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Will the Home Infusion Reimbursement (HIR) Changes Effect Your Agency?

September 02, 2020
Compliance By Patty Klinefelter, Director

According to the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) MM11880, the 21st Century Cures Act amended sections of the Social Security Act, requiring the Secretary to establish a new Medicare Home Infusion Therapy (HIT) services benefit, effective January 1, 2021.

 

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The Medicare HIT services benefit covers professional services, including nursing services furnished in accordance with the plan of care, patient training and education not otherwise covered under the durable medical equipment benefit, remote monitoring, and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier.

The Act defines a home infusion drug as a parenteral or biological drug that is administered intravenously or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment. Infusion drugs do not include insulin pump systems, self-administered drugs, or biologicals on a self-administered drug exclusion list. Drugs are on the self-administered drug exclusion list if more than 50% of Medicare beneficiaries are able to self-administer the drug.

Drugs identified for coverage of home infusion therapy services are paid under the Part B Durable Medical Equipment (DME) benefit; therefore, services related to furnishing the drug, remote or otherwise, are paid under the DME benefit. This includes services by the DME supplier, such as preparation and dispensing of the drugs and education and training on how to effectively and safely use the DME equipment.

According to CMS, reimbursement will be in the form of a single bundle payment, per calendar day, varying based on the different types of infusion therapy and utilization of nursing services by therapy type. CMS finalized the definition of infusion drug administration calendar day in regulation as the day on which HIT services are furnished by a skilled professional(s) in the individual’s home on the day of infusion drug administration. The skilled services provided on such day must be so inherently complex that they can only be safely and effectively performed by or under the supervision of professional or technical personnel.

The HIT benefit differs from the home health benefit in that the home infusion patient does not need to be homebound. Also, effective January 1, 2021, home infusion therapy will no longer be provided to homebound patients under the home health benefit. Home infusion therapy services will be covered under the home infusion benefit for both homebound and patients who are not homebound.

There may be times  a patient is enrolled in home health while receiving home infusions. If the home health services are not related to the home infusion, visits may be billed under the home health benefit. A patient may use the home health and HIT services concurrently. If the home health agency is a HIT provider and a home health provider, the services related to the infusion must be billed using the HIT benefit and visits related to home health to the home health benefit.

In addition, if your home health agency is not a HIT provider you may consider contracting with a HIT provider to provide the in-home infusion services.

 

 For more information, contact Patty Klinefelter at 540-686-1311 or email PKlinefelter@LW-Consult.com.

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