Infusion Therapy and Law

As we mentioned in part one of this blog series, one of the barriers for home infusion therapy is in regards to what expenses are covered by the Medicare fee-for-service program.  Most Medicare beneficiaries are part of this program, which includes many seniors or the disabled; who then find that the home infusion option is often unaffordable. Medicare will reimburse for the expense of the drugs involved, but not for the special equipment involved, along with the services needed to administer this home care.  With these high expenses not being covered, many opt to get the treatment needed in hospitals or other nursing facilities, which in turn comes at a greater expense to the Medicare program and an inconvenience to the patient.

The National Home Infusion Association (NHIA), an organization that represents and advances the interests of organizations that provide infusion and specialized pharmacy services, is in the process of trying to rectify this situation with Medicare. One of the goals of the NHIA is to be sure that the services offered are cost-effective and come at the highest quality possible.  Currently, their highest priority is to enact legislation that will bring coverage to Medicare patients when they need home infusion therapy.

A short timeline of efforts to expand coverage for home infusion therapy started in 2016 when the 21st Century Cures Act was enacted into law. This act included coverage for home infusion therapy services for certain drugs, pumps, and services effective January 1, 2021. Then in 2018, the Bipartisan Budget Act of 2018 was signed into law.  Section 50401 amended section 1834(u) of the Act, by establishing a home infusion therapy services temporary transitional payment for eligible home infusion items and services, starting January 1, 2019.  In August of 2018, ABT Associated brought together an expert panel to collect information and provide recommendations for support in developing the Medicare home infusion benefit that will take effect in 21st Century Cures Act. The Centers for Medicare and Medicaid Services issued a proposed rule updating the temporary transitional payment rates for 2020 in July of 2019. This rule also proposes beneficiary eligibility requirements and payment provisions beginning is 2021.

So, as noted above we will see more coverage provided through Medicare and become a requirement of all private insurance by 2021. The provisions enacted for help prior to 2021 should also allow for more people to take advantage of in-home therapy, and moving forward we should see expansion into providing more of these services at home. 

Champion is ready to answer the call for the need of medical seating for in-home use.  For more information, please contact us at 800-998-5018.