NHIA urges caution on policy changes

Thursday, November 5, 2020

ALEXANDRIA, Va. – The National Home Infusion Association says it’s encouraged by CMS’s acknowledgement that broader access to home infusion services is necessary, but it urges the agency to use caution with any proposed changes to coverage policies. In a recently published proposed rule, CMS proposes expanding the classification of external infusion pumps. “While CMS appears to recognize the need to expand access to home infusion, including for patients suffering from rare diseases, this approach fails to truly modernize the Part B benefit and adds confusion for physicians, providers and beneficiaries relying on these services,” said NHIA President & CEO Connie Sullivan, BSPharm. “We look forward to providing comments on this and other approaches to expanding coverage for home infusion.” Under the proposal, CMS would clarify that, in those circumstances in which an individual is unable to self-administer certain drugs, such drugs can be covered as a supply necessary for the effective use of an external infusion pump under the DME benefit, and that both the pump and the associated supplies can be covered under the DME benefit if reasonable and necessary, but only if the associated home infusion therapy services are also furnished and covered by Medicare. Despite the intent of the proposal, NHIA has concerns that this approach will jeopardize coverage for life-saving therapies for the thousands of beneficiaries relying on existing coverage of home infusion drugs under Medicare Parts B and D. The association believes CMS’s proposed policy changes will have far-reaching impacts and is concerned that the agency is under-estimating the unintended consequences of this proposed policy.