December 9, 2016

Dear NHIA Member:

On Wednesday, Congress passed the 21st Century Cures Act.  The President is expected to sign it into law next week. 

The Cures Act contains two provisions that significantly impact the home and specialty infusion industry. Section 5004 (a) changes the payment structure for infusion drugs under the Medicare Part B DME benefit from an Average Wholesale Price (AWP) metric to an Average Sales Price (ASP) payment methodology.  The move from AWP to ASP takes effect on January 1, 2017.  NHIA has long maintained that any change in reimbursement to infusion drugs under Part B should be accompanied by a separate payment for home infusion services commensurate with the reduction in drug reimbursement. 

Unlike AWP reimbursement rates, which have covered the cost of the infusion drugs and provided a margin for the professional services required for treatment, the new ASP pricing methodology carves away the payment for the professional services. This is problematic for beneficiaries and providers alike. Without a wraparound services payment going to providers, beneficiaries could well lose access to Part B DME home infusion therapies. Exacerbating the challenging reduction in reimbursement is the fact that the effective date is less than a month away.  Providers and their patients, who may need to transition to other sites of care, are left with little time to adjust.

A second provision contained in the Cures Act, section 5012, establishes a reimbursement structure for the professional services associated with Part B DME infusion drugs, but that provision does not take effect until 2021.  The new services reimbursement is a measure largely based on provisions contained in the Medicare Home Infusion Site of Care Act.  Taking those provisions and merging them into the Cures Act is certainly a welcomed step by Congress.  Unfortunately, the four-year gap in the dates between ASP taking effect and the implementation of a services payment creates a sizeable hole in reimbursement.  It is an immediate and significant concern for providers. Patients may find access to home infusion therapies limited during this period.

NHIA has outlined the problems and discussed these concerns with House and Senate legislators who have supported the Medicare Home Infusion Site of Care Act throughout 2015-2016.  A number of lawmakers have made positive statements indicating they want to address the problem early in 2017.  Nonetheless, NHIA is disappointed that Congress passed the Cures Act and approved an unsustainable period of four years without a mechanism for reimbursement of home infusion services.

Closing the gap between the date for ASP pricing and the implementation of the wraparound services payment is the top issue for NHIA.  At the same time, the Association will also work to get other provisions that have been integral to the Medicare Home Infusion Site of Care Act (e.g. a services payment related to Part D infusion drugs) approved by Congress.  

Even though Congress is getting ready to break for the holidays, we encourage everyone in the home infusion community to register their concerns immediately about the inequity of imposing an ASP-based reimbursement reduction without a commensurate payment for infusion services. Use the resources on the NHIA website to contact your representative and senators.  Ask them to modify the effective dates in order to close the gap in reimbursement. Visit the Association’s website for an NHIA analysis comparing the current Medicare Part B Drug AWP-based payments to the ASP-based reimbursement expected to start in January.  Register to attend NHIA’s December 15, 2016, legislative & regulatory webinar for additional information on these new provisions.

As NHIA makes a full-court press to close the gap between the services payment with the ASP reductions, we will need the support of all of you.  The best way to get the attention of Congress and to achieve the fix that is needed is to make sure everyone on Capitol Hill understands the magnitude of the problem.  We will work with all of you to make that happen.

 

Tyler J. Wilson
NHIA President & CEO

Danette Frauenholtz
NHIA Board Chair

 

 

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