Federal Agency to Begin Reimbursing Long-Denied Diagnosis For Dementia (Nov./Dec. 2001)

By Paula Hartman-Stein

            The diagnosis of dementia has long been denied as a reimbursable benefit for Medicare patients.

            No more.

            Beginning with a memorandum released Sept. 25 by the Centers for Medicare and Medicaid Services (CMS), until recently known as the Health Care Financing Administration (HCFA), the new key provision that ends denial of service, reads::

“If a Medicare beneficiary needs psychological therapy or behavior management, and can benefit from such interventions, then a carrier or intermediary cannot deny payment for these services solely because the patient has dementia.”

The new policy is retroactive to Sept. 1.

Credit for the change goes, in large measure, to Leslie Fried, an attorney for the American Bar Association Commission on Legal Problems of the Elderly. Fried has, for some time, investigated denials of payment for several services and procedures of dementia patients, and found inconsistence with local policies for payment coverage and evidence-based clinical guidelines for treatment.

            Changing Federal policy hasn’t come easy.  Fried said that, with help from the national Alzheimer’s Association, she had to educate CMS about diagnosis and treatment of Alzheimer’s disease.  Drafting the new policy and pushing it through bureaucratic channels was “challenging.”

            Fried declared if denials continue, she is prepared to contact the federal agency to ensure compliance.

Fried can be contacted at  FriedL@staff.abanet.org.

 

Hartman-Stein, P.E. (2001) Federal agency to begin reimbursing long-denied diagnosis for dementia. The National Psychologist, Vol. 10, No. 6, p 16.