A “notable” proposal related to establishing a new payment program for caregiver training is signaling a shift in attitudes toward the contributions of family caregivers that could benefit senior living providers, according to an industry expert.
The Centers for Medicare & Medicaid Services is proposing to pay Medicare Part B providers — physicians, nurse practitioners, physician assistants, and speech, physical and occupational therapists — for caregiver training under the Physician Fee Schedule.
The proposal is significant, because CMS traditionally only pays for services delivered directly to Medicare beneficiaries, according to Tyler Overstreet Cromer, head of healthcare research and advisory service firm ATI Advisory’s Medicare innovation team.
“Caregivers are vital to patient success in certain circumstances,” Cromer told McKnight’s Senior Living. “Now they’re proposing to pay for caregiver training for the first time.”
The proposal, she said, shows a recognition that it is difficult to slow the progression of disease or make progress with some Medicare beneficiaries without assistance from a family caregiver. The proposal also aligns with President Biden’s executive order on increasing access to high-quality care and supporting caregivers.
“We’re seeing a real shift in how policymakers are thinking about the role of family caregivers,” Cromer said. “They are recognizing that it is an appropriate medical reimbursement to pay medical providers to train people to help deliver the care plan.”
One way that this effort could be valuable for senior living providers, she said, is via the training of family members of residents who have dementia diagnoses. Family caregivers could be trained to manage certain behaviors and to know what to expect, she said.
“Having more informed family caregivers — more well-trained family caregivers — is absolutely good for residents,” Cromer said.
Another area that could affect senior living is three new sets of codes proposed by CMS related to community health integration services and social determinant health risk assessment — which would pay for community health interventions — and principal illness navigation services.
Cromer said that the principal illness navigation relates to services provided by a community partner to help an individual navigate a specific serious illness diagnosis. With chronic conditions often seen in senior living residents, Cromer said, this service could be of value to assisted living residents, in particular, by placing them on treatment plans.
“We’re seeing an overall shift in openness to paying via the medical system for services that help people to navigate the system, understand their condition, and manage it with or without the presence of a caregiver,” she said.
Dementia care pilot addresses caregivers
Monday, CMS announced another caregiver training model for individuals with dementia.
The Guiding an Improved Dementia Experience, or GUIDE, model, Cromer said, is completely focused on the caregiver / care recipient diad and is integrated into a payment model.
The significance of the Medicare dementia model, she said, is that it pays for respite care.
“This is a pretty significant amount of change,” Cromer said, adding that some dementia care models integrating the caregiver and provider show evidence of better outcomes. “I think the pandemic shone a brother light on the role of caregivers,” she said.
Cromer said she is observing greater policymaker awareness, as well as a shift in medical practices, where the importance of a team-based approach to care has improved outcomes.
