Medicare Coverage of Care Management
Aging Life Care Professionals™ … coordinating services to optimize health and quality of life.
The Aging Life Care Association® (ALCA), formerly National Association of Professional Geriatric Care Managers, is an organization of practitioners who use a holistic, client-centered approach to caring for older adults or people with disabilities facing health challenges. ALCA is committed to maximizing health care recipients’ independence and autonomy and strives to ensure the highest quality and most cost effective health and social care services. Members help older persons, people with disabilities, and their families cope with aging and health challenges through education, advocacy, counseling, referrals, and direct services.
Medicare Coverage of Care Management
ALCA supports the goals of the Affordable Care Act to improve access to affordable healthcare, extend consumer rights and protections in healthcare, and to strengthen Medicare. As Aging Life Care Professionals™ / care managers, we are familiar with the limits of the current system of healthcare for the elderly and disabled in the US. We support the Act's lowering of prescription drug costs, the elimination of denials of coverage for pre-existing conditions, coverage of more preventative services, and improving care coordination and quality of care.
To improve the coordination of care, ALCA supports the creation of the Center for Medicare and Medicaid Innovation, and the search for models of care that improve quality outcomes and reduce costs through care coordination, like models for addressing transitions in care, reducing hospital readmissions, and navigating health care services. We believe that Aging Life Care™ / care management, as defined by the members of ALCA, has a role in improving the coordination of care.
The Medicare program is an important source of health care coverage for older adults and for people with disabilities. Aging Life Care / geriatric care management has become increasingly recognized as a critical tool in health care and service delivery to the segment of this population that has chronic care needs in addition to acute medical needs. It is recognized that addressing the chronic needs of those with acute illness improves the health of the patient and can lower overall costs of acute care. The integration of Aging Life Care / care management within the Medicare program delivered to a defined at-risk population would result in enhanced health outcomes and over-all reduced cost to all parties.
I. SERVICE DELIVERY
- That any model for care or case management as defined under Medicare be one that conforms to the standards of practice to which ALCA adheres. Any such model should be assessment based, person-and-family centered, and interdisciplinary in approach by integrating social model practices with medical model practices. In conforming to the goals of the ACA, Aging Life Care / care management should enhance the capabilities of the informal caregivers.
- That any model for care or case management as defined under Medicare be provided by professionals who are nationally certified and comply with any relevant state and/or professional licensing requirements. Care management certification should be through one of three nationally certifying bodies: The Commission for Case Management Certification, The National Academy of Certified Care Managers, or the National Association of Social Workers.
- That Aging Life Care / care managers adhere to standard professional documentation procedures and/or requirements and adhere to HIPAA rules regarding privacy.
- Conducting evidence-based research that establishes outcome measures and cost-benefit analyses for care management services provided to Medicare recipients,
In the event that any model of care or case management be considered for coverage under Medicare or other insurance system, then we advocate that:
- such care management services be reimbursed at rates that are similar to commonly charged care management rates per geographical region.
- care recipients have the right of choice to purchase additional services from the care management providers that are not covered by Medicare without restrictions imposed by Medicare.
Developed and approved by Public Policy Committee March 2, 2009
Approved by NAPGCM Board of Directors 4.22.09
Reviewed, changed and updated by the Public Policy Committee September 9, 2013.
Approved by the NAPGCM Board of Directors November 7, 2013