Home infusion stakeholders explore options

WASHINGTON - CMS continues to dig in its heels on the new home infusion benefit, leaving stakeholders considering a legislative fix.

In a proposed home health rule for 2021 released on June 25, the agency continues to limit reimbursement to only those days when a nurse is in the home.

“At this point, there's some questions as to what they believe exists within their regulatory authority,” said Shea McCarthy, director of legislative affairs for the National Home Infusion Association. “A legislative solution may, ultimately, be necessary to provide access to home infusion. Without a fix from Congress to address this, I fear that beneficiaries with Medicare fee-for-service will continue to have limited access to home infusion.”

More than 200 members of Congress have already signed letters calling on HHS and CMS to lift restrictions on home infusion during the public health emergency.

Stakeholders had hoped, given the current PHE, that CMS would revisit their “narrow interpretation” of the statue, says McCarthy.

“We are disappointed that the interest of patients and home infusion providers have again not been at the forefront of CMS's mind in policy decisions on this topic,” he said. “We've been really surprised, especially given the outpouring of support from stakeholders (across the continuum) that have not historically been engaged (with this issue).”

In April, more than 160 groups, including the ALS Association, Partners Healthcare System and Massachusetts General Hospital, announced support for a blanket waiver that would have allowed coverage for all home infusion therapies during the current public health emergency.

“Health systems are eager to free up hospital capacity for those patients that need those severe levels of care,” said McCarthy. “Areas of the country right now are experiencing a surge in earnest of COVID infections.”