Updated April 2026: not an official Medicaid document.
Hypothetical example - CHW Workweek NEED TO EDIT THIS SIDE to match your organization
| Activity |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday
Download
to see
Sub-Totals |
Total Time |
Revenue |
| Day Overview |
CHW starts the week in medical Office |
Call to check on rural clients from the office |
CHW drives to unserved neighboring community |
Client meetings in the office |
CHW drives to unserved neighboring community |
|
|
| Travel |
|
|
1.0 |
|
2.0 |
3.0 |
$0.00 |
| Notes |
1.0 |
1.0 |
1.0 |
1.0 |
1.0 |
5.0 |
$0.00 |
| Supervision |
0.5 |
|
|
0.5 |
|
1.0 |
$0.00 |
| Patient Edu |
3.0 |
4.0 |
3.5 |
3.0 |
2.5 |
16.0 |
$586.88 |
| Group of 3 |
1.0 |
|
1.0 |
2.0 |
|
4.0 |
$211.68 |
| Group of 8 |
1.5 |
|
1.0 |
1.5 |
2.0 |
6.0 |
$618.24 |
| Team/Office |
1.0 |
3.0 |
0.5 |
|
0.5 |
5.0 |
$0.00 |
| |
|
|
|
|
|
|
|
| hours/day |
8.0 |
8.0 |
8.0 |
8.0 |
8.0 |
40.0 |
$1,416.80 |
| |
|
|
|
|
|
|
|
| |
|
|
|
|
TIME |
HOURS |
BILLABLE |
| |
|
|
|
|
50 weeks |
2000 |
$70,840.00 |
| |
|
|
|
|
2 weeks PTO |
0.0 |
$0.00 |
| |
|
|
|
|
|
|
|
| |
Hourly Rate |
Annual |
20% Fringe |
5% admin, data, billing |
Annual Cost |
|
|
| 1FTE |
$ 27.25 |
$ 56,680.00 |
$ 11,336.00 |
$ 2,834.00 |
$ 70,850.00 |
|
|
605 COMMUNITY HEALTH WORKER SERVICES
CHWs are trained public health educators improving health care delivery requiring integrated and
coordinated services across the continuum of health. CHWs provide recipients culturally and
linguistically appropriate health education to better understand their condition, responsibilities,
and health care options. CHW services must be related to disease prevention and chronic disease
management that follow current national guidelines, recommendations, and standards of care,
including but not limited to, the United States Preventive Services Task Force (USPSTF) A and B
recommended screenings. CHWs may provide services to recipients (individually or in a group)
within the home, clinical setting, or other community settings.
605.1 COMMUNITY HEALTH WORKER PROVIDER QUALIFICATIONS
A. Certification as a CHW must be obtained through the Nevada Certification Board or
another state-approved training program.
B. Must be supervised by a Nevada Medicaid enrolled Physician, PA, APRN, Dentist, LCSW,
LMFT, LCPC, NM, and Nurse Anesthetist.
605.2 COVERAGE AND LIMITATIONS
A. Covered services:
1. Guidance in attaining health care services.
2. Identify recipient needs and provide education from preventive health services to
chronic disease self-management.
3. Information on health and community resources, including making referrals to
appropriate health care services.
4. Connect recipients to preventive health services or community services to improve
health outcomes.
5. Provide education, including but not limited to, medication adherence, tobacco
cessation, and nutrition.
6. Promote health literacy, including oral health.
B. Non-covered services:
1. Delegate the CHW to perform or render services that require licensure.
2. Transport a recipient to an appointment.
3. Make appointments not already included within the CHW visit/service (i.e.
receptionist duties or front desk support).
4. Deliver appointment reminders.
5. Employment support, including but not limited to resume building, interview skills.
6. Coordinate and participate in community outreach events not related to individual
or group Medicaid recipients.
7. Case management.
8. Accompanying a recipient to an appointment.
9. Provide child-care while the recipient has an appointment.
10. Application assistance for social service programs.
11. Mental health/alcohol and substance abuse services, including peer support
services.
C. Service Limitations:
1. Services provided by a CHW are limited to four units (30 minutes per unit) in a 24-
hour period, not to exceed 24 units per calendar month per recipient. If medically
necessary, prior authorization can be requested for additional services.
2. When providing services in a group setting, the number of participants must be at
a minimum of two and a maximum of eight.
D. Prior authorization is not required.
E. For a list of covered procedure codes please refer to the CHW PT 89 Billing Guide
