12:07:38 started without any acl grant funding we're fortunate to have received the capacity building for Evan <unknown>, and a sustainability grant in 2,019. They're part of the grant included creating new community
12:07:48 health worker positions for the better choices better health program, and We'll talk a little bit more about that in just a bit.
12:07:56 This hasn't been without challenges of course and while we certainly have made a difference along the way.
12:08:00 There is still more to do so. The opportunity for a better choice is better House, South Dakota to become a regular resource for community housework or programs that are being developed across the state will be impactful for the continue sustainability
12:08:16 of our programs. So better choices, better house south dakota is the umbrella organization that offered a suite of programs around for adults as a statewide centralized offering it's managed under one
12:08:34 license that's held by Sdsu Extension that we are in collaborative partnership with the South Dakota Department of Health and the South Dakota department of human services refer to our programs as
12:08:46 self management, education programs and physical activity programs, as we kind of show on the slide here, distance learning opportunities are available to anyone anywhere.
12:08:57 Now in the State there are 8 different programs that can be attended in 3 different formats through December of 2,021. We have hosted 3 or 9 workshops, and i've had nearly 3,000 participants attend to
12:09:11 workshop. So you heard that talk about some of the demographics.
12:09:20 It's not the code at the beginning of this Presentation So this map reflex the counties in South Dakota, 66 of them geographically the distance in South Dakota from west, to east just to give
12:09:31 you a little perspective. it's 400 miles crossed long and up and down 240 miles wide. Excuse me with in-person workshops.
12:09:43 Only better choices. Better health was first primarily in just a few small colonies, and that was heavily depended on where there were trained leaders.
12:09:52 Since the inclusion of distance learning attendance, the statewide impact has changed significantly.
12:09:58 So here's what the colors mean the 5 comedies in black have posted an in-person workshop.
12:10:04 Only the 18 carries in blue have hosted fully distance learning workshops.
12:10:13 In the 27 yellow counties have offered both distance learning and in person.
12:10:16 So that's 50 counties have participated in some form of better choices, Better health programming that's 75% of the counties that we have the other 16 or the other 25% of not had any participation But
12:10:32 What this really means is with the Community House Record Program development all across the State.
12:10:39 That this knowledge and awareness of previous participation and better choices, better health programming will really help support that further or future work and future collaboration with those community health record programs.
12:10:57 So next I wanted to share a brief timeline of the community health worker work here in South Dakota, South Dakota is one of the last States in the United States to start focusing in on the community health worker
12:11:09 profession, and so I wanted to share a quick Timeline of how we've gotten to where we're at now in 2,022.
12:11:17 So back in 2,015 the South Dakota Department of Health conducted an environmental scan of all 50 States to identify what each State's CEO Programming looked like as well as to identify States that closely
12:11:29 aligned with South Dakota additionally we conducted interviews with about 45 different key stakeholders and key organizations across the State, and through those interviews we learned overwhelmingly that
12:11:42 Siege's were a Profession that is very anticipated here in South Dakota, so in 2,016.
12:11:49 Our Department of Health, as well as our South Dakota Department of Social Services, or Dss.
12:11:54 Facilitated a work group to develop key recommendations for C. Hws in South Dakota, and so from 2,016 through 2,019 South Dakota Department of social services who made a South
12:12:07 Dakota. Medicaid reviewed these key recommendations, and continued to work on how they could best support Chws.
12:12:15 Here in South Dakota, and as of April, the first 2,019 South Dakota Department of Social services now provides reimbursement for siege to services as a covered service of South
12:12:25 Dakota Medicaid. so we were very fortunate.
12:12:28 In April of 2,019, to have a State Plan amendment that allows for C Hw.
12:12:35 Reimbursement So just because there's reimbursement for the community health worker workforce doesn't mean that there's a workforce developing and growing or that anyone knows about community health workers so the department
12:12:45 of health introduced the Community health worker, collaborative in the January of 2,020 to promote it, develop a siege.
12:12:53 W. Workforce in South Dakota, and in late 2,020 early 2,021.
12:12:58 Despite the ongoing Covid, 19 pandemic, we were able to pull together key stakeholders from across the State, virtually through a zoom meeting to develop and host multiple zoom meetings to develop a 2,000 and
12:13:11 21 through 2,023 strategic plan and then we'll time to this further in a little bit here, but in 2,021 the Cdc.
12:13:19 Awarded the health disparities grant to all 50 states across the country. And so we're able to utilize some of that funding for the community health worker collaborative to further develop C Hw programs across South
12:13:33 Dakota. So here in South Dakota the scope of work for community health workers was co-developed back in 2,016.
12:13:41 Within that work group that was held by the South Dakota Department of Health and the South Dakota Department of Social Services.
12:13:47 So from that work group, the scope of work for South Dakota was identified, developed, and finalized, and the scope of work includes 3 different areas: health, system, navigation and resource, coordination, health promotion, and
12:14:02 coaching and health education to teach our promote methods and measures that have improvement effective in avoiding illness and or lessening its effects and better choices.
