KMAP BULLETIN: Community Health Worker Services

Date: 06/29/23

Effective with dates of service on and after July 1, 2023, Kansas Medicaid will provide reimbursement for services provided by a Community Health Worker (CHW) for the following codes:

98960
98961
98962

A CHW is an individual certified in the State of Kansas to provide services within the scope of the certification program. Supervision of the certified CHW is included in the scope of practice for each supervising licensed practitioner. Each supervising licensed practitioner shall assume professional responsibility for the services provided by the certified CHW and attest to the CHW’s certification. Each supervising licensed practitioner shall bill for the services of the certified CHW.

Coverage Parameters and Limitations:
Kansas Medicaid will apply the following parameters and limitations to covered CHW services:
        • Services must be provided face-to-face with the member, individually or in a group, in an outpatient, home, clinic, or other community setting.
        • Services are limited to 4 units (or 2 hours) per day, per member.
        • Services are limited to 24 units (or 12 hours) per month, per member.

Billing Instructions:
The services must be billed using the individual or individual group member National Provider Identification (NPI). These services are not reimbursable to a Rural Health Clinic (RHC), Federally Qualified Health Center (FQHC), or Indian Health Center (IHC). If the RHC/FQHC/IHC shares an NPI with the physician group, reimbursement should be to the physician group only.

When billing these services, providers must append modifier U7 to codes 98960, 98961, and 98962 to indicate the CHW has met the required training requirements and has received a certificate of completion. The billing provider must maintain documentation of CHW certification and background checks for the individual providing the CHW services.

Community Health Worker Qualification:
To provide CHW services to members under Kansas Medicaid, a CHW must be certified through a CHW certification recognized by the Kansas Department of Health and Environment (KDHE). Applicants may apply for certification through one of two pathways listed below and must complete KDHE approved CHW training or work experience requirements. Please choose only one pathway option:

Education Pathway: Applicant must complete the KDHE approved CHW training program through the Kansas CHW Coalition or certified Kansas CHW education provider.

Work Experience Pathway: Applicant must complete 800 hours over three years plus three letters of recommendation to document work and/or volunteer experience.

The CHW services shall include:

Screening and assessment to identify health-related social needs and barriers to accessing health care.
Health promotion and coaching to assist members to set goals and action plans to address health-related social needs and barriers to accessing health care; and provide information, coaching, and support to assist members to engage and re-engage in their own health care including adherence to treatment plans, follow up with necessary health care, and self-management of chronic conditions.
Health system navigation and resource coordination and groups of members, consistent with established or recognized health care standards, on methods and measures to prevent disease, disability, and other health conditions or their progression.
Care planning with a member’s care team to support a person-centered holistic approach to care delivery to promote physical and mental health and efficiency, and to address health-related social needs and barriers to accessing health care.

These services may be provided in the community, in a clinic setting, individually or in a group.

Note: The effective date of the policy is July 1, 2023. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.