiliation with dentists, ARPNs, certified PHNs or mental health professionals by completing and faxing a signed Individual Practitioner MHCP Provider Information Change Form (DHS-3535) (PDF).
MHCP Provider Enrollment will process the request within 30 days of receiving the signed and completed application, agreement, and applicant assurance statement and will screen the applicant. Provider Enrollment will send notification to the applicant to notify them of the outcome.
Enrolled CHWs are considered a non-pay-to provider but must be listed on the claim as the individual who rendered the CHW services. CHWs must provide an eligible MHCP enrolled billing provider with their UMPI or NPI, so the eligible billing provider can submit claims for their services.
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Medical Assistance (MA) and MinnesotaCare members are eligible to receive education services provided by a CHW.
MHCP members 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 centers (FQHC) and rural health clinics (RHC): Bill using appropriate electronic claim format.
Providers must bill the enrollee’s 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 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)