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.

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