Federal Panel Hears Medicare Dementia Benefits Overhaul Plan

News May 10, 2023 at 04:53 PM
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Medicare could eventually end up covering a new package of dementia care benefits comparable to the strategy used by UCLA Health's Alzheimer's and Dementia Care Program.

Rani Snyder, a vice president from the John A. Hartford Foundation, and three other experts on care for older adults cited the UCLA Health program as a model earlier this week when they presented a dementia care payment proposal in Washington, at a meeting of the federal Advisory Council on Alzheimer's Research, Care and Services.

Snyder and colleagues — including Dr. David Reuben of the University of California, Los Angeles Center for Health Sciences — recommended that Medicare cover care for the family caregivers of people with dementia as well as the people with dementia; put the people with dementia in categories based on the severity of their illness; and pay doctors a flat fee for each individual with a given level of dementia served.

If Medicare ends up covering all of the services included in the recommendations, dementia care teams could end up talking about services that could be provided by insurance agents and financial advisors when they counsel caregivers about community resources.

What It Means

Medicare could eventually do more to nudge people who already have dementia toward care centers that might talk to them about topics such as paying for care.

The Council

Federal and state governments will spend about $222 billion on dementia this year, and families will spend about $87 billion on dementia care out of pocket, according to the Alzheimer's Association.

U.S. state and federal spending on dementia is comparable to the 2021 gross domestic product of Greece, according to World Bank GDP figures.

Congress provided funding for the advisory council in a bill that was signed into law in 2010.

The council shapes federal efforts to study dementia, stop dementia and pay for dementia care.

Originally, the council was supposed to find a way to cure or prevent dementia quickly, then shut down in 2025. Congress is considering two companion bills, S. 133 and H.R. 619, that would renew funding for the council through 2035.

The Care Coverage Proposal

The Snyder team noted that the dementia care center at UCLA Health, which has ties to the UCLA medical school, earned a passing grade on 92% of the quality indicators used, and that typical community-based physicians have a passing rate of just 18%.

The UCLA Health program provides patient care, caregiver care, medication management and 24-hour access to advice, according to the team's presentation.

The Snyder team suggested that, once a Medicare enrollee had a confirmed dementia diagnosis, the enrollee could enter pathways aimed at patients with one of three different stages of dementia — mild; moderate or severe, with enough informal care support; and moderate or severe, without enough informal care support.

A care center would reassess the enrollee every year.

Expanded Medicare efforts to assess and manage dementia could create demand for the need assessment and care management services offered by private long-term care insurers and their vendors, such as Assured Allies, Genworth's CareScout unit and illumifin's LTCG long-term care insurance administration business.

(Image: Monkey Business Images/iStock)

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