Home Infusion Therapy Suppliers

10.2.2.2 – Home Infusion Therapy Suppliers (Rev. 11891; Issued: 03-09-23; Effective: 04-21-23; Implementation: 06-19-23) Home infusion therapy suppliers are a supplier type that enroll via the Form CMS-855B. A. General Background Information Section 5012 of the 21st Century Cures Act (“the Cures Act”) (Pub. L. 114-255), which amended sections 1861(s)(2) and 1861(iii) of the Act, established a new Medicare home infusion therapy services benefit. The Medicare home infusion therapy services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the durable medical equipment benefit), remote monitoring, and monitoring services for the provision of home infusion therapy and home infusion drugs furnished by a qualified home infusion therapy supplier. This benefit will ensure consistency in coverage for home infusion benefits for all Medicare beneficiaries. Section 1861(iii)(3)(D)(i) of the Act defines a “qualified home infusion therapy supplier” as a pharmacy, physician, or other provider of services or supplier licensed by the state in which supplies or services are furnished. A qualified home infusion therapy supplier must: (1)furnish infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs; (2) ensure the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis; (3) be accredited by an organization designated by the Secretary; and (4) meet other such requirements as the Secretary deems appropriate, taking into account the standards of care for home infusion therapy established by Medicare Advantage plans under Part C and in the private sector. B. Home Infusion Therapy Supplier Eligibility and Enrollment Requirements An entity that wishes to furnish home infusion therapy services to Medicare beneficiaries must enroll as a home infusion therapy supplier. The supplier must meet the following requirements: • Obtain and maintain a valid tax identification number and National Provider Identifier at the organizational level. • Be currently and validly accredited as such by a CMS-recognized home infusion therapy supplier accreditation organization in order to enroll and remain enrolled in Medicare. The CMS-recognized home infusion therapy supplier accreditation organizations include the Joint Commission (TJC), the Utilization Review Accreditation Commission (URAC), the Accreditation Commission for Health Care (ACHC), the Community Health Accreditation Partner (CHAP), the National Association Boards of Pharmacy (NABP), and the Compliance Team (TCT). • Submit documentation containing an effective date of accreditation as well as the locations accredited for home infusion therapy with its application. (This may, but is not required to be, a copy of the accreditation certification and/or accreditation approval letter.) • Be compliant with § 414.1515 and all provisions of 42 CFR Part 486, subpart I in order to enroll and maintain Medicare enrollment. • Certify via the Form CMS-855B application that it meets and will continue to meet the specific requirements for enrollment described in 42 CFR § 424.68 and 42 CFR Part 424, subpart P. • Successfully complete application screening at the limited categorical risk level per § 424.518(a). • Pay an application fee at initial enrollment, revalidation, and when adding a practice location. • Enroll in each state in which it has an accredited practice location. The supplier may provide services in patients’ homes across state borders as long as it is appropriately licensed (if the state requires licensure); the supplier must be appropriately licensed (if the state requires licensure) in each state in which it furnishes home infusion therapy services in patients’ homes. (See section 10.3 of this chapter for certain PECOS application submission policies with respect to enrolling in multiple states within one contractor jurisdiction.) The supplier completes Section 4D (Rendering Services in Patients Homes) of the Form CMS- 855B application to report all locations where health care services are rendered in patients’ homes. This includes locations across state borders. As an illustration, suppose the supplier has two accredited practice locations in Arkansas and furnishes home infusion therapy services in patients’ homes in Arkansas and in Oklahoma; here, the supplier only needs to enroll in Arkansas. If, however, this same supplier wants to add another accredited practice location in Texas, it would have to enroll in in Texas.