Medicare Caregiver Training Services Reimbursement: Evidence Roundup

Blog
Megan Lisch, Center for Health Care Strategies
An elderly Asian woman laughing with her adult daughter in a home kitchen environment.

One in six people in the U.S. are caregivers to older adults. These caregivers include family, friends, and neighbors of Medicare beneficiaries. Despite their critical and demanding roles, most caregivers assume their responsibilities without any formal training. Recognizing this gap, the Centers for Medicare & Medicaid Services (CMS) in the 2024 Medicare Physician Fee Schedule began authorizing the use of billing codes for caregiver training services under Medicare Part B.

Physicians, clinical social workers, mental health counselors, nurse practitioners, and other health care providers can use the new codes to cover training sessions for caregivers of Medicare beneficiaries with a mental or physical health diagnosis. These sessions focus on behavior management or modification and supporting the care recipient’s functional performance in home or community settings as part of a person-centered treatment plan. Care recipients do not need to be present at the training sessions.

The fee schedule also includes a revised caregiver definition to include “an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation” and “a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.” The added language acknowledges the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, a bill passed in 2018 by Congress that requires the U.S. Department of Health and Human Services to establish and monitor a national family caregiving strategy.

EVIDENCE ROUNDUP

This blog post is part of a Playbook series connecting evidence and implementation resources with emerging state and federal policies to help enhance services for people with complex needs.

Why is this important?

Caregivers are disproportionately women and people of color, and typically work full-time in addition to caregiving, according to a national survey from AARP and the National Alliance for Caregiving. Few caregivers report receiving training from health care providers on medical and nursing tasks. As many as two-thirds of surveyed family caregivers feel overwhelmed and anxious, while also maintaining a strong desire to support their care recipient. Feelings of fatigue and stress can result in negative outcomes for both caregivers and care recipients. Models developed by researchers and health care systems report reduced burnout from caregivers that participate in training.

Before this year, traditional Medicare did not cover these services. Now, caregiver training services can be delivered when deemed reasonable and necessary by the beneficiary’s care plan. This new coverage of training services may benefit both care recipients and caregivers by enhancing the skills of caregivers to support their care recipient and communicate effectively with health care providers. Notably, some Medicare Advantage plans offer caregiver support services as a supplemental benefit.

Resources on Caregiver Training Services for Older Adults

Health care and social services professionals, state policymakers, and health plans can look to the following resources to understand emerging evidence and implementation tools:

Beyond the resources above, the Playbook Supporting Family Caregivers Collection highlights promising models and case studies for caregiver support programs.

Share Your Caregiver Training Resources and Tools

Do you have a resource or emerging best practice related to caregiver training services? Please share your experience with the Better Care Playbook. We are interested in growing our library of evidence and implementation practices to help those in the field strengthen and build successful caregiver training programs in communities across the nation.