Home Infusion Therapy Services
Home infusion therapy is a treatment option for patients with a wide range of acute and chronic conditions, ranging from bacterial infections to more complex conditions such as late-stage heart failure and immune deficiencies. Home infusion therapy affords a patient independence and better quality of life, because it is provided in the comfort of the patient’s home at a time that best fits his or her needs. It may also reduce the risk of hospital-acquired infections and provide improved safety and better outcomes for patients. Infusion therapy typically means that a drug is administered intravenously, but the term may also refer to situations where drugs are provided through other non-oral routes, such as intramuscular injections and epidural routes (into the membranes surrounding the spinal cord). Diseases that may require infusion therapy include infections that are unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, and gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system. Other conditions treated with specialty infusion therapies may include some forms of cancers, congestive heart failure, Crohn’s Disease, hemophilia, hepatitis, immune deficiencies, multiple sclerosis and rheumatoid arthritis.
Medicare and Medicaid Programs: CY 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; Home Infusion Therapy Requirements; and Training Requirements for Surveyors of National Accrediting Organizations
On October 31, 2018, CMS published a final rule with comment period (CMS-1689-FC). This final rule implements temporary transitional payments for home infusion therapy services for calendar years 2019 and 2020, as required by section 50401 of the Bipartisan Budget Act of 2018. This final rule also establishes health and safety standards for qualified home infusion therapy suppliers for the full implementation of the home infusion therapy benefit. Finally, this final rule also establishes the approval and oversight process for accrediting organizations of these suppliers as required by the 21st Century Cures Act. We seek comments on our interpretation of “infusion drug administration calendar day” and its potential effects on access to care.
Section 5012 of the 21st Century Cures Act
On December 13, 2016, the 21st Century Cures Act (the Cures Act) was enacted into law. Section 5012 of this new law amended sections 1861(s)(2) and 1861(iii) of the Act, and established a new Medicare home infusion therapy benefit. The Medicare home infusion therapy benefit is for coverage of home infusion therapy-associated professional services for certain drugs and biologicals administered intravenously, or subcutaneously through a pump that is an item of DME, effective January 1, 2021. Section 1861(iii)(2) of the Act defines home infusion therapy to include the following items and services: the professional services (including nursing services), furnished in accordance with the plan, training and education (not otherwise included in the payment for the DME), remote monitoring, and other monitoring services for the provision of home infusion therapy furnished by a qualified home infusion therapy supplier in the patient’s home.
Section 50401 of the Bipartisan Budget Act of 2018
On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. Section 50401 amended section 1834(u) of the Act, by adding a new paragraph (7) that establishes a home infusion therapy services temporary transitional payment for eligible home infusion suppliers for certain items and services furnished in coordination with the furnishing of transitional home infusion drugs beginning January 1, 2019. This temporary payment covers the cost of the same items and services, as defined in section 1861(iii)(2)(A) and (B) of the Act, related to the administration of home infusion drugs. The temporary transitional payment would begin on January 1, 2019 and end the day before the full implementation of the home infusion therapy benefit on January 1, 2021, as required by section 5012 of the 21st Century Cures Act.
Home Infusion Therapy Technical Expert Panel (TEP)Abt Associates convened a Technical Expert Panel (TEP) on August 8, 2018 to collect perspectives and recommendations from a wide variety of industry experts and representatives to support development of the Medicare home infusion benefit as legislated in the 21st Century Cures Act. The TEP slides and summary [PDF, 975KB] are now available for download.
Home Infusion Therapy Payment Policy MailboxFor questions about home infusion therapy payment policy, send your inquiry via email to: HomeInfusionPolicy@cms.hhs.gov.
- Page last Modified: 11/20/2018 9:08 AM
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