New Medicare Policy Prevents ‘Automatic’ Denial of Reimbursement for Some Alzheimer’s Treatments
Medicare beneficiaries with Alzheimer's disease can no longer "automatically be denied" reimbursement for the cost of some treatments, according to a Bush administration policy that "quietly" went into effect in December, the Washington Post reports (Dewar, Washington Post, 4/1). The policy will allow a number of the four million Americans with Alzheimer's to receive Medicare coverage for mental health services, hospice care and home health care. In the past, some Medicare carriers, companies that review Medicare claims for the federal government, had installed software in their computer systems that would automatically reject claims for beneficiaries with Alzheimer's and dementia based on the assumption that "treatment was futile because people with Alzheimer's were incapable of any medical improvement," the New York Times reports (Pear, New York Times, 3/31). According to CMS Administrator Tom Scully, about 20 out of 50 Medicare carriers had used the software before last December. He said that because CMS had found "evidence of fraud" in past years, it had ordered carriers to question claims related to beneficiaries with Alzheimer's (Lueck, Wall Street Journal, 4/1). The new policy bans the use of the software and requires carriers to use the same procedures to review claims submitted by Medicare beneficiaries with Alzheimer's that they use to evaluate other claims (Washington Post, 4/1). Although federal officials did not provide a cost estimate, analysts said that the new policy could cost Medicare an additional several billion dollars annually. However, they said that the new policy -- which would allow beneficiaries with Alzheimer's to reside at home longer, rather than in nursing homes -- could provide some cost reductions in other areas covered by Medicare and Medicaid.
Federal officials said that they issued the new Medicare policy based on studies that have found Alzheimer's patients can often benefit from psychotherapy, physical and occupational therapy and other services. They said that doctors and psychologists today can diagnose early-stage Alzheimer's, when patients can "derive significant benefits" from treatment and therapy, which can "prolong a relatively normal life and save money" (New York Times, 4/1). Scully also said that the Bush administration decided to establish the new policy as a result of "pressure" from patient advocacy groups, which criticized the previous policy as "discriminatory" (Washington Post, 4/1). The groups, including the Alzheimer's Association and the American Bar Association, cited dozens of studies that found Alzheimer's patients could benefit from treatment and therapy. The Bush administration issued the new policy in a memorandum sent to Medicare carriers last December but made no public announcement about the decision (New York Times, 3/31). A Medicare official said that the Bush administration did not announce the new policy because "we saw it mainly as a technical matter for Medicare carriers" (Chicago Sun-Times, 4/1). However, according to the New York Times, some federal officials "apparently did not want to acknowledge that the old policy was, in effect, biased against people with Alzheimer's" (New York Times, 4/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.