<p>As a North Carolina resident and a member of the North Carolina Cardiopulmonary Rehabilitation Association (NCCRA) I would appreciate your assistance with the following issue: Supervision of Cardiac and Pulmonary Rehabilitation Services The Issue We need your support of legislation that would amend the Social Security Act to allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac and pulmonary rehabilitation programs on a day-to-day basis. This change would not alter the requirement for medical direction of these programs – it would simply re-define the requirement for a “physician” to be immediately available and accessible at all times when services are being furnished under these programs. In 2010, authority regarding direct physician supervision was extended to non-physician practitioners for other outpatient services by CMS; however, authorizing language included in Public Law 110-275 (enacted in 2008) imposed an unintended requirement for physician supervision that could not be reversed through regulation. As a result – cardiac and pulmonary rehabilitation require a level of physician supervision that is not commensurate with patient risk; creates access issues in rural and other areas with physician shortages, and creates unnecessary costs for these low-revenue programs. Background Cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) are medically directed and supervised programs designed to improve a patient’s physical, psychological, and social functioning. Both programs utilize supervised exercise, risk factor modification, education, counseling, behavioral intervention, psychosocial assessment and outcomes assessment. A physician, who serves as Medical Director, is responsible for ensuring that the program is safe, comprehensive, cost effective, and medically appropriate for individual patients. Separate and distinct from medical direction is “direct physician supervision” which requires a physician to be immediately available for each session. This individual is typically not the Medical Director and is mainly responsible for responding if an emergency arises. This change is supported by the American Heart Association, the American Association of Cardiovascular and Pulmonary Rehabilitation, and NAMDRC. The Legislative Correction This provision (U.S. Senate bill to be introduced in the 114th Congress) would amend title XVIII (Medicare) of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. Because such physician supervision, regardless of which professional performs the service, is an uncompensated service, there is no cost to the Medicare programs if such a change is adopted. In the last Congress, the legislation was co-introduced by Senators Chuck Schumer (D-NY) and Michael Crapo (R-ID). It had 13 bipartisan cosponsors including Senators Baldwin (D-WI), Blumenthal (D-CT) , Boxer (D-CA), Crapo (R-ID), Durbin (D-IL), Franken (D-MN), Gillibrand (D-NY), Grassley (R-IA), Harkin (D-IA), Markey (D-MA), Risch (R-ID), Thune (R-SD) and Warren (D-MA). </p><p>Thank you for your consideration of this important issue!</p><p>______Signature</p><p>______Printed Name</p><p>______Home Address</p>