S. 329/ H.R. 552 Pulmonary and Cardiac Rehabilitation Acts of 2007
There is no specific benefit category in the Medicare statute to cover pulmonary rehabilitation programs. Individual services that comprise the program are only covered indirectly as “incident to a physician’s service”, which has led to confusion and variations in interpretation. There is no national coverage for pulmonary rehabilitation and Medicdare says it lacks authority to develop such policy even though there is strong medical evidence to support it. These problems have led Medicare contractors to develop their own local policies, some of which are now being withdrawn. This activity has created a patchwork of covered services that vary widely across the country. In some states, such as Wyoming and Utah, there is no coverage of pulmonary rehabilitation because the Medicare contractor used a limited interpretation of policy in the absence of national guidance, leaving Medicare beneficiaries in those states without a means to have their lung diseases treated through pulmonary rehabilitation programs.
S 329 and HR 552,
the Cardiac and Pulmonary Rehabilitation Act, will create a new Medicare
benefit category for both cardiac and pulmonary rehabilitation that will
result in national coverage of these vital programs for all Medicare
beneficiaries. It will put an end to the current confusion and patchwork of
inconsistent coverage of pulmonary rehabilitation services and result in
clear guidance to Medicare contractors regarding who, when, and how much
pulmonary rehabilitation will be covered under the Medicare program.
The Congressional Budget
Office estimates the cost of this initiative to be $27 million in 2007, and
a five-year cost estimate (2007-2011) of $162 million. In the first year,
this comes out to less than 1/100th of one percent of total
Medicare budget projections.
Other organizations supporting this initiative include the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, the National Association for Medical Direction of Respiratory Care, the American Association of Cardiovascular and Pulmonary Rehabilitation, the American College of Cardiology, the American Hospital Association, the COPD Foundation and numerous patient advocacy organizations.
Senator Mike Crapo [ID] and Representative John Lewis [GA] have introduced S 329 and HR 552, respectively, the Pulmonary and Cardiac Rehabilitation Act(s) of 2007. They amend Title XVIII of the Social Security Act to ensure full and uniform Medicare coverage for both cardiac and pulmonary rehabilitation services.
We ask that each of you write your own legislators and ask for their support for these bills. Compose your own letter or use the sample letter here. Your family and friends can help, too, and it's easily done. Here's how:
1. Go to http://www.congress.org/congressorg/home/
2. Enter your Zip Code and click on "GO".
3. Click
on "Federal" in the top box.
4. Click once to remove the checkmark in front
of "George W. Bush, President".
5. As your subject, paste in: S.
329/H.R. 552 "Pulmonary and Cardiac Rehabilitation Act of
2007"
6. As your Issue area, select
"Medicare/medicaid" in the dropdown menu
7. As your message, type in your own, or
paste in the
following:
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I am asking that you cosponsor S. 329/ H.R. 552 "Pulmonary and Cardiac Rehabilitation Act of 2007".
I am one of millions of US citizens suffering from chronic obstructive pulmonary disease (COPD). COPD is comprised of emphysema and/or chronic bronchitis - diseases for which there are currently no cures. However, there is a treatment program (commonly called pulmonary rehabilitation) that can slow their progression, restore functionality and quality of life, and minimize the number, length, and cost of hospitalizations and emergency room visits that inevitably occur without that program.
Many major medical associations vigorously endorse it; most private medical insurers provide coverage for it. And, for many years prior to August 2000 Medicare also covered this program. In fact, in defining current best practice for the NETT study (the combined Medicare/NIH study of lung volume reduction surgery), Medicare mandated it as an essential part of the treatment for all patients in the study, whether or not they received the surgery.
However, in August 2000 Centers for Medicare and Medicaid Services
(CMS) discontinued full coverage except for the NETT study. Although they did
not question the medical value of the program at that time, they concluded that it could not
be covered by Medicare because they believed it lacked clear statutory
authorization - that is, unlike certain other preventive medical services,
coverage for this (partially) preventive service is not specifically authorized
in the Medicare enabling statute (Title XVIII of the Social Security Act). Since
that time, they have covered only selected parts of the program, with even those
parts varying across the country according to the many local Medical Review
Policies.
Your support will help to promptly restore full and uniform access to pulmonary
rehabilitation for all medically qualified Medicare beneficiaries. Amending
Title XVIII of the Social Security Act will make it clear that it is Congress’
intent to cover this program.
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8.
Fill in the blanks with the information about yourself.
9. Enter the "Capwiz
Authentication" numbers as requested.
10. Click on the "Send Message"
button.
That's it! You have just written to both of your US
Senators and your Representative. Now, please drop a note to fbarrettao@aol.com so we can add
your letters to our count. And thank you very much for your
participation!
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