12:14:13 Better health, sd our chronic Disease, Self-management to suite here in South Dakota really focuses in on the last 2 bullet points of our scope of work, the Health promotion and coaching and the
12:14:24 health education. So here in South Dakota we are very fortunate to have multiple training programs available to train C.
12:14:34 Hws at the certificate level and what that means is the individual who's training in that certificate program is completes a training.
12:14:43 Certificate at the community where technical college level.
12:14:45 So it's 16 to 17 credits and is a semester long training program, and we also are very fortunate to have a large tribal population here in South Dakota, who has had community health representatives for
12:15:02 Chrs since the late 1,900 sixtys early 1,900 seventys. and they have the Indian Health Service community health representative training program.
12:15:11 And that's an improved training program here in South Dakota specifically for our tribes and tribal populations.
12:15:17 And then we also have a future training program as well. That is starting next fall.
12:15:22 And then we also have the opportunity to review training programs on a case-by-case basis from other states.
12:15:28 So if someone were to train in a different state and then move to South Dakota, we can have that training program reviewed and approved on a case by case.
12:15:37 Basis. So we're very fortunate to have our certificate level training programs here in South Dakota that can really provide that broad baseline information and education for those Thws, to then go out and work across
12:15:50 our State. Additionally, we have specified training programs, and this is unique to South Dakota and unique to South Dakota State Plan Amendment for Medicaid.
12:16:00 Reimbursement and specified training programs. Look at those 2 areas of the scope of work, the health promotion and coaching and health education and focus in further on evidence-based programs that can really support individuals in both individual and group settings across
12:16:18 our State. So one of those programs here in in South Dakota that's an approved specified training program is better traces, better health, Md.
12:16:27 Which is licensed by Sdsu extension and provides the lay later training.
12:16:32 So how to specify training. How do you specify training programs?
12:16:35 Time to reimbursement is twofold first a community health worker who has completed that certificate level training or a community health representative who's completed the training program through Indian health service in can train in one of
12:16:48 these specified training programs to expand the services that they're able to provide especially services offered in a group setting one step further beyond training our community health workers as specified training program leads.
12:17:02 We also have the opportunity, through South Dakota, Medicaid reimbursement for individuals who have trained to leave these programs to be reimbursed as providing a service of the s Hw scope of work using that
12:17:15 appropriate Cbt code. So what this means, as, for example, in a transitional housing program, that transitional housing manager and a community-based organization, Katrina, as a lay leader for better choices, better health and
12:17:29 lead better choices, better health workshops, and be reimbursed for leading those workshops to South Dakota.
12:17:37 Medicaid reimbursement but they're not necessarily a community health worker who's trained at the certificate level training program.
12:17:43 So this really is a unique opportunity here in South Dakota for our better choices.
12:17:48 Better health. Sd Program to really utilize the Reimbursement to support and sustain better traces.
12:17:57 Better health across our State. So next I want to provide, making the opportunity to share more of an overview of establishing our Chw.
12:18:07 Positions for Sdsu extension here in South Dakota.
12:18:10 All right. Thank you, Ben. So, And looking through establishing a community health worker, position, kind of through the lens of Sdsu extension, and how we grasp the concept and the growing programs, and the growing initiative around community
12:18:26 health workers in South Africa. Coda, so like Laurie, mentioned earlier in 2,019 Sdsu extension was awarded another acl. grant.
12:18:37 So this was the 3 you sustainability Grant, for continued expansion of our better choices.
12:18:43 Better health South Dakota programming. Specifically, we were focusing on those community clinical linkages and continuing to build partnerships with healthcare work sites to address the healthcare needs of rural and
12:18:58 underserved audiences across South Dakota.
12:19:02 A critical component of this funding was the creation of a community.
12:19:05 Health worker model for extension, and we took and built off the concept and the positions already housed within our organization.
12:19:17 And these positions were the F snap or expanded food and nutrition education program, and the Snap ed, or supplemental nutrition assistant program educators.
12:19:28 And these are prayer, professional models and positions that are located currently in a lot of our rural, primarily tribal communities, and are hired with an extension on the same kind of core competencies as identified necessary for community
12:19:47 health worker positions as well. Ssu Extension has over a 50 year history of working with these paraprofessionals to deliver both nutrition and physical activity.
12:19:59 Education, and so best practices and kind of some lessons learned from that work has been applied.
12:20:07 The development and mentoring of these new community health worker positions for extension.
12:20:14 These positions will go through the distance, learning community health, worker, certificate courses in South Dakota that are offered by the text schools, and they will also become certified to teach suite of self-management
12:20:29 education and physical activity workshops that are offered through better choices, but are health, South Dakota.
12:20:36 And so that currently includes all all of the curriculums that Laurie mentioned earlier.
12:20:42 And then our physical activity programs are walk with ease and fit and strong.
12:20:47 So today Sdc extension has developed and recruited for the better choices.
