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CMS expands Medicare coverage to include cardiac rehabilitation for chronic HF
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CMS has announced that it will expand Medicare coverage for cardiac rehabilitation services to patients with stable, chronic HF.
The CMS expansion defines chronic HF as patients with left ventricular ejection fraction ≤35% and symptoms of NYHA class II to IV HF, despite the use of optimal HF therapy for at least 6 weeks. Stable HF is defined as no recent (≤6 weeks) or planned (≤6 months) major CV hospitalizations or procedures, according to the decision memo.
Previously, coverage was available for Medicare beneficiaries who experienced one or more of the following conditions or procedures:
- Acute MI within the prior 12 months.
- CABG.
- Current, stable angina pectoris.
- Heart valve repair/replacement.
- Percutaneous transluminal coronary angioplasty/coronary stenting.
- Heart or heart/lung transplantation.
In 2009, CMS concluded that there was a lack of sufficient evidence to suggest that cardiac rehabilitation programs, particularly exercise interventions, improved health outcomes among Medicare beneficiaries with chronic HF. The American Heart Association, American College of Cardiology, Heart Failure Society of America and American Association of Cardiovascular and Pulmonary Rehabilitation submitted a request for reconsideration of chronic HF as an approved indication for cardiac rehabilitation coverage, according to the memo.
The new decision followed results from a literature review of two evidence-based guidelines; four randomized controlled trials; one secondary extended analysis with a trial; and one consensus statement. The data were collected from a PubMed search from 2006 through January 2014. CMS focused primarily on exercise interventions, with evaluated outcomes including mortality, morbidity and quality of life.
The proposed decision was made open to public comment from June 4 to July 4, 2013, and again from Nov. 11 to Dec. 21, 2013. The final comment period resulted in 83 comments, 79 of which supported expanded coverage.
“As the criteria to identify patients who may benefit from [cardiac rehabilitation] have been better substantiated, the likelihood of improving health outcomes for a specific population has increased,” CMS stated in the memo. “... We conclude that the evidence that supports the clinical benefits of the individual components of [cardiac rehabilitation] programs is sufficient to determine that participation in these programs improves health outcomes for Medicare beneficiaries with chronic HF.”