Medicare approved a new benefit in early 2017 for people with dementia and their families — care planning. But since then only about 1 percent of those eligible have made use of the benefit, according to an estimate by the Alzheimer’s Association.
Now, a new bill is making its way through Congress that would build awareness for this benefit by requiring educational outreach to medical providers and Medicare beneficiaries and by requiring regular reporting on the benefit’s use. It’s called the Improving HOPE for Alzheimer’s Act, a reference to the Health Outcomes, Planning and Education (HOPE) Act, which inspired the planning benefit that went into effect Jan. 1, 2017.
The law would promote more care planning sessions, during which clinicians identify caregivers, assess their knowledge of dementia, and provide resources on social supports and other practical help for taking on caregiving tasks. Patients and caregivers can expect to learn about symptoms of the disease during these sessions and steps to take for financial, legal and end-of-life planning. They can also get advice on simultaneously managing other chronic diseases such as hypertension of diabetes.
Advocates say such planning is crucial following a dementia diagnosis not only for the patient but also the caregivers.
“Many individuals don’t understand the depths of the disease, the course of the disease, the different symptoms that the individual with Alzheimer’s will develop,” said Rachel Conant, senior director of federal affairs at the Alzheimer’s Association. Care planning also “allows individuals with the disease to participate in the decision-making process while they’re still able to. It empowers them.”
A Medicare code gives clinicians a way to be reimbursed for providing comprehensive care planning to patients and their caregivers. This year, Medicare will reimburse $242 per care planning session, and a new one can be billed once every 180 days.
Anyone with a diagnosis of dementia, including Alzheimer’s disease, Lewy-body and vascular dementia, is covered by the care planning benefit. Although Medicare covers the cost of putting together a plan, it may not pay for the elements of care giving themselves.
The Improving HOPE for Alzheimer’s Act would require the Department of Health and Human Services to educate clinicians about the Medicare billing code and report on any barriers to people receiving care planning.
The bill has bipartisan support and was introduced in March by Sens. Susan Collins, R-Maine;, Debbie Stabenow, D-Mich.; Ed Markey, D-Mass.; Shelley Moore Capito, R-W.Va.; and Bob Menendez, D-N.J.
“The Improving HOPE for Alzheimer’s Act would effectively complete the HOPE for Alzheimer’s Act,” Conant said.
Stephanie Kanowitz is a Fairfax, Va.-based freelance writer, fitness instructor, mother and caregiver to her mother, who was diagnosed with dementia in 2012. Stephanie earned journalism degrees from the University of Florida (bachelor’s) and American University (master’s), and her work has appeared in The Washington Post, Washington Post Express, Red Tricycle, the Washington Diplomat and the Kveller blog.