12:20:52 Better health, community, health worker, position through extension. 3 new hires have been onboarded.
12:20:57 The of these positions have completed training as a better traces, better health.
12:21:02 South Dakota leader, and have co-facilitated a total of 42 workshops reaching over 400 participants in our State.
12:21:10 These positions also served a critical role in helping to leave the efforts in 2,020.
12:21:17 After the onset of the pandemic, during which time better traces better held.
12:21:22 South Dakota was launching our virtual workshops, and so these positions helped facilitate technical orientation and assistance.
12:21:34 Was provided out to participants who were new to technology and new to using zoom.
12:21:40 The Zoom platform. So while this model is new and still partially in pilot phase, we continue to adapt best practices to take our lead from the South Dakota Department of Health community health worker work group and the
12:21:56 collaborative the recommendations that they continue to provide on scope, practice, and core competencies along with education and all right.
12:22:06 Next slide. Ben. So in late 2,019 Sdu.
12:22:11 Extension began discussions with the community health, health worker, collaborative of South Dakota potential opportunities to leverage suite of chronic disease, self-management, education, and physical activity. program.
12:22:23 So we got to meet with Ben. He helped introduce us to other partners involved in this work as well.
12:22:29 So those initial discussions led to a series of meetings that took place between the South Dakota Medicaid the Community health worker, collaborative.
12:22:40 The South Dakota Department of Health and Ssd.
12:22:42 Extension to see if the better traces better health. South Dakota, chronic disease, self-management, program training, met the requirements as a Medicaid approved training, and Dr.
12:22:54 Kate Lorick was gracious enough to join us on those calls to provide more evidence to support the Cdsmp. lay leader Trainings alignment with the community health worker program Then, in January of 20
12:23:08 2,020 South Dakota. Medicaid did approve the better traces. Better health.
12:23:14 South Dakota, Cbsmp. Lay leader training for lay leaders to work providing a service of the C.
12:23:20 Hw. scope of work in regards to reimbursement.
12:23:24 So this is a big win for us Additionally, certificate Level C.
12:23:28 Hws have the opportunity to become trained as a lay leader in Cbsmp.
12:23:33 To expand the services that they offer to their communities in which they serve.
12:23:40 So overall This approval really paved the way for incentivizing Medicaid providers to start C. Hw.
12:23:48 Programs as this is, a new program in our State, has been just covered as well as incentivizing organizations and Medicaid providers to utilize the C.
12:23:59 Hw. reimbursement claim. We want to give a special shout-out and thank Dr. Kate Laurie.
12:24:08 Of course, for taking the time to talk with South Dakota.
12:24:10 Medicaid we we couldn't have made these advancements without her support.
12:24:17 All right next slide, Ben. so I just wanted to take a few moments to further share.
12:24:26 What South dakota's medicaid reimbursement looks like for community health workers here in South Dakota, as we're one of just a handful of States that currently have a State plan amendment
12:24:34 to allow for community health worker reimbursement through our statewide Medicaid program, and we're also the only state to have a State plan amendment that also includes chronic disease self-management, for
12:24:47 example, better traces that are held as a reversible program through our S Hw.
12:24:52 Reimbursement. So for an individual to receive C.
12:24:56 Hw. services through South Dakota, Medicaid.
12:24:58 They were required to have a qualifying condition and or a qualifying barrier.
12:25:04 So when looking at the qualifying conditions, we're looking at chronic diseases, obesity, pre diabetes, high risk, pregnancy, etc.
12:25:14 And we know that many of these are addressed and are covered in better choices.
12:25:20 Better health. Other programs that focus in on the individuals in that group setting, as well as the qualifying barriers being J.
12:25:29 Geographic distance, a lack of phone resulting in an individual, maybe going to an emergency room instead of a primary care.
12:25:34 Provider and cultural and language communication barriers as well.
12:25:39 The the qualifying barrier and that are available to allow an individual to be eligible, to receive C Hw.
12:25:47 Services. So, looking again at this scope of work, our medicaid specific scope of work, as you see here, is identical to our overall scope of work here in South Dakota.
12:25:57 So We're. very fortunate to have a so the same scope of work utilized by both Department of health promoting the C Hw.
12:26:05 Workforce as well as within Medicaid promoting reimbursement.
12:26:10 So there's a lot going on on this slide, here. But Ultimately, when we take a look at this slide and we notice the rates specifically built to cpt codes individually.
12:26:21 C. Hw. services are reimbursed at $41 and 78 cents per hour. but in a group setting, looking at 5 to 8 participants, a better trace is better.
12:26:31 Health workshop can receive approximately $116 in reimbursement per class that they offer, as well as over $700 per week shop or per 6 classes.
12:26:44 So this is really crucial in the sustainability of better traces.
12:26:49 Better health in our state. as this is really allowing that reimbursement to help offset some of the costs that organizations are experiencing as they're leading better choices that are health workshops.
