Community Health Integration, also called CHI, is a Medicare-covered category of care-management services that was introduced under the Medicare Physician Fee Schedule beginning in 2024. It is designed for patients whose medical care is being affected by one or more unmet social or environmental circumstances.
CMS sometimes refers to these circumstances as unmet social determinants of health, health-related social needs, or "upstream drivers." In plain terms, these are the everyday barriers that can make it harder for a patient to follow their care plan, attend appointments, obtain medications, or manage their health at home.
What kinds of barriers does CHI address?
CHI may be appropriate when a patient's medical care is being affected by circumstances such as:
- Transportation difficulties
- Food access or food insecurity
- Housing instability or unsafe housing
- Utility difficulties
- Medication affordability
- Financial strain that interferes with treatment
- Limited health literacy
- Language or communication barriers
- Social isolation
- Difficulty navigating the healthcare system
- Difficulty understanding or following a treatment plan
- Lack of reliable caregiver support
However, a difficulty does not automatically qualify a patient for CHI. A licensed billing practitioner must determine that the unmet circumstance significantly limits the practitioner's ability to diagnose or treat the medical problem addressed during the initiating visit.
What does CHI include?
Depending on the patient's individual needs and the clinician's plan of care, CHI may include:
- Person-centered assessment and planning: Learning about the patient's priorities, identifying barriers, and developing an action plan connected to the medical care plan.
- Health-system coordination: Helping the patient navigate healthcare services, coordinate with treating practitioners, and prepare for appointments.
- Community-resource navigation: Identifying community organizations that may address a clinically relevant need and helping the patient understand application or referral processes.
- Patient education: Helping the patient better understand the care plan, reinforcing clinician instructions, and improving health literacy.
- Patient self-advocacy: Helping the patient formulate questions for healthcare providers and make informed healthcare decisions.
- Ongoing follow-up: Checking progress, identifying unresolved barriers, and updating the coordination plan as needed.
Who decides if CHI is appropriate?
Only an authorized licensed practitioner may determine whether CHI is medically appropriate. Call-center personnel, AI agents, community health workers, and other auxiliary personnel must not independently diagnose the patient or guarantee CHI eligibility.
The practitioner must personally perform an appropriate initiating visit, which may be an Annual Wellness Visit when all applicable requirements are satisfied. The same billing practitioner who performs the initiating visit must furnish and bill the subsequent CHI services.
Is CHI free?
No. The standard Medicare Part B deductible and coinsurance generally apply to CHI services. A patient's final responsibility can depend on whether they have met their Part B deductible, whether they have supplemental insurance, whether they are enrolled in Medicaid, or whether they have a Medicare Advantage plan with different cost-sharing rules.
Important: CHI is not a cash benefit, grant, or financial-assistance payment. It is a healthcare service. Resources and approvals from outside organizations are not guaranteed. Each outside organization has its own eligibility rules and makes its own decisions.
Want to learn if CHI might be right for you or a loved one? Call our team to speak with a licensed clinician.
Call (800) 303-1766