Proposal overlooks full array of home infusion services

Stakeholders say it reads like a nursing benefit
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Friday, July 20, 2018

WASHINGTON – CMS’s proposal to establish a new home infusion therapy benefit has taken a wrong turn right out of the gate, say industry stakeholders.

Specifically, the agency wants to require a nurse to be present on the days when an infusion drug is administered in the home to receive payment. However, it is not uncommon for infusion drugs to be administered without a nurse, say stakeholders.

“(In the private sector), if that beneficiary is on your service you get paid, even on days when the nurse isn’t there,” said Ken van Pool, vice president of legislative affairs for the National Home Infusion Association. “For private pay, you would bill for the nursing separately, the drugs separately and then a per diem rate.”

The nursing requirement is part of a larger proposed rule published in the Federal Register July 12. The rule also seeks comments on standards for home infusion therapy suppliers, and an oversight process for organizations that accredit those suppliers.

The problem with the nurse requirement, says van Pool, stems from CMS’s definition of “professional services,” in which it only recognizes nursing as a professional service, but not pharmacy or case management services.

“To get this right, we need to provide a robust definition of professional services in the rule and it should include things like compounding the drug, case management services, and drug utilization review,” he said. “That way, they can adequately pay home infusion providers.”

NHIA says it is preparing to discuss the issue with CMS and with lawmakers, and is organizing grassroots efforts, as well, says van Pool.

“We want to be constructive and ensure that we have a good outcome out of this,” he said.

Additionally, the rule outlines steps to implement temporary transitional payments that are scheduled to take effect on Jan. 1, 2019, to fix a payment gap created by the 21st Century Cures Act.