NHIA provides resources and references to help commercial health plans better understand and utilize outpatient infusion services. Home and alternate sites are well established sites of care for infusion services that can help payors improve patient outcomes and experiences, reduce administrative burden, improve timely access to patient-preferred services, and reduce the total cost of care. The home has proven over decades that it is a safe and effective1,2 and patient-preferred model1 providing significant cost savings1,3,4 over inpatient settings.
Payor Recommendations
NHIA has published recommendations for commercial, Medicaid, and Medicare Advantage payors to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services. By removing barriers to outpatient infusion services, payors can reduce the total cost of care by avoiding or shortening hospital stays, reducing emergency department use, and preventing admissions to long-term care facilities.
The recommendations, designed to be incorporated into contracts between health plans and home and alternate site infusion providers, are largely the result of NHIA-hosted payor summits where payor representatives were invited to discuss ways to improve access and efficiencies associated with infusion services.
Payor Advisory Council
In order to build an ongoing dialog with payors about leveraging the value of alternate site infusion services NHIA launched its Payer Advisory Council (PAC). The Council plays an important role developing policies that promote cost-effective site of care options that are patient accessible as new drug therapies come to market and the health care delivery landscape evolves.
Through the council, NHIA engages on behalf of members with leaders from the payor community who are responsible for infusion policy to share industry trends in access and utilization, and discuss and evaluate novel approaches for how home and alternate sites of care can support:
Interested payors
Interested payors can reach out to schedule a conversation about participating.
Additional Resources
NHIA National Coding Standard
This document, which is widely used by payers and providers throughout the United States, presents the HCPCS (Healthcare Common Procedure Coding System) per diem “S” codes as a comprehensive coding system for home infusion therapy claims and provides procedures for their use, information about what’s included in the home infusion per diem, and detailed coding examples for both typical and unusual claims scenarios that payers and providers are likely to encounter. It also includes procedures and examples for services provided in the Ambulatory Infusion Suite of the Home Infusion Therapy Provider (AIS).
Per Diem Definition
As related to reimbursement, the term “per diem” represents each day that a given patient is provided access to a prescribed therapy, beginning with the day the therapy is initiated and ending with the day the therapy is permanently discontinued. This definition is valid for per diem therapies of duration of up to and including every 72 hours. Therapies provided beyond this range (weekly, monthly, etc.) fall outside of the per diem structure, and should have separate reimbursement rates that are specified on a contractual or other basis.
NHIA Home Infusion Drug List
The National Home Infusion Association (NHIA) Home Infusion Drug List contains the names and therapeutic categories of drugs that were compiled from medication dispensing reports submitted by home infusion providers and reflects current prescribing practices in the United States.
References
1. https://pubmed.ncbi.nlm.nih.gov/28668202/
2. https://nhia.org/infusing-safety-comparing-oncology-infusion-outcomes-at-home-infusion-services-vs-hospital-based-outpatient-infusion-centers/
3. https://nhia.org/cost-savings-home-versus-inpatient-infusion-therapy/
4. https://www.tandfonline.com/doi/full/10.1080/13696998.2023.2194185
NHIA has developed recommendations for commercial, Medicaid and Medicare Advantage payors to reduce administrative burden and remove barriers to accessing certain infusion services.
Designed to be incorporated into contracts between health plans and home and alternate site infusion providers, the recommendations deal with issues such as specialty networks for certain drugs; coordinating the provision of drug, supplies and services; covering preventative services; streamline authorization procedures; and more. Each recommendation includes a detailed rationale and proposed metrics to promote data collection by providers as a means of assessing the success of these proposed policy changes.
By removing barriers to outpatient infusion services, payors can reduce the total cost of care by avoiding hospital stays and emergency room visits, limiting hospital outpatient department use, and preventing admission to long-term care facilities.
The National Home Infusion Association (NHIA) has developed recommendations for commercial, Medicaid, and Medicare Advantage payors to improve patient outcomes and experience, reduce administrative burden, and improve timely access to home infusion services.
The National Home Infusion Association (NHIA) is pleased to hold its second annual one-day Payor Summit. The event, designed to bring together representatives from commercial health insurance plans with home and specialty infusion leaders, will
The National Home Infusion Association (NHIA) is pleased to announce that it successfully petitioned the Centers for Medicare and Medicaid Services (CMS) to secure a new billing code for injectable immunotherapies and revise an existing
The National Home Infusion Association (NHIA) has prepared a white paper summarizing the impact of cost increases incurred by infusion providers due to pandemic-related supply shortages with a particular focus on parenteral nutrition (PN) components
