The 21st Century Cures Act, which was signed into law on December 13, 2016, called for the creation of a bundled payment for providers that supply home infusion therapy services to Medicare beneficiaries. A requirement of the Act stipulated that home infusion suppliers be accredited by an accrediting organization approved by the Centers for Medicare & Medicaid Services (CMS) to receive Medicare reimbursement.

Effective January 1, 2021, all home infusion therapy suppliers must be accredited to receive Medicare reimbursement.

Yes. CMS has recognized ACHC as a national accrediting organization for home infusion therapy suppliers. The decision gives ACHC deeming authority to conduct surveys that meet or exceed Medicare requirements, including the new reimbursement rules mandated by the 21st Century Cures Act.

Yes. All organizations that want to bill Medicare Part B for home infusion therapy services need an additional one-day survey to achieve Home Infusion Therapy Accreditation.

Each location is required to have its own NPI and PTAN numbers. If home health and private duty nursing providers want to provide services and bill separately, they must apply for a Medicare Part B billing number to bill for professional services provided in the client’s/patient’s home. This means that each location must be accredited.

Accredited home infusion therapy organizations can submit an 855B application form to their MAC. Organizations must include the application fee and a copy of their Home Infusion Therapy Accreditation certificate.

Yes. To provide home infusion therapy services, a home health agency that is already billing Part B for flu shots must submit an 855B application.

Neither. If the agency submits a web application via PECOS, it then would select “Home Infusion Therapy” as the supplier type.

Infusion Pharmacy (IRX) Accreditation focuses on the pharmacy services of preparing and dispensing medication, equipment, and supplies to patients receiving home infusion therapy. Home Infusion Therapy Accreditation focuses on the education, assessment, and medication review performed by a nurse during a home visit.

No. Standards for our Infusion Pharmacy (IRX) Accreditation service are the same.

Yes. CMS requires that all locations receive an on-site survey for home infusion therapy services.

An off-site audit is conducted on a percentage of an organization’s renewing locations, based on a methodology that takes into consideration:

• History of complaints with client/patient-related deficiencies.
• Risk potential as identified by performance improvement data.
• Infusion volume.
• Previous survey results.

Home infusion therapy suppliers must have serviced three clients/patients and have one on service.  In rural areas, a new home infusion therapy supplier seeking accreditation must have serviced two clients/patients.

No. The supplier does not need to be a pharmacy. The supplier must be able to meet provisions of the Social Security Act, which defines a supplier as:

• A pharmacy, physician, or other provider of services or a supplier licensed by the state in which the pharmacy, physician, or provider of services or supplier furnishes items or services and that:

• • Furnishes infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs.
  • Ensures the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis.
  • Is accredited by an organization designated by the secretary pursuant to Section 1834(u)(5).

A qualified home infusion therapy supplier may subcontract with a pharmacy, physician, provider of services, or another supplier to meet CMS requirements. The home infusion therapy supplier is responsible for negotiating appropriate contract terms to only assume responsibility for services related to home infusion therapy.

Payment for home infusion therapy services is a bundled payment equivalent to five hours of infusion therapy administration services in a physician’s office for each day an infusion drug is administered. Therefore, even if the clinician is in the home for only three hours, the payment is still equivalent to that for five hours. However, the home infusion therapy services provider still reports the time spent on the claim in 15-minute increments.

Yes. If the patient meets the eligibility criteria for both programs, then the agency can receive both Medicare Part A and Part B reimbursement.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview.html

https://public-inspection.federalregister.gov/2020-24146.pdf