Groups Call on CMS to Modify Medicare Home Infusion Benefit

As people are urged to stay home during the COVID-19 pandemic, CMS has been relaxing a series of health care service policies in support of this need. But one change it hasn’t made is to allow home infusion to be fully covered for all Medicare beneficiaries. Numerous industry stakeholders and members of Congress are pushing for a waiver to allow this to happen.

Traditionally, Medicare reimbursed for home infusion drugs but not the professional services associated with the infusions themselves. This changed in December 2016 with the signing of the 21st Century Cures Act, which established a reimbursement structure for the professional services that are provided with home infusion therapies (RSP 2/18, p. 1). However, this does not take effect until Jan. 1, 2021. But the Cures Act also changed the payment methodology for Medicare Part B drugs furnished through durable medical equipment (DME) starting Jan. 1, 2017, with a handful of drugs seeing a steep decline in reimbursement.

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy (formerly called Specialty Pharmacy News) since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at HemAware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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