Alzheimer's treatment now covered by Medicare

Change based on studies about benefits of therapy


WASHINGTON - In a major change, the Bush administration has authorized Medicare coverage for the treatment of Alzheimer's disease.

The new policy means that Medicare beneficiaries can no longer be denied reimbursement for the costs of mental health services, hospice care or home health care just because they have Alzheimer's. Nearly 4 million Americans have the disease and it is expected to grow to epidemic proportions with the aging of the population.

In the past, many claims were automatically denied on the assumption that treatment was futile because people with Alzheimer's were incapable of medical improvement. Now, federal officials say, studies show that people with Alzheimer's can often benefit from psychotherapy, physical and occupational therapy and other services.

"This is great news for people with Alzheimer's disease and other dementias," said Stephen R. McConnell, chief executive of the Alzheimer's Association. "The new policy should eliminate a form of discrimination against millions of people."

The policy was set forth in a government memo sent late last year to the carriers that review and pay Medicare claims, but there was no public announcement. The companies have just begun to put the change into practice.

The government said it changed its policy because doctors and psychologists can now often diagnose Alzheimer's in its early stages, when patients are most likely to derive significant benefits from treatment and therapy. Although there is no cure, staving off the worst effects can prolong a relatively normal life and save money.

Patients' advocates had supplied studies providing scientific evidence that such therapies were effective.

Experts said the direct cost to Medicare could be several billion dollars a year, but added that some of the cost could be offset by savings elsewhere in Medicare and Medicaid, because the new services will enable patients to live longer on their own.

Many Medicare carriers had programmed their computers to reject claims for people with Alzheimer's and other types of dementia. The new policy bans such computer software instructions and says contractors cannot deny claims simply because a person has Alzheimer's.

Some patients have already received benefits that were once denied and some medical practitioners have secured payment for services that Medicare once refused to cover.

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