Amended IN Assembly March 24, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2697Introduced by Assembly Member Aguiar-CurryFebruary 18, 2022 An act to add Article 4.12 (commencing with Section 14149.95) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2697, as amended, Aguiar-Curry. Medi-Cal: community health workers and promotores.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the department to implement a community health workers (CHW) and promotores benefit under the Medi-Cal program, subject to receipt of any necessary federal approvals and the availability of federal financial participation. Under the bill, CHW and promotores services would be preventive services, as defined under federal law, and would be designed for certain target populations based on health conditions and need for services, for Medi-Cal beneficiaries in the managed care or fee-for-service delivery system.The bill would require CHW and promotores, as defined, to provide health education and navigation, as specified. Under the bill, provision of the services would be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law. The bill would require the department, in collaboration with CHW and promotores stakeholders, to implement and evaluate the benefit, including the development of detailed policy guidance, letters, manuals, and other documents.If the benefit is implemented, the bill would require a Medi-Cal managed care plan to develop an annual outreach and education plan for enrollees and another for providers, including notices and materials containing specified information about the CHW and promotores benefit. The bill would require these outreach and education efforts to, among other things, meet cultural and linguistic appropriateness standards and be subject to review and approval by the department, as specified. The bill would also require a Medi-Cal managed care plan to conduct an annual assessment of CHW and promotores capacity and enrollee need, and to share the assessments with the department, including specified data.The bill would require the department to annually review the outreach and education plans and assessments, and to annually publish an analysis of the CHW and promotores benefit on its internet website, including specified data.Existing law, the Medi-Cal Act, provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would state the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. The bill would further state the intent of the Legislature to enact legislation to establish processes aimed at ensuring, among others, community health workers and promotores have the supportive structures in place to adequately serve community needs, as specified. The bill would make related findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) Community health workers and promotores de salud are critically important in informing communities of color, persons of limited English proficiency, and immigrants about services to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health efficiency.(b) Community health workers and promotores de salud are also crucial to providing access to safety net services that are available to communities with the goal of reducing health disparities and improving health outcomes. (c) Community health workers and promotores are trusted members of their community who have personal experience with a health condition, lived experience, and shared language and cultural background, and who help to address chronic conditions, preventive health care needs, and health-related social needs within their communities.SEC. 2.It is the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. It is further the intent of the Legislature to enact legislation to establish processes aimed at ensuring community health workers, promotores, the State Department of Health Care Services, and the State Department of Public Health have the supportive structures in place to adequately serve community needs, by expanding our health care workforce and thereby expanding access to culturally and linguistically competent care.SEC. 2. Article 4.12 (commencing with Section 14149.95) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read: Article 4.12. Community Health Workers and Promotores Benefit14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
Amended IN Assembly March 24, 2022 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Assembly Bill No. 2697Introduced by Assembly Member Aguiar-CurryFebruary 18, 2022 An act to add Article 4.12 (commencing with Section 14149.95) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2697, as amended, Aguiar-Curry. Medi-Cal: community health workers and promotores.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the department to implement a community health workers (CHW) and promotores benefit under the Medi-Cal program, subject to receipt of any necessary federal approvals and the availability of federal financial participation. Under the bill, CHW and promotores services would be preventive services, as defined under federal law, and would be designed for certain target populations based on health conditions and need for services, for Medi-Cal beneficiaries in the managed care or fee-for-service delivery system.The bill would require CHW and promotores, as defined, to provide health education and navigation, as specified. Under the bill, provision of the services would be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law. The bill would require the department, in collaboration with CHW and promotores stakeholders, to implement and evaluate the benefit, including the development of detailed policy guidance, letters, manuals, and other documents.If the benefit is implemented, the bill would require a Medi-Cal managed care plan to develop an annual outreach and education plan for enrollees and another for providers, including notices and materials containing specified information about the CHW and promotores benefit. The bill would require these outreach and education efforts to, among other