Pull home infusion from bid program, stakeholders say

Friday, November 22, 2013

ALEXANDRIA, Va. – Home infusion stakeholders say they are eyeing possible legislative fixes to address the inclusion of the therapy in competitive bidding.

“The main game in town is the market-pricing program bill,” said Ken Van Pool, vice president of legislative affairs for the National Home Infusion Association (NHIA). “If there was a way we could resolve our problem within that bill, that would be great.”

The association is also considering other vehicles, like the “doc fix” bill, which is expected to be passed before Congress recesses for the year. With any legislation, however, NHIA wants to ensure the Department of Health and Human Services secretary has discretion to pull those items out of competitive bidding.

Time is running out. The program is set to kick off Jan. 1. The single payment amounts for the Round 1 re-compete, released Oct. 1, showed an average reduction of 21% in the home infusion category.

That’s misleading, however, says the NHIA, because, out of about a dozen product codes included in competitive bidding, only three actually apply to the home infusion market: the ambulatory infusion pump (E0781); and two supply kit codes (A4221 and A4222). The other codes are for obsolete equipment that is rarely used or are related to insulin pumps—which home infusion providers typically don’t provide, says the NHIA’s Bill Noyes.

The association has been in constant contact with the Competitive Bidding Implementation Contractor and the National Supplier Clearinghouse to share a host of concerns, including patient safety issues.

“We haven’t had a response to the questions we’ve asked,” said Noyes, vice president of health information policy.

Although NHIA will continue to press its case, the association is also looking ahead to January, when new and existing patients will need to find a contract supplier. NHIA is urging members to document any problems, says Van Pool.

“If people are missing their drugs because they are between providers, the problem doesn’t go away after a few days,” he said. “It’s a drug issue that could become very serious very quickly.”