Heart Failure & Cardiac Rehabilitation

Size: px
Start display at page:

Download "Heart Failure & Cardiac Rehabilitation"

Transcription

1 Heart Failure & Cardiac Rehabilitation Karen Lui, RN, MS, MAACVPR SCACVPR Greenville May 3, I have no disclosures. 2 Outline New Professional Certification New AACVPR CR Guidelines New Heart Failure Coverage Recent CMS direction on MD supervision for PR/CR programs Medicaid Coverage CR FAQs 3 1

2 Add CCRP to your résumé and advance your career. 4 What is the CCRP? The only professional certification specific to cardiac rehabilitation. Why should I take the exam? Earning this certification demonstrates mastery of the core competencies essential in providing quality cardiac rehabilitation. 5 Who is eligible to sit for the exam? Professionals with: 1,200 clinical hours in CR/secondary prevention Minimum of a Bachelor s degree or higher in a health related field from an accredited college or university or current RN licensure. Current RN licensure does not necessitate minimum academic requirement. 6 2

3 How does CCRP compare to other certifications? ACSM CCRP is not intended to replace ACSM clinical exercise physiology certifications. In fact, ACSM certification in clinical exercise physiology is a preferred qualification for hiring an exercise specialist or physiologist in an outpatient cardiac rehabilitation setting. AACVPR Guidelines for Cardiac Rehabilitation, 5th edition, How does CCRP compare to other certifications? ACSM CCRP goes beyond testing only clinical exercise physiology knowledge to include a comprehensive examination based on all the identified core competencies of CR. Therefore, individuals with ACSM certification will not be grandfathered in to the CCRP program. 8 How does CCRP compare to other certifications? ANCC American Nursing Credentialing Center (ANCC) retired a cardiac rehabilitation specific certification years before the publication of evidence based core competencies for CR. The focus of the current ANCC examination has shifted to serve nurses practicing in a cardiovascular setting, such as hospital unit or physician practice. 9 3

4 How does CCRP compare to other certifications? ANCC Because it is not based on the published core competencies for cardiac rehabilitation, individuals with the RN C certification previously offered by ANCC will not be grandfathered in to the CCRP program. CCRP goal is to achieve ANCC magnet status asap. 10 How can I prepare? Download the CCRP Exam Blueprint from aacvpr.org View the Candidate Handbook (available spring 2014) Purchase the Study Guide (available spring 2014) 11 AACVPR Blueprint 10 Domains Patient assessment Nutrition management Weight management BP management Blood lipid management Diabetes management Tobacco cessation Psychosocial mngmnt Physical activity counseling Exercise training Duties and Tasks

5 AACVPR Blueprint Example 1. Patient Assessment # of questions= Explain cardiovascular system anatomy and physiology 1.2 Recognize pathophysiology of cardiovascular diseases (e.g., atherosclerosis, valvularheart disease, chronic heart failure) 1.3 Identify risk factors contributing to atherosclerotic heart disease 1.4 Recognize cardiac dysrhythmias and potential implications during physical activity to When is the exam? Wednesday, September 3, 2014 In advance of the AACVPR 29 th Annual Meeting in Denver, CO How much will it cost? The first exam will be discounted: $249 AACVPR members $299 non members

6 5 th Edition CR Guidelines New: Outcomes based programming emphasized No staff to patient ratio recommendations Preferred hiring qualifications added Higher educational level for program director (MS) ACSM certification preferred for clinical exercise specialists/physiologists Mastery of AACVPR Core Competencies for all nucleus staff, as demonstrated through CCRP 16 Heart Failure Medicare Coverage Regulations National Coverage Determination (NCD) 20:10 Medicare Provision 42 CFR Eligibility criteria ICD 9 CM and ICD 10 CM Codes 17 National Coverage Determination NCD 20:10 Effective date: February 18, 2014 CAG # 00437N HF patients are not eligible for Intensive Cardiac Rehab (ICR) Separate benefit (statute) for ICR Evidence of benefit based on CR model, not ICR 15 6

7 Medicare Provision for CR Same regulation for HF: 42 CFR hour sessions/day >91 minutes=2 sessions <90 minutes=1 session Up to 36 sessions per course Up to 36 weeks to complete CR course Required components Physician prescribed exercise (CR team) Cardiac risk factor reduction interventions 19 Eligibility Criteria CMS criteria were derived from HF ACTION Trial for patient eligibility. Research design often differs from real world procedure for valid reasons. 20 Eligibility Criteria Beneficiaries with stable, chronic heart failure meeting all of following: 1. Left ventricular ejection fraction < 35% 2. NYHA class II IV symptoms despite being on optimal heart failure therapy for at least 6 weeks 3. Stable=have not had recent (< 6 weeks) or planned (< 6 months) major cardiovascular hospitalizations or procedures 21 7

