Intensive Cardiac Rehabilitation (ICR) Program - Benson-Henry Institute Cardiac Wellness Program

CMS has a formal request for a national coverage analysis (NCA) to establish a national coverage determination (NCD) for the Benson-Henry Institute Cardiac Wellness Program. This NCA will review evidence to determine whether the Benson-Henry Institute Cardiac Wellness Program demonstrates the statutorily mandated accomplishments and outcome improvements as established in 42 C.F.R. 410.49.

Through the statute Medicare Improvements for Patients and Providers Act of 2008 CMS covers ICR items and services in approved settings when such services are provided via an approved ICR program. ICR programs must be approved through the NCD process to ensure that they demonstrate the accomplishments and outcomes improvements set forth in the statute; and must demonstrate through peer-reviewed, published research that it has accomplished one or more of the following for its patients:

1. Positively affected the progression of coronary heart disease.
2. Reduced the need for coronary bypass surgery.
3. Reduced the need for percutaneous coronary interventions.

An ICR program must also demonstrate through peer-reviewed published research that it accomplished a statistically significant reduction in 5 or more of the following measures for patients from their levels before cardiac rehabilitation services to after cardiac rehabilitation services:

1. Low density lipoprotein.
2. Triglycerides.
3. Body mass index.
4. Systolic blood pressure.
5. Diastolic blood pressure.
6. The need for cholesterol, blood pressure, and diabetes medications.

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if the ICR provided through the Benson-Henry Institute Cardiac Wellness Program demonstrates the statutorily mandated accomplishments and outcomes improvements to Medicare beneficiaries.

September 3, 2013

February 27, 2014

May 6, 2014