Home Infusion Therapy Services
Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. The components needed to perform home infusion include the drug (for example, antivirals, immune globulin), equipment (for example, a pump), and supplies (for example, tubing and catheters). Likewise, nursing services are necessary to train and educate the patient and caregivers on the safe administration of infusion drugs in the home. Visiting nurses often play a large role in home infusion. Nurses typically train the patient or caregiver to self-administer the drug, educate on side effects and goals of therapy, and visit periodically to assess the infusion site and provide dressing changes. The home infusion process typically requires coordination among multiple entities, including patients, physicians, hospital discharge planners, health plans, home infusion pharmacies, and, if applicable, home health agencies.
Medicare and Medicaid Programs; CY 2020 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; and Home Infusion Therapy Requirements
On October 31, 2019, The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period (CMS-1711-FC) updating the temporary transitional payment rates for home infusion therapy services for calendar year 2020, as required by section 50401 of the Bipartisan Budget Act of 2018. This final rule also finalizes beneficiary eligibility requirements and payment provisions related to the home infusion therapy benefit to be implemented beginning in CY 2021, as required by the 21st Century Cures Act. This final rule also solicits comments on options to enhance future efforts to improve policies related to coverage of eligible drugs for home infusion therapy. CMS seeks comments on the criteria CMS could consider, within the scope of the DME benefit, to allow coverage of additional home infusion drugs.
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.