Improving Care for Populations Disproportionally Affected by Alzheimer’s Disease and Related Dementias : Table 5


: Table 5

Federal AgencyProgram NameCategoryProgram DescriptionSpecial Considerations for Early Onset, Minorities, Intellectual DisabilitiesOpportunities for Improvement
CMS/HHSMedicare Supplemental Health InsuranceDetection & Diagnosis; Treatment & Care CoordinationMedicare Part B benefits cover the diagnosis, evaluation and treatment of Alzheimer's disease, primarily by physicians. In addition, Medicare Part B covers outpatient physical, occupational, and speech therapy Medicare Part B also covers outpatient counseling concerning the management of Alzheimer's either from a physician or from a Medicare-certified psychologist, medical social worker, or other non-physician provider. If the mental health treatment is provided by a non-physician, it must be prescribed by the patient's doctor. Medicare Part B covers: physicians' services outpatient hospital services physical, occupational, and speech therapy diagnostic x-rays laboratory tests durable medical equipment blood home health care services (limited) mental health services  
CMS/HHSMedicare Acute Care ServicesDetection & Diagnosis; Treatment & Care CoordinationMedicare Part A covers acute care services such as: inpatient hospital care limited skilled nursing home care limited home health care hospice care  
CMS/HHSMedicare Prescription Drug CoverageTreatment & Care CoordinationMedicare Part D covers prescription drugs and is available to all Medicare beneficiaries through private insurance plans. Each plan is different regarding the drugs it covers and the out-of-pocket costs. All Medicare drug plans cover some commonly prescribed medications to treat Alzheimer's. All plans are required to cover at least two cholinesterase inhibitors and memantine.  
CMS/HHSHospice BenefitsAdvance Care PlanningMedicare beneficiaries with a terminal illness who are certified by a physician to have 6 months or less to live are eligible for the Medicare hospice benefit. Hospice enrollees must agree to receive all of their care for their terminal illness through the hospice. The Medicare benefit includes: nursing care provided by or under the supervision of a registered professional nurse; physical or occupational therapy, or speech-language pathology services; medical social services under the direction of a physician; services of a home health aide and homemaker services; medical supplies (including drugs and biologicals) and the use of medical appliances; physicians' services; short-term inpatient care (for both caregiver respite and procedures necessary for pain control and acute and chronic symptom management), but such respite care may be provided only on an intermittent, non-routine, and occasional basis and may not be provided longer than 5 consecutive days; counseling (including dietary counseling) with respect to care of the terminally ill individual and adjustment to his death; and any other item or service which is specified in the plan and for which payment may otherwise be made. Hospice is an optional benefit in Medicaid that many, but not all states cover it. Medicaid services mirror Medicare benefits, and are of importance principally to beneficiaries who are not eligible for Medicare.  
VAAmbulatory CareDetection & Diagnosis; Treatment & Care CoordinationOutpatient diagnostic and treatment services are part of the VA's standard benefits package. Outpatient care includes a wide range of primary and specialty care (e.g., geriatrics, neurology, psychiatry, other medical specialties). Coordination of care and interactions with family members are integral components of care. Some VA facilities have developed specialized dementia or other geriatric problem-focused specialty outpatient clinics, which may provide evaluation or ongoing care.  
VAHome-based Primary CareDetection & Diagnosis; Treatment & Care CoordinationHome-based Primary Care, part of the VA Standard Benefits Package, is a unique home care program that provides comprehensive, longitudinal, primary care by an interdisciplinary team of VA staff in the homes of veterans with complex, chronic, disabling disease for whom routine clinic-based care is not effective.  
VAHome TelehealthHCBSHome Telehealth communication technology can play a major role in coordinating veterans' total care with the goal of maintaining independence.  
VAHospital CareDetection & Diagnosis; Treatment & Care CoordinationInpatient diagnostic and treatment services are part of the VA standard benefit package. Inpatient care includes a wide range of specialty care (e.g., geriatrics, neurology, psychiatry, surgery, and other medical specialties). Coordination of care and interactions with family members are integral components of care. Some VA facilities have developed specialized dementia inpatient units, which may provide evaluation and short-term management of complex cases.  
VAGeriatric Evaluation and ManagementDetection & Diagnosis; Treatment & Care CoordinationGeriatric Evaluation and Management is for older veterans with multiple medical, functional, and psychosocial problems and geriatric syndromes (e.g., falls) and is provided by an interdisciplinary team in either inpatient or outpatient settings. Geriatric evaluation--the assessment and care plan development--is required to be available to all veterans who may benefit from it. Geriatric evaluation is offered in geriatric evaluation and management, home-based primary care, and geriatric primary care.  
VAGeriatric Primary CareTreatment & Care CoordinationGeriatric primary care for frail elderly veterans targets complex patients with involved medical histories who need in-depth attention.  
VAGeriatric Research, Education, and Clinical Centers (GRECCs)Detection & Diagnosis; Treatment & Care CoordinationA system of 20 centers of excellence responsible for increasing basic knowledge of aging, developing improved models of clinical services, and implementing a wide variety of educational activities. Four GRECCs have a major focus on dementia.  
VAMental Illness Research, Education, and Clinical Centers (MIRECCs)Detection & Diagnosis; Treatment & Care CoordinationA system of 10 Centers of Excellence whose mission is to generate new knowledge about the causes and treatments of mental disorders, apply new findings to model clinical programs, and widely disseminate new findings. Two of the Centers have a focus on dementia.  
SAMHSA/ HHSOlder Adult Targeted Capacity Expansion (TCE)Detection & Diagnosis Treatment & Care CoordinationDesigned to improve consumers' overall mental health and quality of life, Older Adult TCE helps communities provide direct services and build infrastructure to support expanded services for the behavioral health needs of clients from a variety of ethnic and cultural groups. The program provides direct clinical treatment, LTSS, and prevention services. Additionally, it provides “wraparound” and recovery support services (e.g., community integration and transportation services).  
SAMHSA/ HHSNational Registry of Effective Programs and Practices (NREPP)Detection & Diagnosis; Treatment & Care CoordinationA searchable online registry of more than 190 evidence-based interventions supporting mental health promotion, substance abuse prevention, and mental health and substance abuse treatment. Its purpose is to connect members of the public with intervention developers to learn how to implement these interventions in their communities.  
HRSA/HHSCMS/HHSReducing Adverse Drug Events: Patient Safety and Clinical Pharmacy Services Collaborative (PSPC)Detection & Diagnosis; Treatment & Care CoordinationSeeks to improve the quality of health care by integrating evidence-based clinical pharmacy services into the care and management of high-risk, high-cost, complex patients. Quality Improvement Organizations will foster reduction of adverse drug events in high-risk populations by expansion and formation of community teams focused on patients who are at high medication risk because of multiple medications, multiple providers, multiple conditions or inappropriate/inadequate medication use. The PSPC collaborative includes a joint effort targeting the Medicare population often at higher risk secondary to polypharmacy or potentially inappropriate medication prescription and use.  
VAHome Hospice CareAdvance Care PlanningHome hospice care, part of the VA Standard Benefits Package, is provided by community hospice agencies and includes comfort-oriented and supportive services in the home for veterans in the advanced stages of Alzheimer's disease. Services are provided by an interdisciplinary team of providers and volunteers. Bereavement care is available for the family following the death of the patient.  
VAHospice and Palliative Care Consultation Team (HPC)Advance Care PlanningAll VA facilities are required to have interdisciplinary HPCs available to assist staff, veterans, and their families with serious illness care and end-of-life planning issues.