Position Paper
Medicare Program

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.

The Medicare program is an important source of health care coverage for older adults and people with disabilities. It must be comprehensive in its scope of coverage and services, affordable, flexible in the array of covered options, and designed to maximize the good health and quality of life for all of its beneficiaries.

I. Service and Delivery

ALCA advocates:

  1. For the Medicare program to continue to offer coverage for a set of comprehensive services that includes, at a minimum, preventive care, acute care on both in-patient and out-patient basis, rehabilitation therapies, stays at skilled nursing facilities, home health care, durable medical equipment, hospice care and coverage of prescription drugs.
  2. For the continued offering of well-defined options for delivery of covered services with easy transition between options. This includes the flexibility to add new services and options as technology expands and new needs arise.
  3. That review panels include Aging Life Care Professionals™ / care managers and other experts who practice in the field of long-term care and the continuity of services.
  4. That medical decisions be made between the physician and individual and/or the legal decision-maker and that access to care not be restricted by age or disability.
  5. Removing the barriers to coverage of services and treatment associated with Observation Status. 

ALCA supports:

  1. Staffing and funding of the administrative component of the Medicare program to be adequate, diverse, and responsive to program and beneficiary needs, including monitoring and enforcement of program standards and quality of care.
  2. The availability of benefit counselors and standardized, clear and accurate descriptions of the Medicare program, reasonable and fair information about how to make choices among options, including comparative marketing and performance information. Medicare policy, regulations and practices should be in line with the principles of clarity, ease of use by Medicare beneficiaries, choice, and active promotion of the greatest public good.
  3. The exploration of the addition of long-term care, transitions of care, and chronic care services to the comprehensive Medicare service package, established under the ACA, which appropriately acknowledge the role, scope of practice, and practice models of the Aging Life Care Professional.

II. Financing

ALCA advocates:

  1. For the Medicare program to have reasonable and adequate financing to cover the cost of a comprehensive scope of services, without imposing an undue financial strain on Medicare beneficiaries. Medicare should provide an adequate safety net of health care for all Medicare beneficiaries.
  2. That the payment structure for private insurers (e.g. Medicare Advantage Plans) be no more than the coverage rates of traditional Medicare.

III. Rights and Appeals

ALCA advocates:

  1. That Medicare beneficiaries and their legal or personal representatives be provided notice and opportunity to appeal the denial, reduction or termination of services and benefits in any health care delivery setting, including pre-termination review, Observation Status, and expedited review of requests for urgently needed services.
  2. That the Medicare program provide guidance to its program contractors, service providers, and program administrators about establishing a process for beneficiary complaints in areas such as location of services, provider-beneficiary relations, and courtesy of service.
  3. For procedures which include the resolution of complaints about quality of care.

IV. Medicare Prescription Drugs

ALCA supports:

  1. A drug benefit with a reasonable shared cost.
  2. Open enrollment throughout the year.
  3. The development and enforcement of a system for insuring more expensive drugs be covered if they are medically necessary and if no substitutes are available.

Resolutions Approved by the NAPGCM Board of Directors January 31, 2009.
Revisions Approved by the ALCA Board of Directors October 27, 2017.