National Coverage Analysis (NCA) Tracking Sheet

Cardiac Rehabilitation (CR) Programs - Chronic Heart Failure

CAG-00437N

Issue

CMS has received a formal request submitted by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology (ACC), American Heart Association (AHA), and Heart Failure Society of America (HFSA) for a national coverage determination (NCD) to add the diagnosis of chronic heart failure (CHF) to the list of approved indications for coverage for cardiac rehabilitation (CR). While coverage for CR programs was established through statute (Medicare Improvements for Patients and Providers Act of 2008) and indications for coverage and program components were established in 42 CFR 410.19. The addition of any cardiac indication for coverage of CR can only be done through the NCD process.

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if CR for the diagnosis of CHF, provided through programs that demonstrate the statutorily mandated accomplishments and outcome improvements, provides improved outcomes to Medicare beneficiaries.

In 42 C.F.R. 410.49, which implements the MIPPA provision, CMS covers CR items and services in approved settings when such services are provided via an approved CR program. CR programs must demonstrate the standards, accomplishments and outcomes improvements as set forth in the statute.

Benefit Category

Cardiac Rehabilitation Programs

Requestor Information

Requestor NameRequestor Letter
Anne M. Gavic, MPA, FAACVPR View Letter
Thomas Force, M.D N/A
John Gordon Harold, MD, MACC, MACP, FESC, FCCP, FAHA N/A
Donna K. Arnett, PhD, BSN N/A

Important Dates

Formal Request Accepted and Review Initiated
06/04/2013
Expected NCA Completion Date
02/19/2014
Public Comment Period
06/04/2013 - 07/04/2013
Proposed Decision Memo Released
11/21/2013
Proposed Decision Memo Public Comment Period
11/21/2013 - 12/21/2013
Decision Memo Released
02/18/2014
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
Michelle Issa
Lead Medical Officers
Joseph Chin, MD, MS

Actions Taken

June 4, 2013

CMS initiates this NCA for the addition of the CHF to the cardiac indications for coverage of CR. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS is requesting public comment on the clinical evidence of health benefit outcomes, both short and long term, provided by this service in Medicare beneficiaries with the diagnosis of CHF.

CMS considers all public comments, and is particularly interested in comments that include published clinical studies and other scientific information that provides evidence for improvement in short and long term outcomes related to this this service for the diagnosis of CHF.

Instructions on submitting public comments can be found at http://www.cms.gov/Medicare/Coverage/InfoExchange/publiccomments.html. You can also submit a public comment by clicking on the highlighted word comment in the title bar at the top of this page. We strongly urge that all public comments be submitted through this website. Please do not submit personal health information in public comments. Comments with personal health information may not be posted to the website.

November 21, 2013

February 18, 2014