Ohio Code 5167.173 – Community health worker services or services provided by public health nurse
(A) As used in this section:
Terms Used In Ohio Code 5167.173
- Another: when used to designate the owner of property which is the subject of an offense, includes not only natural persons but also every other owner of property. See Ohio Code 1.02
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means a medicaid recipient who participates in the care management system and enrolls in a medicaid MCO plan. See Ohio Code 5167.01
- Medicaid managed care organization: means a managed care organization under contract with the department of medicaid pursuant to section 5167. See Ohio Code 5167.01
(1) “Board of health” means the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code.
(2) “Certified community health worker” has the same meaning as in section 4723.01 of the Revised Code.
(3) “Community health worker services” means the services described in section 4723.81 of the Revised Code.
(4) “Public health nurse” means a registered nurse employed or contracted by a board of health.
(5) “Qualified community hub” means a central clearinghouse for a network of community care coordination agencies that meets all of the following criteria:
(a) Demonstrates to the director of health that it uses an evidenced-based, pay-for-performance community care coordination model (endorsed by the federal agency for healthcare research and quality, the national institutes of health, and the centers for medicare and medicaid services or their successors) or uses certified community health workers or public health nurses to connect at-risk individuals to health, housing, transportation, employment, education, and other social services;
(b) Is a board of health or demonstrates to the director of health that it has achieved, or is engaged in achieving, certification from a national hub certification program;
(c) Has a plan, approved by the medicaid director, specifying how the board of health or community hub ensures that children served by it receive appropriate developmental screenings as specified in the publication titled “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,” available from the American academy of pediatrics, as well as appropriate early and periodic screening, diagnostic, and treatment services.
(B) Each medicaid managed care organization shall provide to an enrollee who meets the criteria in division (C) of this section, or arrange for the enrollee to receive, both of the following services provided by a certified community health worker or public health nurse, as applicable, who is employed by, or works under a contract with, a qualified community hub:
(1) Community health worker services or services provided by a public health nurse;
(2) Other services that are not community health worker services or services provided by a public health nurse but are performed for the purpose of ensuring that the enrollee is linked to employment services, housing, educational services, social services, or medically necessary physical and behavioral health services.
(C) An enrollee qualifies to receive the services specified in division (B) of this section if the enrollee is pregnant or capable of becoming pregnant, resides in a community served by a qualified community hub, and has been recommended to receive the services by a physician, public health nurse, or another licensed health professional specified in rules adopted under division (D) of this section.
(D) The medicaid director shall adopt rules under section 5167.02 of the Revised Code specifying the licensed health professionals, in addition to physicians and public health nurses, who may recommend that an enrollee receive the services specified in division (B) of this section.