Christopher A. Langston contributed to this post.
Medicare is now paying outpatient providers to address the training needs of beneficiaries’ family members. It is the second expansion of benefits started in January, along with permitting practitioners to bill for services addressing the health-related social needs of patients.
And so this caregiver training benefit, with billing codes unveiled by the Centers for Medicare & Medicaid Services (CMS), is another important step forward this year toward meeting the comprehensive care needs of older adults.
The new payments for training are a welcome echo of part of Archstone Foundation’s Three T’s strategy – bolstering teamwork, improving technology, and enhancing training – for expanding coordinated care for older Californians and their caregivers.
That’s why last month we hosted a listening session where Meena Seshamani, MD, CMS deputy administrator and director of the Center for Medicare, joined family caregivers and many of our state and community partners to discuss how to extend and maximize the new benefits.
Medicare will now cover these types of training for family caregivers:
- behavior management and behavior modification
- functional performance in the home or community to assist with activities of daily living including transfers, mobility, communication, swallowing, feeding, problem solving, and safety practices – as well as reducing the negative impacts of a diagnosis on the patient’s daily life and assisting patients in carrying out a treatment plan
The training may be provided as many times as medically needed to support the patient. And payments are allowed even if the older adult beneficiary is not present during the training.
The new reimbursements are an outgrowth of a 2018 law, known as the RAISE Family Caregivers Act, and catalyzed by President Biden’s executive order last April on “Increasing Access to High-Quality Care and Supporting Caregivers.” With these codes, CMS is building out its commitment to health equity by providing new services to underserved populations.
An Essential Part of the Care Team
Family caregivers are an essential part of care teams and support systems for older adults and persons with disabilities. We have seen the care they are asked to provide become more difficult, more complex, and increasingly medicalized. People are discharged from hospitals and rehabilitation centers with more care needs than ever before. The technologies family caregivers are asked to use have become ever more complex. Appropriate support for these family members, including training, is essential to improving outcomes for older adults – specifically Medicare beneficiaries – while reducing the burden on their caregivers and lowering the costs of public programs.
In my own family, for example, my grandmother cared for my grandfather for years as he struggled with confusion and memory loss – before we even understood that he had dementia. She would have benefitted greatly had someone on his healthcare team been able to provide strategies for managing his wandering and confusion in completing daily tasks.
Partners Provide Good Ideas
During the listening session, officials from CMS and the state’s Department of Aging and Department of Health Care Services discussed the training benefit’s potential with us, family caregivers, doctors, caregiver service organizations, and representatives from The SCAN Foundation.
Dr. Seshamani described the benefit as a sea change for Medicare and described CMS’ interest in understating the pain points family caregivers experience and where the agency can offer guidance and help. Her CMS colleague Doug Jacobs, MD, described the training reimbursements as an important step toward creating equity and closing gaps in health disparities.
Foundation President and CEO Christopher A. Langston, PhD, said the codes afford a tremendous opportunity to make it easier to do the right thing in providing care. But he cautioned that – as with the annual wellness visit and chronic care management benefits – utilization may remain low without concerted efforts to encourage use and adoption. Dr. Langston also shared how follow-up training could have helped after his father fractured his foot after falling in the middle of the night. Instruction on how to safely transfer someone from a bed to a wheelchair could have helped him and his father maintain their safety.
Two other family caregivers also described how caring for a loved one can be cumbersome, complex, and confusing – and how the training now being covered would have been highly beneficial. One described caring for her mother who had dementia and said her work would have been much easier with guidance on how to control her diabetes and meet her nutrition needs.
Zaldy Tan, MD, MPH, director of the Bernard and Maxine Platzer Lynn Family Memory and Healthy Aging Program and medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai Medical Center, praised the new codes as refreshing while echoing Dr. Langston’s description of them as only a first step with implementation challenges ahead. Dr. Tan suggested that allowing training via telehealth would hasten adoption.
Another suggestion about expanding the delivery of training was offered by Donna Benton, PhD, of the USC Family Caregiver Support Center, Kathleen Kelly, MPA, executive director of the Family Caregiver Alliance, and Barbra McLendon public policy director of Alzheimer’s Los Angeles. They all said if health care providers could contract with trusted community-based providers under their general supervision, that would greatly expand capacity to provide caregiver training.
Both state partners had suggestions for scaling and spreading the new training. Susan DeMarois, director of the California Department on Aging, said her department can work with its network of family caregiver resource centers and area agencies on aging to make sure caregivers know about – and request – this training benefit. Anastasia Dodson, MPP, deputy director of the Department of Health Care Services, said there are likely ways to leverage Medicaid to help providers scale the benefit.
Both CMS officials also confirmed the training benefit would be available to family caregivers receiving In-Home Supportive Services, the California program for self-directed care known as “money follows the person” in some states.
Opportunities to Deliver Better Care
The session was a first step to assuring the new benefit is used to its full potential. Healthcare providers must be made aware of the codes in order to put them to use. They will need to consider when and how to offer training to the caregivers of their patients. And there also must be appropriate evaluation of the effort. For example, we should learn: Who is a good candidate for the training? When caregivers receive training, does their care change or improve? If care improves management of behavioral symptoms, can that lead to reductions in medication?
The path to uptake will be complex, and the Foundation will do what it can to help providers make the most of this opportunity.
