Partnership to Align Community Care stakeholders developed a contract template as an example of how Medicare providers and CBOs or CCHs may structure an agreement to provide Community Health Integration (CHI) and Principal Illness Navigation (PIN) services to Medicare beneficiaries.
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, CCHs, and healthcare providers in the delivery of reimbursable CHI and PIN services, the Partnership to Align Community Care, in collaboration with Camden Coalition and Harvard Law School Center for Health Law and Policy Innovation, developed a contract template as an example of how Medicare providers and CBOs or Community Care Hubs may structure an agreement to provide CHI and PIN services to Medicare beneficiaries.
