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.
