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Government Changes Rules On Alzheimer's Coverage
Alzheimer's patients may now have a better chance of receiving Medicare coverage. In a major policy change, Medicare will no longer issue automatic denials for claims related to therapy for Alzheimer's disease-a practice that patient advocates argued was discriminatory. Alzheimer's patients may be able to receive mental health, physical, speech, and occupational therapy services that were previously denied. According to Centers for Medicare and Medicaid Services (CMS) administrator Thomas Scully, contractors who pay Medicare claims had previously been told to be "pretty skeptical" of claims related to Alzheimer's "due to evidence of fraud." To avoid paying such claims about 20 of 50 claim contractors had computer systems that automatically denied payment of claims related to Alzheimer's. As a result, patients in some parts of the nation were covered while others were automatically denied. Evidence of fraud, however, does not appear to be the sole reason for the denials. According to a story in "The New York Times," many claims were denied on the assumption that treatment was futile because Alzheimer's patients were believed incapable of benefiting from any medical treatment. New studies have shown, however, that people with Alzheimer's can often benefit from psychotherapy, physical and occupational therapy, and other services, especially in the early stages of the disease. The policy change was adopted after two years of efforts by the Alzheimer's Association and the American Bar Association's Commission on Legal Problems of the Elderly. An attorney at the commission used the Freedom of Information Act to get copies of local rules used by Medicare carriers to decide whether to pay claims. The documents, she said, showed that "Alzheimer's patients were often denied medically necessary services." From the editor: The government has been virtually silent about the change, giving no public notice of the new policy. If you think a family member may be affected, some of the best information about Medicare coverage for Alzheimer's and the policy change can be found on the web site of the Alzheimer's Association at: http://www.alz.org. The site also provides good information about what to do if you feel you have wrongfully been denied care. Another excellent resource is the Medicare Rights Center found at: http://www.medicarerights.org. The Medicare Rights Center has a booklet about Medicare appeals ($8 with shipping and handling). Order online or call 1-800-333-4114, ext. 10. Sources: "In a First, Medicare Coverage Is Authorized For Alzheimer's," Robert Pear, "The New York Times," March 31, 2002. "Medicare Eases Its Restrictions On Covering Alzheimer's Costs," Sarah Lueck, "The Wall Street Journal," April 1, 2002. To find more excellent resources, click here to read "Social Security & Medicare Questions: Where Can I Find Information on Supplemental Insurance" at http://www.tscl.org/NewContent/101413.asp. For more information on Medicare coverage, click here: http://www.tscl.org/Medicare.asp. May 2002 | ||||||||
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