8 Eligibility Criteria: Stable Stable In general, stable means that the patient's symptoms from heart failure are not worsening relatively rapidly, requiring prompt evaluation for medication adjustment or procedures. Although patients with heart failure can have "good days and bad days", progressive declines in functional capacity due to fatigue or dyspnea or rapid increase in edema or weight may be symptoms of medical instability. 22 Eligibility Criteria: Optimal Optimal Medical therapy varies, depending on a patient's tolerance for medications, but in general includes a beta blocker such as carvedolol or metoprolol and an ACEI or ARB. Referring physicians will understand the concepts of stable and optimal medical therapy, as they relate these terms to patients with heart failure. 23 Eligibility Criteria Beneficiaries with stable, chronic heart failure meeting all of following: 1. Left ventricular ejection fraction < 35% Measurement by any method is OK EF >35% not eligible EF is not an exact measurement 24 8

9 Eligibility Criteria Beneficiaries with stable, chronic heart failure meeting all of following: 2. NYHA class II IV symptoms despite being on optimal heart failure therapy for at least 6 weeks Goal for HF patients is not symptom free, but that patients are able to monitor and control their symptoms Similar to stable angina where goal is selfmanagement skills 25 Eligibility Criteria Beneficiaries with stable, chronic heart failure meeting all of following: 3. Stable=have not had recent (< 6 weeks) or planned (< 6 months) major cardiovascular hospitalizations or procedures Patient does not have to have been hospitalized to be eligible No per year or per lifetime limit, as with all CR dx 26 Eligibility Considerations What constitutes planned and major? LVAD: planned differs from future evaluation for ICD, pacemaker, PCI not typically considered major cardiovascular hospitalizations/procedures EPs increasingly using life vest in CR to assess need for AICD after some weeks of CR 27 9

10 Eligibility Considerations What about patient with AMI who has EF < 35%? What about a patient who begins Phase II and is re hospitalized for HF? What about patient who would benefit from > 36 sessions per course? Similar to stable angina diagnosis 28 Eligibility Considerations Bottom line: Medical necessity, dept policy protocol, CR Medical Director, education & medical judgment of referring MDs will guide these clinical decisions and referral appropriateness. 29 Eligibility Considerations 30 day all cause re admission penalties for HF dx Role for CR to provide or participate in transitional treatment strategies to improve care coordination Start education earlier post DC Plan is that 30 day will move to 60 day to 90 day to 1 year with CMS Episode of Care Program Episode Grouper 30 10

11 Referral Considerations Is it appropriate to obtain referral at hospital discharge? Absolutely EMR/automated + liaison referral (CR team) yields highest rates of enrollment (Sherry Grace et al) Wait times for referral to enrollment (unfortunately) average 20+ days CR initial assessment screens for current stability and appropriateness to begin CR Adds to rationale for CR involvement in transitional care (esp. with ACO model) 31 Billing & Coding Procedure codes There are only two CPT codes available to bill for all Medicare required components of CR services Billing & Coding List of HF ICD 9 and ICD 10 (diagnosis) codes posted on AACVPR HF web page ICD 10 CM codes effective Oct. 1, 2015 CMS web site for ICD 10 instructions ndex.html?redirect=/icd

12 Clinical Considerations for HF & CR Helpful starting points: 1. AACVPR HF Workshop Webinar held March 13th 2. Cardiac Rehabilitation Exercise and Self Care for Chronic Heart Failure. Ades PA, Keteyian SJ, Balady GJ, Houston Miller N, et al. JACC Heart Fail 2013;1: Evidence to support Exercise prescription Self care counseling 34 MD Supervision in CAH Setting 2010: CMS relaxed physician supervision requirement for outpatient services in critical access hospitals, except for cardiac and pulmonary rehab services (Federal Register, Nov 24, 2010, Vol 75, # 226, pg 72000) CAHS allowed to use NPPs except for CR/PR due to statutory language (SSA; Title XVIII, Section 144; i.e., Public Law ) 35 MD Supervision in CAH Setting March 24, 2014 Per CMS: Direct supervision by a physician is required (in CAHs) and will be enforced by CMS for PR/CR/ICR. AACVPR advocacy effort (Day on the Hill) was attempt to obtain use of NPPs for supervision (not medical direction) in all CR/PR programs, regardless of setting 36 12

