Evidence Enough for Coverage of supervised exercise therapy for intermittent claudication, Issues CMS
A proposed decision was released by CMS (Centers for Medicare & Medicaid Services) memo stating that the evidence is enough to cover the supervised exercise therapy for Medicare beneficiaries with intermittent claudication for treatment of symptomatic peripheral artery ailments
A program must involve a therapeutic exercise-training program with sessions lasting 30 to 60 minutes, with 3 sessions each week for up to twelve weeks under the proposal to be covered.
In a hospital or outpatient hospital setting, the program would have to be undertaken by qualified auxiliary personnel trained in basic and advanced life support techniques and in exercise therapy for PAD, under the straight supervision of a physician.
The Medicare administrative contractors would be permitted by proposal to cover supervised exercise therapy beyond 36 sessions over twelve weeks for as long as an extra 36 sessions over time; additional sessions would need a second referral and a justification.
In patients, supervised exercise therapy would not be covered with absolute contraindications to exercise, involving exercise-limiting CVD, amputation or wheelchair confinement.
A sufferer would require a face-to-face meeting with the physician responsible for the treatment of their PAD to review CVD and PAD risk factor reduction to obtain a referral for supervised exercised therapy, possibly involving counseling, education, behavioral interventions and outcome assessments, in accordance to the memo.
In July 2015, The proposal comes after a meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), in which members of the MEDCAC panel reflected moderate confidence that there was enough evidence to support coverage of almost one intervention to make better the intermittent claudication in the short and long term.
CMS received 103 comments, all of which supported Medicare coverage for supervised exercise therapy for the treatment of symptomatic PAD during the initial 30-day public comment for the proposal in September and October.
On the proposed decision, CMS is now accepting comments and will respond to the comments for a final decision. The memo didn’t provide a timetable for the final decision. At www.cms.gov, an online comment form is available on the memo’s page.