The Division of Medicaid defines Phase II Cardiac
Rehabilitation services as a physician supervised program designed to
recondition the cardiovascular system and restore beneficiaries with
cardiovascular heart disease to their optimal functional status including their
physiological, psychological, social, vocational and emotional status
including, but not limited to:
1.
Formal exercise sessions with continuous electrocardiographic (ECG)
monitoring,
2. Risk factor
education, and
3. Behavior
modification counseling.
Providers must comply with all requirements set forth in Part
200, Chapter 4, Rule 4.8 in addition to:
Being a current Mississippi Division of Medicaid
provider,
Being located in the state of Mississippi, and
Holding a current certification from the American Association
of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
C. The Division of Medicaid covers Phase II
Cardiac Rehabilitation services for beneficiaries eighteen (18) and older for
one (1) of the qualifying episodes:
1. Acute
myocardial infarction within the preceding twelve (12) months,
2. Coronary artery bypass graft within six
(6) months,
3. Percutaneous
transluminal coronary angioplasty or percutaneous coronary intervention within
six (6) months,
4. Heart valve
repair/replacement within six (6) months,
5. Heart transplant within one (1) year,
or
6. Stable angina positive stress
test within six (6) months.
D. The Division of Medicaid covers up to
thirty-six (36) Phase II Cardiac Rehabilitation sessions per twelve (12) months
regardless of the number of qualifying episodes.
1. The twelve (12) month period begins with
the initiation of Phase II Cardiac Rehabilitation.
2. Phase II Cardiac Rehabilitation is covered
for only one (1) qualifying episode during the twelve (12) month
period.
3. The thirty-six (36)
Phase II Cardiac Rehabilitation sessions must occur within twelve (12) weeks
from initiation of services unless a medical condition prevents the beneficiary
from completing the thirty-six (36) sessions. Prior authorization for the
extension must be obtained from the Utilization Management and Quality
Improvement Organization (UM/QIO) up to an additional twelve (12)
weeks.
E. Phase II
Cardiac Rehabilitation Services must be:
Furnished in the outpatient hospital setting with physician
supervision as required in compliance with AACVPR guidelines, and
2. Prior authorized by the Utilization
Management and Quality Improvement Organization (UM/QIO).
F. The Division of Medicaid pays for all
medically necessary services for EPSDT-eligible beneficiaries in accordance
with Part 223 of Title 23, without regard to service limitations and with prior
authorization.
42 CFR §410.49;
Miss. Code Ann. §
43-13-121.
