Medicare Expands Service for Cardiac Rehab, Cancer Detection, Home Oxygen

March 27, 2006 – Medicare has recently announced three service expansions that add new coverage for cardiac rehabilitation services, open six demonstration locations to provide better cancer detection for minorities and extends coverage for home oxygen use for those in a clinical trial by the National Heart, Lung and Blood Institute.

Expansion of Coverage for Cardiac Rehabilitation Services

The Centers for Medicare & Medicaid Services has announced it will expand coverage for cardiac rehabilitation services to three additional groups of patients.

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Following an extensive evidence review, CMS is expanding national coverage for cardiac rehabilitation to Medicare beneficiaries who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting, or a heart or combined heart-lung transplant.

While the evidence on the benefits for congestive heart failure is not sufficient for a coverage expansion at this time, ongoing studies are likely to provide more certainty about the impact of cardiac rehabilitation for these patients.

CMS determined that cardiac rehabilitation services should be comprehensive and include medical evaluation, education, and nutrition services. Evaluation of the current medical evidence demonstrated a greater benefit to patients when services were provided in such a comprehensive manner.

“The decision to cover three new clinical indications and provide a comprehensive set of services when treating cardiac rehabilitation patients is consistent with the medical evidence,” CMS Administrator Mark B. McClellan, MD, PhD, said. “This expansion of coverage for rehabilitation will give many more patients with heart disease access to proven treatments to restore a higher quality of life.”

Medicare has covered cardiac rehabilitation services since the 1980s for beneficiaries following heart attack, coronary artery bypass surgery, and angina, and this coverage will continue.

Details of the final national coverage determination announced today are available for review at the CMS coverage website at http://www.cms.hhs.gov/center/coverage.asp.

Sites for Demonstration Seeking Ways to Reduce Disparities in Cancer Health Care

The Centers for Medicare & Medicaid Services (CMS) today announced the selection of sites for six demonstration projects to improve the early detection and treatment of cancer and reduce health disparities among minority Medicare beneficiaries.

“Medicare has the best coverage ever for preventing deaths through earlier detection and treatment, but we still have a big gap in using these treatments, especially for our minority beneficiaries,” said CMS Administrator Dr. Mark McClellan. “These new programs will support our key goal of better quality of care and reduced health disparities for people with Medicare.”

Minority groups in the demonstration include American Indians, Asian Americans and Pacific Islanders; African Americans; and Hispanic Americans. This demonstration project was authorized under Section 122 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000.

CMS has selected the following awardees/sites:

Target Population	Demonstration Awardee	Demonstration Site
American Indian	Huntsman Cancer Institute	> 3 tribal locations in north central Montana > 11 tribal locations throughout Utah
Asian American and Pacific Islanders	Molokai General Hospital	Molokai , Hawaii
Hispanic - Mexican American	University of Texas	Harris County and Houston , Texas
Hispanic - Puerto Rican	New Jersey Medical School	Newark , New Jersey
African American	Johns Hopkins University	Baltimore City , Maryland
African American	Josephine Ford Cancer Center	Oakland , Macomb and Wayne Counties (including Detroit ), Michigan

The demonstration projects will help over 13,000 minority Medicare beneficiaries “navigate” the health care system in a more timely and informative manner. The services provided under this demonstration will help participants overcome barriers to three components of cancer care—screening, diagnosis, and treatment. Project sites will provide services to help participants schedule timely appointments for cancer screening and, if needed, follow-up diagnostic testing.

The sites also will provide services to support participants with cancer in adhering to treatment regimens. Other services that may be provided include assistance with transportation, translation or interpretation, and care coordination.

The demonstration will run for four years and targets breast, cervical, colorectal, and prostate cancers. Through participation in these demonstration projects, beneficiaries will receive more timely cancer screening tests, diagnoses, and treatments, have improved access to care, and experience greater satisfaction with the health care system.

“We need to make sure that all of our beneficiaries, regardless of their background, get these important and lifesaving cancer treatments that Medicare covers,” Dr. McClellan said. “Reducing disparities in cancer screening, diagnosis, and treatment is essential to improving quality of care for people with Medicare, and this demonstration will allow us to determine the effectiveness of the navigator model to achieve this.”

Medicare Launches Efforts to Improve Care for Patients Using Oxygen

The Centers for Medicare & Medicaid Services (CMS) today announced it intends to extend coverage for the home use of oxygen to Medicare beneficiaries enrolled in a CMS approved clinical trial sponsored by the National Heart, Lung & Blood Institute (NHLBI).

“This is an important opportunity to improve the care of our seniors, and to get better evidence on how doctors and patients can achieve the best outcomes for this serious and hard to treat condition,” said CMS Administrator Mark McClellan, MD PhD.

Medicare currently provides coverage for home oxygen for beneficiaries with partial pressure measurements at or below 55 mmHg or oxygen saturation at or below 88 percent.

If certain other diseases/conditions are present, coverage is provided for patients with an oxygen partial pressure of 56-60 mmHg or an oxygen saturation of 89 percent.

The trial will include Medicare beneficiaries with arterial oxygen partial measurements from 56 to 65 mmHg or whose oxygen saturation is at or above 89 percent who do not meet the current Medicare coverage requirements for home oxygen.

The amount of oxygen in arterial blood is generally expressed in one of two ways. The partial pressure of oxygen (pO2) is measured in millimeters of mercury (mm Hg), Hg being the scientific abbreviation for mercury.

This is analogous to the measurement of air pressure with a barometer, which is similarly reported in inches or millimeters of mercury. The other common measurement method looks at the percent of hemoglobin in blood that is saturated with oxygen. Hemoglobin is the protein in red blood cells that carries oxygen.

The final national coverage determination announced today will ensure funding for all clinical items and services are provided to patients enrolled in these trials, where funding for the home use of oxygen for those beneficiaries (meeting the qualifications as describe above) were not previously available.

More information on CMS coverage decisions is located at http://www.cms.hhs.gov/center/coverage.asp.

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