CMS finalizes temporary payment for infusion services

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Thursday, November 1, 2018

WASHINGTON – CMS has finalized a rule that includes a temporarily transitional payment for home infusion services, and implements a new home infusion therapy benefit.

The rule, originally published in July, implements the transition payments effective Jan. 1, 2019, through Dec. 31, 2020, prior to a new permanent home infusion therapy services beginning on Jan. 1, 2021. The temporary payments, required by the Bipartisan Budget Act of 2018, address a payment gap created by the 21st Century Cures Act.

The final rule also establishes health and safety standard for home infusion providers as part of a new infusion therapy service benefit, and establishes the approval and oversight process for accrediting organizations of these providers, as required by the 21st Century Cures Act.

CMS states that is it seeking further comments on its interpretation of “infusion drug administration calendar day” and its potential effects on access to care. Industry stakeholders have expressed concerns about this interpretation, which they say doesn’t take into consideration how infusion drugs are typically administered. Specifically, the agency wants to require a nurse to be present on the days when a drug is administered in the home to receive payment, but it is not uncommon for infusion drugs to be administered without a nurse, they say.

"At a time when private payers, Congress and beneficiaries are seeking to modernize health care delivery, the final home infusion rule doubles down on the payment policy of yesteryear," said Bill Noyes, interim executive vice president for the National Home Infusion Association. "Unfortunately, the result will be more hospitalizations and nursing home visits for beneficiaries, and a higher bill for the taxpayer." 

In a press release, BioScrip the largest independent provider of home infusion services, said it disagrees with the CMS’s interpretation.

“Based on CMS’s final rule, we are evaluating the future treatment of Medicare beneficiaries, while also considering next possible steps to ensure this new transitional benefit is implemented as Congress intended,” said Dan Greenleaf, president and CEO.