December 21, 2021
On December 21, the Centers for Medicare and Medicaid Services (CMS) issued the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) final rule. Of note to home infusion providers, the agency is not finalizing its interpretation of the “appropriate for use in the home” requirement in the definition of DME as it applies to certain external infusion pumps.
CMS noted, “Many commenters believed that the proposal to expand classification of external infusion pumps as DME was unclear, needed more development, and raised safety concerns related to decisions regarding what drug therapies could safely be administered in a home/non-facility setting, as well as concerns about cost-sharing and cost-shifting to beneficiaries. After considering the public comments, CMS is not finalizing the proposed expanded classification of external infusion pumps as DME policy.”
In lengthy comments to CMS, NHIA cautioned against its strategy of attempting to expand home infusion access under the flawed, outdated Medicare Part B benefit, noting that, “the decision about whether to use an infusion pump should always be based on clinical judgment after performing a complete patient and therapy assessment” and not “a primary criterion determining coverage for home infusion.”
Instead, the association recommended that CMS not mandate that a pump be used in order for a drug to be covered and consider implementing a modern home infusion therapy services benefit that would provide for an alternate coverage path for drugs that do not require either an infusion pump.
“While we appreciate that CMS is interested in increasing access to more therapies in the home setting, NHIA is pleased that the agency did not finalize the proposed changes to the external infusion pump benefit under Part B,” said NHIA President and CEO Connie Sullivan, BSPharm. “Medicare beneficiaries deserve a safe, modern, and comprehensive home infusion benefit similar to what has been available in the commercial sector for over 40 years.”
CMS released its annual monitoring report[link] on the Medicare Part B Home Infusion Therapy (HIT) Services benefit showing that both provider participation and beneficiary utilization have declined over the past year.
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.
This week, during a House Energy and Commerce Health Subcommittee hearing on Health Care Spending in the United States, Rep. Debbie Dingell (D-MI) addressed Medicare costs and the potential for home infusion to lead to significant cost savings.
