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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.

NHIA has negotiated an expedited briefing schedule and expect to get the merits before the Court quickly. Our hope is that the case will be litigated and a judgement rendered by early-mid Summer.

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