CMS Issues Guidance to State Healthcare Officials on SDOH

Tuesday, January 12, 2021

The Centers for Medicare and Medicaid Services (CMS) issued guidance last week to state health officials aimed at increasing adoption of strategies that address social determinants of health (SDOH) in Medicaid and the Children’s Health Insurance Program (CHIP).

As CMS notes in its guidance, many Medicaid and CHIP beneficiaries face challenges related to SDOH, such as limited to access to nutritious food, affordable and accessible housing, convenient and efficient transportation, safe neighborhoods, strong social connections, quality education, and opportunities for meaningful employment.

The guidance gives numerous examples of ways states “can leverage existing flexibilities under federal law to tackle adverse health outcomes that can be impacted by SDOH and supports states with designing programs, benefits, and services that can more effectively improve population health and reduce the cost of caring for our nation’s most vulnerable and high-risk populations,” according to the CMS press release.

As CMS points out, the growing shift toward alternative payment models and value-based care has accelerated the interest in addressing SDOH through CHIP and Medicaid in to help lower healthcare costs and improve outcomes.

Lauren Riplinger, JD, AHIMA’s vice president of policy and government affairs, says the guidance is an indication that CMS, going forward, will continue to think about how SDOH plays a role in value-based care payments.

“It was a priority for this administration and it’ll continue to be a priority for the next administration. It’s saying that, increasingly, when we think about value-based care, social determinants are a part of that conversation—how do we leverage them to improve outcomes and care coordination and all the good things that flow from value-based care payments,” Riplinger says.

She adds that it’s important for health information management (HIM) professionals to know how to code and document SDOH data as state health officials will be increasingly reliant on it when and if they follow this guidance. What’s more, Riplinger says that the section of the guidance focused on data integration and information sharing is another sign that the government is trying to ensure that the US has the proper health IT infrastructure in place to make healthcare transactions more electronic than they’ve been in the past.

“What this letter does is sends a signal to states saying ‘here are the authorities you can use if you want to address SDOH as part of your program. And here’s where the opportunities are.’ It gives states a nudge to say ‘this is something we can focus on and work on within our Medicaid program.’”

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