Starting in 2021, Medicare patients could have access to a new permanent home infusion benefit. The Center for Medicare & Medicaid Services (CMS) proposed the benefit in July as part of its proposed home health payment rule, with the goal being to move more care into the home.
While some view the proposed benefit as a win and an opportunity creator for home health care companies, others argue the benefit is “deeply flawed” and doesn’t go far enough.
Home infusion is the at-home delivery of a drug directly into a patient’s vein through a needle or catheter. Currently, Medicare only offers home infusion benefits to certain patients.
While Congress passed the 21st Century Cures Act in 2016 to offer a home infusion benefit, the start of those benefits was delayed until 2021. On top of that, reimbursement changes in recent years have made it difficult for patients already receiving Medicare-covered home infusions to afford the services.
However, the aim of this proposed benefit, which would take effect in 2021, is to change that, giving the patients the choice to receive care in their homes.
“We are proud to announce the new permanent home infusion therapy benefit that will give patients the freedom to safely access critical treatments, such as chemotherapy, at home instead of traveling to the hospital or doctor’s office, improving their quality of life,” CMS Administrator Seema Verma said in a press release following the proposed rule’s release.
In addition to chemotherapy, other examples of home infusion include immune deficiency and anti-infective treatment. All three would be Medicare-reimbursable if the home infusion benefit takes effect.
“This is fantastic,” Laizer Kornwasser, President and COO of CareCentrix, told Home Health Care News. “We believe that patients want to be treated in the home when they’re able to. This allows for patients to be treated in the home. It’s a win-win for patients, and it provides tremendous opportunity for [home health] providers.”
Hartford, Connecticut-based CareCentrix is a post-acute and home health care solutions company that works with a network of providers to help ensure patients get the right services at the right time, in the right location. The company also takes on readmissions risk for post-acute care providers a full 90-days post-discharge, Kornwasser said.
Overall, he says CareCentrix’s home health clients are excited about the prospect of delivering home infusion using the proposed benefit in the years to come.
“From what I’ve heard, people are embracing the fact that this will open up more volume coming to the home, and it will create opportunity,” Kornwasser said.
While many logistics surrounding how the proposed benefit will work remain unclear, CMS has proposed breaking home infusion medications down into three payment categories, in addition to paying higher reimbursements for initial home infusion visits, while slightly decreasing reimbursements to follow.
On top of creating opportunities for home health providers, the benefit could also mean a huge cost savings for Medicare. The Congressional Budget Office previously estimated that a home infusion benefit could reduce Medicare spending by $372 million through 2026.
“As you move care into the home, costs go down,” Kornwasser said. “You’re not paying all the fees that are associated with hospital settings. You’re not paying for transportation. [And] you’re also increasing compliance with therapy treatment by making it more convenient for the patient.”
‘Deep Flaws’
Not everyone is sold on the idea that the proposed benefit will be able to move a large number of Medicaid-covered infusion patients into the home.
Take Option Care Health Chief Strategy Officer Richard Denness, for example.
“The proposed CMS rule is deeply flawed because it limits reimbursement for home infusion services to just the days when a nurse is present in the patient’s home,” Denness told HHCN. “The proposed rule does not reflect the reality of how most patients receive home infusion therapy.”
Bannockburn, Illinois-based Option Care Health is one of the largest home infusion providers in the country, serving patients in all 50 states and delivering more than 2 million home infusion doses each month across all therapy areas.
Denness says the proposed benefit misunderstands and devalues all the elements that go into home infusion, leaving the cost of the service still largely out of reach.
“For most patients, a nurse is only present once per week, and home infusion therapy is coordinated by specialty pharmacists who design the therapy in coordination with a patient’s physician, assess the patient, monitor for adverse drug reactions, coordinate care with a care team and make modifications to the plan of care as necessary,” he said.
Without access to reimbursement for professional services, home infusion can be unaffordable for Medicare patients, Denness said.
As such, Option Care Health continues to work with other members of the National Home Infusion Association (NHIA) to advocate for improved reimbursement from CMS.
“Any patient that is a candidate for home infusion should have that option, and we’re working to help make that possible,” Denness said.
CMS is accepting comments on the proposed rule, which includes the permanent home infusion benefit, through September 9.
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