REIMBURSEMENT ALERT:
CRITICALLY IMPORTANT INFORMATION
TIME SENSITIVE

The Centers for Medicare and Medicaid Services (CMS) released a Decision Memo on pulmonary rehabilitation on June 27, 2007, which can be found on their Web site by clicking HERE.

The CMS decision was to NOT issue a National Coverage Determination (NCD) for pulmonary rehabilitation services. The reason given for not promulgating an NCD is that the Social Security Act does not expressly define a comprehensive pulmonary rehabilitation program as a part B benefit. In other words, CMS claims it does not have the statutory authority to cover pulmonary rehabilitation. These “respiratory care services” are considered reasonable and necessary only in a Comprehensive Outpatient Rehabilitation Facility (CORF) where pulmonary rehabilitation is included in the statute.

This is why passage of the Pulmonary and Cardiac Rehabilitation Act of 2007, HR 552/S 329, is urgently needed. Without a NCD, Medicare Administrative Contractors (MACs), which are replacing Fiscal Intermediaries over the next 18 months, will be within their authority to limit or totally eliminate coverage of pulmonary rehabilitation services. They have been instructed by CMS to review all current Local Coverage Determinations (LCDs). We have already seen pulmonary rehabilitation LCDs retired in a number of states.

Even though Cardiac Rehabilitation has a NCD, it remains in the same situation. Due to the lack of a specific statute that mandates coverage of these services (as HR 552 and S 329 would provide), the medical necessity and coverage of “incident-to services” are extremely vulnerable to interpretation by CMS.

THE CRITICAL TIME FOR YOUR ACTION IS NOW. We will not have this opportunity again, and it is critical that we ACT NOW. Both the U.S. House of Representatives and the U.S. Senate are currently working on a larger Medicare bill that could be introduced and voted on as soon as next month. This “vehicle” could include our bills if we can show a majority of support in Congress. We do not yet have a majority of co-sponsors for our legislation.

Please help secure your future in this profession. If the U.S. Representative in your district has not yet co-sponsored HR 552, please call the Representative’s Washington, D.C. office and ask for that support. It is not enough if they say they’ll support it when it comes up for vote or they’ll “consider it”. WE NEED THEIR SUPPORT NOW AS A CO-SPONSOR ON THE BILL. Call your Affiliate leadership and ask what you need to do to help. Go to the AACVPR Grass Roots Web page for all the information you need to make the call to your congressional member and make a difference. It is not difficult and only takes a few minutes of your time. You will find contact information for your congressional member, talking points to use when you make the call, background information you can provide the legislator’s office, easy-to-use techniques to involve the patients in your program so constituents are heard on this issue. DO NOT REMAIN SILENT ANY LONGER. Your professional colleagues and AACVPR need your help on this NOW. It may be the most important action you take in your career-to save your career!