AACVPR UPDATE ON LEGISLATIVE AND REGULATORY ACTIVITIES
AUGUST 2, 2007

AACVPR leaders and members have been working hard on the legislative issues this summer. As expected, the pace of Congressional activity quickened as the August recess approached, and both the House Ways & Means and Energy & Commerce Committees marked up legislation affecting Medicare. Despite having 130 House co-sponsors, our lead Democratic member in the House, John Lewis (D-GA) was not able to insert HR 552 into the Medicare package for consideration. That action (or inaction) requires AACVPR to shift its focus back to the Senate where 33 co-sponsors have signaled their support for the Senate version, S 329.

On a conference call with AACVPR leadership from states where the 33 Senate co-sponsors call home, an aggressive grass roots plan was kicked into gear for the August Congressional recess, urging the Senate Democratic co-sponsors to contact key Finance Democrats Max Baucus and Jay Rockefeller and Senate Republican co-sponsors to contact Finance Committee Republican Charles Grassley. The message is simple – make sure that any conference agreement with the House that addresses Medicare must include S 329.

Additional Background: The Senate has approved legislation addressing SCHIP, the State Children’s Health Insurance Program, a large component of Medicaid. Although the Senate has not passed any Medicare legislation, it is the SCHIP action by the Senate and the CHAMP (Children’s Health and Medicare Improvement) action by the House that will trigger a “conference” to reconcile the differences. Because both bills address the children’s health portion of Medicaid, the bills will be discussed in conference, even though the Senate bill has no Medicare provisions at all.

Proposed change in cardiac rehab billing: CMS has proposed a technical but dramatic change in billing for cardiac rehabilitation services. The proposal, appearing in two separate Federal Register notices, recommends dropping the CPT codes for cardiac rehabilitation and using in their place new G codes. The changes, if implemented, would go into effect January 1, 2008.

What the changes mean: If the proposal is adopted, the concept of “sessions” will disappear” and in its place will be codes reflecting one hour of service provided. The AACVPR leadership believes that change is acceptable if it permits greater flexibility for programs to design their programs to meet varying patient needs. According to CMS, the change is necessary “to more specifically reflect the way cardiac rehabilitation services are provided in hospital outpatient departments so that reporting would be more straightforward for hospitals and would result in more accurate data for …rate setting in two years.”

What is more problematic, however, is the wording of the G codes – the Federal Register tables describe the codes not as cardiac rehab with, and without, monitoring, but as MD service cardiac rehab with and without ECG monitoring. It is the explicit term “MD service” that raises very serious concern.

Under the best case scenario, there would be no practical changes other than a shift from the concept of “sessions” to hours. However, we are fearful that the insertion of the phrase “MD service” could encourage Medicare contractors to develop their own policies that would require physician presence in the immediate area, just as old Medicare policies had required. We believe it is imperative for CMS to take action in its clarification of these codes to preclude Medicare contractors from policies that would be more restrictive than the current national coverage policy 20.10. The AACVPR is working closely with both the American College of Cardiology and the American Hospital Association to refine comments and echo each others formal statements to CMS later this summer.

As always, the AACVPR will update you with status and progress reports on both the legislative and regulatory issues as new information becomes available.

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