FOR IMMEDIATE RELEASE
Contact: Scott Kesselman
scott.kesselman@nhia.org
703-993-0081
Alexandria, VA (March 12, 2024)—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. 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 2024 recommendations, designed to be incorporated into contracts between health plans and home and alternate site infusion providers, deal with issues such as value-based programs, billing secondary payors, prior authorization, ensuring patient care during emergencies, and so on. Each recommendation includes a detailed rationale and proposed metrics to promote data collection as a means of assessing the success and impacts of these proposed policy changes.
The recommendations are largely the result of the association’s payor summit, held in the fall of 2023. At that meeting, payor representatives with responsibilities for benefit structure, network decisions, value-based programing, and specialty pharmacy policy were invited to discuss ways to improve access and efficiencies associated with home and alternate site infusion services.
Among NHIA’s 7 recommendations, the association encourages payors to remove prior authorization requirements for infusion nursing and discontinue policies that place arbitrary caps on the number of infusion nursing visits.
NHIA also recommends Medicare Advantage (MA) plans mirror commercial health plan infusion coverage by using the HCPCS home infusion S-code billing system to offer home infusion coverage for the widest range of infused drugs, facilitate timely discharge from facilities, and improve access for rural patients and those with disabilities.
“NHIA appreciates the receptiveness from payors to suggestions for how infusion providers can better support health plans and their beneficiaries,” said Connie Sullivan, BSPharm, NHIA’s President and CEO. “Many health plans already recognize the value of outpatient and home-based infusion therapy, and we look forward to ongoing collaboration with payors to further align infusion contracts with the patient care capabilities of our members.”
To learn more about NHIA’s efforts to expand outreach to commercial payors and to see the 2023 payor recommendations, go to https://nhia.org/advocate/commercial-payors/.
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NHIA is a trade association that represents companies accredited to provide medically necessary infusion therapies to patients with acute and chronic health conditions, as well as companies that manufacture and supply infusion related products and services. Infusion therapy involves patient-specific compounded medications, supplies, and a range of pharmacy, nursing, and other clinical services for delivering care to patients in the home or suite setting.
