Running Head: HB 856 TASK FORCE ON COMMUNITY HEALTH WORKERS

Health Policy Analysis

HB 856: Task Force on Community Health Workers
Nurs 550: Health Systems Policy, Organizations and Financing
Honorine Ayah Mumah
Instructor: Dr Nayna Philipsen
Coppin State University
Helen Fuld School of Nursing
March 25, 2014

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House Bill 856 is put forth to develop a Task force on Community Health Workers
(CHWs). The purpose of this bill is to establish, provide a composition, chair and staffing for a
task force on community health workers. The responsibilities of the task force workers would
include conduct extended studies on CHWs, developing- standardized training and practice
standards, recommend curriculum and certifications, and recommendations for reimbursement
for community health workers. The task force will be accountable to committees of the General
Assembly and will be eligible for reimbursement for certain expenses
(http://mgaleg.maryland.gov/2014RS/fnotes/bil_0006/hb0856.pdf).
This Bill is supported by Delegates like Delegate Nathan-Pulliam of district 10 who is a
Registered Nurse with years of experience as head nurse and team leader in several hospitals in
the Baltimore metropolitan area and quality assurance coordinator in the Baltimore community
where she worked first hand with CHWs. Other stakeholders who support this bill have worked
very closely with programs that utilize CHWs, others have helped designed models to support
the services of CHWs and others have conducted extensive research on CHWs. This bill was
introduced for the first time in Maryland on February 5th of 2014. It was adopted with favorable
amendments on March 12th and again in March 28th 2014. This bill has passed and will take effect
on June 1st 2014 (http://mgaleg.maryland.gov/2014RS/fnotes/bil_0006/hb0856.pdf). According
to the American Public Health Association, as of December 31, 2012, six different states,
including the District of Columbia enacted laws addressing CHW infrastructure, professional
identity, workforce development, and financing (American Public Health Association, 2013).
Five other states enacted workforce development laws that create a certification process for
CHWs. Seven states have laws authorizing Medicaid reimbursement for certain CHW services.

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Presently there no laws in any state that requires CHW coverage by private insurers (Henry &
Perry, 2013).
According to a recent article by Henry and Perry (2013), community health workers
existed and operated under different capacities and definitions that have evolved over the years
since the 80s (Henry & Perry, 2013). A most recent definition by the American Public Health
Association describes a community health worker as a frontline public health worker who is a
trusted member of and/or has an unusually close understanding of the community served
(American Public Health Association, 2013). The key activities performed by the CHW include;
serving as a liaison between the health/ social services and the community, creating a more
effective relationships between communities and health care systems, providing health education
and information to the community, assist and advocate for underserved individuals to receive
appropriate services and facilitate access to healthcare, provide informal counseling, directly
address basic needs, and build community capacity in addressing health issues (Hongoro &
McPake, 2004). These functions are usually performed in different settings of the healthcare
system like physician offices, education program, outpatient care, individual or family services,
social advocacy groups, etc.
Several research studies have established that community health workers produce
positive health outcomes and financial benefits. Singh and Chokshi (2013), the usefulness of
CHWs have been demonstrated and proven valuable in multiple arenas including: increasing
enrollment in health insurance, assisting individuals manage chronic health conditions,
improving maternal and child health, reducing infant mortality through primary prevention and
education, increasing awareness and encouraging screening for cervical and breast cancers
(Singh & Chokshi, 2013). CHWs have also been effectively utilized in the prevention and

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management of chronic diseases, such as diabetes, hypertension, cardiovascular disease, asthma,
depression, and mental illness (Hongoro & McPake, 2004). It is very evident that the efficacy of
CHWs can be attributed to more time spent with individuals in the community, presenting
important health information in a culturally-competent manner and in the language spoken by the
patient, identify and address behavior changes that may contribute to non-compliance with the
plan of care proposed by the primary healthcare provider.
The functions and benefits the CHWs discussed above can serve as reasons enough to
support this bill. However, from a health standpoint, reasons why stakeholders are in support of
this bill include the fact that, developing standardized training, certification and practice
standards for CHW will create consistency and quality in the care provided to individuals in the
communities served (http://mgaleg.maryland.gov/2014RS/fnotes/bil_0006/hb0856.pdf). From a
financial point of view, standardizes health care delivery and documentation will lead to effective
reimbursement of services rendered by the CHWs through Medicaid and other government
general funds (http://mgaleg.maryland.gov/2014RS/fnotes/bil_0006/hb0856.pdf). This will
enable payment models to shift from activity and patient volume based billing system to an
outcome and value based in order to sustain and maintain the CHWs role in the community and
the health care system. Utilizing a Task Force will also develop a robust system to incorporate
the interdisciplinary health care team into the existing community health care workforce.
Currently, in the state of Maryland, there are no oppositions to this bill. However,
according to Henry and Perry some arguments that were dealt with in other states that passed this
law included the fact that several definitions for CHWs existed (Henry & Perry, 2013). There
was a concern that people outside the profession may not fully understand the role of CHWs and
that a national definition was required. It was also a supposed that CHWs might cause a threat to