things, meet cultural and linguistic appropriateness standards and be subject to review and approval by the department, as specified. The bill would also require a Medi-Cal managed care plan to conduct an annual assessment of CHW and promotores capacity and enrollee need, and to share the assessments with the department, including specified data.The bill would require the department to annually review the outreach and education plans and assessments, and to annually publish an analysis of the CHW and promotores benefit on its internet website, including specified data.Existing law, the Medi-Cal Act, provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would state the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. The bill would further state the intent of the Legislature to enact legislation to establish processes aimed at ensuring, among others, community health workers and promotores have the supportive structures in place to adequately serve community needs, as specified. The bill would make related findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO
Amended IN Assembly March 24, 2022
Amended IN Assembly March 24, 2022
CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION
Assembly Bill
No. 2697
Introduced by Assembly Member Aguiar-CurryFebruary 18, 2022
Introduced by Assembly Member Aguiar-Curry
February 18, 2022
An act to add Article 4.12 (commencing with Section 14149.95) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2697, as amended, Aguiar-Curry. Medi-Cal: community health workers and promotores.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the department to implement a community health workers (CHW) and promotores benefit under the Medi-Cal program, subject to receipt of any necessary federal approvals and the availability of federal financial participation. Under the bill, CHW and promotores services would be preventive services, as defined under federal law, and would be designed for certain target populations based on health conditions and need for services, for Medi-Cal beneficiaries in the managed care or fee-for-service delivery system.The bill would require CHW and promotores, as defined, to provide health education and navigation, as specified. Under the bill, provision of the services would be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law. The bill would require the department, in collaboration with CHW and promotores stakeholders, to implement and evaluate the benefit, including the development of detailed policy guidance, letters, manuals, and other documents.If the benefit is implemented, the bill would require a Medi-Cal managed care plan to develop an annual outreach and education plan for enrollees and another for providers, including notices and materials containing specified information about the CHW and promotores benefit. The bill would require these outreach and education efforts to, among other things, meet cultural and linguistic appropriateness standards and be subject to review and approval by the department, as specified. The bill would also require a Medi-Cal managed care plan to conduct an annual assessment of CHW and promotores capacity and enrollee need, and to share the assessments with the department, including specified data.The bill would require the department to annually review the outreach and education plans and assessments, and to annually publish an analysis of the CHW and promotores benefit on its internet website, including specified data.Existing law, the Medi-Cal Act, provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would state the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. The bill would further state the intent of the Legislature to enact legislation to establish processes aimed at ensuring, among others, community health workers and promotores have the supportive structures in place to adequately serve community needs, as specified. The bill would make related findings and declarations.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various delivery systems, including fee-for-service and managed care. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill would require the department to implement a community health workers (CHW) and promotores benefit under the Medi-Cal program, subject to receipt of any necessary federal approvals and the availability of federal financial participation. Under the bill, CHW and promotores services would be preventive services, as defined under federal law, and would be designed for certain target populations based on health conditions and need for services, for Medi-Cal beneficiaries in the managed care or fee-for-service delivery system.
The bill would require CHW and promotores, as defined, to provide health education and navigation, as specified. Under the bill, provision of the services would be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law. The bill would require the department, in collaboration with CHW and promotores stakeholders, to implement and evaluate the benefit, including the development of detailed policy guidance, letters, manuals, and other documents.
If the benefit is implemented, the bill would require a Medi-Cal managed care plan to develop an annual outreach and education plan for enrollees and another for providers, including notices and materials containing specified information about the CHW and promotores benefit. The bill would require these outreach and education efforts to, among other things, meet cultural and linguistic appropriateness standards and be subject to review and approval by the department, as specified. The bill would also require a Medi-Cal managed care plan to conduct an annual assessment of CHW and promotores capacity and enrollee need, and to share the assessments with the department, including specified data.
The bill would require the department to annually review the outreach and education plans and assessments, and to annually publish an analysis of the CHW and promotores benefit on its internet website, including specified data.
