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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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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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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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

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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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