Arizona Community Health Worker
Voluntary Certification Updates
Arizona Rural Health Conference
June 7, 2023
Carin Watts, MPH
Health Disparities Program Manager
Arizona Department of Health Services
St a t u s o f CHW Vo lu n t a ry Ce rt ifica t io n
● Number of CHWs certified as of May 23, 2023: 131
● The online application for voluntary certification opened November 7, 2022, when the
fin a l ru le s
went into effect.
● To s e e a list o f c e rt ifie d CHW s visit t h e AZ Care Ch e ck database.
● Th e Sp e c ia l Lic e n s in g CHW Lic e n s in g website features a variety of materials to
support applicants with the application process, including a documentation c h e c k list
,
p o rt a l g u id e (a p p lic a t io n a ss is t a n c e )
, FAQs and other support materials.
● CHW Vo lu n t a ry Ce rt ifica t io n FAQ document (how to apply, documentation, request
support with application, Notice of Deficiency or Request for Information, application
denial, renewal, etc.).
Ce rt ific a t io n Elig ib ilit y
An in d ivid u a l is e lig ib le t o p ra c t ic e a s a c e rt ifie d
CHW , if (
R9-16 -802):
● 18 years of age or older
● Do c u m e n t a t io n o f cit ize n s h ip o r a lie n st a t u s
● Hig h s c h o o l d ip lo m a , e q u iva le n t d ip lo m a , o r
higher education degree
● Documentation of training and/or paid or
volunteer experience
● Co m p le t io n o f in it ia l CHW c e rt ific a t io n
a p p lica t io n
● Submission of nonrefundable fees
● No examination/testing requirement set by
ADHS t o o b t a in c e rt ific a t io n
Diploma/Degree Requirement
● Applicants are required to submit documentation that the applicant received a high school
diploma, a high school equivalency diploma, or higher education degree.
● Documentation from countries other than the US (including Mexico) are accepted as long as
the department can clearly identify the documents as such.
○ If the documentation is not clear, the applicant will receive a Request for Information
(RFI) t h a t w ill e xp la in w h a t a d d it io n a l d o c u m e n t a t io n is re q u ire d (ce rt ifie d t ra n s c rip t
translation) to process their application.
● If an applicant does not have a copy of their high school diploma or other degree, it is
suggested that they reach out to their school, or school district, to obtain a copy of their
diploma/degree, or of their transcript showing that they received that diploma/degree.
● If not available, it is suggested that the applicant acquire a US GED. More information can be
found at the GED Te s t in g Se rvic e
website.
○ Rio Sa la d o Co lle g e
o ffe rs in -person and online GED preparation courses (English only)
○ Chicanos Por La Causa
offers preparation courses in Spanish
CHWs Certified in Another State
● If a CHW has been licensed in another state for at least one year they can qualify
for reciprocity.
● In lieu of documentation of training and/or paid or volunteer hours (on the next
slide) an applicant can provide the information outlined in section
R9-16 -804 - B of
t h e fin a l ru le s.
○ A copy of the professional certificate or license by each state.
○ A completed and signed Attestation of Licensure in Another State form .
● For m ore inform ation on recognition of out-of-state licenses, see A.R.S § 32-4302
Do cu m e n t a t io n o f Tra in in g & Exp e rie n c e Ho u rs
If a CHW does not qualify under reciprocity, they are required to provide documentation of:
● Pathway 1: 960 hours of paid or volunteer experience providing CHR or CHW services in the core
competencies specified in the final rules and completed during the previous three-year time period; OR
● Pathway 2: Completion of a CHW certificate program, including core competencies, provided by an
accredited college AND 480 hours of paid or volunteer experience completed during the previous three-
ye a r s ; OR
● Pathway 3: Completion of a CHW training program provided by an organization (approved through the
AzCHO W Tra in in g Ap p ro va l P ro c e ss) or c e rt ifie d CHW t ra in e r(s), in c lu d in g c o re co m p e t e n c ie s , AND 480
hours of paid or volunteer experience completed during the previous three-y e a r s ; OR
● Pathway 4: Completion of a Community Health Representative National Training Program (provided by
IH S ):
○ Ba s ic t ra in in g p ro g ra m AND 480 hours of paid or volunteer experience completed during the previous
th ree-ye a rs , o r
○ Advanced training program AND 380 hours of paid or volunteer experience completed during the
previous three-years
*A CHW only needs to provide documentation for one of the four pathways above.
