Medicare Coverage of Care Management
Aging Life Care Managers® … coordinating services to optimize health and quality of life.
The Aging Life Care Association® (ALCA) is an organization of practitioners who use a holistic, client-centered approach to caring for older adults or others facing ongoing health or other challenges of aging and/or disabilities. ALCA is committed to maximizing the independence and autonomy of clients and strives to ensure the highest quality and most cost-effective health and human services. Members help clients and their families cope with challenges faced by people with disabilities and older adults through education, advocacy, counseling, and service delivery.
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 Managers®, we are familiar with the limits of the current system of healthcare for the elderly and disabled in the United States. 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 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 / care management has become recognized as a critical tool in health care and service delivery for those who have chronic, in addition to acute medical needs. It is recognized that addressing the chronic needs of those with acute illness improves their overall health and lowers overall costs of acute care. The cooperative integration of Aging Life Care / care management within the Medicare program should result in enhanced health outcomes and overall reduced cost to all parties.
I. SERVICE DELIVERY
- 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.
- 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 recognized certifying bodies: the National Academy of Certified Care Managers, the Commission for Case Management Certification, or the National Association of Social Workers.
- 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:
- 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.
Approved by the ALCA Board of Directors April 22, 2009
Approved by the ALCA Board of Directors, November 7, 2013
Approved by the ALCA Board of Directors October 20, 2023