Directs the Oregon Health Authority to assess current fee-for-service billing practices and non-fee-for-service payment pathways for community health workers serving medical assistance recipients to identify improvements for ensuring adequate and sustainable funding.

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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
A-Engrossed
House Bill 2216
Ordered by the House April 7
Including House Amendments dated April 7
Introduced and printed pursuant to House Rule 12.00. Presession filed (at the request of House Interim Committee
on Behavioral Health and Health Care for Representative Rob Nosse)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure. The statement includes a measure digest written in compliance with applicable readability standards.
Digest: The Act tells OHA to study ways to improve how community health workers are paid.
(Flesch Readability Score: 67.5).
Directs the Oregon Health Authority to assess current fee-for-service billing practices and non-
fee-for-service payment pathways for community health workers serving medical assistance recipi-
ents to identify improvements for ensuring adequate and sustainable funding. Directs the authority
to provide technical assistance to coordinated care organizations , organizations that serve med-
ical assistance recipients who are not enrolled in a coordinated care organization and com-
munity health worker organizations in establishing billing structures or alternative payment
pathways for community health worker services.
Sunsets January 2, 2027.
Declares an emergency, effective July 1, 2025.
A BILL FOR AN ACT
Relating to community health workers; and declaring an emergency.
Whereas a community health worker is a frontline public health worker with expertise engaging
within local communities and has been recognized as an effective provider in addressing health eq-
uity and social determinants of health; and
Whereas community health workers often share ethnicity, language, socioeconomic status and
life experiences with the communities they serve; and
Whereas the trusting relationship between community health workers and the communities they
serve enables community health workers to serve as a community link to available health and social
services, facilitating connections to resources and improving access to and the quality of care; and
Whereas despite the demonstrated impact of their work, community health workers remain one
of the lowest paid health professionals nationally; and
Whereas most of the work of community health workers is funded through a fragmented web
of reimbursement approaches and unsustainable one-time grants; and
Whereas understanding and navigating the reimbursement approaches is challenging for com-
munity health workers, even community health workers who work in established health systems and
those with strong relationships with the Oregon Health Authority and coordinated care organiza-
tions; and
Whereas technical support is limited and insufficient to adequately provide community health
workers and their organizations with the resources they need to engage with funding systems, which
has led to a rotating door of turnover, burnout and services provided unreliably to those most in
need; now, therefore,
NOTE:Matter in boldfaced type in an amended section is new; matter [ italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 2694
A-Eng. HB 2216
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Be It Enacted by the People of the State of Oregon:
SECTION 1.
(1) As used in this section, “community health worker” and “medical as-
sistance” have the meanings given those terms in ORS 414.025.
(2) The Oregon Health Authority shall assess current fee-for-service billing practices
with respect to community health workers serving medical assistance recipients to identify
funding improvements and expansions that will ensure adequate and sustainable funding. The
assessment must include, but is not limited to:
(a) A review of the current billing codes for community health workers to ensure that
each code takes into account the full range and duration of the scope of services provided
by community health workers;
(b) A review of and revisions to billing codes for services that fall within the scope of
practice of community health workers but are not currently available to community health
workers, including social determinants of health codes as primary diagnostic codes;
(c) Revisions to current billing structures for community health workers to align the
structures with the most recent Medicare physician fee schedule codes for community health
integration, social determinants of health and principal illness navigation services;
(d) Revisions to current reimbursement rates for community health workers to align the
rates with the full duration and nature of work performed, including consideration of labor
costs, the mix of services provided, caseloads and supervision costs;
(e) A review of current reimbursement codes, rates and mechanisms for community
health workers to ensure access to the full array of diverse settings in which community
health workers practice, both clinical and community based; and
(f) A study of the economic model of community health worker organizations to identify
ways that policies or fee schedules can be designed to more closely fit the model in practice.
(3) The authority may contract with a third party to conduct the assessment described
in this section.
SECTION 2. (1) As used in this section, “community health worker” and “medical as-
sistance” have the meanings given those terms in ORS 414.025.
(2) The Oregon Health Authority shall assess current payment models, other than fee-
for-service, with respect to community health workers serving medical assistance recipients
in nonclinical settings to identify ways to improve access to adequate and sustainable fund-
ing. The assessment must include, but is not limited to, a review of:
(a) Existing non-fee-for-service payment models, including in lieu of services, value-based
payments, health-related services and other community investment programs;
(b) How a community health worker may access sustainable funding for services provided
to medical assistance recipients without the supervision of a clinical supervisor;
(c) How community health worker services may be used to support the provision of
health-related social needs services, such as housing supports, nutritional assistance and
climate-related assistance, approved for the demonstration project under 42 U.S.C. 1315 by
the Centers for Medicare and Medicaid Services; and
(d) The need to establish and support community billing hubs and the role of community
billing hubs in streamlining the billing process for community health workers and community
health worker organizations.
(3) The authority may:
(a) Contract with a third party to conduct the assessment described in this section.
[2]
A-Eng. HB 2216
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(b) Adopt rules that would support new and emerging payment models for community
health workers.
(4) The authority shall submit a report in the manner provided in ORS 192.245, including
a plan for implementing the improvements identified in the assessment conducted under this
section, to the interim committees of the Legislative Assembly related to health no later
than November 1, 2026.
SECTION 3.
(1) As used in this section, “community health worker,” “coordinated care
organization” and “medical assistance” have the meanings given those terms in ORS 414.025.
(2) The Oregon Health Authority shall provide technical assistance and support for co-
ordinated care organizations, organizations that serve medical assistance recipients who are
not enrolled in a coordinated care organization and community health worker organizations
in establishing billing structures or alternative payment models for community health
worker services that are provided to medical assistance recipients. When appropriate, the
technical assistance and support shall be provided in collaboration with coordinated care
organizations’ traditional health worker liaisons.
(3) The authority may contract with a third party to provide the technical assistance and
support described in this section.
SECTION 4. Sections 1 to 3 of this 2025 Act are repealed on January 2, 2027.
SECTION 5. In addition to and not in lieu of any other appropriation, there is appropri-
ated to the Oregon Health Authority, for the biennium beginning July 1, 2025, out of the
General Fund, the amount of $_______, which may be expended for carrying out the pro-
visions of sections 1 to 3 of this 2025 Act.
SECTION 6.
This 2025 Act being necessary for the immediate preservation of the public
peace, health and safety, an emergency is declared to exist, and this 2025 Act takes effect
July 1, 2025.
[3]