TAILIEUCHUNG - United States Government Accountability Office

Infusion therapy—drug treatment generally administered intravenously—was once provided strictly in hospitals. However, clinical developments and emphasis on cost containment have prompted a shift to other settings, including the home. Home infusion requires coordination among providers of drugs, equipment, and skilled nursing care, as needed. GAO was asked to review home infusion coverage policies and practices to help inform Medicare policy. In this report, GAO describes (1) coverage of home infusion therapy components under Medicare fee-for-service (FFS),. | United States Government Accountability Office GAO Report to Congressional Requesters June 2010 HOME INFUSION THERAPY Differences between Medicare and Private Insurers Coverage GAO Accountability Integrity Reliability GAO-10-426 June 2010 À GAO Accountability Integrity Reliability Highlights HOME INFUSION THERAPY Differences between Medicare and Private Insurers Coverage Highlights of GAO-10-426 a report to congressional requesters Why GAO Did This Study Infusion therapy drug treatment generally administered intravenously was once provided strictly in hospitals. However clinical developments and emphasis on cost containment have prompted a shift to other settings including the home. Home infusion requires coordination among providers of drugs equipment and skilled nursing care as needed. GAO was asked to review home infusion coverage policies and practices to help inform Medicare policy. In this report GAO describes 1 coverage of home infusion therapy components under Medicare fee-for-service FFS 2 coverage and payment for home infusion therapy by other health insurers both commercial plans and Medicare Advantage MA plans which provide a private alternative to Medicare FFS and 3 the utilization and quality management practices that health insurers use with home infusion therapy benefits. To do this work GAO reviewed Medicare program statutes regulations policies and benefits data. GAO also interviewed officials of five large private health insurers that offered commercial and MA plans. What GAO Recommends GAO recommends that the Secretary of Health and Human Services conduct a study of home infusion therapy to inform Congress regarding the potential program costs savings and other issues associated with a comprehensive Medicare benefit. View GAO-10-426 or key components. For more information contact Kathleen M. King at 202 512-7114 or kingk@. What GAO Found The extent of Medicare FFS coverage of home infusion therapy depends on whether the beneficiary is .

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• therapy
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