If you are looking for your email from DHHS about your Cardiac rehab license renewal please see the latest information that we received:

“Cardiac Rehab has been delayed until the end of September.  Hopefully, if all continues to go well – we should have the online renewals ready for you at that time.”

 

As you may be aware the NC Medicaid Managed Care plans kicked off on July 1st.  We wanted to share some information about cardiovascular and pulmonary rehab coverage for these plans but encouraged you to contact your business office regarding your organizations participation with each plan.

In contacting United Healthcare Community Care for a patient we were told that both Cardiac (93797/93798)  and Pulmonary Rehabilitation (G0424/G0239) allow up to 15 sessions of therapy and no pre-authorization was needed.

In contacting Healthy Blue we were told that Cardiac rehabilitation must be pre-authorized and that we could suggested the number of therapy sessions we think are needed and that Clinical Review would either except or indicate the number of sessions allowed.  We were told there is no coverage for Pulmonary or Respiratory therapy.

In contacting WellCare we were told that Cardiac Rehabilitation(93797 and 93798) and Pulmonary Rehabilitation must be pre-authorized but Respiratory Therapy (G0239) did not require pre-authorization.

In contacting AmeriHealth Caritas they tell us that Cardiac Rehabilitation(93797/93798) does not require pre-authorization for participating providers but would require pre-authorization for non-participating providers. They could find no information for either Pulmonary Rehabilitation (G0424) or Respiratory Therapy (G0239) and suggested that those services would require pre-authorization.

We did not check with Carolina Complete Health or EBCI Tribal Option.

And NC Medicaid Direct is continuing with the traditional plan as it has been.

Below is are the links to the Health Plans.

https://ncmedicaidplans.gov/learn/get-answers

Health plans
For health plan questions, or to learn more about covered services, contact the health plan.

WellCare
wellcare.com/NC
This health plan is offered statewide.

UnitedHealthcare Community Plan
uhccommunityplan.com/nc
This health plan is offered statewide.

Healthy Blue
HealthyBlueNC.com
This health plan is offered statewide.

AmeriHealth Caritas
amerihealthcaritasnc.com
This health plan is offered statewide.

Carolina Complete Health
carolinacompletehealth.com
Carolina Complete Health is a provider-led entity offered to people who live in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren, Wilson.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option
EBCITribalOption.com
The EBCI Tribal Option is for federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider.

NC Medicaid Direct
bit.ly/NCBeneficiaryPortal
NC Medicaid Direct is for members who qualify.

Have you received your letter?  DHSR certification renewal will be available electronically!  Make sure you review your letter and directions so you meet the first deadline of this new process which is August 13th!

 

New DHSR certification renewal

The Office of Inspector General (OIG) issued a report of an audit that reviewed their cardiac, intensive cardiac, and pulmonary rehabilitation (CR/ICR/PR) programs. As you may remember there was an OIG audit in 2015 of cardiac and pulmonary services (CR/PR) and identified claims for these services did not comply with Federal requirements.

The objective of this audit was to determine whether CMS regulatory requirements contained sufficient information to ensure that claims for CR/ICR/PR complied with Medicare coverage requirements.  One hospital was selected to review an audit period covering April 2016 through March 2018.

The OIG’s conclusion was that CMS’s regulatory requirements may not be sufficient to ensure providers complied with the intent of the Medicare coverage requirements. More details about specific findings are found in the report.

The recommendation from the OIG was that CMS should revise the regulations to ensure that providers meet coverage requirements. The CMS response to this recommendation was that such changes would require notice and a public comment period and that consideration would be given to CMS’s next steps.

We are uncertain what the next steps will be.  AACVPR is very aware of this issue and we will keep the NCCRA membership aware of any communications or additional information that comes to light.

See a copy of the report here: OIG report 5-2021

We hope that enjoyed this year’s virtual symposium.  There were a few follow up items that we wanted to include that were discussed during the event:

1.  Article mentioned by Dr. Crouch’s session titled:  AACVPR Guidelines for Pulmonary Rehabilitation 2020-2021: What’s New?
   jama_lindenauer_2020_oi_200034 (1)    jama_rochester_2020_ed_200025
   
2. Patient education sheets mentioned by Dr. Sears during his talk entitied: Walk This Way! Psychological Benefits of Exercise in the Cardiac Rehab Setting
   af pt page
   chf 2013 confidence pt page
   coping with trauma pt page 2013
   icd spouse patient page 2009
   pt page covid
   pt page shock
   sexual health and icd 2010
   sexual health with CAD 2014
3. Dr. King’s slides for his talk entitled: Fundamentals of PAD Rehab: “The Journey of a Thousand Miles begins with a Single Step-Tao”
   PAD slides

by Bridget Way

One of the goals of the NCCRA is to increase awareness of our profession. A great way to do this is by reaching out to students and educators across the state at schools that have Exercise Science programs. In 2019, the Membership Committee began presenting at local schools and received wonderful feedback. The pandemic paused our outreach efforts, but we were able to begin presenting virtually across the state a few months later. So far, we’ve presented at Campbell, Shaw, Chapel Hill, Meredith, Mount Olive (2 separate presentations), Appalachian, and Wake Forest.

We want to provide students the opportunity to network with and learn from professionals in the field of Cardiopulmonary Rehabilitation, beyond the regular internships and the annual Symposium. We want to reach students who may have never heard of this field. By giving a presentation or simply talking about what you do, our members can play a crucial role in helping meet these goals.

We created a Google spreadsheet with all the current contact information for each school, along with space to record your information when you pick a school you want to present to. We also created a basic power point presentation that you can modify to meet your needs.  Below is the Google drive link for the sign-up sheet. The power point is posted on the NCCRA website.

https://drive.google.com/file/d/1ahD4IluaTUGyCh295MJtCsrfTz3Qsiwh/view?usp=sharing

School Presentation_generic – Cardiac & Pulmonary Rehabilitation