NHIA makes payer recommendations

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid and Medicare Advantage payers to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services.  

The 2024 recommendations, designed to be incorporated into contracts between health plans and home and alternate site infusion providers, address value-based programs, secondary payers, prior authorization, patient care during emergencies, and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection to assess the success and impacts of these proposed policy changes. 

“NHIA appreciates the receptiveness from payers to suggestions for how infusion providers can better support health plans and their beneficiaries,” said Connie Sullivan, BSPharm, NHIA’s president and CEO. “Many health plans already recognize the value of outpatient and home-based infusion therapy, and we look forward to ongoing collaboration with payers to further align infusion contracts with the patient care capabilities of our members.” 

The recommendations are largely the result of the association’s payer summit, where payer representatives with responsibilities for benefit structure, network decisions, value-based programing, and specialty pharmacy policy were invited to discuss ways to improve access and efficiencies associated with home and alternate site infusion services. 

Among NHIA’s seven recommendations: 

• Remove prior authorization requirements for infusion nursing 

• Discontinue policies that place arbitrary caps on the number of infusion nursing visits. 

• Require Medicare Advantage plans mirror commercial health plan infusion coverage by using the HCPCS home infusion S-code billing system to offer home infusion coverage for the widest range of infused drugs, facilitate timely discharge from facilities, and improve access for rural patients and those with disabilities. 

To learn more about NHIA’s efforts to expand outreach to commercial payers and to see the 2023 payer recommendations, go to https://nhia.org/advocate/commercial-payors/.