Medicare Wants Your Input

By John Showalter, MD

As a primary care physician who specializes in treating patients with cognitive decline, I find few things more frustrating than not being able to deliver optimal care because of systemic barriers, especially health insurance coverage.

Whether you are a clinician, healthcare administrator, patient, or caregiver, you’ve encountered problems in the healthcare system that seem solvable, if only you could get the right information to the right people.

For those interested in raising the standards of care around Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD), that’s no longer the case. There is now a direct channel to participate in the policymaking process.

The Centers for Medicare and Medicaid Services (CMS) published the Calendar Year 2027 Proposed Physician Fee Schedule on July 16, 2026. The Medicare Physician Fee Schedule is the federal rulemaking process for Medicare payment policies for Medicare Part B services; it’s how CMS determines what services to cover, who can provide them, who can receive them, and how much providers are paid. And the comment process is how everyone interested in the Medicare program can have a voice.

Alzheimer’s is one of the most-feared diagnoses for older Americans. They are more afraid of developing Alzheimer’s disease than of cancer. At the same time, there’s a growing body of evidence that lifestyle changes can slow the progression of cognitive decline and AD/ADRD. Lifestyle interventions include behaviors like eliminating tobacco use, addressing hearing loss, and managing other chronic conditions as well as nutrition, activity, sleep, socialization, and more. Intensive lifestyle intervention is a primary area of concern for CMS.

To better understand the barriers to effective lifestyle intervention and AD/ADRD care, CMS seeks comment on a number of questions, including:

• Does biomarker diagnostic testing support earlier detection or improved care in AD/ADRD, and what role might it play in identifying patients eligible for an intensive lifestyle intervention program?

• What types of interventions should be included in an intensive lifestyle intervention program to reduce the risk for cognitive decline in older adults who may be at risk of AD/ADRD, and which of these are appropriate for Medicare to cover?

• Should interventions be a one-time service (e.g., teaching older adults how to make changes for a healthier lifestyle) or a recurring service?

• Should eligibility be restricted to patients with a diagnosis of MCI or early dementia?

• Which healthcare professionals should be involved in an intensive lifestyle intervention program that likely will include interventions in domains such as physical activity, nutrition, sleep, stress management, and more?

• What is the right “dose” (frequency) of intervention and what is the most effective modality of delivery for these interventions?

• How should CMS develop the health technology ecosystem to support older adults in reducing their risk for developing ADRD using intensive lifestyle intervention?

While many of CMS’s questions are seeking scientifically accurate evidence, patient and caregiver experiences are invaluable in framing the reality of delivering and receiving lifestyle interventions. Everyone who has an interest in AD/ADRD should participate in creating the future of care for older adults.

You don’t need to answer every question. A comment that addresses one meaningful barrier or success factor is a useful contribution. CMS reads every comment.

The full request for information is available in the Federal Register. CMS is accepting comments now through September 14, 2026. When commenting, refer to file code CMS–1848–P. You can submit comments:

• Electronically here.

• By regular mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1848–P, P.O. Box 8016, Baltimore, MD 21244–8016

• By express/overnight mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1848–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.

Alzheimer’s touches nearly every family in this country. Here is a real chance to speak directly to policymakers and shape what the future of Alzheimer’s and dementia prevention and care looks like. The comment period is open.

John Showalter, MD, is a practicing internal medicine physician at Mindful Integrative Medicine and the Chief Operating Officer at Linus Health, a digital health company focused on improving brain health.