Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 1970. Home infusion therapy

7 AAC 43.1970. Home infusion therapy

(a) The department will enroll a provider of home infusion therapy services if the provider

(1) meets the requirements of 7 AAC 43.1900(a);

(2) presents evidence of a pharmacy or pharmacist license issued under AS 08.80; and

(3) documents that it meets the guidelines for pharmacies and pharmacists under 12 AAC 52.400 - 12 AAC 52.440, on a form provided by the department.

(b) The department will pay a provider that employs or contracts with a registered nurse who performs home infusion nursing services and has provided to the provider documentation of training and skills in

(1) intravenous insertion techniques;

(2) parenteral administration;

(3) line and site management; and

(4) the proper use of equipment.

(c) The department will pay an enrolled provider for home infusion therapy services as follows:

(1) at a rate described in 7 AAC 43.922(c) (1) per visit for home infusion and specialty drug administration;

(2) on a per diem basis for home infusion administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment as follows:

(A) the department will pay a percentage of the maximum allowed amount under (B) and (C) of this paragraph that is

(i) 100 percent for the first administered therapy;

(ii) 80 percent for the second concurrently administered therapy; and

(iii) 75 percent for the third and each subsequent concurrently administered therapy;

(B) the maximum allowed amount will be based on the department's Home Infusion Therapy Services Fee Schedule, dated 2005, and adopted by reference;

(C) for services not listed on the fee schedule adopted by reference in (B) of this paragraph, the department will establish a maximum allowed amount using the method described in 7 AAC 43.1920(c);

(3) in accordance with 7 AAC 43.591, for drugs covered under 7 AAC 43.590 and used in home infusion therapy; a provider may not include compounding and dispensing fees paid under (1) of this subsection on the claim for drugs;

(4) as described in 7 AAC 43.1960 for enteral and oral nutritional products.

(d) For drugs covered under 7 AAC 43.590 and used in home infusion therapy, the department will accept electronic claims in the standard claim format adopted under 45 C.F.R. 162.1102(b)(1) by the United States Secretary of Health and Human Services.

(e) The department will not separately pay a provider under this section for the following items identified in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005, as amended from time to time and adopted by reference:

(1) routine servicing of an infusion device for equipment already included under (c)(2) of this section;

(2) catheter care and maintenance identified as "not otherwise classified";

(3) nursing services only for insertion of a peripherally inserted central venous catheter (PICC);

(4) nursing services only for insertion of a midline central venous catheter;

(5) the following items, without a specific dosage timing or quantity:

(A) pain management infusion;

(B) chemotherapy infusion;

(C) total parenteral nutrition (TPN);

(D) hydration therapy;

(E) antibiotic, antiviral, or antifungal therapy;

(F) professional pharmacy services;

(6) continuous insulin infusion therapy;

(7) after-hours care;

(8) home injectable therapy;

(9) dietitian services;

(10) delivery or service to high-risk areas requiring escort or extra protection;

(11) high-technology registered nursing services;

(12) infusion suite services;

(13) home therapy enteral nutrition;

(14) home administration of aerosol drug therapy;

(15) home transfusion of blood products;

(16) home irrigation therapy.

History: Eff. 1/11/2006, Register 177

Authority: AS 47.05.010

AS 47.05.015

AS 47.07.030

AS 47.07.040

Editor's note: A copy of the pharmacists' guidelines form referred to in 7 AAC 43.1970(a) may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.

A copy of the Department of Health and Social Service's Home Infusion Therapy Services Fee Schedule adopted by reference in 7 AAC 43.1970(c)(2) may be obtained from the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.

A copy of the standard claim format referred to in 7 AAC 43.1970(d) may be obtained from the National Council for Prescription Drug Programs, 9240 E. Raintree Dr., Scottsdale, AZ 85260-7518; telephone: (480) 477 - 1000; Internet address: http://www.ncpdp.org.

The United States Department of Health and Human Services, Centers for Medicare and Medicaid Services's (CMS) Healthcare Common Procedure Coding System (HCPCS) 2005, adopted by reference in 7 AAC 43.1970(e), may be obtained by contacting the Superintendent of Documents, United States Government Printing Office, Washington, D.C. 20402. A copy of the HCPCS is available for examination at the Department of Health and Social Services, Division of Health Care Services, 350 Main St., Juneau, Alaska 99801.