Big GREAT News for CHWs!
Up until now, some individual states (including RI!) have been setting up their own Medicaid reimbursement for CHW services. Now the federal Centers for Medicare & Medicaid Services (CMS) have finalized policy changes for MediCARE payments effective on or after January 1, 2024 that cover “services involving community health workers, care navigators, and peer support specialists.” This is a game-changer!
Details are provided on the CMS.gov page: Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.
From Centers for Medicare & Medicaid Services (CMS):
“Specifically, we are finalizing to 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.“
NOTE: This billing will be complex and CHWARI will strive in future months to provide opportunities for learning how to manage the new policy and to make sure CHW voices are heard amidst its roll out.
CHW Voices for Leadership & Advocacy Group
Speaking of voices, join fellow CHWs on the last Monday of every month to:
• Meet other CHWs
• Contribute to policy discussions
• Strengthen community connections
• Join networking groups
• Keep up to date on CHW news
Next meeting November 27th at 11am. Learn more here!