13 Medicaid Coverage Medicare is under SSA Title XVIII Medicaid is under SSA Title XIX Medicaid is obligated to cover same outpatient services that Medicare covers Coverage and payment are separate issues example PAD exercise 37 Medicaid Coverage Medicaid is state run & state funded program States have some flexibility to impose amount, duration or scope limitations on required benefits as long as most enrollees who need the benefit are fully served. Some enrollees will receive alternate benefit packages modeled after commercial benchmark coverage that includes essential health benefits. States that don t accept federal funding? 38 CR FAQs of 2014 Valve repair/replacement coverage Any technique is acceptable TAVR KX Modifier Needed for every session after 36 as a Medicare beneficiary as of Jan, 2010 CWF/HETS/C SNAP or other CMS tracking system is used by your billing dept to check utilization Referred to as CMS Patient Inquiry Screen 39 13

14 Thank you 40 14

Priorities for Cardiac Rehabilitation Programs in 2015

Priorities for Cardiac Rehabilitation Programs in 2015 Priorities for Cardiac Rehabilitation Programs in 2015 Karen Lui, RN, MS, MAACVPR GRQ, LLC NCCRA March 6, 2015 1 I have no disclosures. 2 Outline 1. Coming changes in Medicare billing & coding for cardiac

More information

2013 ACO Quality Measures

2013 ACO Quality Measures ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating

More information

Pulmonary Rehab FAQ s (Abstracted from AACVPR site)

Pulmonary Rehab FAQ s (Abstracted from AACVPR site) (Abstracted from AACVPR site) MAC J-15 Committee 1) Q: Is the 36 session PR program once in a lifetime or per calendar year or per event? Answer: CMS does not limit to one PR course to a calendar year.

More information

Central Office N/A N/A

Central Office N/A N/A LCD ID Number L32688 LCD Title Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Contractor s Determination Number L32688 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American

More information

Congestive Heart Failure Management Program

Congestive Heart Failure Management Program Congestive Heart Failure Management Program The Congestive Heart Failure Program is the third statewide disease management program developed by CCNC. The clinical directors reviewed prevalence and outcome

More information

Medicare Part A. Pulmonary Rehab Program Services Web-Based Training February 25, 2010 - Q & As

Medicare Part A. Pulmonary Rehab Program Services Web-Based Training February 25, 2010 - Q & As Pulmonary Rehab Program Services Web-Based Training February 25, 2010 - Q & As The following are the question and answers from the Pulmonary Rehabilitation Program Services web-based training which was

More information

Utilization Review Cardiac Rehabilitation Services: Underutilized

Utilization Review Cardiac Rehabilitation Services: Underutilized Utilization Review Cardiac Rehabilitation Services: Underutilized William J. Gill, MD Krannert Institute of Cardiology Indiana University School of Medicine Indianapolis, Indiana What is Cardiac Rehab?

More information

I. Current Cardiac Rehabilitation Requirements

I. Current Cardiac Rehabilitation Requirements CLIENT ADVISORY July 24, 2009 CMS Proposes Changes to Cardiac Rehabilitation Program Design and Physician Supervision Requirements The Centers for Medicare and Medicaid Services (CMS) recently published

More information

The Department of Vermont Health Access Medical Policy

The Department of Vermont Health Access Medical Policy State of Vermont Department of Vermont Health Access 312 Hurricane Lane, Suite 201 [Phone] 802-879-5903 Williston, VT 05495-2807 [Fax] 802-879-5963 www.dvha.vermont.gov Agency of Human Services The Department

More information

National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1)

National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1) National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1) Tracking Information Publication Number 100-3 Manual Section Number 20.10.1 Manual Section

More information

Protocol. Cardiac Rehabilitation in the Outpatient Setting

Protocol. Cardiac Rehabilitation in the Outpatient Setting Protocol Cardiac Rehabilitation in the Outpatient Setting (80308) Medical Benefit Effective Date: 07/01/14 Next Review Date: 09/15 Preauthorization No Review Dates: 07/07, 07/08, 05/09, 05/10, 05/11, 05/12,

More information

What have health care professionals done to decrease rates of physical inactivity?

