Medicare to provide coverage for critical care and support services for those living with Alzheimer’s disease

For the first time, people living with Alzheimer’s disease will have access to care planning with a medical professional. The Centers for Medicare & Medicaid Services has finalized its decision to pay for cognitive and functional assessments and care planning for patients with Alzheimer’s disease and other cognitive impairments.

The decision, first announced in July as a proposal, comes following rapidly growing bipartisan support in Congress for the Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act (S. 857, H.R. 1559). CMS has now made it easier for physicians to provide critical care and support services for persons living with Alzheimer’s disease.

For too long there has been a critical gap in care and support, with individuals unable to receive necessary diagnosis and care planning support from care providers. Following a diagnosis, care planning is crucial to improving outcomes and maintaining quality of life for the diagnosed and their caregivers, as well as controlling costs and planning appropriately for the future.

“This final decision by CMS means individuals living with Alzheimer’s disease will finally have access to critical care and support services that can improve quality-of-life for the individual, their family and caregivers,” said Harry Johns, Alzheimer’s Association President and CEO. “Now that care planning sessions will be available to them, individuals living with the disease will have access to much-needed information on treatments and services.”

More than 5 million Americans are living with the disease today, and that number could rise as high as 16 million by 2050. What’s more, over 85 percent of people with Alzheimer’s and other dementias have one or more other chronic conditions, such as diabetes or heart disease. Care planning is critical for coordinating care and managing chronic conditions.

“Thousands of our families have reached out to us over the past several months to tell us how essential this service is for those contending with Alzheimer’s disease. Now that CMS is increasing access to cognitive assessment and care planning sessions, individuals and their medical professionals can develop a plan to better manage these conditions,” said Robert Egge, Alzheimer’s Association Chief Public Policy Officer. “Proper care planning results in fewer hospitalizations, fewer emergency room visits and better management of medication — all of which improves the quality of life for both patients and caregivers, and helps manage overall care costs.”

Executive Director of the Alzheimer’s Association – Greater Kentucky and Southern Indiana Chapter stated, “We could not be more pleased that the Alzheimer’s Association had an opportunity to influence this decision through our advocacy efforts. This legislation will give families in our chapter access to planning and resources and will result in a higher quality of life and safety for the patients as well as the caregivers.”

Alzheimer’s is the most expensive disease in America at a cost of $236 billion annually, and our public policy decisions should reflect that reality. It is also the only leading cause of death in the U.S. that cannot be prevented, cured or even slowed.