CMS Proposes Intensive Behavioral Tx Coverage for CVD

The Centers for Medicare & Medicaid Services (CMS) concludes that intensive behavioral therapy for cardiovascular disease (CVD) is necessary for it’s prevention or early detection. CMS proposes in a proposed decision memo “to cover one face-to-face CVD risk reduction visit every two years for Medicare beneficiaries who are competent and alert at the time that counseling is provided; and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting.”

Intensive behavioral therapy consists of these three components:

Certified Interventional Radiology Cardiovascular Coder CIRCC

  • Encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risks for men age 45-79 years and women 55-79 years
  • Screening for high blood pressure in adults age 18 years and older
  • Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age, and other known risk factors for cardiovascular and diet-related chronic disease

CMS is proposing that the vast majority of beneficiaries receive all three components, because only a small proportion (about 4 percent) of the Medicare population is under 45 years (men) or 55 years (women).

The behavioral counseling intervention for aspirin use and healthy diet should be consistent with the “Five As” approach that has been adopted by the U.S. Preventive Services Task Force (USPSTF) to describe such services:

  • Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  • Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  • Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  • Assist:Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  • Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

CMS is requesting public comments on this proposed determination to help make a final determination and issue a final decision memorandum. See  the proposed decision Memo for Intensive Behavioral Therapy for Cardiovascular Disease (CAG-00424N) for more information.

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