Background:

Community health workers (CHWs) are known by a number of names and may be referred to as community health advisors, lay health educators, peer health promoters, and promotores de salud, among other names. Community health workers are not defined in statute, although some states have enacted laws regarding CHWs.

The Community Health Worker Task Force was established in 2015 to create policy change recommendations aligning the CHW workforce with the Healthier Washington initiative. The task force focused on making recommendations supporting integration of CHWs into community health and the health care system. The task forced included 55 members from across the state including legislators, representatives from health care delivery systems, community-based organizations, local health jurisdictions, tribes, professional associations, labor, CHWs from a wide range of sectors, and others. The task force issued a report in December 2015 that detailed recommendations related to the definition of CHWs, their roles and skills, CHW training and education, and CHW financing and sustainability.

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Summary of Substitute Bill:

The intent of the Legislature is to define the roles of community health workers (CHW) in statute in "an effort to create consistency across the state." "Community health worker" is defined as "a frontline public health worker who is a trusted member of or who has a uniquely close understanding of the community served. This trusting relationship enables the worker to serve as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery." "Frontline public health worker" is defined as someone who works to improve community health.

The roles and activities of CHWs may include:

cultural mediation among individuals, communities, and health and social service systems;
providing culturally appropriate health education and information;
conducting outreach;
care coordination, case management, and system navigation;
providing coaching and social support;
advocating for individuals and communities;
building individual and community capacity;
implementing individual and community assessments; and
participating in evaluation and research.

By July 1, 2019, the Department of Health (DOH) must adopt rules defining the direct services that CHWs may provide. By October 1, 2018, the DOH, to the extent of its existing authority, must begin to implement the recommendations of the task force related to training and education and report the progress to the Legislature by July 1, 2020.

By July 1, 2019, public and private entities employing CHWs must perform a fingerprint-based background check through the Washington State Patrol for all CHWs who perform the roles defined in the bill on the entity's behalf.

Substitute Bill Compared to Original Bill:

The substitute bill eliminates the role that allows community health workers (CHWs) to provide direct services such as basic screening tests and basic services with adequate supervision and training, and instead requires the Department of Health (DOH) to adopt rules defining the direct services that CHWs may provide. The DOH must also begin implementing the recommendations of the Community Health Worker Task Force related to training and education by October 2018 and to report to the Legislature on the progress by July 1, 2020.

The substitute bill also requires public and private entities that employ CHWs to perform a background check through the Washington State Patrol for all CHWs that perform the roles described in the bill on the entity's behalf.

Staff Summary of Public Testimony:

(In support) Community health workers (CHWs) have a long history and are used across the world. Community health workers act as a bridge to social services and health providers, help people be their healthiest, and increase provider engagement. Community health workers are needed to make health reform work and there is a growing evidence base about the importance of CHWs. One of the fundamental values of local public health is providing quality and culturally competent care. Community health worker fill these gaps and ensure that people are empowered to use and access health care system.

All nine Accountable Communities of Health (ACOs) have included CHWs in their plans. However, there is some uncertainty as to the definition, so a formal and consistent definition moving us forward in one direction is necessary. Community health workers operate in such a wide variety of roles, we need a clear definition of what they are and what they do, and need a robust training system.

The Community Health Workers Task Force was convened by the Department of Health and the Health Care Authority in anticipation that CHWs would be essential to meet the goals of health reform. The task force had 55 members representing health systems, managed care, government agencies, and many CHWs. The recommendations were passed unanimously and this bill comes directly from those recommendations.

(Opposed) None.

(Other) While increasing access to care where people are located makes a lot of sense, there is a concern that CHWs may exercise clinical judgment. Some sort of standardized training or a consistent form used by all CHWs and developed by a central agency, may solve these issues. There are also concerns that supervision may cause liability for entities employing CHWs.

Most states that regulate CHWs have training and certification requirements. Washington already has a voluntary training program. Others are worried that a scope of practice is being developed in the bill, without any training requirements. CHWs should be brought in under the Uniform Disciplinary Act.

Persons Testifying: (In support) Representative Robinson, prime sponsor; Kathy Burgoyne, Foundation for Healthy Generations; Michelle DiMisicio, Public Health Seattle and King County; Margaret Braun, Spokane Regional Health District; and Jaime Bodden, Washington State Medical Association of Local Public Health Officials.

(Opposed) None.

(Other) Katie Kolan, Washington State Medical Association; and Justin Gill, Washington State Nurses Association.