12:26:58 So when you think of having 5 to 8 participants in a class, and having a $116 in reimbursement for that class, that certainly can divide out and provide reimbursement to cover not only the time for those
12:27:11 lately leaders within the class, but also some of the time preparing for the class providing follow-up from the class, etc.
12:27:19 So this was really impactful for our better choices. Better health programming here in South Dakota, as it really further opens the door to sustainability for the program here in South Dakota.
12:27:31 So next I wanted to share just a brief overview of the health disparities.
12:27:35 Grant that we referenced earlier, as this provides a lot of expanded supports for our C.
12:27:41 Hws here in South Dakota, so in March of 2021, the South Dakota Department of Health learned of the national initiative to address Covid 19 health disparities.
12:27:51 Among populations at high risk, and underserved, including racial and ethnic minority populations and rural communities.
12:27:59 Grant health disparities for short because it's a rather long title, and this funding opportunity includes 4 strategies and all 50 States were awarded.
12:28:08 This funding opportunity strategies one and 2 focus on Covid, 19 testing and Covid, 19 vaccination and strategy.
12:28:17 3 focuses on building, leveraging and expanding infrastructure support for Covid, 19 prevention and control among populations that are at higher risk and underserved.
12:28:27 Specifically calling out to build and expand an inclusive public health workforce, including hiring people from the community or community health workers.
12:28:37 So we were very fortunate that we were able to have Medicaid reimbursement in place, and have a lot of the infrastructure supports available to really utilize this funding to its full capacity to
12:28:47 further expand our sustainable siege. W. workforce across South Dakota, and strategy for looks at mobilizing partners and collaborators to advance health, equity and address social detachments of health.
12:29:00 As they relate to Kovat, 19 health disparities.
12:29:04 So this funding opportunity really allowed us to work with our key partners across the State to further expand our C. Hw.
12:29:11 Workforce, C. Hw. Programming and Chw. infrastructure across South Dakota.
12:29:17 So all right, and then I will just touch on to thanks, Ben kind of continuing on from Sdsu extensions, perspective, and lend kind of what we were doing.
12:29:31 While all this work was building with the collaborative, and things were happening with C Hw.
12:29:38 Programming. So the alignment between Fbc extension and the Community health worker collaborative, has been really beneficial for advancing health care, support of our better traces.
12:29:52 Better health. South Dakota program. and it's also provided a brand new opportunity.
12:29:58 And a strategic framework that we could use to help integrate the chronic disease, self-management program, lay leader training to the certificate level.
12:30:10 C. Hw. training programs in South Dakota. So the Inaugural better traces, Better health.
12:30:16 South Dakota, Cdsmp. Lay Leader Training for C.
12:30:19 Hw. students actually started last Wednesday and i'm one of the master trainers.
12:30:26 So it's been really exciting to finally get to this place where we're in training and offering it
12:30:34 It's being held virtually. over. zoom with with those students who have enrolled in the certificate course through lake Area Technical College.
12:30:44 So that's who we partnered for this first inaugural training and lake Area Tech is located in Watertown, South Dakota.
12:30:52 But all the students are participating via distance learning the lake area.
12:30:59 Technical college instructors are in the process of becoming trained better traces, better health.
12:31:04 South Dakota master trainers to facilitate the Cdsmp.
12:31:09 Layilater training to the students as a model moving forward and this model will be adopted by other technical colleges in South Dakota, with southeast Technical college that's located in Sioux Falls being the
12:31:23 next College to move forward with this process, and as part of the health disparities grant funding that then just introduced Sdsu extension, had the opportunity to hire a community outreach coordinator so Laura on the call
12:31:38 with us today, and she serves as the direct contact for partners looking to implement workshops within their organization and community that fall under the better choices. Better health suite of offerings specifically partner with those organizations who are applying
12:31:55 for the Rfa. to develop a C Hw. program.
12:31:59 So this position, Laura, will also be the lead contact for these technical colleges who are offering this level.
12:32:09 C. Hw. training programs and and helping to integrate and and form that connection even further.
12:32:17 And then after, of course, the students complete the training. You know.
12:32:21 The next step. So whether that means forming a plan for implementation of the workshops with their patients and kind of filling out that that model for moving forward, and how to be successful and maintain a program within their organization within their community and
12:32:41 addressing a new barriers that come up. So I just wanted to share a little bit more about our request for applications process, and how that is further expanding our collaborations between community health workers. and better choices.
12:33:00 Better health of South Dakota. So we're able to award through the Department of Health and the Health Disparities funding 300 awards to fund the development of siege programs across South Dakota and this
12:33:10 is looking to fund the development of C. Hw. programs in medical and clinical sites.
12:33:17 Community-based sites, and in other sites across South Dakota, where a siegew might cross, train, in their current position, to also be able to work as a chw.
12:33:26 So our funding with the Department of Health can support awareness of the C Hw.
12:33:30 Profession, and can support that training or cross training of an individual to become a community health worker, and can also assist in providing funding for workforce and organizational development to ensure that their C Hw.