What have health care professionals done to decrease rates of physical inactivity? 1 2 3 4 5 6 7 8 9 10 Careers in Clinical Exercise Physiology Credentialing, Scope, and Practice Jennifer S. Blevins, Ph.D. ACSM ES RCEP and Program Director SM blevinsj@uta.edu Exercise and Medicine Physicians

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

Pulmonary Rehabilitation: Billing & Coding Medicare Guidelines

Pulmonary Rehabilitation: Billing & Coding Medicare Guidelines Pulmonary Rehabilitation: Billing & Coding Medicare Guidelines Deborah Recko, MN, RN-BC, CCRP Clinical Coordinator, Cardiac & Pulmonary Rehab University Hospitals St. John Medical Center Westlake, Ohio

More information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1 Post CABG Rehabilitation i Ahmed Elkerdany Professor of Cardiac Surgery Ain Shams University 1 Definition Cardiac rehabilitation services are comprehensive, long-term programs involving : medical evaluation.

More information

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy File name: Cardiac Rehabilitation (Outpatient Phase II) File code: UM.REHAB.04 Origination: 08/1994 Last Review: 08/2011 Next Review:

More information

Jurisdiction South Carolina. Retirement Date N/A

Jurisdiction South Carolina. Retirement Date N/A Local Coverage Determination (LCD): Cardiac Rehabilitation (L32872) Contractor Information Contractor Name Palmetto GBA opens in new window Back to Top LCD Information Document Information Contract Number

More information

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation JA6850

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation JA6850 Cardiac Rehabilitation and Intensive Cardiac Rehabilitation JA6850 Related CR Release Date: March 21, 2010 Revised Date Job Aid Revised: November 17, 2010 Effective Date: January 1, 2010 Implementation

More information

HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES. Measure Short Name. Adult Smoking Cessation Advice/Counseling

HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES. Measure Short Name. Adult Smoking Cessation Advice/Counseling Release Notes: Measure Information Form Version 2.6 HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES Set Measure ID # HF-2 Discharge Instructions Evaluation of LVS Function ACEI or ARB for LVSD

More information

Chapter Three Accountable Care Organizations

Chapter Three Accountable Care Organizations Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

More information

Cardiac Rehabilitation at AUBMC

Cardiac Rehabilitation at AUBMC Cardiac Rehabilitation at AUBMC Clinical Protocols and The Role of The Advanced Practice Nurse Presentation by: Mohamad Issa, MSN, BSN, BC- RN, AUBMC CCU OUTLINE Background on cardiovascular diseases History

More information

Initial Preventive Physical Examination

Initial Preventive Physical Examination Initial Preventive Physical Examination Overview The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expanded Medicare's coverage of preventive services. Central to the Centers

More information

Table of Contents. Respiratory, Developmental,

Table of Contents. Respiratory, Developmental, Provider Handbook Rehab and Restorative Services Table of Contents 1. Section Modifications... 1 2. Rehab, and Restorative Services... 2 2.1. General Policy... 2 2.2. Independent Occupational Therapists

More information

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References) CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient

More information

Medical Direc1on: CMS Standards

Medical Direc1on: CMS Standards Statement of Disclosure Cardiac Rehab Rules & Regula1ons Update I have no disclosures. The opinions expressed are my own. Candace Steele, RN, MA, FAACVPR Wheaton Franciscan Healthcare candace.steele@wdc.org

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 September 2013 This booklet was current at the time it was published or uploaded onto

More information

Test Content Outline Effective Date: February 6, 2015. Cardiac-Vascular Nursing Board Certification Examination

Test Content Outline Effective Date: February 6, 2015. Cardiac-Vascular Nursing Board Certification Examination Effective Date: February 6, 2015 Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are pretest questions that are not scored. Pretest

More information

HealthCare Partners of Nevada. Heart Failure

HealthCare Partners of Nevada. Heart Failure HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with

More information

Medicare Respiratory Therapist Access Act - 2013

Medicare Respiratory Therapist Access Act - 2013 Medicare Respiratory Therapist Access Act - 2013 These Frequently Asked Questions (FAQs) are designed to provide insight into developing a legislative initiative, to discuss why AARC is taking a different

More information

FY2015 Final Hospital Inpatient Rule Summary

FY2015 Final Hospital Inpatient Rule Summary FY2015 Final Hospital Inpatient Rule Summary Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) released

More information

5557 FAQs & Definitions

5557 FAQs & Definitions 5557 FAQs & Definitions These Questions and Answers are intended to present information that has been acquired as part of the discovery process and provides necessary context for the Policy Directives

More information

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97 6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older

More information

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data

More information

caresy caresync Chronic Care Management

caresy caresync Chronic Care Management caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in

More information

KIH Cardiac Rehabilitation Program

KIH Cardiac Rehabilitation Program KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to

