HR 4136 — Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act

Summary

Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act This bill amends title XVIII (Medicare) of the Social Security Act to revise requirements related the approval of intensive cardiac rehabilitation programs by the Centers for Medicare & Medicaid Services (CMS) for purposes of Medicare coverage. To be approved by the CMS as an intensive cardiac rehabilitation program under current law, a program must show that it: (1) positively affected the progression of coronary heart disease or reduced the need for either coronary bypass surgery or percutaneous coronary interventions, and (2) accomplished a significant reduction in other specified health measures. The bill instead requires a program to show that it: (1) reversed the progression of coronary heart disease or reduced the need for coronary bypass surgery; and (2) accomplished, in addition to a significant reduction in other specified health measures, a significant increase in the measure of blood flow to the heart. The bill further requires a program to show, using research specific to its own program, that these measures were accomplished by lifestyle changes alone. The bill removes the specific requirement that such a program be "physician-supervised" but retains other existing requirements for program supervision. A program that was previously approved by the CMS as an intensive cardiac rehabilitation program shall be deemed to have met these requirements. To be eligible for an intensive cardiac rehabilitation program under current law, an individual must have had one of several specified conditions or interventions. The bill adds to the list of qualifying conditions: (1) stable, chronic heart failure; and (2) any additional condition that the CMS determines shall be covered under such a program.

Bill Text

• Introduced Introduced in House Current html October 25, 2017

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill amends existing requirements for Medicare intensive cardiac rehabilitation programs to strengthen their protocols and coverage.

• 42 U.S.C. 1395x(eee)(4)

  physician-supervised program (as described in paragraph (2)) → program (supervised as described in paragraph (2) for cardiac rehabilitation)

  Updates the terminology for supervised cardiac rehabilitation programs.

• 42 U.S.C. 1395x(eee)(4)

  , in peer-reviewed published research, that it accomplished → in peer-reviewed published research specific to the exact program, that, notwithstanding other concurrent therapies, including prescription drugs, by lifestyle changes alone it accomplished

  Clarifies the research requirements for the effectiveness of rehabilitation programs.

• 42 U.S.C. 1395x(eee)(4)

  positively affected → reversed

  Changes the language regarding outcomes of the rehabilitation programs to emphasize reversal of condition.

• 42 U.S.C. 1395x(eee)(4)

  or → and

  Modifies the criteria for program effectiveness by requiring both outcomes instead of one or the other.

• 42 U.S.C. 1395x(eee)(4)

  subclause (III)

  Removes a specific subclause that may have described a previous requirement for programs.

• 42 U.S.C. 1395x(eee)(4)

  both a statistically significant increase in the measure of blood flow to the heart when compared to a control group and

  Adds a new requirement for cardiac rehabilitation programs to demonstrate significant blood flow improvement.

• 42 U.S.C. 1395x(eee)(4)

  Any program that the Secretary approved under this paragraph before the date of the enactment of the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act as an intensive cardiac rehabilitation program according to the requirements under this subparagraph as in effect before such date shall be deemed to meet the requirements under this subparagraph applied pursuant to the amendments made by such Act.

  Ensures that previously approved programs continue to be recognized under the new requirements.

• 42 U.S.C. 1395x(eee)(4)

  stable, chronic heart failure (defined as patients with left ventricular ejection fraction of 35 percent or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks);

  Introduces a new condition that qualifies for Medicare coverage under cardiac rehabilitation.

• 42 U.S.C. 1395x(eee)(4)

  any additional condition for which the Secretary has determined that a cardiac rehabilitation program shall be covered.

  Allows flexibility for the Secretary to add further conditions eligible for coverage under cardiac rehabilitation.

Action History

1. October 27, 2017

   Referred to the Subcommittee on Health.

2. October 25, 2017

   Introduced in House

3. October 25, 2017

   Introduced in House

4. October 25, 2017

   Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

5. October 25, 2017

   Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsors

• Jason Smith · Primary

Subjects