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National Coverage Analysis (NCA) Tracking Sheet

Cardiac Rehabilitation Programs

CAG-00089R

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Issue

In 2001, CMS opened a reconsideration of the coverage policy for cardiac rehabilitation programs to review the following proposed new indications for coverage: (1) heart valve replacement; (2) angioplasty; (3) heart or heart lung transplant; and (4) congestive heart failure. Later that year the Office of the Inspector General began research to review compliance with the physician supervision and “incident to” requirements of the policy. CMS chose not to move forward with the reconsideration until information from the OIG report was available to guide policy changes. Although CMS expects the OIG’s final report to be available later this year, individual facility reports are available on the OIG web site at www.oig.hhs.gov.

Due to the length of time the reconsideration was pending, CMS has closed the previous analysis without modifying the coverage policy and is opening another reconsideration to research and evaluate the four proposed indications using current evidence. This reconsideration will also include a review of the three currently covered indications for patients who: (1) have a documented diagnosis of acute myocardial infarction within the preceding 12 months; or (2) have had coronary bypass surgery; and/or (3) have stable angina pectoris. In addition CMS intends to revisit the language regarding physician supervision and “incident to” requirements in order to provide clarity.

CMS is requesting public comment on all seven clinical indications, the physician supervision requirement and to which physician (referring or hospital-clinic) the services should be “incident to.”

National Coverage Determinations

Benefit Category

Incident to a physician's professional Service

Requestor Information

Requestor Name Requestor Letter
Internally Generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
06/29/2005
Expected NCA Completion Date
03/22/2006
Public Comment Period
06/29/2005 - 07/29/2005
Proposed Decision Memo Due Date
Proposed Decision Memo Released
12/22/2005
Proposed Decision Memo Public Comment Period
12/22/2005 - 01/22/2006
Decision Memo Released
03/22/2006
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
JoAnna Baldwin
Sarah Fulton
Lead Medical Officers
Lawrence Schott, MD
Joseph Chin, MD

Medicare Benefit Category Determination Date

Actions Taken

June 29, 2005

CMS has closed the previous reconsideration for cardiac rehabilitation programs and is opening a new reconsideration to review seven clinical indications and additional policy concerns. CMS requests that the public comment on the following questions:
  1. In persons age 65 years and older, what is the clinical evidence for a net health benefit from cardiac rehabilitation for the seven indications?
  2. What is the appropriate level of physician supervision for these services?
  3. To which physician (referring or hospital-clinic) should the cardiac rehabilitation services be “incident to”?
  4. What are the individual components that comprise a cardiac rehabilitation program?
  5. What is the appropriate number of cardiac rehabilitation sessions needed to achieve a net health benefit? 

After considering the public comments and reviewing relevant evidence, we will release a proposed decision memorandum.

Instructions for submitting public comments can be found at https://www.cms.hhs.gov/coverage/8h.asp

December 22, 2005

The proposed decision is now available for 30 days of public comment. CMS requested a report by the Agency for Healthcare Research and Quality evaluating clincial trials studying cardiac rehabilitation. The report is also now available.

February 2, 2006

The tracking sheet is now updated to include the benefit category. The benefit category for cardiac rehabilitation is further discussed in the proposed decision posted on December 22, 2005.

March 22, 2006
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