Home Infusion Therapy (HIT) Supplier Benefit
12/10/2020
Home Infusion Therapy (HIT) Supplier Benefit
December 10, 2020
Mary Carr, Vice President for Regulatory Affairs, NAHC Jennifer Keiser, Senior Director, Pharmacy Product Management, Brightree LLC
? 2020 National Association for Home Care & Hospice
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10/7/2020
Home Infusion Therapy(HIT) Supplier Benefit
Mary Carr, V.P. for Regulatory Affairs, NAHC Jennifer Keiser. Sr. Director, Pharmacy Product Management, Brightree LLC
Home Infusion Therapy Supplier Benefit
? History ? Structure ?coverage, quality, and enrollment ? Payment and Billing ? Concerns and Considerations
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10/7/2020
History
? 21st Century Cures Act --2016 ? Established the HIT supplier benefit
? Covers professional services for Medicare Part B infusion drugs ? Medicare and HIT
? Reimbursement for Part B infusion drugs changed from the AWP to ASP ? Implementation date 1/1/2021 ? Professional services associated with Part B infusion drugs are carved out of the
home health benefit
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MC2
Transition Period
? Balanced Budget Act 2018 provided for a transition period ? January 1, 2019 through December 31, 2020 ? DME supplies enrolled as pharmacies ? Home health agencies may continue to provide the professional
service related to Part B infusion drugs
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Slide 4 MC2 Mary Carr, 9/30/2020
10/7/2020
Dual Benefits
? Part B "home infusion drugs" are drugs 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.
? Only certain infusion drugs are covered under Part B DME ( antifungals, chemotherapy, inotropic and some pain medications, IGs )
? Billed under the DME benefit
? The professional services for home infusion therapy (including nursing) are furnished in accordance with the plan, include training and education (not otherwise included in the payment for the DME), remote monitoring, and other monitoring services for the provision of home infusion therapy furnished by a qualified home infusion therapy supplier in the patient's home.
? Billed under the home infusion therapy supplier benefit
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Coverage
? A `qualified home infusion therapy supplier 'may be a pharmacy, physician, or other provider of services or supplier licensed by the State in which the pharmacy, physician, or provider or services or supplier furnishes items or services.
? Home health agencies may become HIT suppliers ? Must be accredited as a HIT supplier by a Medicare approved AO ? Must enroll in Medicare Part B ? HIT suppliers may subcontract for professional services
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