More information

AACVPR Cardiac Rehabilitation. Anne M Gavic, MPA, RCEP President Elect, AACVPR Manager, Cardiopulmonary Rehabilitation Northwest Community Hospital

AACVPR Cardiac Rehabilitation. Anne M Gavic, MPA, RCEP President Elect, AACVPR Manager, Cardiopulmonary Rehabilitation Northwest Community Hospital AACVPR Cardiac Rehabilitation Program Certification Anne M Gavic, MPA, RCEP President Elect, AACVPR Manager, Cardiopulmonary Rehabilitation Northwest Community Hospital QuickTime?and a decompressor are

More information

Collaborative Care Tips for Sustainability. Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative

Collaborative Care Tips for Sustainability. Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative Collaborative Care Tips for Sustainability Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative Teamwork Applies to Billing Too!!! Combine with other initiatives

More information

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation How Does CMS Measure the Rate of Acute Care Hospitalization (ACH)? Until January 2013, CMS measured Acute Care Hospitalization (ACH) through the Outcomes Assessment and Information Set (OASIS) reporting

More information

Nurses: Architects of an Integrated Healthcare Delivery System. Billie Lynn Allard, MS, RN Administrative Director of Outpatient Services

Nurses: Architects of an Integrated Healthcare Delivery System. Billie Lynn Allard, MS, RN Administrative Director of Outpatient Services Nurses: Architects of an Integrated Healthcare Delivery System Billie Lynn Allard, MS, RN Administrative Director of Outpatient Services Presentation ID: 338 1 Disclosure Today s presenters do not have

More information

CMS National Coverage Policy

CMS National Coverage Policy LCD ID Number L32764 LCD Title Pulmonary Rehabilitation (PR) Programs Contractor s Determination Number L32764 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American Medical Association.

More information

Electronic Health Record (EHR) Incentive Program. Stage 2 Final Rule Update Part 2

Electronic Health Record (EHR) Incentive Program. Stage 2 Final Rule Update Part 2 Office of Medical Assistance Programs Electronic Health Record (EHR) Incentive Program Stage 2 Final Rule Update Part 2 November 7, 2012 Medical Assistance HIT Initiative 1 Office of Medical Assistance

More information

Integrating Cardiac Rehab into your Medical Fitness Program. Bob Brown MPH MBA Manager Heart Wellness Program At Spartanburg Regional Hospital

Integrating Cardiac Rehab into your Medical Fitness Program. Bob Brown MPH MBA Manager Heart Wellness Program At Spartanburg Regional Hospital Integrating Cardiac Rehab into your Medical Fitness Program Bob Brown MPH MBA Manager Heart Wellness Program At Spartanburg Regional Hospital Faculty Disclosure Presenter has listed no financial interest/arrangement

More information

Medicaid Support for Community Prevention

Medicaid Support for Community Prevention Medicaid Support for Community Prevention ASTHO Million Hearts Peer Call April 4, 2014 Anne De Biasi Director of Policy Development About TFAH: Who We Are Trust for America s Health (TFAH) is a non-profit,

More information

25 Cardiac Rehabilitation Staffing

25 Cardiac Rehabilitation Staffing 25 Cardiac Rehabilitation Staffing Gregory J. Lawson, MS, RCEP, FAACVPR CONTENTS Inpatient Cardiac Rehabilitation Staffing 277 Outpatient Cardiac Rehabilitation Staffing 279 Medical Director 282 Program

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2014 benchmarks for ACO-9 and ACO-10 quality

More information

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality

More information

Implementing Chronic Care Management (CCM) - CPT 99490

Implementing Chronic Care Management (CCM) - CPT 99490 Implementing Chronic Care Management (CCM) - CPT 99490 Dulcian, Inc. May 2015 The Need Population-based statistics published by the Centers for Medicare and Medicaid Services (CMS) tell the story. Most

More information

THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES

THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES REPORT TO CONGRESS STANDARDS FOR SUPERVISION OF PHYSICAL THERAPIST ASSISTANTS (PTAs) AND THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES

More information

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE May 2014 THE UNIVERSITY OF MARYLAND CAREY SCHOOL OF LAW DRUG POLICY AND PUBLIC HEALTH STRATEGIES CLINIC 2 PARITY ACT RESOURCE GUIDE TABLE OF

More information

. 4 " ~ f.".2 DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF INSPECTOR GENERAL. December 19,2003. Our Reference: Report Number A-O2-03-01016

