A multi-year effort by Members of Congress, led by Rep. Chris Smith (NJ-04) and advocacy organizations, to provide Medicare coverage for a care planning session for patients diagnosed with Alzheimer’s disease, is garnering more support and making some progress as last week the Centers for Medicare and Medicaid Services (CMS) proposed regulations providing this coverage for beneficiaries–for 2017.

Smith, author of the “Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act,” which creates a permanent care planning benefit for Alzheimer’s patients and their caregivers, said last week’s announcement by CMS shows that the premise for his legislation and the benefit provided is compelling and necessary, but he pointed out that a one-year commitment is simply not enough.

“The Centers for Medicare and Medicaid Services proposal to provide Alzheimer’s patients with care planning for a one-year trial basis is a step forward, however more can and must be done immediately to ensure that this benefit meets the needs of patients and caregivers permanently,” said Smith, who is also the Co-Founder and Co-Chairman of the House Alzheimer’s Caucus.

Smith’s HOPE for Alzheimer’s Act, HR 1559, a bill that has wide bipartisan support and 294 co-sponsors, is the legislative blueprint which CMS essentially adopted in its Physician Fee Schedule Proposed Rule for 2017. He said it would have been better for all seniors if the announcement was for a permanent benefit. “It is our moral imperative to fully support individuals with Alzheimer’s and their caregivers. We have an obligation to care for our citizens as they age and we must support them as they struggle to face the challenges of this disease,” Smith said.

Under Smith’s permanent legislation and CMS’ one year proposal, Medicare would cover a care planning session where diagnosed Alzheimer’s patients would receive information about medical and non-medical options for themselves and their caregivers to plan for their future care.

“I urge CMS to implement this much needed benefit, but not stop here. With over 5.4 million Americans suffering with this terrible disease and that number expected to climb as the baby boom population ages, we must ensure that all Alzheimer’s patients are able to receive optimal care going forward,” said Smith.

“Upon receiving an Alzheimer’s diagnosis, patients and their families are frequently at a loss for how to effectively plan for the next stage of their lives. While Medicare currently covers a diagnostic evaluation for beneficiaries, the program then offers little support in terms of next steps. It is vital that patients and caregivers are armed with the facts, prognosis, and most efficacious treatment plan,” Smith continued.

Last month, Smith testified before the House Ways and Means Health Subcommittee in support of his bill. First and foremost, Smith stressed the need to find ways to better mitigate the suffering of those with Alzheimer’s and those who care for them, often their family members.

Smith has worked closely with the Alzheimer’s Association in the fight to provide optimal care to all Alzheimer’s patients. Upon CMS’ announcement, Robert Egge, the Alzheimer’s Association Chief Public Policy Officer said, “The Alzheimer’s Association and our advocates are thankful to Congressman Smith for his leadership to advance the HOPE for Alzheimer’s Act and commitment to increasing care and support services for the millions of Americans living with Alzheimer’s disease,” said Egge. “Access to care planning services leads to better health outcomes for individuals with Alzheimer’s disease and through the new CMS service health care professionals have the time and resources to discuss the diagnosis, treatment and support options with patients and their families.”

Not only would the care planning benefit proposed in HOPE and adopted by CMS improve health outcomes for Alzheimer’s patients, it is also expected to mitigate huge, unnecessary costs associated with preventable trips to hospitals and emergency rooms. This is especially important given the state of Medicare and Alzheimer’s place as the most expensive disease in America.

According to the Alzheimer’s Association, in 2016 alone, direct costs to American society of caring for those with Alzheimer’s will total an estimated $236 billion, with just under half of the costs borne by Medicare. To put this in perspective, nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias.

A cost estimate commissioned by the Alzheimer’s Association and conducted by Healthsperien, a Washington, D.C.-based health care consulting firm, indicated that as a result of Smith’s legislation, net federal health spending would decrease by $692 million over the 10-year period.

Smith and then-Rep. Ed Markey (D-MA) are co-authors of the National Alzheimer’s Project Act, one of the most significant victories in the fight against Alzheimer’s disease in the past three decades. Enacted into law in 2010, NAPA (P.L. 111-375) requires the creation of an annually-updated strategic National Alzheimer’s Plan to help those with the disease and their families today and to change the trajectory of the disease for the future.

Smith also held the first-ever congressional hearing examining the global strategies to address Alzheimer’s disease, entitled “Global Strategies to Combat the Devastating Health and Economic Impacts of Alzheimer’s Disease” in 2011, and a second in 2013. 

###