With the Patient-Driven Grouping Model (PDGM) ruling out therapy volume as a driving factor for reimbursements, home health agencies are challenged to explore ways to optimize utilization and revenue base.
The new Medicare Home Infusion Therapy (HIT) benefit, which took effect on January 1st, 2021, holds the potential for home health agencies to offer a new service line. It covers the professional services, including nursing services, patient training, and education (not otherwise covered under the Durable Medical Equipment [DME] benefit), remote monitoring, and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier.
Essentially, this category covers the service component of safe and effective administration of certain drugs. Here is a rundown of the criteria for skilled services to be covered under the HIT benefit:
- Covered services include patient evaluation and assessment, training and education of patients and their caretakers, assessment of vascular access sites and obtaining any necessary bloodwork, and evaluation of medication administration.
- Skilled services provided must be complex enough that they can only be safely and effectively performed/supervised by a professional.
- The patient must be under the care of a physician, nurse practitioner, or physician’s assistant in accordance with an established Plan of Care (POC) that prescribes the type, amount, and duration of infusion therapy services that must be periodically reviewed by a physician.
- Patients must receive the drugs at home and through an external infusion pump.
- The drugs must be either IV or subcutaneous and have an administration period of 15 minutes or more and less than five hours.
- Infusion pumps and supplies are covered under the Part B DME benefit, and the DME supplier is responsible for the delivery and setup of the equipment and training and education on the operation of the infusion pump.
- The DME benefit also covers pharmacy services (i.e. drug preparation and dispensing).
The home health agency and the HIT supplier can be the same organization. Agencies that meet the qualifications can also be accredited as HIT suppliers and can offer it as a specialty service. Since the HIT benefit does not require patients to be homebound nor needing other skilled services, these agencies can offer HIT as a standalone service.
If the home health agency is NOT accredited as a HIT supplier, the agency would NOT be able to admit patients requiring the HIT services unless there is an accredited supplier willing to provide the service or the home health agency is subcontracted to provide the service.
While a lot of agencies have yet to explore this new opportunity, there is still confusion about how it really works. It is important for agencies to fully understand the dynamics of this new benefit and strategically assess if it is highly beneficial for them to pursue in order to diversify their income source.