● Co m m u n ic a t io n s k ills
● Interpersonal and relationship-b u ild in g
● Service coordination and navigation
● Ca p a c it y b u ild in g
● Advocacy
● Ed u c a t io n a n d fa c ilit a t io n
● Individual and community assessment
● Outreach
● P ro fe ss io n a l sk ills a n d c o n d u c t
● Eva lu a t io n a n d re se a rc h sk ills
● Knowledge base
Core Competencies
Ce rtifie d CHW Scop e of Practice
(R9-16 -802 - C)
● P ro vid in g c u lt u ra l m e d ia t io n a m o n g in d ivid u a ls , c o m m u n it ie s, a n d h e a lt h
and social system s
● Providing culturally appropriate health education and information
● Providing care coordination, case coordination and system navigation;
● Providing coaching and social support
● Advocating for individuals and communities
● Bu ild in g in d ivid u a l a n d co m m u n it y c a p a c it y
● P ro vid in g d ire c t s e rvic e s
● Implementing individual and community assessments
● Conducting outreach
● P a rt ic ip a t in g in e va lu a t io n a n d re s e a rc h
Ot h e r Ro le & Ac t ivit ie s
(R9-16 -802 - D)
●Diabetes education
●Disease intervention
●Nutrition, specifically food prep and
purchasing
●Parenting education
●Community wellness partner
●Connect clients to health education
and community resources
●Blood pressure education
●Delivery of medical supplies and equipment
●Outreach to clients who are out of care
●Hearing and vision screenings
●O t h e r sim ila r h e a lt h a n d s o c ia l se rvic e s
provided on behalf of health and behavioral
health service provides
Requirements to
Ma in t a in Ce rt ific a t io n
● Ce rt ific a t io n is va lid fo r t w o ye a rs (R9-16 -805)
● Submit a renewal application and fees at
least 30 days before the expiration date of
c e rt ifica t io n (va lid fo r t w o ye a rs).
● Com plete a m inim um of 24 hours of
continuing education
hours within the two
years prior to renewal(
R9-16 -806).
● Notify the department of updates to name
or contact inform ation.
ADHS Fee Waivers
● At this time no applicant is paying more than $1.
● Fee Waiver $0 (AZ Statute 41-1080.01): - The agency shall waive any fee charged for an
in it ia l lic e n se fo r a n y o f t h e fo llo w in g in d ivid u a ls : t h o s e w h o s e fa m ily in c o m e d o e s n o t
exceed 200% of the federal poverty guidelines, active duty military spouse, or any
honorably discharged veteran (no more than 2-ye a rs ).
○ Bo t h t h e a p p lic a t io n a n d c e rt ifica t io n fe e s w ill b e w a ive d fo r q u a lifyin g in d ivid u a ls
w h o a re a p p lyin g fo r c e rt ific a t io n fo r t h e first t im e . Th e se in d ivid u a ls w ill b e
re q u ire d t o fill o u t a n d su b m it a Fee Waiver Attestation
● Reduced Fee $1: This reduced fee is available until the funding is spent or the expiration
date for the funding is reached.
○ For applicants that do not q u a lify fo r t h e firs t w a ive r (a b o ve - A Z S t a t u t e 4 1.10 8 0 . 0 1)
○ Th e firs t 18 0 in d ivid u a ls t o a p p ly fo r c e rt ifica t io n w ill re c e ive a d isc o u n t e d fe e a n d
b e re q u ire d t o p a y o n ly $ 1.0 0 . Th is w a ive r w ill b e g ive n o n a first c o m e b a sis . (Le ss
than 60 remaining as of 5.23.23)
Be n e fits of CHW
Ce rt ific a t io n
● Provid es a pathway for furth er
p ro fe s s io n a liza t io n a n d su s t a in a b ility o f t h e
CHW workforce
● Ce rt ifie d CHW s w ill b e iss u e d a c e rt ific a t io n
and have their education, work experience,
and other qualifications verified by the state
health department
● Increase in reimbursement opportunities for
CHW services
● Many other valuable benefits for the
com munities serves, employers, and the
workforce as a whole.
Arizona CHW Workforce Coalition
● A network of organizations collaborating with AzCHOW and ADHS to
support the sustainability of the Arizona CHW workforce.
● Meets quarterly and is composed of CHWs, including Promotores de
Sa lu d , Co m m u n it y He a lt h Re p re se n t a t ive s , Co m m u n it y He a lt h Ad vis o rs
and other related titles, as well as the University of Arizona, Local Health
Departm ents, Com m unity Health Centers, Area Health Education
Centers, and other workforce allied partners.
● To join please reach out to Ramses Sepulveda @ ram ses@arizona.edu
Next m eeting: Friday, July 7, 2023 10:00am - 12:00pm
Resources
● ADHS CHW W ebpag e: https://www.azdhs.gov/prevention/tobacco-c h ro n ic -d is e a se /c o m m u n it y-h e a lt h -workers
● Sp e c ia l Lic e n s in g CHW Lic e n s in g : https://www.azdhs.gov/licensing/special/index.php#comm unity-h e a lt h -workers
● ADHS CHW P o rt a l Gu id e : https://www.azdhs.gov/documents/licensing/special-lic e n sin g /a p p lic a t io n s/b sl-lic e n se e -
provider-reference-guide.pdf
● ADHS CHW Ap p lic a t io n Ch e c k lis t : https://www.azdhs.gov/documents/licensing/special-lic e n s in g /a p p lic a t io n s /c h w -
checklist.p d f?v=20221220
● CHW Hours Worked/Volunteered Attestation Form : https://www.azdhs.gov/documents/licensing/special-
lic e n sin g /a p p lica t io n s/re c o rd -h ou rs-employment-volunteer-form .p d f?v=20230127
● AZ Care Check Database - List o f a ll CHW s c e rt ifie d in t h e St a t e o f Arizo n a :
https://azcarecheck.azdhs.gov/s/?programType=Com munity%20Health%20Worker&licenseType=All
● AzCHOW CHW Training Approval Process:https://azchow.org/training-prog ram -approval
● AzCHOW Approved Training Program s: https://azchow.org/approved-az-chw-t ra in in g
Community Health Worker (CHW) Updates
Alex Demyan, Interim Assistant Director
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Community Health Worker/ Community Health
Representative
A frontline public health worker who
is a trusted member of the
community to help people:
• Navigate health care system,
• Encourage preventive care,
• Manage chronic illnesses,
• Maintain healthy lifestyles, and
• Assist in culturally and linguistically
relevant ways.
