Partnership stakeholders developed implementation guidance for FQHCs and RHCs navigating CHI and PIN codes, alongside briefs intended to provide clarification on the application of CHI/PIN when services are rendered by a CSW and key strategies for broader whole-person health integration. The toolkit also features actionable delivery guidance for HBAI services, equipping community networks and clinical partners with the resources needed to successfully implement and scale these reimbursable service pathways.
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 upstream drivers of health. These services codes, which were established in 2024 and updated in 2025, provide a 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 (CBOs) that can provide staffing to address identified upstream drivers of health for affected populations.
To support CBOs, Community Care Hubs, and healthcare providers in the delivery of reimbursable CHI and PIN services, the Partnership to Align Community Care, in collaboration with Freedmen's Health Consulting, developed operational implementation guidance for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) navigating CHI and PIN codes, alongside specialized briefs intended to provide clarification on the application of CHI/PIN when services are rendered by a Clinical Social Worker (CSW) and key strategies for broader whole-person health integration. The toolkit also features actionable delivery guidance for Health Behavior Assessment and Intervention (HBAI) services, equipping community networks and clinical partners with the technical resources needed to successfully implement and scale these reimbursable service pathways.
