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Nationwide Rules Against Disputed Alzheimer’s Program

April 30, 1990

COLUMBUS, Ohio (AP) _ Nationwide Insurance said today it was holding to its decision to reject claims filed by an agency that offers therapy for Alzheimer’s disease victims in Ohio. A spokesman for the agency said the program would fold.

The company’s decision, announced in an unsigned statement, came after the company reviewed claims filed by Toledo-based Intergenerational Services Inc., a non-profit agency that offers therapeutic services to Alzheimer’s patients in 66 nursing home in 15 northwest Ohio counties.

Columbus-based Nationwide, which administers the Medicare program in Ohio, contends the activities that Intergenerational offers to Alzheimer’s patients are recreational and social, not psychotherapy. The services, in the company’s view, therefore do not qualify for even partial reimbursement under the government’s medical insurance program.

Intergenerational said today it would go out of business because of Nationwide’s policy, because it could not afford to continue operations during an appeal.

″Even though they are going to appeal Nationwide’s decision, they’re going to be phasing out the program,″ said Stan Collins, an agency spokesman. ″They just can’t stay in business.″

Nationwide had stopped making partial payments for the services in October. In its statement today, the insurance company said it would have been irresponsible for a Medicare contractor to pay for a program it deemed ineligible.

The agency, which serves some 2,000 people in northwestern Ohio, had depended on Medicare for 80 percent of its $2.5 million annual budget.

The Rev. Al Baumann, president of the board of Intergenerationl, said its program is psychotherapy. Patients reminisce about the past, sing songs and examine objects that will spark their memories. The programs for patients are not conducted by doctors, but doctors do supervise the program, its administrators have said.

Nationwide saidIntergenerational’s services should be provided by nursing homes.

Intergenerational will take its case to the National Health Care Finance Administration, which oversees the Medicare program. The administration, part of the U.S. Department of Health and Human Services, has said it would not intervene.

Medicare does not have specific guidelines involving how to define psychotherapy for Alzheimer’s patients, said Steven Arney, chief of carrier operations for the finance administration. But a decision by a state contractor such as Nationwide to deny payment for such programs would be within the federal guidelines, he said.

Arney has said he knew of no other program in the country serving Alzheimer’s patients where a similar dispute over whether to define it as psychotherapy has arisen.

The agency has 100 staff members at offices in Toledo, Findlay, Defiance and Bellevue. The agency also will end its affiliation with 40 doctors who work the therapy program.

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