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nurses and social workers because the CHW role was not clearly defined and understood.
However, if all members of the care team were licensed or went through some sought of
certification process then overlapping should be minimal. Finally, there was also the argument
that paying CHWs may lose authenticity and trust in the community, and that a volunteer-based
model is advantageous for this reason (Henry & Perry, 2013). However, through creating a
standardize training and practice, the care delivered by CHWs will be consistent and CHWs will
be held accountable for their actions through certification programs.
The Affordable Care Act explicitly calls out CHWs as members of the health care
workforce, listing them among primary care professionals (American Public Health
Association, 2013). It is then only reasonable that a task force that constitute of health care
professionals should be involved in developing a standardized curriculum, training and
certification process for CHWs. According to U.S. Department of Health and Human Services,
Health Resources and Services Administration, Bureau of Health Professions (2007), this process
is thought to be a promising approach that will increase perceived value of the CHW model,
create consistency in the workforce, improve CHW skills and knowledge, and promote
reimbursement for CHW services (U.S. Department of Health and Human Services, Health
Resources and Services Administration, Bureau of Health Professions, 2007).
According to Singh and Sullivan (2011), several research studies have undoubtedly
shown evidence of the financial and health benefits of utilization of CHWs in the healthcare
system (Singh & Sullivan, 2011). However, because CHWs constitute of lay people who live in
the community they serve, to create an effective platform for health care delivery and proper
reimbursement, a task force is required to develop a standardized system under which they must
function (Singh & Sullivan, 2011). Creating such task force in Maryland does not require

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reinventing the wheel as many other states like Texas, California, Washington, Floridajust to
name a few, have already implemented this bill. Modifications and amendments applicable to
Maryland must be considered.
In conclusion, this bill as it is a thoughtful approach in building a firm foundation for a
higher performing community health care program. Mandating a standardize program will
reestablish the relationship between patients in the community who have not sought health care
either because of non-compliance, finances or other reasons and the health care system. This will
result in an increase in the effectiveness of preventive care, decrease in health, racial or ethnic
disparity, and increase access to health care and outcomes, lower cost and consequently save
lives. Furthermore, by developing recommendations for reimbursement programs for CHWs, the
services provided through hard work and compassion will be appropriately documented and
reimbursed.

References

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American Public Health Association (2013). Community health workers. Retrieved from
http://www.apha.org/membergroups/sections/aphasections/chw
Brownstein, J., Willaert, A., Rosenthal, E., Scott, J., (2010). Community health workers: Part of
the solution. Jounal of Health Affairs 17(9), 114-119.
Department of Legislative Services. Maryland General Assembly 2014 Session. Task Force on
Community Health Workers Retrieved from
http://mgaleg.maryland.gov/2014RS/fnotes/bil_0006/hb0856.pdf
Gordon, M., Anne, L., & Prabhjot, S., (2013, February 13) Deployment of community health
workers across rural sub-Saharan Africa: financial considerations and operational
assumptions. Bulletin of the World Health Organization 2012;91:244-253B. doi:
http://dx.doi.org/10.2471/BLT.12.109660
Henry, P., Perry, C., (2013, September 18). A brief history of community health worker
programs. BMC Public Health, 1-9. doi.org/10.1186/1471-2458-12-844
Hongoro, C., McPake, B., (2004) Community health workers: How to bridge the gap in human
resources for health. The Lancet 2004; 364: 1451-6 http://dx.doi.org/10.1016/S01406736(04)17229-2 pmid: 15488222.
Singh, P., Chokshi, A., (2013) Community health workers: An opportunity for reverse
innovation Authors' reply. The Lancet 382: 1324- 1327
Singh P., Sullivan, S., (2011 May 5) One million community health workers: technical task force
report. Retrieved from
http://www.millenniumvillages.org/uploads/ReportPaper/1mCHW_TechnicalTaskForceR
eport
U.S. Department of Health and Human Services, Health Resources and Services Administration,

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Bureau of Health Professions (2007). Community health worker national workforce
study. Retrieved from http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf
Viswanathan, M., Kraschnewski, J., Nishikawa, B., Morgan, L., Honeycutt, A., Thieda, P., et al.
(2010). Outcomes and costs of community health worker interventions: a systematic
.review. Med Care 2010; 48: 792-808 http://dx.doi.org/10.1097/MLR.0b013e3181e35b51
pmid: 20706166.