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Electronic Code of Federal Regulations

e-CFR data is current as of June 1, 2020

Title 42Chapter IVSubchapter GPart 486 → Subpart I


Title 42: Public Health
PART 486—CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED BY SUPPLIERS


Subpart I—Requirements for Home Infusion Therapy Suppliers


Contents

General Provisions

§486.500   Basis and scope.
§486.505   Definitions.

Standards for Home Infusion Therapy

§486.520   Plan of care.
§486.525   Required services.

Source: 83 FR 56630, Nov. 13, 2018, unless otherwise noted.

General Provisions

§486.500   Basis and scope.

Section 1861(s)(2)(iii) of the Act requires the Secretary to establish the conditions that home infusion therapy suppliers must meet in order to participate in the Medicare program and which are considered necessary to ensure the health and safety of patients.

§486.505   Definitions.

As used in §§486.520 and 486.525:

Applicable provider means a physician, a nurse practitioner, and a physician assistant.

Home means a place of residence used as the home of an individual, including an institution that is used as a home. An institution that is used as a home may not be a hospital, CAH, or SNF as defined in section 1861(e)(1), 1861(mm)(1), or 1819(a)(1) of the Act, respectively.

Home infusion drug means a parental drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment. The term does not include insulin pump systems or a self-administered drug or biological on a self-administered drug exclusion list.

Infusion drug administration calendar day means the day on which home infusion therapy services are furnished by skilled professionals in the individual's home on the day of infusion drug administration. The skilled services provided on such day must be so inherently complex that they can only be safely and effectively performed by, or under the supervision of, professional or technical personnel.

Qualified home infusion therapy supplier means a supplier of home infusion therapy that meets the all of the following criteria which are set forth at section 1861(iii)(3)(D)(i) of the Act:

(1) Furnishes infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs.

(2) Ensures the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis.

(3) Is accredited by an organization designated by the Secretary in accordance with section 1834(u)(5) of the Act.

(4) Meets such other requirements as the Secretary determines appropriate.

[83 FR 56630, Nov. 13, 2018, as amended at 84 FR 60646, Nov. 8, 2019]

Standards for Home Infusion Therapy

§486.520   Plan of care.

The qualified home infusion therapy supplier ensures the following:

(a) All patients must be under the care of an applicable provider.

(b) All patients must have a plan of care established by a physician that prescribes the type, amount, and duration of the home infusion therapy services that are to be furnished.

(c) The plan of care for each patient must be periodically reviewed by the physician.

§486.525   Required services.

(a) The qualified home infusion therapy supplier must provide the following services on a 7-day-a-week, 24-hour-a-day basis in accordance with the plan of care:

(1) Professional services, including nursing services.

(2) Patient training and education not otherwise paid for as durable medical equipment as described in §424.57(c)(12) of this chapter.

(3) Remote monitoring and monitoring services for the provision of home infusion therapy services and home infusion drugs.

(b) All home infusion therapy suppliers must provide home infusion therapy services in accordance with nationally recognized standards of practice, and in accordance with all applicable state and federal laws and regulations.

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