By AMERICAN HEART ASSOCIATION NEWS

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A new Medicare proposal would cover supervised exercise therapy for patients with peripheral artery disease, or PAD, that is causing symptoms, according to a draft decision by the Centers for Medicare and Medicaid Services.

PAD occurs when plaque builds up in the arteries and the legs don’t get enough blood, causing cramping, pain and difficulty walking. The condition affects about 8.5 million Americans.

The proposed decision issued this month would require beneficiaries to have a face-to-face visit with a physician to receive a referral for supervised exercise therapy, or SET, and information about reducing risk factors, which may include education, counseling and behavioral interventions. The benefit was designed using evidence-based guidelines from the American Heart Association and American College of Cardiology.

Last fall, the AHA asked CMS to consider providing Medicare coverage of SET for PAD patients by filing a formal national coverage determination request.

Under the proposal, Medicare would cover three 30- to 60-minute sessions per week for up to 12 weeks. AHA/ACC guidelines recommend SET as the initial treatment for PAD patients. Medicare administrative contractors could choose to cover an additional 36 sessions over an extended period if it is deemed the patient would benefit from additional sessions.

When making national coverage determinations, CMS reviews clinical evidence to determine whether the data are sufficient to support including a service in a particular benefit category. CMS noted that there is significant evidence to support Medicare coverage of SET because it improves health outcomes for Medicare beneficiaries with intermittent claudication – cramping leg pain when walking – due to PAD.

Alan T. Hirsch, M.D., of the University of Minnesota Medical School, said CMS’ proposal could dramatically change quality of life for PAD patients.

“SET is proven to offer the most clinically effective, safe and cost-effective improvement in claudication symptoms,” said Hirsch, advocacy ambassador to AHA’s Council on Peripheral Vascular Disease. Medicare coverage will help create a “community of vascular health,” he said.

Council chair Joshua Beckman, M.D., of Vanderbilt University Medical Center, agreed, calling SET the “cornerstone” of PAD management.

In the proposal, CMS encourages providers to adopt and adhere to evidence-based care for patients with PAD.

The agency is accepting comments on the draft decision until April 1. The agency is expected to announce a final decision by May 31.