Medicare to Reimburse for System Navigation and Caregiving Training

For the first time, Medicare will reimburse services from peer support specialists and Community Health Workers.

Earlier this month, Medicare released its final rule for services covered through Medicare Part B beginning January 1, 2024.

The rule includes two new services:

• Caregiver training, which has received the most attention. (Read “Medicare Proposal Would Cover Training for Family Caregivers” from July.)

• Community Health Integration (CHI) and Principal Illness Navigation (PIN) services, which can be delivered by Community Health Workers and peer support specialists. It's the first time Medicare will reimburse for services provided by auxiliary personnel.

In addition:

• New codes have been added to the billing codes related to Social Determinants of Health. These codes would seem to cover these conditions:

  • Caregiver role strain

  • Caregiver stress

  • Family conflict

  • Family disruption

  • Family disruption issues in remission

  • Family maladjustment

  • Family stress

  • Family tension

  • Stress due to family tension

Individuals who completed our Certified Caregiving Consultant (CCC) and Comfort Care Family Coach (CCFC) training programs meet the peer support specialist training and certification requirements. Our CCC and CCFC includes training on helping a family caregiver manage stress, family conflict, burn-out, system navigation and shifting priorities (plus a lot more). (We’ll add additional modules so these consultants and coaches meet the core competencies for Community Health Workers and will earn the Certified Caregiving Community Coach designation.)

Imagine:

• When you need to find services for your family member with dementia, you can connect with a professional who gets it because they went through it. The services provided by these professionals would be covered through Medicare. (In this case, Medicare will cover services provided to the family caregiver when the Medicare beneficiary can’t participate in care plans because of the disease progression.)

• When your family receives a diagnosis, you could connect with a professional who understands how the diagnosis turns the world upside down. Image having a planning meeting with a professional, whose support is covered by Medicare, so you and your family can begin receiving support and help.

• When you feel overwhelmed by the stress and strain of your caregiving experience, your doctor could refer you to a peer support specialist for help and support. (Currently, this service is available if you receive Medicare benefits.)

• When you need more help and support but don't have the time to find it, your caree's doctor could refer you to a peer support specialist who researches community programs and services.

• When you transform your personal caregiving experience into a new career coaching family caregivers, you get reimbursed from Medicare!!

This development is really exciting! I’ve been tracking these new rules since August and will share updates as I continue to understand how these new services will help us.

Medicare, I hope, is just the start. I hope other insurance plans and payers take a page from Medicare’s rule book and look to reimburse peer support specialists (who get it!!) to provide the critical support family caregivers deserve.

I also hope this gets us closer to reimbursing family caregivers for the care they provide. What if trained family caregivers were the next group of auxiliary professionals who receive reimbursement from Medicare and other insurance payers?

In essence, we finally got a billing code!

Resources

We bring awareness for the need to support and help family caregivers during these special days in November:

• What’s it like to navigate The 17 Caregiving Systems? We’d love to know.

• Join our advocacy campaign to raise money for financial support for family caregivers.

• Kiss a Caregiver Day on November 21.

• Tackle the Tasks is November 25. We encourage others to help around the house of the family caregiver or caree.

• Give to a Family Caregiver on #GivingTuesday (November 28). We encourage individuals to give a tax-free gift to a family caregiver.

• Our Certified Caregiving Advocate training is free in November. Join me for our one-hour training on November 29 at 1 p.m. ET (Noon CT, 11 a.m. PT).

(Image by 🆓 Use at your Ease 👌🏼 from Pixabay)

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