- Under a new CMS proposal unveiled Thursday, Medicare patients will have access to a new permanent home infusion therapy benefit aimed at shifting care from healthcare settings to the home, starting in 2021.
- The push, part of changes housed within the Home Health Prospective Payment System proposed rule, also calls for $250 million in increased funding for home health agencies, or 1.3% over the current baseline. However, in an effort to combat fraud, CMS is planning to phase out prepayment for home health services.
- The agency is also proposing to allow therapist assistants to be able to provide maintenance therapy, rather than only therapists.
Home infusion therapy allows for the delivery of certain drugs, such as anti-infectives, chemotherapy or treatment for immune deficiencies, with the use of a durable medical equipment pump at a patient’s home.
The Medicare home infusion benefit, established by the 21st Century Cures Act, will reimburse for nursing services, patient training and education, remote monitoring services and monitoring services for home infusion therapy treatment.
Infusion pumps and home infusion drugs are separately covered by the Medicare Part B durable medical equipment benefit. Additionally, insulin pump systems and self-administered drugs or biologics on the self-administered drug exclusion list are not classified as a home infusion drug.
Under the new proposed rule, CMS will allow therapist assistants to provide care if allowed by individual state practice requirements. Industry requested the change in last year’s proposed rule.
"This proposed change would be consistent with regulations for skilled nursing facilities where therapist assistants can perform maintenance therapy; would allow therapist assistants to practice at the top of their state licensure; and would provide HHAs the flexibility to use either therapists or therapist assistants to meet the maintenance therapy needs of their patients," a CMS fact sheet states.
CMS is also ending requirements for a request for anticipated payment as it transitions to a system that doesn't prepay a portion of care.
"This is intended to prevent duplicate billing for supplies and therapy services that are bundled into the home health payment amount," the agency wrote. "CMS believes that phasing out the RAP may mitigate potential fraud and is an important step in paying responsibly and appropriately for home health services."