NHIA: CMS still doesn’t get it

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Tuesday, September 3, 2019

WASHINGTON – CMS’s recent proposed rule on payments for home infusion services “rearranges dollars,” but fails to fix fundamental structural issues with the benefit, says the National Home Infusion Association.

Stakeholders had hoped the proposed rule, released in July, might contain changes to CMS’s plan to limit reimbursement for professional services to only those days a “skilled professional”—which it defines as a nurse—is in the home.

“We were hoping they would reconsider and take our comments and all the feedback that our industry has sent them under consideration,” said Connie Sullivan, CEO.

Instead, CMS has proposed, among other things, higher payment amounts for the first home infusion therapy visit, along with a small decrease in the payment amounts for each subsequent visit to make the adjustments budget neutral.

The proposed rule does acknowledge that there’s a certain amount of care coordination and other services needed besides nursing, says Sullivan, but CMS wants to pay for those services either through the nursing payment bundle or under the DME benefit—something the NHIA disagrees with.

“They are saying that the DME benefit is there to ensure coverage of equipment and supplies, and ensure patients understand how to use those supplies,” she said. “But we would argue that the front-end work is heavier on the pharmacy end to coordinate the benefit and the clinical assessment that is done to get the patient onboard.”

Not taking no for an answer, NHIA in February filed a lawsuit against the U.S. Department of Health and Human Services in federal court over its “skilled professional” requirement. It is currently waiting for the judge to schedule oral arguments, said Sullivan.