EMAIL TO YOUR U.S. SENATOR-INITIAL CONTACT
Dear Senator __________,
On behalf of patients with chronic obstructive pulmonary disease (COPD) and cardiovascular disease across
America I am asking for your support of legislation that ensures COPD and heart disease patients who live in rural
America have access to pulmonary and cardiac rehabilitation services under Medicare.
Chronic Obstructive Pulmonary Disease or COPD is the 3rd leading cause of death in the United States. COPD is a
term used to describe the obstruction of airflow associated primarily with emphysema and chronic bronchitis. The
Centers for Disease Control and Prevention estimates that 24 million Americans have COPD, but that only half of
them know it. That means that 12 million Americans don’t know they have a life-threatening chronic illness.
Medicare cover cardiac rehabilitation services and one of the only effective treatments for COPD – pulmonary
rehabilitation. Pulmonary and cardiac rehabilitation is a set of physician-ordered patient services that include initial
evaluation and goal setting, therapeutic exercise, education, psycho-social support and ongoing assessment of
patient progress. The effectiveness of these rehabilitation services, in terms of improving patient’s lives and
reducing medical expenditures, is well established in the medical literature.
Since 2010, CMS has allowed hospital outpatient services that require direct physician supervision to utilize
qualified nonphysician practitioners to meet this physician requirement. However, due entirely to CMS
interpretation of the statutory language used in P.L. 110-275 (passed in MIPPA in July, 2008), the same flexibility
was not extended to pulmonary and cardiac rehabilitation programs. This is particularly problematic for rural and
critical access hospitals (CAHs), as well as for many major medical centers. In fact, CAHs are allowed to staff an
emergency room with nonphysician practitioners without a physician physically present, but cardiac and pulmonary
rehab services must have a physician on site. This bureaucratic barrier hinders access to pulmonary and cardiac
rehabilitation for many rural Medicare beneficiaries.
A Senate bill has been introduced which offers the technical correction the CMS said is needed to correct this
situation. S.382, co-introduced by Senators Schumer and Crapo, will allow hospitals to provide pulmonary and
cardiac rehabilitation services the same way that hospitals provide all other hospital outpatient services.
The current supervision restriction is contrary to the intent of the existing legislation, as expressed in a letter from
the Senate Finance Committee (SFC) to then CMS acting administrator, Dr. Donald Berwick. In fact, it was Dr.
Berwick’s response to the SFC that this technical correction is the necessary solution.
This bill is at CBO for scoring. It is not expected to cost the Medicare program any new expenditure. This is
because regardless of which health care professional supervises a cardiac or pulmonary rehabilitation program, that
supervision is an uncompensated, non-reimbursable service. Therefore, permitting NPPs to supervise these programs
has no impact on Medicare outlays.
In conclusion, this is a non-partisan, non-controversial, anticipated no cost technical correction that will solve the
issue by clearly signaling to CMS the actual Congressional intent of the cardiac and pulmonary rehabilitation
Medicare legislation. AACVPR is asking that this bill be included as part of an appropriate legislative vehicle that
arises later this year.
I hope you support this legislation to ensure all Medicare beneficiaries have access to pulmonary and cardiac
rehabilitation services. I will follow-up with you and look forward to your sponsorship of S.382.
Sincerely,
Your name and title
Institution name