Diabetes-Specific Community Health Worker (CHW) Request for Applications (RFA)

Diabetes-Specific Community Health Worker (CHW) Request for Applications (RFA)

For questions or concerns regarding the application, please email info@chwsd.org.

Overview
The South Dakota Department of Health’s Diabetes Program is pleased to announce the release of the Diabetes-Specific Community Health Worker (CHW) Program Request for Applications (RFA).

This funding opportunity will provide one medical/clinical organization with funding to hire and train an individual to work with patients with Type 2 Diabetes and prediabetes.

The organization awarded the funding opportunity will receive technical assistance and support from the SD Diabetes Program as well as the Community Health Worker Collaborative of South Dakota (CHWSD). To learn more about CHWs, visit:

The funding period will be from Fall 2024 through May 31, 2025.

Organization Information
Organization Name*
Organization Mailing Address (as it should appear on a contract, if awarded)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Project Contact Person*

First NameLast Name
Project Contact Person Email*
example@example.com
Project Contact Person Phone Number*
Please enter a valid phone number.
Contract Signatory*

First NameLast Name
Contract Signatory Email*
example@example.com
Contract Signatory Phone Number*
Please enter a valid phone number.
Which of the following best describes your organization:*

Health SystemIndependent HospitalClinicFQHCTribal Health ProgramOther
If you selected "Other," please describe:

Population of Focus
Describe the target population your Diabetes-focused CHW Program will work with (i.e., Type 2 Diabetes, Prediabetes, etc.)*
Please provide a thorough description in narrative format.
Describe how your CHW Program will address health equity and health disparities among the target population.*
Please provide a thorough description in narrative format.
Briefly describe your organization's previous experience working with patients with Type 2 Diabetes and Prediabetes.*
Please provide a thorough description in narrative format.
Summarize the percentage of your patient population that has a diagnosis of Type 2 Diabetes and those at risk for developing Type 2 Diabetes (Prediabetes).*
Please provide a thorough description in narrative format.

Organization Narrative
Explain who will be the project lead and what role they will play in developing the Diabetes-specific CHW Program.*
Please provide a thorough description in narrative format.
Describe the process of hiring and training an individual to work as a CHW within your program. If a CHW is already employed by your organization, please summarize how their role will be redefined to support a Diabetes-specific CHW program.*
Please provide a thorough description in narrative format.
Describe the sustainability plan for your CHW program, including summarizing your understanding of Medicaid and Medicare reimbursement to assist in sustaining the program.*
Please provide a thorough description in narrative format.
Describe previous Medicaid/Medicare billing experiences, if applicable.*
Please provide a thorough description in narrative format.
Describe how your organization plans to evaluate this CHW position/program.

The following data will need to be submitted to the SD DOH and CHWSD to help develop a best practice brief for future Diabetes CHW Programs:
- Total number of patients seen.
- Total number of CHW visits/appointments.
- Pre-and Post A1C numbers for at least 50% of patients who have seen the CHW at least 5 times.
- Define data points related to your CHW interventions (i.e., if healthy food and obtaining healthy food is a strategy of your program, data may be evaluated and shared based on BMI or A1C).
Describe how your organization plans to evaluate this CHW position/program.*
Please provide a thorough description in narrative format.

Required File Uploads
The following is a draft budget for a Diabetes-Specific CHW Program RFA. The application budget should be uploaded as an Excel Spreadsheet or PDF.
- $3,500 training and textbooks
- $1,000 laptop for training/work as CHW
- $2,000 for diabetes-specific training/shadowing
- $14,400 would cover 3 months at full salary at $30 per hour
- $24,000 – would cover 20 hours per week at full salary at $30 per hour
  - (Medicaid Reimbursement - $67.45 per hour)
  - (Medicare Reimbursement - ~$70.00 per hour)
- $2,500 supervisor expenses
- $1,000 awareness expenses
- $48,400
The following expenses are not allowed:
- Food and beverage
- Vehicle purchases
- Rent or building remodels
Budget Justification*

Cancelof
W-9 Form*

Cancelof
Proof of Insurance*

Cancelof
Certificate of Completion of CHW Toolkit*

Cancelof
Individual Submitting Application

First NameLast Name
Signature of Individual Submitting Application

Clear
Should be Empty: