VNS Health EasyCare Plus: Cardiac Rehabilitation Services (Cardiac Rehab)

Cardiac rehab reduces the chance of death in the 5 years after a heart attack or bypass by about 35%. It also improves heart failure status and outcomes.

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Cost
0% - 20% coinsurance
Prior Authorization Required
Yes
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  1. It is likely that the network hospital will have arranged for prior authorization for cardiac rehab prior to Phase 1 (while inpatient).

    • If authorization is uncertain, Contact the VNS Health EasyCare Plus Team at (866) 783-1444 (TTY 711) with questions.

  2. Obtain a network cardiologist clearance and order to engage in Phase 2 cardiac rehab following discharge from the hospital (outpatient).

  3. Schedule an initial appointment at a network facility selected by the network cardiologist.

  4. Attend the initial appointment and schedule ongoing sessions.

  5. Attend additional sessions, as scheduled.

  6. If transportation is needed to and from the appointment:

    • Call (877) 718-4219 (TTY: 711), M-F 8am-8pm, at least 48 hours in advance of the needed transportation.

    • Have the date, time, location, and reason for transportation ready when calling.

    • Receive authorization and guidance on scheduling the transportation service.

    • Get confirmation of scheduled transportation.

    • Use the transportation service to and from the appointment.

Availability
A max of 2 one-hour sessions per day for up to 36 sessions or 36 weeks

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Cardiac rehab is a physician-supervised program designed to improve cardiovascular health following a major cardiac event or existing chronic cardiac condition. It is defined by the World Health Organization (WHO) as “The sum of activity and interventions required to ensure the best possible physical, mental, and social conditions so that patients with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or resume their proper place in society and lead an active life.”

Comprehensive cardiac rehab programs and services include exercise, education, and counseling.  Intensive cardiac rehab programs contain the same elements as traditional cardiac rehab programs but are typically more rigorous or more intense.  These services are covered when administered in a physician’s office or hospital outpatient setting.  Some cardiac rehab is moving into the community and even home-based settings.

There are three defined phases to cardiac rehab: the clinical phase (1), outpatient cardiac rehab (2), and post-cardiac rehab (3).

Phase 1 begins in the inpatient setting soon after a cardiovascular event or completion of a cardiovascular intervention and includes assessment, education, physical therapy, and discharge planning.  There is usually a 3-6 week recovery period between Phase 1 and Phase 2, where healing and Phase 1 learning reinforcement occur (prior to cardiology clearing the patient for Phase 2).

Phase 2 occurs once a patient is stable and cleared by cardiology to begin outpatient cardiac rehab, where the exercise, education, and counseling begin.  Cardiac rehab is typically scheduled 2-3 days per week for about 3 months but can range anywhere from 2 to 8 months.  Attendance determines how long it will take to finish the program.  Those who attend regularly, as scheduled, tend to complete the program sooner.

Phase 3 is achieved when Phase 2 is successfully completed and involves more independence and self-monitoring, focused on increasing flexibility, strength, and aerobic conditioning.

Those who qualify for cardiac rehab:

Cardiac rehab is significantly underutilized, despite strong evidence that it supports immediate and long-term target health behaviors and lifestyle changes, producing higher quality of life outcomes.

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