12/18/2019

CMS Releases Info on New Home Infusion Therapy Benefit

An MLN SE article regarding the new Home Infusion Therapy (HIT) Benefit under Medicare Part B was recently released.  MLN SE19029 Medicare Part B Home Infusion Therapy Services With The Use of Durable Medical Equipment is intended for entities seeking accreditation to become qualified suppliers that furnish HIT services in coordination with the furnishing of home infusion drugs administered through an item of durable medical equipment (DME) beginning in calendar year 2021 and in subsequent years.

As reported previously, the 21st Century Cures Act (Act) included a provision that called for the development of new home infusion therapy benefit under Medicare Part B. The Medicare HIT benefit is for coverage of HIT services for certain drugs and biologicals administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual, through a pump that is a DME item. This benefit is effective January 1, 2021.

Once the home infusion therapy supplier benefit becomes a permanent coverage for Part B, infusion services will be carved out of the home health benefit. Therefore, only accredited home infusion therapy suppliers will be able to bill Medicare for these services. While it will still be possible for home health agencies to provide these professional services under contract with a Part B HIT supplier, a home health agency wanting to bill Medicare directly for these services will need to enroll in Medicare Part B as a home infusion therapy supplier and bill the services on a professional claim (1500/837P).

The new HIT benefit covers the service component, meaning the professional services, training and education (not otherwise covered under the DME benefit), and monitoring furnished by a qualified HIT supplier needed to administer the home infusion drug in the patient’s home. The DME benefit covers three components: the external infusion pump, the related supplies, and the infusion drug. Additionally, this benefit covers the related services required to furnish these items (e.g., pharmacy services, delivery, equipment set up, maintenance of rented equipment, and training and education on the use of the covered items) by an eligible DME supplier. No payment is made under the HIT benefit for these DME items and services.

Qualified HIT suppliers can only bill and be paid for the HIT services furnished on the day on which a professional is physically present in the patient’s home and an infusion drug is being administered on such day. Medicare payment for an infusion drug administration calendar day is separate from the payment for DME items and services.

This MLN SE article provides a detailed summary of the HIT benefit, including a graphic that depicts what is covered under the HIT benefit and what is covered under the DME benefit as well as a table that outlines the billing codes to be used.  CMS provides examples of the types of services that would be considered professional services covered by the HIT.

A qualified home infusion supplier must be accredited by a CMS-approved accreditation organization prior to providing services under the HIT benefit. To locate or inquire about an approved accreditation organization, you may submit a question to the CMS HIT Accreditation mailbox at HITaccreditation@cms.hhs.gov.  Accrediting organizations have until February 2020 to apply for authority to accredit HIT suppliers. 

(Shared from NAHC)