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CMS Issues Multiple Regulations Affecting Home and Alternate Site Infusion
November 4, 2021
This week, the Centers for Medicare & Medicaid Services (CMS) released a number of Medicare-related final rules for 2022 that directly or indirectly affect infusion providers. Following is a summary of the major highlights.
Medicare Physician Fee Schedule
The finalized rule for CY 2022 promotes greater access to telehealth services, updates payment rates for vaccine administration, and more. Of interest to infusion providers:
CMS will retire the Enteral and Parenteral Nutrition National Coverage Determinations (NCDs); thus, coverage will be defined by the Local Coverage Determinations (LCDs). NHIA advocated for revising rather than retiring the NCDs due to concerns about inconsistent policies at the local level. Revised medical coverage criteria for enteral and parenteral nutrition went into effect on September 5 and are expected to greatly improve access to this benefit. To learn more, watch this webinar.
Special coverage for COVID-19 treatments, including administration of monoclonal antibodies in the home, will remain in place for the remainder of the year in which the public health emergency is discontinued—through the end of 2022, at the earliest. NHIA’s comments to CMS on its proposed rule emphasized the lack of home infusion coverage for Medicare beneficiaries once the PHE ends.
The finalized rule for CY2022 aims to improve access to home health services for older adults and people with disabilities. It also updates payments rates and outlines quality reporting and provider requirements, among other things. Of interest to home infusion:
Home Infusion Therapy Services will continue to only be billable when a professional (nurse) is physically in the patient’s home on a day the covered drug is infused.
Initial visits will continue to be paid using the budget-neutral differential.
Payment rates for home infusion therapy services will continue to be adjusted geographically.
COVID-19 Vaccine Requirements for Employees and Health Care Workers
CMS and the Occupational Safety and Health Administration (OSHA) published interim final rules with request for comments regarding COVID-19 vaccine mandates. The CMS rule, which requires health care workers at Medicare and Medicaid facilities to be fully vaccinated by January 4, 2022 with no option for testing, has a 60-day comment period. The OSHA rule, which requires private sector employers with 100 or more workers to have their employees get vaccinated by January 4, 2022 or test negative for the virus once a week, has a 30-day comment period.
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) rule
Still pending is the release of the DMEPOS final rule, which may or may not reflect changes from the proposed rule issued near the end of the Trump administration. The proposed rule would have expanded the criteria for drugs covered under the Part B DMEPOS benefit. NHIA will notify members once this rule is released.
NHIA’s regulatory and advocacy team continues to review the details and will host a Talk Infusion update on November 30. Be sure to join us for a more thorough discussion and stay tuned for registration details.
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