Category: Resources

Each year the Centers for Medicare and Medicaid Services (CMS) reviews payment practices and policy changes under fee-for-service, or traditional, Medicare. The CY2024 PFS included important coding and payment changes for services to address health-related social needs (HRSNs) through separate payments for Community Health Integration (CHI), SDOH Risk Assessment, and Principal Illness Navigation (PIN) services.

In July 2024, CMS released its annual draft proposed updates for next year’s rules (CY2025 Medicare Physician Fee Schedule), which includes a request for information (RFI) regarding barriers to implementation for services to address HRSNs. 

The draft rule also includes proposed updates to:

• Caregiver Training Services;
• ACO quality measures re: screening for HRSNs; and
• the Advanced Primary Care Model (APCM)

All of these proposed changes could affect services to address HRSNs. 

On September 9, 20204 the Partnership submitted two letters to CMS on behalf of Partnership Co-Chairs and undersigned organizations. Sixty-five organizations signed on to the response to the request for information (RFI) regarding current barriers to implementing services to address HRSNs (CHI/PIN). Fifty-three organizations signed on to the letter regarding changes needed and proposed updates for telehealth, caregiver training services, ACO quality measures, and the Advanced Primary Care Model. Agency officials will review and document the more than 12,000 comments submitted as they finalize the rule.

Stay tuned for updates once we see the final rule published—likely in early November 2024. We will also be in touch with stakeholders regarding implementation resources that we plan to create and promote
once we see the final rule.

Each year the Centers for Medicare and Medicaid Services (CMS) reviews payment practices and policy changes under fee-for-service, or traditional, Medicare. The CY2024 PFS included important coding and payment changes for services to address health-related social needs (HRSNs) through separate payments for Community Health Integration (CHI), SDOH Risk Assessment, and Principal Illness Navigation (PIN) services.

In July 2024, CMS released its annual draft proposed updates for next year’s rules (CY2025 Medicare Physician Fee Schedule), which includes a request for information (RFI) regarding barriers to implementation for services to address HRSNs. 

The draft rule also includes proposed updates to:

• Caregiver Training Services;
• ACO quality measures re: screening for HRSNs; and
• the Advanced Primary Care Model (APCM)

All of these proposed changes could affect services to address HRSNs. 

SIGN-ON REQUEST:
Please consider joining the Partnership to Align Social Care Co-Chairs and other organizational stakeholders on TWO sign-on letters offering comments. You may sign on to one or both letters: 

1. Sign-on letter responding to the RFI re: barriers to implementing services to address HRSNs
2. Sign-on letter responding changes needed and proposed updates for telehealth, caregiver training services, ACO quality measures, and the Advanced Primary Care Model

We also encourage you to download template language covering all of these issues and incorporate as applicable into your organization's response . As a reminder, comments are due by 5:00 p.m. ET on September 9, 2024, and can be submitted online.  

RESOURCES:

• SIGN-ON Letters (combined) responding to CMS CY2025 PFS Proposed Rule (pdf)
• Template language provided by the Partnership (Word version available for download)
• CMS CY2025 PFS Proposed Rule: https://www.regulations.gov/document/CMS-2024-0256-0045 
• Additional information and resources from the Partnership about this proposed rule: https://www.partnership2asc.org/implementation-resources/ and Resources List

The Partnership to Align Social Care hosted a webinar, What Does the CY 2025 Medicare Physician Fee Schedule Proposed Rule Mean for Addressing HRSNs? on Tuesday, July 30.

Attendees heard an overview and discussion of these updates and learned about relevant CMS requests for information, and additional opportunities to inform the public comment process. CBOs and community care hubs, health plans, health systems, Federally Qualified and Rural Health Centers (FQHCs and RHCs), other healthcare providers, and caregiver advocate attendees learned about how the proposed coding and payment changes could impact efforts to align health and social care ecosystems.

This session focused on the intersection of data security, compliance, and quality improvement from a Community Care Hub perspective. Abigail Morgan, President & CEO of Direction Home Akron Canton Area Agency on Aging & Disabilities, discussed the milestones in her organization's journey to develop their data security infrastructure and shared lessons learned. Participants broke out into groups for facilitated discussions to learn from their peers about data security experiences and opportunities.

Link to recording

Meeting Slides (PDF)

Meeting Summary and Notes (PDF)

This session focused on what to expect from negotiations with a health plan when developing a contracted partnership. Nikki Kmicinski, Executive Director at Western New York Integrated Care Collaborative, Inc., shared her experiences in negotiating with healthcare organizations and discussed strategies to achieve a mutually beneficial contract for both parties. Attendees also had the opportunity to break into moderated group discussions with their peers.

Link to Recording

Meeting slides (PDF)

Meeting Summary and Notes

The Partnership to Align Social Care hosted a lunch and learn event on April 3, which was the first in a series of upcoming resources, A Primer: Understanding the Medicare Physician Fee Schedule Billing Codes for Community Health Integration (CHI), Principal Illness Navigation (PIN), and Principal Illness Navigation - Peer Support (PIN-PS) Services.

This webinar aimed to build upon previous Partnership events detailing opportunities to address HRSNs through fee-for-service Medicare. Attendees will have an opportunity to ask questions to help inform planning for, and implementation of, CHI and PIN services.

Our Partnership to Align Social Care co-chair, Timothy McNeill, RN, MPH, spoke at USAging's Aging Policy Briefing with colleagues from around the nation about the 2024 Medicare Physician Fee Schedule and how to implement changes in billing codes to better align care between CBOs, health entities, and Area Agencies on Aging.

Tim was joined by Kelly Cronin, Deputy Administrator, Center for Innovation and Partnership, U.S. Administration for Community Living; Doug Jacobs, MD, MPH, Chief Transformation Officer, Center for Medicare & Medicaid Services; and Christine Vanlandingham, CEO, Region IV AAA in St. Joseph Michigan.

We encourage you to learn more about these changes in the Medicare Physician Fee Schedule here: https://go.cms.gov/4c5f090

Join the Partnership to Align Social Care and Camden Coalition for a monthly peer learning series that provides an opportunity for presenters and participants to go deeper into specific topics related to contracting between CBOs/CCHs and healthcare organizations.

Sessions will allow participants to:

• Participate in peer-to-peer learning about contracting between CBOs, CCHs, and healthcare organizations;
• Learn about and engage with stakeholders and leaders of the Partnership to Align Social Care;
• Find opportunities to support new CCHs and get involved in ongoing national initiatives;
  Generate new learning which can be packaged into future resources and leading practices.

Register for the series and learn more at www.partnership2asc.org/coffee-and-contracts!

The recording and materials are available for the February 27, 2024 Partnership to Align Social Care event, Meeting the Administration’s Call-to-Action: Leading Practices to Address Health-Related Social Needs in Communities Across the Nation, featuring a discussion with officials from the U.S. Department of Health and Human Services (HHS) and key community and health care leaders on opportunities to address health-related social needs (HRSNs) through community partnerships.

Healthcare entities and social services providers are increasingly recognizing the importance of partnerships among historically siloed sectors to address health-related social needs (HRSNs). While the number of community-based organizations (CBOs) and community care hubs (CCHs) pursuing contracting relationships with healthcare organizations is increasing, CBOs and CCHs can experience challenges entering into contracting arrangements with the healthcare sector.

The Partnership to Align Social Care, the Aging and Disability Business Institute, and Camden Coalition created a Healthcare Guide to Contracting with CBOs. This toolkit offers a deep dive into leading contracting practices to effectively and efficiently address HRSNs. Each module focuses on the essential elements of contracting between health care and community partners and features leading practices from the field.