12:33:45 Program can be a sustainable program that continues after this initial funding, Opportunity ends additionally.
12:33:50 Funding can also support the development of training. A. C. Hw.
12:33:54 As well as other team members to be lay leaders for better choices.
12:33:57 Better help Sd. and lead better traces. Better health Sd.
12:34:03 Workshops under the management of sdsu extension So it's a great partnership that really allows us to utilize this funding to not only start community health worker programs across South dakota but also
12:34:14 utilize these C Hw. programs to further the reach and number of workshops available for better traces.
12:34:21 Better help. Sd So now i'll provide laura the opportunity to share more about the great work that she's doing across South Dakota as our community outreach Coordinator for better choices better health thanks
12:34:34 Ben. So this infographic that you see on the screen may be found at the link, provided it demonstrates the cross-pollination between the Chw.
12:34:44 And the Bcbh programs and the financial impact. This offers our partners.
12:34:49 Our goal is to simultaneously develop Chws in grant-funded communities in collaboration with the Bcbh program been mentioned up to 300 grantee communities will be awarded which will further support our sustainability for
12:35:02 the Bc. program. in my role I help assist the development of these relationships connecting people and programs to deepen our collaborations.
12:35:15 Here's just a short list of key stakeholders that have partnered with us in the first faces of our implementation, because we are a small and interconnected reaching across the aisle to collaborate happens
12:35:27 quickly, especially when there is work to be accomplished for the good of our population.
12:35:31 We identified our early adopters for the quick winds to give momentum to the project.
12:35:37 The willingness of partners and key players to pull together has helped us to be able to move quickly, and from there the word just gets around when learning on our when leaning on our professional partners, a cold call is only cold through the
12:35:50 introduction. rapport is rapidly established through our mutual connections.
12:35:59 Celticultans are very hearty and very proud.
12:36:02 A good hand shake still means something. here. seat yourself in any local sporting event with competing teams within the State.
12:36:09 You will quickly find families. Former college roommates as well as professional colleagues collaborating and catching up in the lobby between quarters or half times small, is not a disadvantage in fact we've shown it
12:36:20 to be advantageous. Our circles largely intersect across businesses, county lines, organizations and communities, projects and opportunities such as the Chw.
12:36:32 Collaborative. give us just another reason to join forces. Make no mistake.
12:36:36 South Dakotans. No people who know people we are most definitely stronger together.
12:36:42 In the 605. We even have an official day to celebrate us.
12:36:45 June 5 katie, that's all we have for today, so we can turn it back to you, or see if there's any questions from that.
12:37:25 Yes, thank you so much for that great presentation today, and we have had a few questions.
12:37:30 Come in through the chat box or a reminder to everybody that's listening.
12:37:35 But you, if you do have any questions to feel free to either put them in the chat or the Q.
12:37:39 And a box, and we'll be sure to go through them so
12:37:43 The first question. I know we had a question about the difference between what is Cdsme and, what is better, choices better health.
12:37:53 So just to clarify better choices. Better health is the local marketing name used for CD Sme programs in South Dakota.
12:38:03 So that is the those same program. And then so so one attendee asked.
12:38:12 They noted there were 2 slides speaking to the requirements to qualify for receiving.
12:38:16 The Medicaid approved services, who makes the determination for approving access to the Medicaid approved services?
12:38:23 And what is the tool used to make that determination? I think I can answer that question here.
12:38:30 So when looking at those qualifying conditions or qualifying barriers that are required for C.
12:38:35 Hw. services Medicaid sets what those qualifying conditions are qualifying barriers.
12:38:41 Aren't. and then it's up to the medical provider within their medical care plan, as they refer that patient to A. C.
12:38:49 Hw. to write in that care plan. the need for C.
12:38:52 Hw. services based on those qualifying conditions and or qualifying barriers.
12:38:58 So it can really be as simple as for example a patient's qualifying condition might be diabetes, and they're qualified, and they might not even have a qualifying barrier, or they could also have a quality thing barrier
12:39:10 as well. But within that care plan and lots of times these care plans are developed in electronic health records.
12:39:18 So they're these know simply a checkbox or a couple check boxes for that medical provider, knowing that they have a lot going on, and can't take time to formally sit down and write out a full care plan but it might
12:39:28 be something as simple as checking the box for diabetes as the qualifying condition, and then checking a box that says Address social determinants of health related to diabetes diagnosis.
12:39:39 It's, and checking another box that says encourage participation and better choices.
12:39:45 Better health, testing, or diabetes management, and then that would then allow for Medicaid reimbursement for that patient, as they work with this Hw.
12:39:55 And also as they participate in better choices, Better health, great.
12:40:00 Thank you so much, Ben. I see we also had a question around plans for how community health workers will be trained to implement chronic disease, self-management, education programs.
12:40:15 Can you share a little bit about whether C. Hws will be trained as master trainers in the future?
12:40:22 I can start with that. So I did mention it back in chat to answer that question. so you can reference that information.
