Headline
This toolkit details options for implementing recently introduced Medicare services that address members’ health-related social needs.
Background
In 2024, Medicare began reimbursing certain services provided by community health workers and other nontraditional providers to assess and address enrollees’ health-related social needs or high-risk conditions. This toolkit offers an overview of these reimbursable services.
Findings
This toolkit provides an overview of the Community Health Integration (CHI) and Principal Illness Navigation (PIN) services now reimbursable by Medicare, detailing:
- Healthcare Common Procedure Coding System (HCPCS) codes that providers can use to bill for allowable services, such as person-centered assessments, action planning, and health education;
- Provider and auxiliary personnel types that are eligible to provide CHI and PIN services, including community health workers and community-based organizations; and
- Billing limits that allow a provider to submit a claim for recorded services that are medically necessary and follow an enrollee’s care plan.
Policy/Program Takeaways
Services now available under Medicare aim to help people with complex health and social needs coordinate their care and navigate the health system. Health plans and community-based organizations interested in implementing these services can use this toolkit, along with these process maps, to understand Medicare requirements and how these services can be implemented in different settings.