. 4  ~ f..2 DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF INSPECTOR GENERAL. December 19,2003. Our Reference: Report Number A-O2-03-01016 . 4 " ~..+.-"..i"..,. f.".2 '" '" ~ DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF INSPECTOR GENERAL Office of Audit Services Region II Jacob K. Javits Federal Building New York, New York 10278 (212)

More information

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION OBJECTIVES Kimberly S. Hodge, PhDc, MSN, RN, ACNS-BC, CCRN- K Director, ACO Care Management & Clinical Nurse Specialist Franciscan ACO, Inc. Central Indiana Region Indianapolis, IN By the end of this session

More information

Other diagnostic, screening, preventive, and rehabilitative services, i.e., other. than those provided elsewhere in the plan.

Other diagnostic, screening, preventive, and rehabilitative services, i.e., other. than those provided elsewhere in the plan. State Ut Ohio Attachment 3.1 -A Item 13 -d 1- Page 1 of 28 13. Other diagnostic, screening, preventive, and rehabilitative services, i.e., other 1. Rehabilitative services provided by community mental

More information

Carol Novak, RN, CHC Martin Yuson, DPT, JD. Tips for Effective Auditing/Monitoring of Medicare Documentation for OT, PT and Speech 4/24/2013

Carol Novak, RN, CHC Martin Yuson, DPT, JD. Tips for Effective Auditing/Monitoring of Medicare Documentation for OT, PT and Speech 4/24/2013 Carol Novak, RN, CHC Martin Yuson, DPT, JD Tips for Effective Auditing/Monitoring of Medicare Documentation for OT, PT and Speech 4/24/2013 The wonderful thing about standards is that there are so many

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 January 2015 This booklet was current at the time it was published or uploaded onto the

More information

Draft LCD for Draft LCD for Cardiac and Intensive Cardiac Rehabilitation (DL31393)

Draft LCD for Draft LCD for Cardiac and Intensive Cardiac Rehabilitation (DL31393) Image description. Draft Stamp End of image description. Draft LCD for Draft LCD for Cardiac and Intensive Cardiac Rehabilitation (DL31393) Please note: This is a Draft policy. Draft LCDs are works in

More information

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit The Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all. Nevertheless, portions of our files including charts,

More information

IC 3 : Improving Continuous Cardiac Care Quality Improvement in Practice

IC 3 : Improving Continuous Cardiac Care Quality Improvement in Practice IC 3 : Improving Continuous Cardiac Care Quality Improvement in Practice Presenter Disclosure Information Paul Chan, MD FINANCIAL DISCLOSURE: None FUNDING FOR THE IC3 PROGRAM: Bristol-Myers Squibb / Sanofi

More information

UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors

UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors Case Requirements Updated 3/16/2011 According to the Case Society of America (CMSA), Case Model Act of 2009, Case management is a collaborative process of assessment, planning, facilitation, care coordination,

More information

Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health

More information

IRG/APS Healthcare Utilization Management Guidelines for West Virginia Health Homes - Bipolar and Hepatitis

IRG/APS Healthcare Utilization Management Guidelines for West Virginia Health Homes - Bipolar and Hepatitis IRG/APS Healthcare Utilization Management Guidelines for West Virginia Health Homes - Bipolar and Hepatitis CHANGE LOG Medicaid Chapter Policy # Effective Date Chapter 535 Health Homes 535.1 Bipolar and

More information

ICD 10 ESSENTIALS. Debbie Sarason Manager, Practice Enhancement and Quality Reporting

ICD 10 ESSENTIALS. Debbie Sarason Manager, Practice Enhancement and Quality Reporting ICD 10 ESSENTIALS Debbie Sarason Manager, Practice Enhancement and Quality Reporting October 29, 2015 CHANGING FROM 1CD 9 TO ICD 10 IN 2015 Rest of world has been using ICD 10 for decades World Health

More information

Heart Failure Outpatient Clinical Pathway

Heart Failure Outpatient Clinical Pathway Heart Failure Outpatient Clinical Pathway PHASE 1: PHASE 2: PHASE 3: PHASE 4: Initial Consult and Treatment Optimization of Therapy Reassessment and Further Optimization Maintenance I. Provider II. Consults

More information

The Essentials of Cardiac-Vascular Nurse Certification: Everything You Need to Know to Get Certified in 2013

The Essentials of Cardiac-Vascular Nurse Certification: Everything You Need to Know to Get Certified in 2013 The Essentials of Cardiac-Vascular Nurse Certification: Everything You Need to Know to Get Certified in 2013 Barbara Masters, BSN, RN-BC Memorial Hospital, Belleville, IL ANCC Board Certified Cardiac-Vascular

