CHICAGO (November 22, 2013) — The Centers for Medicare & Medicaid Services (CMS) yesterday proposed a coverage policy that would improve access to cardiac rehabilitation services by inclusion of certain Medicare beneficiaries with heart failure. Read the proposed decision memo.
Earlier this year the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology (ACC), American Heart Association (AHA), and the Heart Failure Society of America (HFSA) submitted a formal request to CMS to consider this patient population of Medicare beneficiaries as eligible to receive cardiac rehabilitation. Under current Medicare policy, eligibility is limited to beneficiaries with a recent heart attack, coronary bypass surgery, stable angina, coronary artery angioplasty or coronary stent, heart valve repair or replacement, and heart or heart-lung transplant.
After a review of evidence sufficient to determine that cardiac rehabilitation for Medicare beneficiaries with chronic heart failure significantly improves health outcomes, CMS has announced the decision to include heart failure patients who have an ejection fraction of 35% or less and New York Heart Association (NYHA) class II-IV symptoms despite being on optimal heart failure therapy for at least 6 weeks. This proposed coverage policy would become effective in 2014, although an effective date has not yet been released.
This is welcome news for persons who live with a disease that is a major cause of morbidity, mortality, hospitalizations, and disability. For many years, chronic heart failure was considered a medical reason to not exercise. In recent years, numerous studies have shown that regular exercise is safe and self-care strategies are beneficial for persons with this disease.
Dr. Philip Ades, Professor of Medicine and Medical Director of Cardiac Rehabilitation and Prevention at University of Vermont College of Medicine and lead author of a recent publication on cardiac rehabilitation exercise and self-care for chronic heart failure, stated, “I am extremely pleased with this decision. CMS extensively reviewed the literature and came to the same conclusion we did, which is that cardiac rehabilitation is enormously helpful for patients with CHF; it improves the quality and the quantity of life for these patients.”