Home Infusion Therapy Services

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(The Content below is taken from the Centers for Medicare & medicaid Services: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html)

Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Certain drugs can be infused in the home, but the nature of the home setting presents different challenges than [other settings]. The components needed to perform home infusion include the drug (for example, antivirals, immune globulin), equipment (for example, a pump), and supplies (for example, tubing and catheters). Likewise, nursing services are necessary to train and educate the patient and caregivers on the safe administration of infusion drugs in the home. Visiting nurses often play a large role in home infusion. Nurses typically train the patient or caregiver to self-administer the drug, educate on side effects and goals of therapy, and visit periodically to assess the infusion site and provide dressing changes. Depending on patient acuity or the complexity of the drug administration, certain infusions may require more nursing time, especially those that require special handling or pre-or post-infusion protocols. The home infusion process typically requires coordination among multiple entities, including patients, physicians, hospital discharge planners, health plans, home infusion pharmacies, and, if applicable, home health agencies.

On October 31, 2018, CMS published a final rule with comment period (CMS-1689-FC).  This final rule implements temporary transitional payments for home infusion therapy services for calendar years 2019 and 2020, as required by section 50401 of the Bipartisan Budget Act of 2018 (see below). This final rule also establishes health and safety standards for qualified home infusion therapy suppliers for the full implementation of the home infusion therapy benefit. Finally, this final rule also establishes the approval and oversight process for accrediting organizations of these suppliers as required by the 21st Century Cures Act.

The 21st Century Cures Act

On December 13, 2016, the 21st Century Cures Act (the Cures Act) was enacted into law. Section 5012 of this new law amended sections 1861(s)(2) and 1861(iii) of the Act, and established a new Medicare home infusion therapy benefit. The Medicare home infusion therapy benefit is for coverage of home infusion therapy-associated professional services for certain drugs and biologicals administered intravenously, or subcutaneously through a pump that is an item of DME, effective January 1, 2021. Section 1861(iii)(2) of the Act defines home infusion therapy to include the following items and services: the professional services (including nursing services), furnished in accordance with the plan, training and education (not otherwise included in the payment for the DME), remote monitoring, and other monitoring services for the provision of home infusion therapy furnished by a qualified home infusion therapy supplier in the patient’s home.

Section 50401 of the Bipartisan Budget Act of 2018

On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. Section 50401 amended section 1834(u) of the Act, by adding a new paragraph (7) that establishes a home infusion therapy services temporary transitional payment for eligible home infusion suppliers for certain items and services furnished in coordination with the furnishing of transitional home infusion drugs beginning January 1, 2019. This temporary payment covers the cost of the same items and services, as defined in section 1861(iii)(2)(A) and (B) of the Act, related to the administration of home infusion drugs. The temporary transitional payment would begin on January 1, 2019 and end the day before the full implementation of the home infusion therapy benefit on January 1, 2021, as required by section 5012 of the 21st Century Cures Act.

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