CMS released a roadmap outlining how states can adopt strategies to address social determinants of health (SDOH) in Medicaid and CHIP in efforts to further improve health outcomes, reduce health disparities and lower overall program costs. SDOH describes a range of social, environmental and economic factors – such as affordable housing, employment status and access to nutritious food – that can impact a patient’s health. CMS guidance details how Medicaid and CHIP programs can improve delivery approaches, benefits and reimbursement methodologies to improve outcomes.
Coding opportunities also have expanded to address SDOH. ICD-10-CM has added a series of diagnostic codes to identify social diagnoses that create barriers for patients to obtain quality healthcare services. Examples of these diagnosis codes include problems related to:
- Education and literacy
- Employment and unemployment
- Housing and economic circumstances
CDT also contains codes for dental case management in relation to addressing appointment compliance barriers, motivational interviewing, identifying special healthcare needs and patient education to improve oral health literacy.
Considering CMS’s recent announcement and expanded coding opportunities, it is anticipated SDOH initiatives will increase. SDOH objectives are further explained on the HHS website.