12:40:31 But thank you for your question, Carl. So I do agree that that is a great strategy and a way to kind of build up the community health workers with the knowledge and training and that next level from a lay leader to a master trainer
12:40:47 we're always needing increased capacity to actually offer these programs and trainings.
12:40:55 And so a wonderful connection I forgot to mention earlier, when I was speaking to our community health worker positions, that 2 of our community health workers did a pain.
12:41:07 Their master trainer certification. and our initial plans were to have those community health workers help us with the partnership with the technical colleges to offer that integrated training to the students.
12:41:21 Since they went through the certificate, C Hw.
12:41:25 Program they could relate to Peer-to-peer.
12:41:26 Look on that level as well. And just also a great idea like I mentioned earlier to increase the capacity as well.
12:41:36 So anything else, Laurie, that you wanna add so in everything I would have said, Thanks, great, thank you both.
12:41:47 I know this is a time of a lot of growth and planning for expansion of C. H.
12:41:53 Ws. in the State, so it's exciting to hear how you anticipate that that will go over the next few years.
12:41:59 So another question around payment under Medicaid. So another attendee asked.
12:42:07 It appears from your presentation that individuals can be paid under Medicaid for specific services.
12:42:12 After receiving training on those programs, even without being certified in core community health worker skills.
12:42:20 Is that correct? And if so, what other qualifications are required for those individuals to build Medicaid?
12:42:27 Sure I can answer that one as well. So it does get a little bit confusing.
12:42:31 So great question to further clarify that so if we're looking in this specific situation.
12:42:37 If it's an individual who's a lay leader and who's leading better traces.
12:42:41 Better health, but they haven't completed a certificate level.
12:42:45 C. Hw. training program. They are only able to be reimbursed through Medicaid for providing better choices.
12:42:51 Better health Sd: they're not able to provide any other services outside of the chronic disease self-management group program.
12:43:02 So that really allows individuals to receive that reimbursement but also protects our community health worker scope of work, and that it doesn't allow individuals to provide C Hw.
12:43:13 Services without have received. having received C Hw. training here in South Dakota.
12:43:18 For an agency to enroll as a Medicaid reimburseable agency here in South Dakota.
12:43:22 They do do need to submit policies and procedures for their organization before they can seek that reinforcement.
12:43:29 And so within those policies and procedures other qualifications are outlined for those individuals, so they're required to pass a background check.
12:43:37 They cannot be on the inspector. Generals list of excluded individuals for billing Medicaid, and there's other additional policies and procedures as well that the agency has to meet before an individual is able to provide
12:43:50 better choices, Better health in that specific scenario situation.
12:43:54 So there it's a lot more fine printed when it comes to our billing and policy manual about the medicaid reimbursement, and how it relates the overall the short.
12:44:05 Answer is that for those individuals who Aren't trained as certificate levels to Hws they are only able to offer what they've received.
12:44:15 Training to do so, for example, for better tricks as better health It would be.
12:44:18 They're only able to offer that group lay leader of program for lately lead program.
12:44:23 Should they? great? Thank you so much, Ben. Lots of specifics, and all of the the payment details for sure.
12:44:32 So we also received a question around referrals and I anticipate that this could be a piece that might still be under construction, as you're in the process of training community health.
12:44:43 Workers. But one of the attendees asked, You take referrals directly through the electronic medical record.
12:44:50 And how is that structured? or do you use any referral platforms like Aunt Bertha?
12:45:02 Well, I can certainly start answering that question, and then I might tune it over to Lori to follow up
12:45:08 As you mentioned, things are rapidly changing here in South Dakota, and so we did as a State.
12:45:14 The Department of Health recently launched a request for proposals for what we're calling right now a community information exchange or a program that can allow that cross communication and closed loop refers system to take place.
12:45:29 We Can't speak too much on that right now, because there request for proposals was just submitted and and do, and in late February.
12:45:37 And so that hasn't been announced what group or groups have been awarded that, or will be awarded them funding.
12:45:43 But that's something that We're certainly in the works to work on here in South Dakota moving forward.
12:45:47 But right now there are some great opportunities and programs being utilized here in South Dakota as well, and all that Laurie and or others from Sdsu extension share more about what's currently in place to
12:45:59 support those referrals. Sure, thanks, Ben, and yes, use a variety of different systems to get referrals now into better choices, better health workshops.
12:46:15 So we do an online registration process set up through question probe.
12:46:23 Then we use a workshop wizard as our software for data management and evaluation.
12:46:28 And back to the origin or what Ben just said about the Community Information Exchange platform that the goal and division for that linkage is for better choices.
12:46:41 Better health to be recognized as a resource there that could really make seamless referrals and registration all through that software system. and Megan or Gloria.
12:46:55 If anything else you want to add to that piece I mean it's kind of a group effort on that response.
12:47:02 Yeah. and that system I think Ben alluded to. but that will the opportunity to have closed Loop to referrals from the health system.
