AHCCCS is in the process of implementing Medicaid reimbursement for Community Health Workers (CHWs) and Community Health Representatives (CHRs).
In 2018 the Arizona Legislature passed, and the Governor signed, House Bill 2324, which required the Arizona Department of Health Services (ADHS) to establish qualifications, a scope of practice, and core competencies for Certified Community Health Workers (CHWs). ADHS was also charged with establishing a voluntary certification program that outlined the education and training program requirements as well as standards for CHW/CHR trainers. ADHS has since published a Final Rule on CHW Voluntary Certification, which took effect on November 7, 2022.
Following publication of the Final Rule on CHW Voluntary Certification, AHCCCS submitted a State Plan Amendment (SPA), seeking approval from the Centers for Medicare and Medicaid Services (CMS) for the state to provide Medicaid reimbursement of CHW/CHR services. On February 22, 2023, CMS approved AHCCCS’s SPA.
As of 4/1/23, certified Community Health Workers (CHWs) and Community Health Representatives (CHRs) employed by AHCCCS registered providers can bill for reimbursable services.
Claims for covered services provided by the certified CHW or CHR need to be submitted by the registered AHCCCS provider. A CHW or CHR can be employed by multiple AHCCCS registered providers. Additionally, AHCCCS registered providers may employ multiple CHWs or CHRs.
In order to obtain Medicaid reimbursement, the CHW or CHR must be certified by ADHS and may only deliver covered services within their scope of practice under specified AHCCCS registered provider types. These provider types are listed in question 8 of the CHW/CHR Frequently Asked Questions.
The employer may only submit claims using the allowed codes for the covered services provided by its CHWs or CHRs. Additional billing guidance will be added to the AHCCCS Fee-for-Service Provider Billing Manual.
Information on CHW certification is posted on the Arizona Department of Health Services Community Health Worker (CHW) Licensing Management System (LMS) page.
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