Failing to get through to CMS, NHIA makes its case in court

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Friday, February 22, 2019

WASHINGTON – Stakeholders say they were left with no other options when they filed a lawsuit against the U.S. Department of Health and Human Services over its transitional payment for home infusion services.

“We have been fighting this at every level and made no progress,” said Sharon Pearce, vice president of government affairs for the National Home Infusion Association. “We really tried to find a resolution, but their thinking and position hasn’t moved one inch from the final rule.”

The final rule, published in November 2018, implemented the transitional payments on Jan. 1, 2019, through Dec. 31, 2020, to address a payment gap created by the 21st Century Cures Act. However, the rule limits reimbursement for professional services to only those days a “skilled professional is in the home.”

When Congress passed the Cures Act and the transitional payment, it was clear on how home infusion was supposed to be paid for, says Pearce.

“Payment is to be made per IV administration day and, for these services to take place, this is how it needs to be reimbursed,” she said. “We’re going on two months now under this new system and these providers are now getting underpaid for their services. It’s going to affect patient care.”

The lawsuit, filed Feb. 14 in the U.S. District Court for the District of Columbia, seeks to: change regulations to comply with statute requirements, including “faithfully implementing the statutory definition of infusion drug administration calendar day;” withdraw or suspend the final rule until it is brought into compliance with the statute; and make prompt payments that have been withheld as a result of the final rule.

Pearce says the association hopes to make its arguments in late spring and receive a decision sometime this summer.

“Given that we have only a two-year window under this rule, we feel like we need to have an expedited process,” she said.