NHIA sues over transitional payment

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Friday, February 15, 2019

WASHINGTON – The National Home Infusion Association is suing the Department of Health and Human Services over its transitional payment for home infusion therapy services.

A final rule published in November 2018 limits reimbursement for professional services to only those days a “skilled professional is in the home.” Under CMS’s interpretation, reimbursement for services by pharmacists and other professionals services are not recognized, according to a press release.

“This rule undercuts Congress’ intent to ensure that Medicare beneficiaries can access these therapies in the safety and comfort of their own homes,” said Varner Richards, PharmD, chairman of the NHIA board of directors and a home infusion pharmacist in Columbia, S.C. “It simply doesn’t reflect the reality of how home infusion services are currently delivered and reimbursed.”

The rule implemented the transition payments on Jan. 1, 2019, through Dec. 31, 2020 to address a payment gap created by the 21st Century Cures Act.

NHIA and other home infusion stakeholders have sought to modify the regulations, which they say do not align with Congressional intent.

“We believe the agency violated the statute and have concluded that legal action is our only recourse for protecting the interests of our members and access to services by Medicare beneficiaries,’ said Connie Sullivan, NHIA president and CEO.