NATION'S HOME INFUSION PROVIDERS URGE CMS TO RECONSIDER DECISION TO INCLUDE CERTAIN HOME INFUSION THERAPIES IN COMPETITIVE BIDDING PROGRAM
(WASHINGTON, DC, April 19, 2011)--The National Home Infusion Association (NHIA) today urged the Centers for Medicare and Medicaid Services (CMS) to reconsider its April 17, 2012, decision to include certain home infusion therapies in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program's re-bid of the Round One contracts. NHIA represents the more than 400 independent local and regional home infusion pharmacies; national home infusion providers; and hospital-based home infusion organizations that provide infusion therapy services to more than one million patients a year at the home or in an outpatient setting.
"Tuesday's decision to include infusion in the Round One re-bid is very surprising and disappointing, given CMS' previous decision to exclude home infusion therapy from the initial Round One, the re-start of Round One, and most recently Round Two of the competitive bidding program," said NHIA President and CEO Russell Bodoff.
"Infusion should continue to be excluded from the DMEPOS competitive bidding program," said NHIA Board Chair, Mary Ann Cope, President, HomeChoice Partners, Inc. "Home infusion therapy is one of the most service-intensive and invasive therapies covered under Part B of the Medicare program. The Medicare program should avoid the illogical situation where it is encouraging infusion pharmacies to participate in Part D for the provision of home infusion therapy, while limiting their participation in Part B for the provision of other home infusion therapies," Cope added.
A common occurrence among infusion patients is the need for more than one therapy, where one treatment is Part B-covered (cancer drug), and a second therapy (IV antibiotic) is Part D-covered. Under competitive bidding, the patient may have to receive services from more than one infusion pharmacy because the infusion pharmacy that supplies the Part D drug may not be a contract supplier under the competitive bidding program for the Part B-covered home infusion therapy.
Presently, Congress is considering legislation that would create a comprehensive and coordinated home infusion therapy benefit under Medicare. Subjecting home infusion therapy to the competitive bidding program would needlessly complicate Medicare reimbursement for an area with such complex, unresolved issues. Home infusion therapy has been covered by private insurers for more than three decades and has proven itself to be a safe, cost-effective alternative to institutional care, allowing infusion patients to be treated in the comfort of their own homes. This form of therapy is clinically possible in the home primarily because of the specialized professional services provided by home infusion pharmacies and the trusting relationship between patient, physician and pharmacist. "The DMEPOS competitive bidding program was designed largely for product-driven therapies. Subjecting Part B-covered home infusion therapy to competitive bidding may expose Medicare beneficiaries to needless risk of substandard care. Ultimately, this is not in the best interest of the patient or the viability of the nation's healthcare system. This policy decision should be withdrawn," said Bodoff.
NHIA, based in Alexandria, VA, represents and advances the interests of organizations that provide infusion and specialized pharmacy products and services to the entire spectrum of home-based patients. It is the leading voice in representing the interests of older and disabled Medicare patients denied home infusion coverage. For more information, visit www.nhia.org