CMS proposes cardiac rehabilitation plan

The Centers for Medicare and Medicaid Services late last month proposed a new model of bundled payments for cardiac rehabilitation services.

The newly unveiled model would provide incentive payments to hospitals treating covered patients for heart attacks or bypass surgery based on “utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge,” according to a notice from CMS.

Hospitals operating under the model would receive coverage for coordinating cardiac rehabilitation and supporting adherence to the rehab plans in hopes of improving cardiovascular fitness and outcomes. Testing of the model will take place in 45 geographic areas and will cover a 5-year period.

The payment plan will operate in 2 parts, CMS, with an itial payment of $25 per cardiac rehabilitation for the 1st 11 services and $175 per service past the 11th. Standard medicare payments for cardiac rehab services would continue throughout the model, CMS added.

The number of cardiac rehabilitation sessions covered by the program would be limited to a maximum of 2 1-hour sessions per day for up to 36 sessions over up to 36 weeks, with an option for an additional 36 sessions over an extended period of time if approved by a Medicare Administrative Contractor, CMS said. Intensive cardiac rehab program sessions would be limited to 72 1-hour sessions, up to 6 a day over up to 18 weeks.

In July, CMS said it is on board with plans to create a unique device identifier for implantable medical devices, after years of resistance from the federal health insurer.

CMS had balked at implementing the FDA’s UDI program because of the cost and difficulty of integrating UDIs into electronic health records. Congress enacted the UDI law in 2007, intending to have the FDA use billing claims data with the UDI number to track medical device safety. Medtech companies began incorporating UDIs into their labeling in 2014. But CMS opposed the UDI plan, saying the project is too large and expensive to implement.

In a July 13 letter to the Accredited Standards Committee X12, acting CMS administrator Andrew Slavitt and FDA commissioner Dr. Robert Califf said that the Health & Human Services Dept. supports adding UDIs to Medicare claims for implantable medical devices “if sufficient funding and resources are provided to make the necessary Medicare claims processing system changes.”

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