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CHW Voluntary Certification Rule
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• The final CHW Voluntary Certification Rules were approved
by the Governor's Regulatory Review Council (GRRC) and
were filed with the Secretary of State on September 7, 2022.
• The rules are effective as of November 6, 2022.
• The ADHS Special Licensing department is accepting
applications as of November 7, 2022 through an online
portal.
CHW Services - SPA Language
Arizona state certified Community Health Workers (CHW) may provide AHCCCS-covered patient education and
preventive services to individuals with a chronic condition or at risk for a chronic condition or for individuals
with a documented barrier that is affecting the individual’s health. CHW services must be recommended by a
physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under
State law. Services must be documented in the member’s medical record and may include:
• Health system navigation and resource coordination,
• Health education and training. The purpose of this service is to train and/or
increase the member’s awareness of methods and measures that have been
proven effective in avoiding illness and/or lessening its effects. The content
of the education must be consistent with established or recognized
healthcare standards, or
• Health promotion and coaching. The purpose of this service is to
provide information and training to members that enables them to
make positive contributions to their health status.
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Reimbursement Pathways
Medicaid Claim
Reimbursement
CHW/CHR
obtains
certification
CHW/CHR obtains
certification
CHW/CHR is employed
by a currently registered
provider.
CHW/CHR delivers a
covered service within
their scope of practice.
Registered provider submits a
claim for the covered service
provided by the CHW/CHR.
CHW/CHR organization will enroll with
AHCCCS through the AHCCCS
provider enrollment process.
CHW/CHR is employed
by a CHW/CHR
organization.
CHW/CHR delivers a
covered service within
their scope of practice.
CHW organization submits a
claim for the covered service
provided by the CHW/CHR.
Phase 1 - Effective April 1, 2023
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Phase 2- Anticipated effective date: fall 2023
List of Eligible Providers for Phase 1
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• Attendant Care Providers (PT 40)
• BH Outpatient Clinic (PT 77)
• Chiropractor (PT 16)
• Clinic (PT 05)
• Community/Rural Health Center (PT 29)
• Dentist (PT 07)
• Dialysis Clinic (PT 41)
• DO-Physician Osteopath (PT 31)
• Federally Qualified Health Center
(FQHC) (PT C2)
• Habilitation Providers (PT39)
• Hospital (PT 02)
• Integrated Clinic (PT IC)
• MD-Physician (PT 08)
• Naturopath (PT 17)
• Optometrist (PT 69)
• Physicians Assistant (PT 18)
• Registered Nurse Practitioner (PT 19)
CHW/CHR Employer Roles and Responsibilities
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• Once an employer is registered with AHCCCS, it must ensure any
CHW/CHR it submits Medicaid claims for are certified.
• The employer can submit claims using the allowed codes for the
covered services provided by its CHWs/CHRs.
• The employer must maintain accurate and current records of all
CHW/CHR certification document.
• Providers may employ CHWs/CHRs who are not certified, but they
will not be able to bill Medicaid for service provided by
non-licensed CHWs/CHRs.
Reimbursable Service Codes
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• Education and training for patient self-management by a qualified,
nonphysician health care professional using a standardized curriculum,
face-to-face with the patient (could include caregiver/family) each billed
in 30 minutes increments.
o 98960- education and training provided for an individual patient for each 30
minutes of service.
o 98961- for a group of two to four patients.
o 98962- or a group of five to eight patients.
• AHCCCS is currently developing guidance to establish per member per
month billing limits.
o If additional services are medically necessary, prior authorization would be
required.
• A certified CHW/CHR can perform the full scope of practice
as specified in A.A.C. R9-16-802; however,
• For Medicaid covered services to be billed, when serving
Medicaid members:
o CHW/CHR services must be medically necessary and
recommended by a physician or other licensed practitioner.
o The certified CHW/CHR must work under the direction of an
eligible AHCCCS-registered provider.
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Services Provided by a CHW/CHR
AHCCCS Next Steps
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● Finalization of a CHW Policy. While this policy is in development,
the AHCCCS FAQ Document (HERE
), is available as a point of
reference for community stakeholders.
● Development of a CHW Provider Type for Community Based
Organizations (CBO). Our team is currently working on this and
expect to have more details in the upcoming months.
Open Discussion
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