Community Health Worker (CHW) Benefit Updates
| Date: | May 6, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers |
| Type: | Regulatory |
| Subject: | Community Health Worker (CHW) Benefit Updates |
| Business: | Medi-Cal Managed Care |
Effective April 1, 2025, the Department of Healthcare Services (DHCS) updated the Community Health Worker (CHW) benefit. DHCS provided additional guidance which includes new Healthcare Common Procedure Coding System (HPCPS) codes, billing structure and policy updates. Please review the information below:
- General Medicine Bulletin, item number five:
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine
- Community Health Worker (CHW) Preventive Services section, Part 2 of the Medi-Cal provider manual found here:
- State Plan Amendment (SPA) 25-0016 Public Notice:
(https://www.dhcs.ca.gov/SPA/Documents/SPA-25-0016-Public-Notice.pdf) has been issued to set the rates for the two new codes to 100% of the Medicare rate, pursuant to Welfare & Institutions Code Section 14105.25.
- Statewide standing recommendation:
(https://www.dhcs.ca.gov/services/medi-cal/Documents/Standing-Recommendation-for-CHW-Services.pdf) has been issued that all Medi-Cal members who meet the defined eligibility criteria for receiving CHW services would benefit from CHW services.
For more information regarding CHW and FAQs, please visit https://www.dhcs.ca.gov/community-health-workers.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
