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NHIA Files Suit Against CMS Over Medicare Transitional Payment

On February 14th, NHIA filed a complaint in U.S. District Court against the Centers for Medicare and Medicaid Services (CMS) related to the agency’s Home Infusion Final Rule. Specifically, NHIA is challenging the Agency’s interpretation of “infusion drug administration calendar day,” which limits payment to only those days in which a “skilled professional is in the patient’s home.”

NHIA did not undertake this decision lightly. Since the rule was initially released, NHIA has fought tirelessly to convince CMS that their interpretation was contrary to Congress’ intent, which was to provide reimbursement for each day a patient received an infusion drug. We made legal, policy, and political arguments imploring CMS to recognize and reimburse pharmacy services that are provided remotely, in addition to the nursing services covered under the existing rule. Unfortunately, CMS’ refusal to recognize those services has left NHIA with little other choice than to pursue legal action.

On June 15, a U.S. district court dismissed NHIA’s case over the implementation of a Medicare home infusion therapy services benefit for a “lack of subject matter jurisdiction.” The lawsuit, filed in 2019 against the Department of Health and Human Services (HHS), argued that its final rule implementing a policy enacted by the Bipartisan Budget Act (BBA) of 2018 ignores the intent of Congress. The final rule, which was carried over to the permanent benefit under 21st Century Cures, limited provider payments to days when a “skilled professional was in the patient’s home,” rather than for each day that a drug is administered to a patient. The Association joined with several member providers whose claims for services were denied under the benefit to file the suit.

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