The 2024 Medicare Physician Fee Schedule (PFS) Final Rule, as developed by the Centers for Medicare & Medicaid Services (CMS), went into effect on January 1, 2024. The PFS includes Medicare Part B coding and payment changes for certified or trained auxiliary personnel — including community health workers — under the direction of a Medicare-billing practitioner, to be reimbursed for providing a new set of services called “Community Health Integration.” Such services represent the first time that Medicare services were designed to include a specific role for community health workers.

This policy cheat sheet can support states, health plans, health care providers, and community-based organizations considering implementing or expanding the use of community health workers to address the unmet health-related social needs of Medicare enrollees, including individuals dually eligible for both Medicare and Medicaid. The policy cheat sheet was developed by the Center for Health Care Strategies through support from the Association of State and Territorial Health Officials.