More information

Preparation "Dietitian and Nutritionist Overview"

Preparation Dietitian and Nutritionist Overview Dietitian and Nutritionist Overview The Field - Preparation - Day in the Life - Earnings - Employment - Career Path Forecast - Professional Organizations The Field Dietitians and nutritionists plan food

More information

Medicare Pulmonary Rehabilitation (PR) Benefit Frequently Asked Questions June 2010 (Latest Updates: December 18, 2013 and February 12, 2014)

Medicare Pulmonary Rehabilitation (PR) Benefit Frequently Asked Questions June 2010 (Latest Updates: December 18, 2013 and February 12, 2014) Medicare Pulmonary Rehabilitation (PR) Benefit Frequently Asked Questions June 2010 (Latest Updates: December 18, 2013 and February 12, 2014) Coverage Criteria Q. CMS has stated that only patients with

More information

Diabetes Outpatient Self-Management Training (NCD 40.1)

Diabetes Outpatient Self-Management Training (NCD 40.1) Policy Number 40.1 Approved By UnitedHealthcare Medicare Reimbursement Policy Committee Current Approval Date 02/11/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification Disease Management UnitedHealthcare Disease Management (DM) programs are part of our innovative Care Management Program. Our Disease Management (DM) program is guided by the principles of the UnitedHealthcare

More information

Breathe With Ease. Asthma Disease Management Program

Breathe With Ease. Asthma Disease Management Program Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program

More information

Section 6. Medical Management Program

Section 6. Medical Management Program Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Teresa DuChateau, DNP, RN, CPNP Wisconsin Public Health Association School Nurse Resource Coordinator

Teresa DuChateau, DNP, RN, CPNP Wisconsin Public Health Association School Nurse Resource Coordinator Teresa DuChateau, DNP, RN, CPNP Wisconsin Public Health Association School Nurse Resource Coordinator Early part of century: focused on population health Photo credit: http://schoolnurses.wordpress.com/

More information

2010 Medicare Cardiac and Pulmonary Rehabilitation Regulations: What is Said and What it Means Presented by: Karen Lui, RN, MS, FAACVPR

2010 Medicare Cardiac and Pulmonary Rehabilitation Regulations: What is Said and What it Means Presented by: Karen Lui, RN, MS, FAACVPR March 5, 2010 Program Director s Conference, Washington, DC 2010 Medicare Cardiac and Pulmonary Rehabilitation Regulations: What is Said and What it Means Presented by: Karen Lui, RN, MS, FAACVPR Physician

More information

MEDICARE RISK ADJUSTMENT A PROSPECTIVE APPROACH TO RISK ADJUSTMENT AND ACCURATE DOCUMENTATION AND CODING

MEDICARE RISK ADJUSTMENT A PROSPECTIVE APPROACH TO RISK ADJUSTMENT AND ACCURATE DOCUMENTATION AND CODING MEDICARE RISK ADJUSTMENT A PROSPECTIVE APPROACH TO RISK ADJUSTMENT AND ACCURATE DOCUMENTATION AND CODING WHAT IS RISK ADJUSTMENT? Risk Adjustment ensures that accurate payments are made to Medicare Advantage

More information

Berkshire Medical Center Heart Failure Program

Berkshire Medical Center Heart Failure Program Berkshire Medical Center Heart Failure Program Reducing Readmissions A Multi Disciplinary Approach 1 Project Goals To improve the overall care of Berkshire County Heart Failure Patients Reduce 30 day readmission

More information

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Marian Taylor, M.D. Medical University of South Carolina Director, Cardiac Rehabilitation I have no disclosures.

More information

Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures

Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures Ohio Health Homes Learning Community Meeting Overview of Health Homes Measures Tuesday, March 5, 2013 Presenter: Amber Saldivar, MHSM Associate Director, Informatics Analysis Health Services Advisory Group,

More information

Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions. Neville Suskin Heart & Stroke Clinical Update 2012

Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions. Neville Suskin Heart & Stroke Clinical Update 2012 Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions Neville Suskin Heart & Stroke Clinical Update 2012 1 Disclosure Med. Director SJHC CR Co-principal of Lawson e-cr application LCVIS SJHC

More information

CABHAs and non-cabha agencies may provide Comprehensive Clinical Assessments, Medication Management, and Outpatient Therapy.

