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Supported Line of Business: Medicare Advantage

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Overview

CHI services are incident-to services performed by auxiliary personnel (such as community health workers, care coordinators, or patient navigators) under the general supervision of a billing practitioner.

There are no National or Local Coverage Determinations (NCDs/LCDs) specific to CHI — the policies are governed entirely through the PFS final rules.

To qualify for Community Health Integration services:

• The patient must have one or more unmet health-related social needs that interfere with the diagnosis or treatment of a medical condition.
• Services must be initiated by a billing practitioner as part of an established care plan.
• Auxiliary personnel must meet CMS training requirements and/or applicable state licensure requirements to provide CHI services, which Bridge outlines in our Staff Oversight Policy for Principal Illness Navigation (PIN) & Community Health Integration (CHI).

CHI services focus on:

• Assessing and identifying unmet social needs (e.g., housing instability, food insecurity, transportation barriers, utility needs, interpersonal safety)
• Developing and implementing a person-centered care plan
• Coordinating referrals to appropriate community-based organizations and social service providers
• Monitoring progress and facilitating ongoing communication between the patient, care team, and community resources

Unlike PIN Services or Service Line Guide: Chronic Care Management (CCM) , CHI services are not condition-specific to a single high-risk illness or chronic conditions. Instead, eligibility is driven by the presence of unmet health-related social needs that materially affect the patient’s health outcomes and care plan.

Consent requirements

Providers must obtain and document patient consent before initiating Community Health Integration (CHI) services. We recommend combining informed consent for Telehealth + Community Health Integration services into one policy for operational simplicity.

As part of the consent for CHI, you must explain to the patient that cost sharing applies (i.e. any applicable medical deductible, copay, coinsurance) and that only 1 practitioner may furnish and bill the services in each month. You don’t need to get consent again unless the practitioner furnishing and billing CHI changes.

• Consent to treat and consent to CHI services policy will be provided