12:47:09 What other whatever emr they're using can send in a referral. And then the Help line center of South Dakota is the lead kind of identifying what systems to work for that exchange.
12:47:23 Network. And so they're going to be a big part of that, and community health workers will have their own hotline that they can access through that exchange.
12:47:32 And so, as you can see, these small steps that we are working on right now and integrating in with the community health worker programs offering better traces, better health, Cdsmp workshops, it's one small step at a time
12:47:44 for that bigger network to hopefully be established that's fantastic.
12:47:51 Yeah, putting all the all the infrastructure pieces in place so that when community health workers are trained the system is is ready for them.
12:47:59 That's wonderful. and building on that a little bit another attendee asked a book about the role of community-based organizations in the community, health worker model, and a little bit more about any plans for the recruitment
12:48:15 process for community health workers. Big Question. So to our health disparities funding, we were able to move ahead very quickly with our development of our Hw.
12:48:27 Workforce across South dakota so we've started to see that in the past 6 months we've really been able to move forward about 6 years because of the opportunities that we've had through this funding opportunity and so
12:48:39 We have added a staff member to the community health worker, collaborative, who specifically works with community-based organizations.
12:48:46 So she's able to work with our cbs across the state, not only doing awareness to all of our community-based organizations on what A. C. Hw.
12:48:55 Is how they can work within their organization. things like that but she's also able to support the community based organizations that receive funding to start a Chw.
12:49:05 Program. So we're really looking forward to the opportunity to expand better choices, Better health into those new cbo programs across South Dakota.
12:49:13 It's and really work with those cbo's to further reach participants for better choices.
12:49:19 Better help sd across South dakota as far as the recruitment for individuals to become community health workers here in South Dakota. I think I can agree with probably everyone else across the country that we're in the
12:49:32 same boat looking for c hws to work here in South Dakota, looking for individuals to want to jump on board with this new profession.
12:49:41 So we're recruiting across the State through our partners to hire for those positions, to promote the workforce, to raise the awareness and to really focus in on the need for those individuals working in those professions to really
12:49:55 connect back to the populations that they're serving so we really want to emphasize the lived experiences that individuals might have with the populations that they're working with cultural appropriateness for the individuals that we're they're
12:50:09 working with, etc. So I wish I had a better answer for that question.
12:50:11 But I think that's the $1,000,000 question it's just how can we continue to develop this workforce and find individuals to work?
12:50:19 So we're really doing that awareness across our state to really hopefully develop a lot of sustainable cdw positions across our State, and also higher the right people.
12:50:30 For those positions. Wonderful! Thank you. And building off that a little bit with a few more details we did have a question about if somebody is interested in obtaining their certification to be a siege W.
12:50:44 How would they find that information? and along the same lines could you share a little bit about the training cost at the technical schools?
12:50:53 That's being offered sure so specific to south Dakota.
12:50:56 The Community health worker, collaborative of South Dakota website, or C.
12:51:00 Hwsd. Org has resources, including a form that an individual can fill out, and we will connect them with available or assume to open C Hw.
12:51:11 Positions within South Dakota, and this really closely aligns with that request for applications funding which allows 300 sites across South Dakota to hire individuals with the intention of them going through the training
12:51:24 program. So throughout the the timeline of our health disparities funding here in South Dakota, we're really able to cover those training costs for individuals who are wanting to become community health workers.
12:51:38 But if the grant was not to cover their training program, or in the future, when our funding is no longer available for that grant, we really have an opportunity, then, to look into that training program, and it costs about $4,500 total for that whole
12:51:54 certificate level training program. Wonderful. Thank you so much, Ben.
12:52:01 Another logistical question. So one of the attendees asked whether you have registered nurse supervisors for all community health workers at various placements.
12:52:12 So that's another great question we don't require a just to be the supervisor, although in some medical examiner, nurse, or nurse manager for that medical clinic does tend to be the supervisor,
12:52:26 for those community health workers. But We're really ramping up our efforts across South Dakota through the community health worker, collaborative to further provide support for those who are managing community health workers, knowing that the majority of not all
12:52:38 of those supervisors Are not community health workers themselves so really providing those supports for them.
12:52:45 To understand this unique profession, and really providing them with opportunities to manage their C Hw.
12:52:51 Or C. Hws, while also recognizing how they further connect within their community and with the C.
12:52:58 Hw. workforce across South Dakota. Great. Thank you so much.
12:53:06 Another question around the payment for the Cds Me programs through Medicaid.
12:53:12 So can you clarify that the number of billable units is limited to 2 units per day or 1 h?
12:53:19 And does this conflict with the length of the Cds Me session?
12:53:24 So I can answer that, and then turn it over to our Sdsu extension team as well to further
12:53:31 But unfortunately, at this time South Dakota Medicaid does only reimburse for 2 units or 1 h per day.
12:53:39 But in that example given in our presentation, you know if there were 8 individuals within the class that would be about a $116.
