HR # 4838 – SOS: Sustaining Outpatient Services Act

AACVPR members have been going to Washington D.C. since 2018, asking for a correction to drastic reimbursement reductions for cardiac and pulmonary rehabilitation (CR/PR) services that are located off-campus.

We are ready to get this bill passed, but that will only happen with your help.

Every affiliate now has an AACVPR-state affiliate contact person responsible for helping members in your state contact U.S. House members in your state’s districts. At this time, we have a U.S. House bill, so your U.S. House of Representatives member who serves your district is who you should contact. When we have a companion (identical) bill in the U.S. Senate, we will add a template letter for U.S. Senators and ask you to request support of that bill (different bill #) in the Senate. Please check with your affiliate leadership regarding who the AACVPR-State Affiliate contact person is who can help you take action.

NEW: AACVPR now has a virtual lobbying tool on the Advocacy web page, accessible to anyone. This tool will make it very simple to send an email to the U.S. Representative for your district. There are three template letters available that can easily be personalized: patients, physcians and providers.

Most importantly, there is a letter for practitioners who provide CR and PR, to voice concern about the adverse effect that reduced reimbursement in an off-campus location will have on patient access to these services. Please note: you would be sending this letter as a professional unless you have the authority to send it representing your institution.

There is also a letter for physicians, such as your medical director and your CR/PR physician champions in your institution. There is an additional letter for grateful patients to send who appreciate how CR/PR has helped them. Your rehabilitation participants would be sending it as concerned individual constituents of your state, also not representing your hospital. Please share the link to the virtual lobbying tool far and wide within your networks.

We would recommend these letters be sent in the next 2-3 week time frame, so our follow-up with Congressional offices can be more effective.

Further negative consequences of Section 603

As more Medicare beneficiaries choose Medicare Advantage (MA) plans, there are severe implications for non-excepted (non-grandfathered) CR and PR programs that are located off-campus. Because reimbursement for these services is reduced to roughly 40% or more compared to reimbursement of outpatient programs on campus, co-payments are exceeding the amount that is reimbursed. MA plans are held to the same cap of $50 co-pay for CR and $30 co-pay for PR; however, reimbursement is less than the co-payment cap. As clinically absurd as this is, it is legal and allowed. This is more evidence of the extent to which this bill is needed asap.

AACVPR is working to provide a companion bill in the U.S. Senate, but now is the time to ask for sponsorship of HR 4838. If this bill is not part of a year-end “package” (larger Medicare fix bill) in this session of Congress, it will be our focus throughout 2020 with special attention on March 2-3, 2020 at AACVPR’s Day on the Hill (DOTH). This issue has been our mission the past two years and last year we found much more receptivity from both sides of the aisle. Now with a bill number, we expect to be successful obtaining a significant number of U.S. House member signatures – but only if you ask.