ABOUT THE ISSUE
On December 7, 2016, Congress passed the 21st Century Cures Act with two provisions that significantly affect the home infusion community. Sections 5004(a) changes the payment structure for infusion drugs under the Medicare Part B DME benefit from an Average Wholesale Price (AWP) metric to an Average Sales Price (ASP) payment methodology. The move from AWP to ASP took effect on January 1, 2017.
A second provision contained in the Cures Act, section 5012, establishes a reimbursement structure, based largely on provisions contained in the Medicare Home Infusion Site of Care Act, for the professional services associated with Part B DME infusion drugs to take effect in 2021. The gap between the two implementation dates will cause an unsustainable hole in reimbursement for home infusion services.
NHIA and the home infusion community is working to close the gap between ASP reimbursement and Part B DME coverage of home infusion drugs and to attain a services payment for Part D infusion drugs adopted by Congress.
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