The Centers for Medicare & Medicaid Services (CMS) has unveiled exciting proposals for Medicare reimbursement of certain key services that support health-related social needs: community health worker services, navigation services, and social determinants of health risk assessment.
More specifically, CMS is considering reforms to the Physician Fee Schedule that will better identify and value, through five new codes, the time and resources that go into removing health-related social barriers that are interfering with a health care providers’ ability to execute a medically necessary plan of care, or into helping patients with serious illnesses navigate the health care system. As regulators explain, “[m]edical practice has evolved to increasingly recognize the importance of these activities, and we believe practitioners are performing them more often. However, this work is not explicitly identified in current coding, and as such, we believe it is underutilized and undervalued.”
CHLPI prepared a summary of relevant features to aid stakeholders in preparing public comments and otherwise understanding potential changes ahead. The public comment period closes on September 11, 2023.