After leading a multi-year, multi-faceted effort to provide Medicare coverage for a care planning session for patients diagnosed with Alzheimer’s disease, Rep. Chris Smith (NJ-04) announced today that Medicare has now agreed to cover the costs of planning sessions for seniors with Alzheimer’s disease. The confirmation of the new benefit was included in the Centers for Medicare and Medicaid Services (CMS) final rule for Calendar Year 2017 Physician Fee Schedule. The new care planning benefit included in the Fee Schedule is an amended version of the benefit outlined in Smith’s legislation, the “Health Outcomes, Planning, and Education (HOPE) for Alzheimer’s Act” (HR 1559).

     “The Centers for Medicare and Medicaid Services decision to provide Alzheimer’s patients with care planning is a necessary step to address the needs of the over 5 million Americans suffering from this devastating, progressive disease. As we work to find a cure for Alzheimer’s, we must never forget the people who are suffering now and we cannot fail to provide them with the best care possible,” said Smith, co-founder and Co-Chair of the Congressional Alzheimer’s Disease Task Force. “I am encouraged by CMS’ action and will closely monitor the implementation of this code to ensure that this new benefit meets the needs of patients and caregivers permanently.”

     In July, CMS released its proposed regulations which included a code for the Assessment and Care Planning for Patients with Cognitive Impairment. In response, Smith and Rep. Maxine Waters led a bipartisan letter signed by over 70 Members of Congress to Andy Slavitt, the Acting Administrator of CMS, urging CMS to adopt this code in its final rule. In the letter, Smith urged CMS to make this a permanent benefit and to ensure that caregivers are included in the care planning process.

     The new coverage mirrors provisions in Smith’s HOPE for Alzheimer’s Act, legislation he introduced to create a permanent care planning benefit for Alzheimer’s patients and their caregivers. HR 1559, which gained wide bipartisan support and 307 co-sponsors, is the legislative blueprint which CMS essentially adopted in its Physician Fee Schedule Proposed Rule for 2017.

     In their letter to CMS, Smith and his colleagues stressed the importance of including caregiver needs and supports in the final benefit. According to the Alzheimer’s Association, in 2015, more than 15 million Americans provided over 18 billion hours of unpaid care for Alzheimer’s patients.

     “I am extremely pleased that addressing caregiver needs and social supports will be included in this benefit. These remarkable caregivers shoulder a tremendous responsibility and assume financial and emotional hardship in order to care for their loved ones.

     “Identifying the best care through a care planning session not only helps patients but also gives guidance and support to caregivers – who are often family members. Not only is this the right thing to do, but supporting caregivers has been proven to delay institutionalization of Alzheimer’s patients by over a year, saving CMS money and allowing individuals to live in the comfort of home,” Smith continued. 

     “I commend the Centers for Medicare and Medicaid Services for its decision to make care planning sessions available to Alzheimer’s patients and their caregivers,” said Rep. Maxine Waters (CA-43), Co-Chair of the Congressional Alzheimer’s Disease Task Force. “Facing an Alzheimer’s diagnosis can be daunting. Care planning sessions provide patients and caregivers critical information on the progression of the disease, treatment options, and caregiving strategies.  As we continue to seek a cure for this devastating disease, we must do everything we can to support caregivers and enable Alzheimer’s patients to live with dignity.”

     Robert Egge, the Chief Public Policy Officer of Alzheimer's Association, added that “Care planning is crucial to improving outcomes and maintaining quality of life, for the diagnosed and their caregivers, as well as controlling costs and planning appropriately for the future. Understanding this, Congressman Smith has worked closely with the Alzheimer's Association and our advocates to advance the HOPE for Alzheimer's Act. We thank him for his support and work to increase access to critical support services.”

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