Existing law, the Medi-Cal Act, provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill would state the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. The bill would further state the intent of the Legislature to enact legislation to establish processes aimed at ensuring, among others, community health workers and promotores have the supportive structures in place to adequately serve community needs, as specified. The bill would make related findings and declarations.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) Community health workers and promotores de salud are critically important in informing communities of color, persons of limited English proficiency, and immigrants about services to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health efficiency.(b) Community health workers and promotores de salud are also crucial to providing access to safety net services that are available to communities with the goal of reducing health disparities and improving health outcomes. (c) Community health workers and promotores are trusted members of their community who have personal experience with a health condition, lived experience, and shared language and cultural background, and who help to address chronic conditions, preventive health care needs, and health-related social needs within their communities.SEC. 2.It is the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. It is further the intent of the Legislature to enact legislation to establish processes aimed at ensuring community health workers, promotores, the State Department of Health Care Services, and the State Department of Public Health have the supportive structures in place to adequately serve community needs, by expanding our health care workforce and thereby expanding access to culturally and linguistically competent care.SEC. 2. Article 4.12 (commencing with Section 14149.95) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read: Article 4.12. Community Health Workers and Promotores Benefit14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. The Legislature finds and declares all of the following:(a) Community health workers and promotores de salud are critically important in informing communities of color, persons of limited English proficiency, and immigrants about services to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health efficiency.(b) Community health workers and promotores de salud are also crucial to providing access to safety net services that are available to communities with the goal of reducing health disparities and improving health outcomes. (c) Community health workers and promotores are trusted members of their community who have personal experience with a health condition, lived experience, and shared language and cultural background, and who help to address chronic conditions, preventive health care needs, and health-related social needs within their communities.
SECTION 1. The Legislature finds and declares all of the following:(a) Community health workers and promotores de salud are critically important in informing communities of color, persons of limited English proficiency, and immigrants about services to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health efficiency.(b) Community health workers and promotores de salud are also crucial to providing access to safety net services that are available to communities with the goal of reducing health disparities and improving health outcomes. (c) Community health workers and promotores are trusted members of their community who have personal experience with a health condition, lived experience, and shared language and cultural background, and who help to address chronic conditions, preventive health care needs, and health-related social needs within their communities.
SECTION 1. The Legislature finds and declares all of the following:
### SECTION 1.
(a) Community health workers and promotores de salud are critically important in informing communities of color, persons of limited English proficiency, and immigrants about services to prevent disease, disability, and other health conditions or their progression, prolong life, and promote physical and mental health efficiency.
(b) Community health workers and promotores de salud are also crucial to providing access to safety net services that are available to communities with the goal of reducing health disparities and improving health outcomes.
(c) Community health workers and promotores are trusted members of their community who have personal experience with a health condition, lived experience, and shared language and cultural background, and who help to address chronic conditions, preventive health care needs, and health-related social needs within their communities.
It is the intent of the Legislature to enact legislation to establish standards and requirements for qualification, payment and reimbursement, supervision, and scope of eligible services, and to create an advisory structure for a community health worker and promotores benefit in the Medi-Cal program. It is further the intent of the Legislature to enact legislation to establish processes aimed at ensuring community health workers, promotores, the State Department of Health Care Services, and the State Department of Public Health have the supportive structures in place to adequately serve community needs, by expanding our health care workforce and thereby expanding access to culturally and linguistically competent care.
SEC. 2. Article 4.12 (commencing with Section 14149.95) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read: Article 4.12. Community Health Workers and Promotores Benefit14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
SEC. 2. Article 4.12 (commencing with Section 14149.95) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
### SEC. 2.
Article 4.12. Community Health Workers and Promotores Benefit14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
Article 4.12. Community Health Workers and Promotores Benefit14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
Article 4.12. Community Health Workers and Promotores Benefit
Article 4.12. Community Health Workers and Promotores Benefit
14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:(1) Individuals with a chronic condition who are unable to self-manage their condition.(2) Individuals who are at risk of a chronic condition or injury.(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.(e) CHW and promotores preventive services may be provided to an individual or group in any setting.(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.(j) (1) The department shall seek any necessary federal approvals to implement this section.(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.
