Department of Health & Human Services
Tuesday, April 02, 2002
Statement of Tom Scully, Administrator Centers for Medicare & Medicaid Services On Therapy Coverage of Alzheimer’s Disease Patients Our technical clarification to Medicare contractors regarding payment for therapies for Alzheimer’s patients reinforces our commitment to making sure that all beneficiaries receive the care to which they are entitled to under Medicare. Advances in medical science are helping physicians diagnose Alzheimer's Disease at its earliest stages. Depending on a beneficiary's medical condition, the Centers for Medicare & Medicaid Services believes that certain specific therapies can be helpful in slowing a beneficiary’s decline due to this terrible illness. In response to advocate concerns that Medicare contractors were increasingly denying services to Medicare beneficiaries based solely because they had been diagnosed with Alzheimer's Disease, CMS issued the memorandum to clarify existing reimbursement policies. The September 2001 instructions direct Medicare contractors not to install system edits that would automatically deny Medicare covered services based solely on claims for dementia. These actions clarify that Medicare would provide payment for specific speech, occupational and rehabilitation therapies. More specifically, Medicare may pay doctors and other healthcare providers for neuro-diagnostic testing, medication management and psychological therapy when provided to patients with Alzheimer’s Disease. Alzheimer’s advocates came to us with what seemed to be a significant problem for Alzheimer’s patients. Intuitively, this longstanding approach appeared to discriminate against Alzheimer’s patients, and we were happy to fix it. The memorandum is available at http://www.hcfa.gov/pubforms/transmit/AB01135.pdf.