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AARC Continues to Push CMS to Expand Pulmonary Rehab (PR) Coverage Criteria

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October 6, 2009

AARC has joined with the American Association of Cardiovascular and Pulmonary Rehabilitation, the American College of Chest Physicians, the American Thoracic Society and the National Association for Medical Direction of Respiratory Care in requesting that the Centers for Medicare and Medicaid Services (CMS) conduct a formal national coverage determination (NCD) to expand pulmonary rehabilitation coverage criteria beyond the conditions of moderate and severe COPD as proposed in its recent 2010 update to the physician fee schedule.  Payment issues, however, are not part of the NCD process.  View the request (in PDF format), signed by the president of each organization.

Although CMS had laid out its proposed policies to implement the new pulmonary rehabilitation benefit under Medicare, it falls far short of the standards of care reflected in clinical literature as well as the conditions that are currently covered under local coverage policies established by several Medicare Administrative Contractors.

In its proposed rules, CMS has stated that it intends to use the national coverage determination process to expand coverage of items and services furnished by pulmonary rehabilitation programs.  AARC, along with our partner organizations, has insisted in formal comments that current scientific literature supports the expansion of criteria beyond those proposed by CMS.

Anne Marie Hummel, AARC’s Regulatory Director explains.  “While CMS has the ability to expand its coverage criteria as it develops final rules, we want to jump ahead of the game and request a formal NCD now to ensure that every possible avenue is covered so patients currently enrolled in these valuable programs are not denied access.”

CMS final rules to implement the pulmonary rehabilitation benefit are expected in early November 2009.  The benefit becomes effective January 1, 2010.