In a time of turbulence and change, we need to come together and be more attentive to how new legislation shapes the services we provide. We need to advocate loudly for how beneficial our services are. Otherwise, cardiac and pulmonary rehabilitation will remain the best kept secrets in secondary prevention.
Current Bills to Be Aware Of
US House bill # HR ____/US Senate bill # S.____ (HR4838/S.4151 in 116th Congress-new bill numbers for 117th Congress are coming): This bill will exempt certain hospital outpatient services from a drastic reimbursement reduction that are based solely on the location of the hospital outpatient service. Download the PDF or read our 2021 Legislative Priority.
As the Legislative Priority explains, the SOS: Sustaining Outpatient Services Act mandates implementation of regulations that create specific financial thresholds. As long as no physician specialty - nationwide - bills for any CPT or HCPCS code under the Medicare Physician Fee Schedule (in an aggregate amount greater than $2 million) in the previous year for which data are available, that code (or codes) would be exempt from reduced reimbursement requirements for off-campus outpatient services. Cardiac and pulmonary rehabilitation services are in this category and, therefore, would be included in the exemption.
Currently, hospitals that choose to expand or relocate (beyond the 250-yard threshold) CR and PR services must bill at the physician fee schedule rate, thereby creating a very strong disincentive for hospitals to improve access to CR and PR services. A very limited number of exceptions to this exist. While CMS recognizes this reality as an “unintended consequence” of Section 603, the Agency states it has no authority to address our problem. It will take legislation to correct this barrier to expanded patient access to these beneficial services.
The Increasing Access to Cardiac Rehabilitation Care Act of 2021, HR 1956 in 117th Congress, is back. AACVPR members worked hard for four years to successfully pass this bill in 2018. HR 1956 will simply accelerate the effective date of when nonphysician practitioners (NPPs or APPs) are eligible to independently order and supervise cardiac, intensive cardiac, and pulmonary rehabilitation services. The effective date is currently January 1, 2024. This bill, if passed, will move that effective date up to January 1, 2022.
Obviously, HR 1956 and the SOS Act are synergistic. Programs are at capacity with excessively long waiting lists to even begin CR, ICR, or PR. (CMS expects enrollment within 2-3 weeks after hospital discharge for optimal patient outcomes!) With this bill, cardiopulmonary rehabilitation services will be able to improve access and meet the increasing demand for these beneficial treatments.
Take Steps to Advocate: Contact Your Representatives and US Senators with Customizable Letters
Want to help? It’s not too late to join fellow practitioners in your state to advocate for CR, ICR, and PR services. When AACVPR members follow up with the SOS Act bill number for Congressional members to sign onto, we will also seek support for HR 1956. Come along and be part of the solution. This is going to take the whole CR/ICR/PR community.
AACVPR has made it easy to become an advocate for CR and PR services. Use the below pre-drafted, customizable letters to contact your U.S. House representative and advocate for bills above. Just 5 minutes and one letter could make a huge difference! Show your support for the life-changing effects of CR/PR, and click on one of the buttons below to start your letter.
Send a Letter
Meet with Your U.S. Representatives and U.S. Senators at Day on the Hill 2021
Advocate for our profession in person by coming to Washington, D.C., for Day on the Hill (DOTH) 2021, March 9-11. Registration is complimentary! Your elected officials who vote on legislation and make Medicare decisions, must stay informed on what is important to us as constituents and providers of cardiopulmonary rehabilitation. At DOTH, you have the opportunity to meet with your U.S. Senators and your state’s U.S. House Representatives to represent your state in those Congressional offices.
AACVPR provides many resources to use when advocating for cardiac and pulmonary rehabilitation, including tips for communicating and meeting with officials, fact sheets, infographics, and more. Explore our resources on the Day on the Hill web page.