14149.95. (a) Subject to subdivision (j), the department shall implement a community health workers (CHW) and promotores benefit under the Medi-Cal program pursuant to this section.
(b) CHW and promotores services are preventive services, as defined in Section 440.130(c) of Title 42 of the Code of Federal Regulations, and shall be designed for all of the following target populations:
(1) Individuals with a chronic condition who are unable to self-manage their condition.
(2) Individuals who are at risk of a chronic condition or injury.
(3) Individuals who have a documented barrier resulting in a need for those services to prevent disease, disability, and other health conditions or their progression.
(4) Individuals who need those services to prolong life and promote physical and mental health and efficiency.
(c) CHW and promotores services shall be available to all Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system, who meet the eligibility criteria pursuant to this article.
(d) For purposes of this article, community health workers and promotores or CHW and promotores may include community health representatives, promotores (promoters), peer health promoters, and other nonlicensed public health workers, including violence prevention professionals.
(e) CHW and promotores preventive services may be provided to an individual or group in any setting.
(f) CHW and promotores shall provide health education and navigation, including, but not limited to, both of the following:
(1) Health education to promote, or address barriers to, health care, including providing culturally and linguistically appropriate information or instruction on topics that may include, but are not limited to, control and prevention of chronic or infectious diseases, behavioral health conditions, perinatal health conditions, sexual and reproductive health, environmental health, oral health conditions, injury or violence prevention, child health and development, or older adult health matters, including serious illness, death, or dying. The content of health education shall be consistent with established or recognized health care standards. Health education may include coaching and goal-setting to improve an individuals health or ability to self-manage health conditions.
(2) (A) Health navigation, through which a community health worker or promotora provides information, training, referrals, or support to assist recipients with both of the following:
(i) Accessing health care, understanding the health care system, or engaging in their health own care, including assistance with enrolling in health care coverage.
(ii) Connecting to community resources necessary to improve health, address health care barriers, or address health-related social needs, including, but not limited to, food and nutrition, housing security, economic and employment support, and legal services.
(B) Health navigation may include serving as a cultural liaison or assisting a licensed health care provider to create a care plan, as part of a health care team.
(C) Health navigation may include screening and assessment that do not require a license and that assist beneficiaries to connect to appropriate services to improve their health.
(D) Health navigation includes assessing the individual community members needs to maintain or improve their health and to access resources.
(g) Provision of CHW and promotores services shall be subject to referral by a physician or other licensed practitioner of the healing arts within their scope of practice under state law.
(h) CHW or promotores shall have either sufficient training as a community health worker or promotora or a minimum of three years of work experience, whether paid or volunteer, as a community health worker or promotora.
(i) The department, in collaboration with CHW and promotores stakeholders, shall implement and evaluate the CHW and promotores benefit, including the development of detailed policy guidance, letters, manuals, and other documents relating to subdivisions (a) to (h), inclusive.
(j) (1) The department shall seek any necessary federal approvals to implement this section.
(2) This section shall be implemented to the extent that any necessary federal approvals are obtained and federal financial participation is available.
14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.(1) Notices and materials to enrollees shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Eligibility criteria.(C) Covered services.(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(F) An email address, internet website, and telephone number for enrollees to call to request additional information.(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.(1) Notices and materials to providers shall include all of the following information:(A) A description of the CHW and promotores benefit.(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.(D) Eligibility criteria.(E) A complete list of covered services.(F) The types of providers authorized to refer individuals to CHW and promotores services.(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.(H) Medi-Cal managed care plan billing and coding procedures.(I) A telephone number to call for provider information and questions.(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:(A) Number of eligible enrollees.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.(G) Enrollee health outcomes.
14149.96. (a) If the community health workers (CHW) and promotores benefit is implemented pursuant to Section 14149.95, a Medi-Cal managed care plan shall engage in outreach and education efforts pursuant to this section.
