The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023. The final rule, effective January 1, 2024, includes policy changes for Medicare to authorize payment for Community Health Worker (CHW) services to address health-related social needs (HRSNs) for the first time in history. There are also provisions to support Medicare providers contracting with community-based organizations (CBOs) or community care hubs (CCHs) to address HRSNs for priority populations. These codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists, and that allow these services to be provided by personnel employed by CCHs/CBOs under the general supervision of the billing practitioner. CMS will pay separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services to account for resources when clinicians involve certain types of health care support staff such as community health workers, care navigators, and peer support specialists in furnishing medically necessary care. While these types of health care support staff have been able to serve as auxiliary personnel to perform covered services incident to the services of a Medicare-enrolled billing physician or practitioner, the services described by the finalized codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists.
The PA CHW Collaborative was pleased to provide comments to CMS about the proposed rule in October 2023 (link to CMS comments PDF), specifically about these topics. The calendar year (CY) 2024 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation.
Here is CMS fact sheet, and here is the pre-publication version of the final rule. There are 2 upcoming opportunities to learn more below. I’ll share additional T.A. resources and briefing information as CMS releases it.