Key federal agency recognizes streets as legitimate locale to deliver health care

The Centers for Medicare and Medicaid Services (CMS) officially recognized that medical care can be delivered on the street, making it possible for providers like USC's Street Medicine team to be reimbursed for services provided to people who are currently unhoused.

The decision, which was announced on June 28, 2023, was the result of a multi-year effort on the part of leaders of USC Street Medicine and the Street Medicine Institute to have CMS create a place of service (POS) code for the street. As a result of this designation, street medicine providers nationwide will be able to be reimbursed for their services effective October 1, 2023.

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

Code removes roadblock to services

The lack of a POS code has caused numerous obstacles for the medical professionals who deliver care to patients outside of the walls of a typical health care facility. According to Feldman, who led an effort in 2018 to survey street medicine providers across the country, more than 70% of the nation's street medicine teams do not attempt to be reimbursed for services due to the lack of this code.

In addition, patients have often been unable to get additional services because insurers could not process their claims without a POS code. Because their claims went unprocessed, Feldman noted that patients were frequently denied the opportunity to see specialists, had difficulty obtaining medications and couldn't get access to devices like walkers or wheelchairs.

Prior to this decision, the only insurers that reimbursed care given by street medicine providers were the state Medicaid programs in California and Hawaii. This decision helped to streamline the process of submitting claims and allowed providers to order additional services for their patients in those states.

The new code will also make it possible for researchers to identify street medicine visits and patients, allowing them to collect data to gain a better understanding of the needs of people experiencing unsheltered homelessness. This type of research could lead to the creation of a more equitable care model.

Potential turning point for street medicine

Feldman first began researching this issue in 2015 when he was leading a street medicine team in Pennsylvania. When he joined the board of the Street Medicine Institute in 2017, he conducted additional research, including surveying members about billing practices.

Feldman's research ultimately led the USC Street Medicine team, the Street Medicine Institute and other partners to submit a formal proposal to CMS to have the street designated as a legitimate place to deliver health care services.

Street medicine, he noted, is still a relatively young field of medicine, which may help explain why CMS had not designated a POS code for the street. Street medicine is growing, however and there are now street medicine teams active in more than 100 cities in the U.S.

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

"Most street medicine programs fight to exist and survive right now," said Feldman. "This recognition by CMS helps makes street medicine sustainable and scalable and could really help these programs to grow and thrive."

Provided by University of Southern California