Resources Available to Implement Services to Address Upstream Drivers of Health in Medicare and Beyond

The Partnership to Align Social Care is developing a number of resources intended to help health and social care stakeholders implement opportunities inherent in Medicare billing codes to address upstream drivers of health.

Check out recent Partnership webinars and ongoing stakeholder calls regarding Opportunities to Inform Medicare Payment Policies to Address Upstream Drivers of Health.

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The Partnership to Align Social Care is again leading on an effort to inform and respond to Medicare payment policies included in the CY 2026 Medicare Physician Fee Schedule. The Partnership is hosting a series of webinars and stakeholder calls in August to review updates and answer questions about an important CMS Request for Information included in the Physician Fee Schedule. Comments are due on Friday, September 12.

BACKGROUND

The 2024 and 2025 Physician Fee Schedule Final Rules advanced significant policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues including coding and payment changes for Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN)–services to address Health-Related Social Needs (HRSNs) services.

These services codes, which were established in 2024 and updated in 2025, provide a direct pathway for reimbursement for the labor extended by auxiliary personnel, including community health workers, to the Medicare provider. In addition, they allow providers to contract with community-based organizations that can provide staffing to address identified HRSNs and the health navigation of affected populations.

To support community-based organizations and healthcare providers in the delivery of reimbursable CHI and PIN services, the Partnership and Freedmen’s Health Consulting have developed and disseminated numerous resources. Partnership and FHC have also hosted a webinar series, Addressing HRSNs Through Medicare: An Update on CY 2025 Changes and Implementation Activity for Community Health Integration and Principle Illness Navigation (CHI/PIN) Codes.

The January 22 webinar provided an overview of the codes and updates that were included in the CY 2025 Fee Schedule. The January 29 event featured a panel discussion among several organizations that are currently exploring and implementing billing and reimbursement opportunities through CHI and PIN. Both webinars are of interest to cross-sector health care and social care stakeholders who want to learn more about these codes and to hear from peers who are engaged in implementation activities.

CY 2026 Medicare Physician Fee Schedule Proposed Rule RFI re: Upstream Drivers of Health


Previous Partnership to Align Social Care Resources

Freedmen’s Health Consulting Resources:

Administration Resources: