News & Updates

Arizona Society of Cardiovascular and Pulmonary Rehabilitation

6/4/2020 Health Policy & Reimbursement Update from AACVPR

Disruption of Rehabilitation Services

Cardiac, pulmonary, and supervised exercise therapy (SET) programs were abruptly interrupted by the public health emergency (PHE). Many AACVPR members have asked if Medicare beneficiaries will be able to resume their course once programs are able to re-open if the time limit for those services has passed in the interim. AACVPR asked this of CMS last week and received the following information.

Traditional CR (Cardiac Rehabilitation) allows for MAC (Medicare Administrative Contractor) discretion for additional sessions over an extended period of time past the initial coverage allowance of up to 36 sessions over up to 36 weeks. SET (Supervised Exercise Therapy for PAD) also allows for MAC discretion for additional sessions beyond the 12-week window allowed for up to 36 SET sessions. CMS has stated that this allows the MACs to use their discretion to cover more sessions once patients are able to safely participate in CR or SET after this PHE (public health emergency). Claims for these services would include the KX modifier.

Because the session and time limits for ICR (Intensive Cardiac Rehabilitation), 72 sessions over up to 18 weeks, were established in statute (MIPPA), CMS has determined that this cannot be waived or paused during the PHE.

PR (Pulmonary Rehabilitation) is covered for up to 36 sessions over an undefined period of time with MAC discretion for an additional 36 sessions over an extended period of time. Once patients are able to safely resume after the PHE, the MACs would continue to have discretion for up to an additional 36 sessions. Claims for sessions after the initial 36 (sessions 37 through 72) would include the KX modifier. Once 72 sessions have been provided in a Medicare beneficiary’s “lifetime”, no further sessions are covered, despite future qualifying diagnoses.

 

AACVPR Requests CMS Waivers

Members have been made aware of the communication between AACVPR and partner professional organizations with CMS asking for the ability to deliver CR and PR services through the PHE. AACVPR has not yet received an answer to the second request for some mechanism to obtain reimbursement for the various means programs are using to serve our Medicare beneficiaries while programs have been closed.

CMS declined the first request for expansion of telehealth code usage by CR and PR programs because our services are primarily delivered by clinical staff in the hospital outpatient setting. Telehealth codes are available only for physicians and Qualified Health Care Practitioners (QHPs), such as NPs, PAs, CNS, licensed psychologists, etc., who directly bill Medicare under the Physician Fee Schedule (PFS) for their professional services.


 

 

4/7/2020 COVID-19 Resources from AACVPR

AACVPR has great information related to Cardiac and Pulmonary Rehab during this COVID-19 pandemic. So many resources ALL in 1 place!

Click this link to go to the FAQs page:


 

3/6/2020 - Day on the Hill

Holly and Janelle were back on Capitol Hill, joining our colleagues from AACVPR and JF MAC to meet with our Representatives urging them to sign on to HR 4838. They also met with our Senators seeking their support for an upcoming companion Senate bill. They even made Senator McSally’s Facebook page! #DOTH

Click here to see pictures!


 

2/21/2020 - Take Action Now!

Take Action Now!

HR #4838- S.O.S: Sustaining Outpatient Services Act.

Current Bills to Be Aware Of

U.S. House Bill # HR 4838This bill will exempt certain hospital outpatient services from a drastic reimbursement reduction that are based solely on the location of the hospital outpatient service.

As the Legislative Priority explains, the SOS: Sustaining Outpatient Services Act mandates implementation of regulations that create specific financial thresholds. As long as no physician specialty - nationwide - bills for any CPT or HCPCS code under the Medicare Physician Fee Schedule (in an aggregate amount greater than $2 million) in the previous year for which data are available, that code (or codes) would be exempt from reduced reimbursement requirements for off-campus outpatient services. Cardiac and pulmonary rehabilitation services are in this category and, therefore, would be included in the exemption.

Currently, hospitals that choose to expand or relocate (beyond the 250-yard threshold) CR and PR services must bill at the physician fee schedule rate, thereby creating a very strong disincentive for hospitals to improve access to CR and PR services. A very limited number of exceptions to this exist. While CMS recognizes this reality as an “unintended consequence” of Section 603, the Agency states it has no authority to address our problem. It will take legislation to correct this barrier to expanded patient access to these beneficial services.

That's where you come in...

Click button below to go to AACVPR site to find form templates for your letters to your legislators.

11/25/2019 - Follow Up: Health Policy & Reimbursement Update from AACVPR

Update from AACVPR on Grassroots Efforts

HR #4838- S.O.S: Sustaining Outpatient Services Act.

AACVPR members are demonstrating an understanding of the importance of improving access for cardiac and pulmonary patients and the financial necessity to expand space and capacity without being forced to take a 40%+ cut in reimbursement.