12:53:47 Technically it's a $116 and 96 cents of reimbursement for that specific class.
12:53:52 So even when looking at dividing that over the 2 and a half hours, that $116 can really go a long way in supporting the hourly wage for that individual who's working as the lay later and leading better choices
12:54:07 better health. so certainly something that we worked with itself to put a medicaid on to see if there's opportunities in the future to expand the number of reimbursable hours that can be provided within a day but for right now we have
12:54:20 that cap at 1 h. However, we know better traces. better. Health, Sd.
12:54:24 Is really a 2 and a half hour class for those workshops.
12:54:28 So, Laurie Megan, Laura, anything else to add to that?
12:54:33 Or did I answer that appropriately, for how we're all responding perfect.
12:54:37 Yeah, and I would just add to you know we're really excited to get that approval.
12:54:42 And you know, start those conversations and getting that, as you know, the the training program that can be a remember through better choices.
12:54:53 Better health right now, but definitely future plans for sustainability of our network of programs.
12:54:59 We're hopefully gonna have additional discussions around reimbursement for walk with these and fit and strong And then concurrently, we're working on defining our return on investment for all these programs.
12:55:12 So hopefully. that will be additional information that can be used to support the case for re-modifying you know those billing codes, and maybe having that full class in the future.
12:55:23 But Ben described it really well and kind of how you can sustain a program.
12:55:27 But through having a group class great. Thank you so much.
12:55:35 Megan and Ben. I know there are a lot of details of these types of reimbursement.
12:55:39 Mechanisms are set up, and I see that we have a few comments in the Q.
12:55:43 And a box from Carl Rush around State plan amendments that are being passed in California and Rhode Island.
12:55:52 Carl, I wonder if I unmute you? If you would like to speak to that for a moment, you should be able to unmute.
12:56:04 Now, if you would like, Okay, can you hear me now? Yes, Ok.
12:56:08 Yeah, i'm working with both of those and and They're There has been a lot of concern among community-based organizations that do employ
12:56:19 The majority of C. Hws in most States. And and so there is concern, particularly with smaller organizations that the administrative burden of billing is going to be too much.
12:56:32 Basically. So they're looking at ways to set up partnerships, administrative arrangements were they can work with, say, a county health department or fairly qualified health center to to process their billing for them
12:56:52 And It's I also wanted to add that There is There may be more evidence to support this over time, but neither California nor Rhode Island are imposing limits on the number of units of service that can be provided to a
12:57:10 recipient either per day. or per month per year whatever they've decided that there's there's really not much risk, not much need for that limitation.
12:57:23 So there may be more that you can draw on from the experience of other States in this over time.
12:57:29 It's certainly been the experience. of minnesota that they haven't been overwhelmed by the amount of billing that's taking place.
12:57:42 Great. Oh, go ahead, Ben. It was just going to add I think we're here in South Dakota very excited for others deep to continue to roll out State plan amendments to reimburse for Hw.
12:57:55 Services, because each of those new State plan amendments that roll out really provides us with an opportunity to meet with ourselves, to cook a Medicaid team and share more information about what those other State plan amendments look like and certainly something that our
12:58:08 State plan or excuse me. Our Medicaid team has on their radar.
12:58:14 As far as our State Plan Amendment looking at what other States are doing.
12:58:17 So we really do have a great working relationship with our Medicaid team, and we hope to continue to make those minor tweaks as this continues to roll out across South Dakota to really be supportive to those programs across our
12:58:29 State, and we are are just next door to Minnesota.
12:58:33 There are neighbors to the East, and so we really have a lot of great resources that we've been able to connect with the Minnesota to further lay out and and recognize how we can support our community based organizations knowing that there is a lot that goes into
12:58:48 that Medicaid billing piece, and how can we best support them as a partnerships with other organizations? things like that?
12:58:54 So it's really beneficial to have our neighboring state of Minnesota have have a State plan amendment as well, and have those successes, and it's really something that we're looking into as well for our
12:59:05 community based organizations. And I add one more quick thought on that.
12:59:13 Sure. Yeah, that majority of States involve managed care in their Medicaid programs and the States that have implemented payment for C.
12:59:24 Hws by and large have not used managed care as the vehicle.
12:59:29 They're they're typically providing for fee for service billing for C Hw.
12:59:35 Services with the reasoning that they need experience with cost and utilization in order to set rates for managed care, plans, or alternative payment models.
12:59:45 And that's sort of thing, but we have heard from cms that they are interested in working with states to help them develop actuarially sound rates of of payment for systems other than fee, for service, which which are also might include
13:00:05 let's say the fairly qualified health centers. so cms definitely has all the stuff on their radar.
13:00:15 Awesome that's always great to hear absolutely yeah wonderful to see activity across States.
13:00:21 In this movement. So I think that brings us to the end of our event today, and I think then there should be one more slide, as so just a reminder to everybody that attended today to fill out the post event survey that pops up
13:00:40 on Ancoa connect under the event where you join today.