AACVPR REIMBURSEMENT UPDATE
OCTOBER 29, 2007

The Pulmonary & Cardiac Rehabilitation Act of 2007

AACVPR along with a number of other professional and patient societies are pushing very hard to get S 329 included in a Senate Medicare bill that is currently being written. Although we were disappointed when HR 552 was not included in the recent House (CHAMP) bill that addressed various Medicare issues, the negotiated House/Senate version of that bill dealt solely with state children’s health insurance plans (SCHIP) and was consequently vetoed by President Bush.

Recently Senator Max Baucus (D-MT), Chair of the Senate Finance Committee, called on his Democratic committee members to submit their top priorities for inclusion in this developing bill. Due to the contacts and relationships established by our Day on the Hill attendees and the state affiliates in advocacy efforts, particularly over the past 10+ months, AACVPR was able to quickly mobilize and ask constituents of these VIP committee members to put S 329 at the top of their requests going to Senator Baucus. Additionally, Grace Anne Koppel, wife of reporter Ted Koppel, and living with COPD herself, has been serving as a high profile spokesperson for the value of pulmonary rehabilitation. She and Ted accompanied representatives of ATS and AARC on visits to a number of congressional offices solely to discuss the significance of pulmonary rehabilitation programs and the importance of this legislation.

All of the efforts of AACVPR members and others appear to be paying off. We are fairly confident that S 329 will be part of the 2007 Senate Medicare bill. Now the challenge will be to assure that it remains in the bill when House and Senate conferees (committee leaders) from the Senate Finance, House Ways & Means, and House Energy & Commerce Committees sit down to craft the final version that will go to the President. To that end, AACVPR will again use those established and important grass roots relationships to focus first on the Senate Finance Committee and then on Democratic members of the two House committees who are already co-sponsors of HR 552. The full process of a Senate Medicare bill being introduced, voted on and passed by the full Senate (with compromises reached in conference with House counterparts), sent to the respective floors for final approval and then to the President will occur over the next eight weeks (yes, very likely right up to the weeks preceding Christmas). Please watch for AACVPR updates to this important process.

What does this mean for your program? It means that we are 80% of the way toward accomplishing our goal and it also means that your work is not done yet. Every additional co-sponsor we gain over the next few weeks strengthens our chance of being included in the final Medicare bill. It is not too late to do your share if your Senator and Representative are not already co-sponsors. All the information you need is on the AACVPR website, including a template letter, a one page hand-out that can be faxed to the DC congressional office, and talking points for a brief phone call to that office (ideally with the health staffer). A huge thank-you goes to those who have worked diligently to secure co-sponsorship from your members of Congress. We are so close, let’s be sure we each do everything possible to make this effort a success.

Cardiac Rehab G-Code Update

AACVPR submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to a proposed rule change for cardiac rehabilitation coding that would take effect January 1, 2008 (see Sept. Reimbursement Update-HERE). AACVPR comments are posted on the AACVPR Web site (CLICK HERE) and are supported by similar concerns submitted to CMS by the American Hospital Association (AHA) and American College of Cardiology (ACC). The final rule is expected to appear in the Federal Register shortly. You will receive an AACVPR update as soon as that occurs and the CMS decision is known.

MAC Update

The transition of merging Fiscal Intermediaries (FIs) and Carriers into Medicare Administrative Contractors (MACs) continues. For more information, CLICK HERE. CMS will contract with 15 MACs to process Medicare claims in 15 geographical regions of the country. The first MAC, Jurisdiction 3 (“J-3”), was awarded to Noridian Administrative Services in 2006 and includes the states of Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming. Contracts have recently been announced for J-4 (going to Trailblazer) and J-5 (going to Wisconsin Physician Services). The contract for J-12 has just been announced and was awarded to Highmark. Before the end of 2007, contracts are scheduled to also be announced for J-1, J-2, J-7, and J-13. In 2008, the remaining jurisdictions (J-6, J-8, J-9, J-10, J-11, J-14, and J-15) will be bid on by various contractors and awarded by CMS.

AACVPR Affiliate leaders are very involved in the preparation for this transition because it will directly affect your cardiac and pulmonary rehab program. At the AACVPR Annual Conference in Salt Lake City, a workshop was held for Affiliate presidents and reimbursement representatives. AACVPR leaders are forming “MAC Committees” consisting of rehabilitation practitioners from each state in the jurisdiction so that a relationship with each MAC and MAC Medical Director can be established. This will allow for better cooperation and communication between providers and Medicare contractors. Please contact your Affiliate leadership for more information on the time line for your MAC. As information is obtained from CMS, it will be posted in the MAC section of the AACVPR Web site. This is an opportunity for our national and state professional organizations to partner with payers and be viewed as the experts in the delivery of quality cardiopulmonary rehabilitation services.

As always, AACVPR members will receive the latest information on Medicare reimbursement and related issues as that information becomes available. Please watch for further AACVPR reimbursement updates.

Karen Lui, R.N., M.S.
(FL phn) 239-768-6412
(DC phn) 703-752-4353
Karen@GRQConsulting.com