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Streets recognized by CMS as legal places to provide health services

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The Center for Medicare and Medicaid Services (CMS) officially recognizes that medical care can be provided on the street, allowing providers such as the USC Street Medicine team to get reimbursed for services provided to people who are currently homeless.

The Center for Medicare and Medicaid Services (CMS) officially recognizes that medical care can be provided on the street, allowing providers such as the USC Street Medicine team to get reimbursed for services provided to people who are currently homeless.

The decision, announced on June 28, 2023, is the result of years of efforts by USC Street Medicine and Street Medicine Institute leaders to get CMS to create a place of service (POS) code for the street. As a result of this appointment, national street drug providers will be reimbursable for their services from October 1, 2023.

“This is an important decision for street drug providers, but also for our patients,” said Brett Feldman, director and co-founder of USC Street Medicine and assistant professor of family medicine at USC’s Keck School of Medicine. “Our patients rely on street medicine to survive and by recognizing the streets as a legitimate place to provide health care, it recognizes their right to exist.”

The code removes roadblocks to the service

The lack of a ZIP code has created many obstacles for medical professionals providing care to patients outside the walls of a typical healthcare facility. According to Feldman, who led an effort in 2018 to survey street medicine providers across the country, more than 70% of street medicine teams nationwide do not seek reimbursement for services due to this lack of codes.

In addition, patients are often unable to obtain additional services because insurers cannot process their claims without a ZIP code. Because their claims are not processed, Feldman notes that patients are often denied opportunities to see specialists, have difficulty obtaining medications, and are unable to access devices such as walkers or wheelchairs.

Prior to this decision, the only insurance companies that reimbursed treatment provided by street drug providers were the state Medicaid programs in California and Hawaii. This decision helps streamline the claims filing process and allows providers to order additional services for their patients in the state.

The new code will also allow researchers to identify street medicine visits and patients, allowing them to collect data to gain a better understanding of the needs of people who experience unprotected homelessness. This type of research can lead to the creation of more equitable models of care.

Potential turning point for street medicine

Feldman first started researching the issue in 2015 when he led a street medicine team in Pennsylvania. When he joined the Street Medicine Institute’s board in 2017, he did additional research, including surveying members about billing practices.

Feldman’s research ultimately led the USC Street Medicine team, Street Medicine Institute and other partners to submit a formal proposal to CMS for the street to be designated as a legal place to provide health care services.

Street medicine, he says, is still a relatively young field of medicine, which may help explain why CMS hasn’t assigned a ZIP code to the street. However, street medicine is growing and there are now active street medicine teams in over 100 US cities

This change could be a major turning point for street drug delivery across the country. Feldman said that while some street medicine teams get grants or philanthropic support to provide care, many are small and underfunded.

“Most street medicine programs are struggling to exist and survive today,” says Feldman. “This recognition by CMS helps make street medicine sustainable and scalable and can really help this program grow and thrive.”

About USC’s Keck School of Medicine

Founded in 1885, the Keck School of Medicine of USC is one of the nation’s leading medical institutions, known for innovative patient care, scientific discovery, education, and community service. Medical and postgraduate students work closely with world-renowned faculty and receive hands-on training in one of the nation’s most diverse communities. They participate in cutting-edge research as they develop into future health leaders. The Keck School faculty is a key participant in the training of 1200 resident physicians in 70 specialization and subspecialty programs, thereby playing a major role in the education of practicing physicians in Southern California.


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