CMS finalizes payment rules to spur greater use of innovative kidney drugs, home infusion

Home health senior nurse
The Centers for Medicare & Medicaid Services released final rules to encourage use of innovative kidney drugs and create a new permanent home infusion therapy benefit. (KatarzynaBialasiewicz/Getty)

The Trump administration finalized a new home infusion therapy benefit as part of a final home payment rule.

The Centers for Medicare & Medicaid Services (CMS) Home Health Prospective Payment System rule was finalized late Thursday. In addition to the new benefit, the rule also increases payments to home health agencies by an estimated $250 million for the calendar year 2020.

The home infusion therapy benefit—which will be implemented in 2021—will cover the administration of certain medication through a durable medical equipment pump in a patient’s home. It will also cover professional services such as nursing, patient education and training and patient monitoring.

“The new permanent home infusion therapy benefit increases the availability of home-based care by giving patients the choice and convenience to receive critical treatments, such as anti-infectives and chemotherapy, safety at home instead of a hospital or doctor’s office,” said CMS Administrator Seema Verma in a statement Thursday.

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The home health payment rule also implements a new case mix payment method for home health services that relies on a patient’s characteristics rather than the volume of care provided.

“Today’s final rule also rewards value over volume by focusing on patient information such as their diagnosis and other health conditions, to more accurately pay for home health services,” Verma said.

CMS will also start phasing out next year pre-payments for home health services and eliminate those payments completely by 2021.

“CMS has seen a marked increase in Request for Anticipated Payment (RAP) fraud schemes perpetuated by existing HHAs that receive significant upfront payments, then never submit final claims and close for business, making Medicare recoupment efforts impossible,” the agency said in a release Thursday. “CMS believes that eliminating RAP payments over the next two years would serve to mitigate potential fraud schemes.”

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The agency also finalized changes to the Medicare rules to durable medical equipment prosthetics, orthotics and supplies and the End-Stage Renal Disease Prospective Payment System. The rule aims to better target payment for innovative new renal dialysis drugs.

"These changes support the development and use of innovative technologies, provide greater access to new treatments in kidney care and modernize our program integrity methods to better combat waste, fraud and abuse in the Medicare program," the agency said in a release.