1)  The news we have been waiting for! On March 22, 2006 CMS issued the Decision Memo for Cardiac Rehabilitation Programs. This article can be found at
www.TrailblazerHealth.com.  Implementation by the Fiscal Intermediaries is June 21, 2006. Texas’ Fiscal Intermediary is TrailBlazer or Mutual of Omaha.  A summary of the changes are:

1. Three additional diagnosis added to the diagnosis criteria for entry into outpatient Cardiac Rehab:
                    - Heart Valve Repair/Replacement
                    - PTCA/Stenting
                    - Heart or Heart-Lung Transplant 
2. Coverage of 36 sessions up to 18 weeks not to exceed 72 sessions for 36 weeks
3. All specific requirements related to physician supervision that could have possibly been construed as unique to Cardiac Rehab have been removed. This means that physician supervision is presumed to be met when provided within the hospital. Previous requirements addressing physician proximity and immediate availability are no longer present in the policy. However, if the service is provided in a setting other than the hospital campus, a physician must be immediately available while the program is in session.
4. If your facility is >250 yards from the hospital, you will need a physician present & “immediately available”.
5. Incident-to still applies to Cardiac Rehab. However, CMS simply states that it would not be appropriate to have specific “incident-to” rules for Cardiac Rehab.

2)  In late August and early September, our board worked to contact each program in the state to recruit their staff’s participation in our AACVPR Grass Roots Campaign. This campaign was to request our U.S. House of Representatives to co-sponsor bill HR4824, and our U.S. Senators to co-sponsor bill S1440. Unless we can get these bills passed to make it mandatory for Medicare beneficiaries to receive our services, future coverage for cardiac and pulmonary rehab services will not be a guarantee. 

The Senate and House bills will play a very important part in the future of cardiac and pulmonary rehabilitation.  By now, these are documents that all cardiac and pulmonary rehab professionals should be familiar with.  For more information, log onto the AACVPR website at www.AACVPR.org and click on the “Legislative and Regulatory Issues” button; this will navigate you to a number of documents to help you better understand these bills.

Thank you to all who participated by writing, faxing, and emailing your hospital’s House Rep and Senator.  Now, we need you to follow up with the Congressman and Senator’s office to ensure that they’ve received your letters and find out if they plan on co-sponsoring the bill.  This is a crucial step in solidifying their level of involvement.  Please do your part to help ensure the future of our state’s rehab services!

If you have any questions of concerns on any of this information, please call or email Lorri Lee at 830.606.3658, llee@mckenna.org.