CABHAs and non-cabha agencies may provide Comprehensive Clinical Assessments, Medication Management, and Outpatient Therapy. Page 7c.1b 4.b Early and periodic screening, diagnostic and treatment services for individuals under 21 years of age, and treatment of conditions found. (continued) Critical Access Behavioral Health Agency

More information

Prepublication Requirements

Prepublication Requirements Issued Prepublication Requirements The Joint Commission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals

More information

Note: This article was updated on January 3, 2013, to reflect current Web addresses. All other information remains unchanged.

Note: This article was updated on January 3, 2013, to reflect current Web addresses. All other information remains unchanged. News Flash The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor that processes and pays

More information

Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603

Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603 Klamath Tribal Health & Family Services 3949 South 6 th Street Klamath Falls, OR 97603 Phone: (541) 882-1487 or 1-800-552-6290 HR Fax: (541) 273-4564 OPEN: 10/02/12 CLOSE: WHEN FILLED POSITION: RESPONSIBLE

More information

PROVIDER POLICIES & PROCEDURES

PROVIDER POLICIES & PROCEDURES PROVIDER POLICIES & PROCEDURES HOMEMAKER-HOME HEALTH AIDE MEDICATION ADMINISTRATION SERVICES The purpose of this policy is to provide guidance to providers enrolled in the Connecticut Medical Assistance

More information

Medicaid Services for Substance Abuse

Medicaid Services for Substance Abuse Medicaid Services for Substance Abuse Community Behavioral Health Services Coverage and Limitations Handbook 2007 FADAA Annual Conference-Orlando Making Medicaid Work for Substance Abuse Agenda Overview

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations...

410-127-0020 Definitions... 1. 410-127-0040 Coverage... 5. 410-127-0050 Client Copayments... 6. 410-127-0060 Reimbursement and Limitations... Home Health Services Administrative Rulebook Division of Medical Assistance Programs Policy and Planning Section Table of Contents Chapter 410, Division 127 Effective January 1, 2014 410-127-0020 Definitions...

More information

Risk Adjustment in the Medicare ACO Shared Savings Program

Risk Adjustment in the Medicare ACO Shared Savings Program Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research

More information

For Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care

For Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care For Retirees of City of Memphis Features that Add Value The Cigna Medicare Surround indemnity medical plan helps pay some of the health care costs that your Medicare Part A or Part B do not cover such

More information

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

More information

PROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS

PROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS PROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS The information listed below is Sections B of the proposed ruling

More information

UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage

UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage UnitedHealthcare Choice Plus United HealthCare Insurance Company Certificate of Coverage For Westminster College Enrolling Group Number: 715916 Effective Date: January 1, 2009 Offered and Underwritten

More information

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.

other caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization. 4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,

More information

Annual Assessment Report: 2009-2010 Bachelor of Science in Exercise Science School of Kinesiology College of Education and Human Services

Annual Assessment Report: 2009-2010 Bachelor of Science in Exercise Science School of Kinesiology College of Education and Human Services Annual Assessment Report: 2009-2010 Bachelor of Science in Exercise Science School of Kinesiology College of Education and Human Services Introduction The School of Kinesiology (Formally the Division of

More information

Outpatient Therapy Services

Outpatient Therapy Services Outpatient Therapy Services Presented by WPS Medicare Provider Outreach and Education Updated March 2014 http://www.wpsmedicare.com/ Module 1 General Guidelines Acronyms OT Occupational Therapy PT Physical

More information

Provider Manual. Section 18.0 - Case Management and Disease Management

Provider Manual. Section 18.0 - Case Management and Disease Management Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute

More information

Pre-Screening and Risk Stratification

Pre-Screening and Risk Stratification Pre-Screening and Risk Stratification Chapter 1, 2 and 3 ACSM What is involved in the prescreening process? The Basic Goal To determine if it is safe for an individual to start an exercise program, what

More information

HOSPITAL AND SPECIALTY BEDS

HOSPITAL AND SPECIALTY BEDS HOSPITAL AND SPECIALTY BEDS BRIEF COVERAGE STATEMENT A hospital bed is defined as a single bed with a frame in three sections, so that the head or middle or foot can be raised as required. A specialty

More information

Memphis TGA Ryan White Part A & MAI Substance Abuse-Outpatient Standards of Care

Memphis TGA Ryan White Part A & MAI Substance Abuse-Outpatient Standards of Care PURPOSE Memphis TGA Ryan White Part A & MAI Substance Abuse-Outpatient The purpose of the Ryan White Part A and MAI Substance Abuse- Outpatient is to ensure that uniformity of service exists in the Memphis

More information