Perspective               

Medicare Has New Guidelines for Alzheimer's Coverage

The Bush Administration recently announced its new policy for Medicare coverage of Alzheimer's disease, stating that people with Medicare can no longer be denied mental health services, hospice care, or home health care just because they have Alzheimer's. But the real news is not that Medicare now covers treatments for people with Alzheimer's. It is that Medicare has been arbitrarily denying coverage for Alzheimer's treatment all along.

Before this new policy was put into practice, around 40 percent of Medicare carriers, private companies that review Medicare claims for the government, used computer coding systems that automatically routinely denied the claims of people with Alzheimer's. Their assumption for years was that treatment was useless because people with the disease were unable to improve medically.

Studies have shown, however, that people with Alzheimer's, especially those in the early stages of the disease, can benefit from physical, occupational, speech-language, and other therapies. Even more important, the law states that Medicare covers all medially reasonable and necessary services, with limited exceptions. But all too often, Medicare automatically and wrongly refuses to pay for treatment for people with certain conditions. The Bush Administration needs to review such denial policies to ensure basic compliance with Medicare laws.

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