Adoption of Medicare's Cognitive Assessment and Care Plan Services Benefit: People, Plans, Payment, and Providers

High quality dementia care is expected to address cognitive, functional, behavioral, social, and caregiving needs of patients and families, but such comprehensive care is challenging to provide. Medicare introduced the cognitive assessment and care plan (CACP) billing code in 2017 to reimburse comprehensive assessment and care planning for patients with dementia. We aimed to describe trends in the service and characterize potential drivers of low uptake.

This study sampled repeated cross-sections of Medicare beneficiaries, providers, and services from 100% samples of Medicare fee-for-service claims and Medicare Advantage (MA) Encounters from 2017 to 2022. We examined rates of CACP receipt among Medicare beneficiaries aged ≥ 65 with dementia in fee-for-service Medicare and MA (n = 5,175,137 in 2022) and assessed CACP receipt across sociodemographic subgroups. We measured CACP claim-denial rates in fee-for-service Medicare and the types of MA plans associated with CACP receipt. We also examined the specialty of healthcare providers who billed for CACP during the study period (n = 6635 providers and n = 172,982 visits in 2022).

Through 2022, 5% of fee-for-service beneficiaries with dementia received CACP compared to 3% of MA beneficiaries (p < 0.001). We observed a high denial rate for CACP fee-for-service claims (7%). MA enrollees who received CACP were more likely to be enrolled in preferred provider organization plans (46% vs. 37%, p < 0.001). In 2022, primary care physicians accounted for the plurality of CACP-adopting providers (49% of providers, 40% of visits). Neurologists accounted for a disproportionately high share of CACP visits in the same year (11% of total providers, 20% of total visits).

CACP delivery remained low despite annual growth in CACP adoption during our study period. Payment incentives in MA, drivers of payment denial in fee-for-service, and dissemination and implementation strategies warrant further exploration.