(b) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify enrollees of the Medi-Cal managed care plan about the CHW and promotores benefit.
(1) Notices and materials to enrollees shall include all of the following information:
(A) A description of the CHW and promotores benefit.
(B) Eligibility criteria.
(C) Covered services.
(D) A list of providers that are authorized to refer individuals to CHW and promotores services, and an explanation of how to request a referral.
(E) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.
(F) An email address, internet website, and telephone number for enrollees to call to request additional information.
(2) Outreach and education efforts shall meet cultural and linguistic appropriateness standards, as set forth by the department, shall incorporate best practices in reaching vulnerable populations, and shall provide multiple points of contact for enrollees to access the CHW and promotores benefit.
(3) (A) Annual outreach and education efforts shall be subject to review and approval by the department to ensure appropriate local stakeholder engagement, alignment with the Population Needs Assessment, and cultural and linguistic appropriateness.
(B) The department shall consult with stakeholders, including, but not limited to, consumer advocates, providers and Medi-Cal managed care plan stakeholders, to develop the standards by which outreach and education efforts shall be reviewed and approved.
(c) The Medi-Cal managed care plan shall develop an annual outreach and education plan to notify providers about the CHW and promotores benefit.
(1) Notices and materials to providers shall include all of the following information:
(A) A description of the CHW and promotores benefit.
(B) Examples of CHW and promotores use cases and opportunities for inclusion in community and health settings that takes into account guidance from the federal Centers for Disease Control and Prevention.
(C) Evidence regarding the benefits of CHW and promotores for diverse members in providing culturally and linguistically competent, community- and patient-centered care.
(D) Eligibility criteria.
(E) A complete list of covered services.
(F) The types of providers authorized to refer individuals to CHW and promotores services.
(G) A list of contracted CHW and promotores entities, including community clinics and community-based organizations available to provide these services, updated at least annually.
(H) Medi-Cal managed care plan billing and coding procedures.
(I) A telephone number to call for provider information and questions.
(2) Outreach and education efforts described in this subdivision shall meet the requirements of paragraphs (2) and (3) of subdivision (b), as applicable.
(d) (1) The Medi-Cal managed care plan shall conduct an annual assessment of CHW and promotores capacity and enrollee need.
(2) The Medi-Cal managed care plan shall share the annual assessments with the department, excluding any personally identifiable information, and shall include all of the following information, disaggregated by geographic region, race, ethnicity, language, and other sociodemographic factors:
(A) Number of eligible enrollees.
(B) Number of referrals by provider type.
(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.
(D) Racial, ethnic, and linguistic diversity of CHW and promotores entities.
(E) Total enrollees served, disaggregated by race, ethnicity, language, and other sociodemographic factors.
(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
(G) Enrollee health outcomes.
14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:(A) Number of eligible beneficiaries.(B) Number of referrals by provider type.(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.
14149.97. (a) The department shall annually review the outreach and education plans developed by Medi-Cal managed care plans, and the assessments, as described in Section 14149.96.
(b) The department shall annually publish an analysis of the community health workers (CHW) and promotores benefit on its internet website, excluding any personally identifiable information. This analysis shall include both of the following:
(1) An assessment of CHW and promotores capacity and the needs of Medi-Cal beneficiaries, including those enrolled in Medi-Cal managed care plans or under the fee-for-service delivery system.
(2) A disaggregation of the assessment by geographic region, race, ethnicity, language, and other sociodemographic factors, and by Medi-Cal managed care plan as applicable, including all of the following:
(A) Number of eligible beneficiaries.
(B) Number of referrals by provider type.
(C) Number of contracted CHW and promotores entities by CHW and promotores subgroup and employer, including a community-based organization, licensed provider, clinic, or hospital.
(D) Racial, ethnic and linguistic diversity of CHW and promotores entities.
(E) Total beneficiaries served, disaggregated by race, ethnicity, language, and other sociodemographic factors.
(F) Number of contracted CHW and promotores entities needed to meet expected demand for CHW and promotores services.