Reimbursement

For several years, NHIA has been working to secure sustainable reimbursement for home infusion professional services provided to beneficiaries under the Medicare program.

Congress included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 requiring CMS to create both a permanent and transitional payment for home infusion professional services necessary to deliver Medicare Part B-covered home infusion drugs. The intent was for CMS to create a benefit that would cover all professional services, including nursing services, that are required to provide home infusions.

Unfortunately, in 2018, the Centers for Medicare and Medicaid Services (CMS) issued a policy that is already impairing seniors’ ability to receive infusion services in the safety and comfort of their homes. Under CMS’ current interpretation, home infusion therapy professional services are only reimbursed when they are delivered in-person in the patient’s home. Home infusion providers are not reimbursed when remote professional services (including pharmacy services, care planning, care coordination, remote monitoring, or round-the-clock emergency care) are furnished. This ruling prompted NHIA to take legal action against CMS. Learn more.

Further, in July 2019, CMS issued its CY 2020 Proposed Home Infusion Rule, which continues this deeply flawed policy. NHIA is engaged in a number of advocacy activities, including our litigation, legislative solutions, and regulatory advocacy, to combat this dangerous rule.

As we fight this policy, however, it is important that NHIA members understand and adhere to the rules. NHIA has assembled a collection of resources and materials that are included on the member-only resources page. NHIA member companies can use these resources to garner a full understanding of the regulation, including detailed analysis of the new law, answers to frequently asked questions, and insight into CMS’ implementation of the law.

The site also provides information on legislative and legal efforts underway to require CMS to reimburse for all professional related services and on each infusion drug administration calendar day.

 Information about the CY 2020 Proposed Home Infusion Rule

 

Reimbursement Resources

Learn how the transitional payment law is currently being implemented.


 

Reimbursement Archives: Advocacy and Policy Resources


 

 

Take Action!

Donate to the PITCH In Campaign to support NHIA’s Grassroots Efforts.

Click here