Medicare to Cover Rehab for Heart Failure Patients

Medicare to Cover Rehab for Cardiac Failure Patients

Medicare, Medicaid, and private insurance benefit coverage is constantly changing. While healthcare industry trends often move at lightning speed, government health policies are notorious for not always keeping pace with patients’ needs. In a welcome move, Medicare recently decided to make a major change in its coverage policy for those individuals with chronic heart failure. Medicare will now cover cardiac rehab for some heart failure patients. While Medicare provides rehab benefits for other cardiac patients, such as those having heart by-pass surgery, people with cardiac failure have not been able to participate in rehab as a covered service.

Cardiac failure is a condition in which the heart isn’t able to pump enough blood to supply oxygen to organs in the body. Symptoms include shortness of breath, chronic fatigue, and edema which is the buildup of often dangerous amounts of fluid in the lungs and extremities. According to the American Heart Association, around 6.5 million Americans have heart failure and is one of the most common incidents of Medicare beneficiaries being hospitalized.

This new policy, decided after over 10 years of debate, was based on a 2009 study of 2,300 chronic, but stable, heart failure patients who benefited from exercise training. The study concluded that the test subjects saw a reduction in hospitalizations and deaths. Medical professionals stress that any exercise program for cardiac failure patients must be strictly supervised and adapted to their activity and strength levels. But the new evidence of success with exercise is a very different approach from the previously recommended advice of limited physical activity.

The specific Medicare guidelines apply to patients with a certain level of heart function –  “stable, chronic heart failure defined as patients with left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least six weeks.” The benefit covers 36 one-hour exercise sessions over a period of 36 weeks. Further information is available on the CMS.gov website.

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