Philadelphia Inquirer Backs Policy Change Concerning Medicare Coverage of Alzheimer’s Disease

Eliminating a practice that automatically denied Medicare beneficiaries with Alzheimer's disease various treatments, including mental health services, hospice care and home health care, is the "right policy, even if [CMS] ... didn't bother to announce it publicly," a Philadelphia Inquirer editorial states, joining the "chorus of huzzahs" at the news of the policy change (Philadelphia Inquirer, 4/5). In the past, about 20 out of 50 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. A policy forbidding such denials went into effect in December but was not published in newspapers until this week (Kaiser Daily Health Policy Report, 4/2). Although the editorial praises the new policy, it questions whether Medicare can afford to implement the change, a process likely to cost "several billion dollars a year on the front end." Still, it suggests that initial costs could be offset by future savings in nursing home expenses if Alzheimer's patients are able to receive care at home longer. And while Medicare will not cover all treatment expenses for Alzheimer's disease, the new policy leaves patients and their families "better positioned to deal with a disease that -- in robbing memory, reason and even the awareness of life -- is cruel enough" (Philadelphia Inquirer, 4/5).