Non-Traditional Health Workers Temporary Rules OAR 333-002-0300
through 333-002-0380
Traditional Health Workers
October 26, 2015April Johnson, MPA Health Equity Workforce
Manager
1OverviewHealth Equity Workforce IntroductionPurpose and Role of
THWsTHW System UpdatesTHW Commission and SubcommitteesSystem
CoordinationMedicaid Rule for Prescribing THWs for Preventative
ServicesPayment Methods
The Goal of the Health Equity Workforce Program is to:Advance
health equityHelp achieve the Triple Aim*improving patient
experience (including quality and satisfaction), improving
population health, reducing per capita health care costsGrow and
diversify our health care and public health workforce
Community Health Workers; Peer Support;Peer Wellness
Specialist;Personal Health Navigators; and birthDoulas Individuals
and Communities
Health and social service systems
Traditional Health Workers: A Community-Based Model of Care
5Purpose of Traditional Health WorkersReduce costs associated with
health care and burden on society Understand and address the social
determinants of health Address health disparities in
culturally-appropriate ways Take a less siloed approach to health
care
Role of the THWA Traditional Health Worker (THW) is a frontline
health professional who applies his or her unique understanding of
the experience, language and/or culture of the populations he or
she serves in order to carry out one or more of the following
roles:
Providing culturally-appropriate health education, information
and outreach in a variety of settings such as homes, clinics,
hospitals, schools, shelters, local businesses, and community
centers;Bridging/culturally mediating between individuals,
communities and health and human services, including actively
building individual and community capacity;Assuring that people
access the services they need;Providing direct services, such as
informal counseling, social support, care coordination and health
screenings; andAdvocating for individual and community needs.
Training and CertificationTraining Program RequirementsTraining
curriculum must meet standards required by OARs 410-180-0350 by THW
typeCertification RequirementsMust be 18 Years of ageMust pass a
criminal background checkMust be trained by an OHA approved
training program unless grandfathering or provisionally
applyingMust submit a completed application to OEI with I.D.THW
System UpdatesTraditional Health Worker Commission and
SubcommitteesTraining Evaluation Metrics Program & Scoring
SubcommitteeDevelop the metrics, standards & guidance needed to
review and approve THW training program applications and establish
the metrics, standards and guidance for continuing education
requirements for all traditional health workers who wish to qualify
for (re)-certification by the Oregon Health Authority.Scope of
Practice SubcommitteeDevelop roles, expectations, and supervisory
relationships as outlined in Division 180 THW Rule 410-180-0370 for
Community Health Workers, Peer Wellness Specialists, Personal
Health Navigators, and Peer Support Specialists Certification
Curriculum Standards to faciliate appropriate hiring of THWsSystems
Integration SubcommitteeIntegration of the THW workforce into the
health care system by analyzing opportunities and barriers to
employment and creating a strategic plan to improve health equity
to underserved populations. Strategies may include outreach,
training, and education of CCOs and other community based
organizations, monitoring and reporting on employment standards
such as wages, benefits, and scope of work State Level THW System
CoordinationTransformation Center CoordinationTHW Registry
EnhancementsHealth Equity Workforce (HEW) team has partnered with
the Transformation Center and OIS to fund registry enhancements
that will:Collect and sort relevant data, e.g., race/ethnicity,
geography, and by worker type;Notification to THWs for
recertification;Provide HEW team with notification of newly
submitted applications; and result in an improved system for
providers to locate and hire THWs.
CCWD CoordinationMedical Assistance Programs42 CFR 440.130 (c)
Rule Change-The CMS final rule published on July 15, 2013 included
a change to the regulatory definition of preventive services at 42
CFR 440.130(c) of the federal Medicaid program. Previously,
preventive services could only be provided by a physician or other
licensed practitioner (OLP) of the healing arts for Medicaid
reimbursement practitioners, OLPs, can provide and be reimbursed
for furnishing preventive services recommended by a physician or
other licensed practitioner
Current Funding MechanismsIn most delivery systems THW services
are funded using braided payment methods. For example, the
behavioral health system uses a variety of federal, state, and
local resources to fund Peer Support Specialist. Public Health has
historically provided Community Health Workers in underserved
communities to provide training, outreach, education and testing to
stop the spread of communicable diseases and to eliminate infant
mortality. These programs are grant funded and their duration is
often limited due to emerging national and global health
priorities.
Examples of Payment Models for THWsPeer Support SpecialistOregon
providers can purchase peer services through funding sources such
as:Federal (SAMHSA, TANF, Medicaid), State and Local Funding,
Private funding; and Drug Courts (federal, state and local
funding), and DOJ fundingCommunity Health WorkersOregon providers
currently purchase CHW Services with:CDC grants (Public Health; HIV
Testing and Education)Foundation Grants (Legacy Emanuel-ER
CHWs)Provider Investment (Central City Concerns-FQHC, Housing and
Behavioral Health)CCOs (Pilot Project)QUESTIONS?
Contact Us:April Johnson, MPAHealth Equity Workforce
ManagerOffice of Equity and
[email protected]
Shawn ClarkPeer Delivered Services CoordinatorAddictions and
Mental Health [email protected]
payments for THWs:Don RossManagerDMAPPolicy and Planning
[email protected] THW Committee Website:
www.oregon.gov/oha/oei/Pages/non-traditional-health-worker-committee.aspx
Subscribe to mailing list through website for updates.
THW Rules:
http://www.dhs.state.or.us/policy/healthplan/rules/notices.html
(N)THW Report: www.oregon.gov/OHA/oei/docs/nthw-report-120106.pdf
HB3311 Report:
www.oregon.gov/oha/legactivity/2012/hb3311report-doulas.pdf 22