To date, over 1,974 letters, tweets, and Facebook posts have been sent to US House of Representatives members, asking for support of HR 4838. Take Action! This request is coming from CR and PR practitioners, physician champions and medical directors, hospital administrations, and most importantly, patients who are grateful they received the benefits of cardiac or pulmonary rehabilitation and want others to have the same opportunity. Template letters that can be personalized are posted for each of these groups.

A companion bill will soon be introduced in the US Senate. You’ll then be asked to send a letter to each of your two US Senators, again utilizing an AACVPR template letter, personalizing it as you wish.

With enough support in Congress over the next 2-3 weeks, this bill could even conceivably be attached to a larger, year-end Medicare package. Every Congressional sponsor name on this bill is valuable.

Thank you for all you’re doing for your profession and for your patients.

Click button below to go to AACVPR site to find form templates for your letters to your legislators.

11/5/2019 - Follow Up: Health Policy & Reimbursement Update 

ASCVPR Members Please Take Action!

HR #4838- S.O.S: Sustaining Outpatient Services Act.

Last week, you may have seen an AACVPR Reimbursement Update with information about a current bill in the U.S. House of Representatives (HR #4838) that aims to correct drastic reimbursement reductions for cardiac and pulmonary rehabilitation programs located off campus. In that update was a link to AACVPR's new virtual lobbying tool, which can be used to send customized letters to your U.S. representatives, advocating for the bill.

Since that update, more than 500 letters from practitioners, medical directors, physicians, and patients have been sent. Every U.S. House of Representatives signature counts, so we need your full participation to pass this bill. The virtual lobbying tool makes this easy; it takes less than three minutes to send a letter!

Advocate for Your Field in Two Steps:

  1. Take Action: Send a letter. We have templates for CR/PR practitioners, medical directors/physicians, grateful patients, and hospital administrators (new!).
  2. Share in Your Network: Post your support on Facebook and Twitter to encourage others to take action with you.

Tips for Taking Action:

  • Encourage your hospital administration to send a letter with a personal note about the specific negative impact on your hospital’s services.
  • To add your credentials, enter them with your name in the “tell us about yourself” section.

Click button below to go to AACVPR site to find form templates for your letters to your legislators.


11/2/2019 - Health Policy & Reimbursement Update 

ASCVPR Members Please Take Action!

HR #4838- S.O.S: Sustaining Outpatient Services Act.
“AACVPR members have been going to Washington D.C. since 2018, asking for a correction to drastic reimbursement reductions for cardiac and pulmonary rehabilitation (CR/PR) services that are located off-campus.We are ready to get this bill passed, but that will only happen with your help.” 

AACVPR now has a virtual lobbying tool on the Advocacy web page, accessible to anyone. This tool will make it very simple to send an email to the U.S. Representative for your district. There are three template letters available that can easily be personalized: patients, physcians and providers.

Most importantly, there is a letter for practitioners who provide CR and PR, to voice concern about the adverse effect that reduced reimbursement in an off-campus location will have on patient access to these services. Please note: you would be sending this letter as a professional unless you have the authority to send it representing your institution.

There is also a letter for physicians, such as your medical director and your CR/PR physician champions in your institution. There is an additional letter for grateful patients to send who appreciate how CR/PR has helped them. Your rehabilitation participants would be sending it as concerned individual constituents of your state, also not representing your hospital. Please share the link to the virtual lobbying tool far and wide within your networks.

We would recommend these letters be sent in the next 2-3 week time frame, so our follow-up with Congressional offices can be more effective.

Further negative consequences of Section 603

As more Medicare beneficiaries choose Medicare Advantage (MA) plans, there are severe implications for non-excepted (non-grandfathered) CR and PR programs that are located off-campus. Because reimbursement for these services is reduced to roughly 40% or more compared to reimbursement of outpatient programs on campus, co-payments are exceeding the amount that is reimbursed. MA plans are held to the same cap of $50 co-pay for CR and $30 co-pay for PR; however, reimbursement is less than the co-payment cap. As clinically absurd as this is, it is legal and allowed. This is more evidence of the extent to which this bill is needed asap.

AACVPR is working to provide a companion bill in the U.S. Senate, but now is the time to ask for sponsorship of HR 4838. If this bill is not part of a year-end “package” (larger Medicare fix bill) in this session of Congress, it will be our focus throughout 2020 with special attention on March 2-3, 2020 at AACVPR’s Day on the Hill (DOTH). This issue has been our mission the past two years and last year we found much more receptivity from both sides of the aisle. Now with a bill number, we expect to be successful obtaining a significant number of U.S. House member signatures – but only if you ask.”

Click button below to go to AACVPR site to find form templates for your letters to your legislators.