How Can the CHR Program Be Reimbursed?

1. How Can the CHR Program Be Reimbursed? Working Together – CMS, Tribes and the Aberdeen Area August 29 & 30, 2007

2. Look to other Models • Alaska CHAP • What services do CHRs provide • Transportation • Physician extender

3. Alaska Community Health Aide Program • State approved provider type • Community Health Aides/Community Health Practitioners (CHAP) • CHAPs are hired from candidates selected by the communities in which they will serve. • Work in the clinic as soon as they are hired, learning the CHA/P role. • Formal training occurs as soon as possible • CHAs carry the full responsibility for their position prior to completion of their education.

4. CHAP Supervision • Field Supervisors employed by the tribal organizations ensure that the policies of the organization are implemented. • Supervisors for CHA/Ps provide oversight via field visits to village clinics and through daily to weekly telephone communications with the CHA/P. • Three critical components to field supervision: • Administrative (recruit CHA/Ps, evaluations, schedules, policies, regulatory compliance with • CLIA, OSHA, JCAHO) • Clinical (post session learning needs, evaluations, quality assurance, medico-legal issues) • Psychosocial support (critical incidence stress debriefing)

5. CHAP Training • 4 Community Health Aide Training Centers– (undergo reviews) • Managed by a tribal health organization • Accommodate from 42-64 students per year. T • Total system capacity is 208 students per year • Alaska Native Tribal Health Consortium (Anchorage) Capacity: 54 • Norton Sound Health Corporation (Nome) Capacity: 48 • Southeast Alaska Regional Health Consortium (Sitka) Capacity: 42 • Yukon Kuskokwim Health Corporation (Bethel) Capacity: 64

6. COMMUNITY HEALTH AIDE BASIC TRAINING CURRICULUM • Approved by State • Administered by CHAP Board of Directors/Committee • Curriculum is extensive – A few examples: • Emergency Care • Eye Care • Dental • Circulatory and Respiratory Systems • Diseases • Wellness Promotion

7. CHAP Reimbursement • Operate under Tribal 638 Authorities • Rates of reimbursement negotiated with State • 100% FMAP applies due to 638 status

8. What Services Do CHRs Provide • Compare CHR services to Medicaid services • Can a case be made for reimbursements? • Two examples: • Transportation • Nurse or Physician extender

9. Transportation • Review and comment on proposed rule – Medicaid Program; State Option to Establish Non-Emergency Medical Transportation Program (CMS-2234-P) • Published in Federal Register on August 23, 2007 • 30 day comment period

10. Nurse or Physician Extender Services Look to State laws that may provide an avenue for service match Must meet standards Licensure requirement may or may not apply 100% FMAP applies due to CHR 638 status Nevada Example: Nurses Aide services

11. Tribal Affairs GroupCMS Dorothy A. Dupree, Director