Cardiac rehabilitation has been found to be safe and effective for patients with certain types of cardiac ailments. CMS plans to expand coverage for cardiac rehabilitation to patients with congestive heart failure, a previously uncovered condition, and is in the process of reviewing public comments before issuing its final decision. Does the evidence warrant the change?
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed decision memo to expand coverage for cardiac rehabilitation services for beneficiaries with chronic heart failure (CHF). The agency defines CHF as patients with left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) Class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.
The proposed decision memo was generated by a formal request from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) for a National Coverage Determination (NCD) to add CHF to the list of approved indications for coverage for cardiac rehabilitation.
Specifically, coverage is currently permitted for beneficiaries who have experienced one or more of the following:
- Acute myocardial infarction within the preceding 12 months
- Coronary artery bypass surgery
- Current stable angina pectoris
- Heart valve repair or replacement
- Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting
- Heart or heart-lung transplant
However, the regulations also establish that CMS may add “other cardiac conditions as specified through a national coverage determination.”
For Medicare coverage purposes, cardiac rehabilitation is defined as containing all of these elements: physician-prescribed exercise; cardiac risk factor modification, including education, counseling, and behavioral intervention; psychosocial assessment; outcomes assessment. Physician supervision is also a requirement. At the time these final regulations were issued, the evidence was not adequate to conclude that cardiac rehabilitation was reasonable and necessary for CHF.
CMS is seeking comments on the proposed decision and will respond to public comments in a final decision memorandum.
- Centers for Medicare & Medicaid Services (CMS). Proposed Decision Memo for Cardiac Rehabilitation (CR) Program – Heart Failure (CAG-00437N). November 21, 2013. Available at: http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=270. Accessed November 25, 2013.