Medicaid

Specialty Pharmacy News
July 1, 2007

Alan K. Parver

The coverage under Part B has two aspects: (1) professional services other than nursing services and all necessary supplies and equipment, and (2) nursing services except for those covered under the home health benefit. Separating these was necessary "to avoid duplicate coverage and payment," said attorney Alan Parver, a partner at Powell Goldstein LLP , who also spoke at the conference.

Parver pointed to one facet of the bill found within its definition of "qualified home infusion therapy provider." The third characteristic is any pharmacy, physician or provider licensed by the state who "meets the standards established by the secretary for the safe and effective provision of home infusion therapy on a seven-day-a-week, 24-hour-a-day basis," says Parver . He said that this was "an important element" of the bill, and said that "we've been having an ongoing conversation with CMS over logistical concerns with Part D and getting patients into the system in time to get their treatment. If they don't, patients often stay in nursing homes," which is costly and inconvenient for them, or they could even miss required infusions. According to Parver , "CMS is on board, as evidenced by the fact that it issued a proposed rule for Part D" that says there "must be a qualification of a patient before their next dose or within 24 hours, whichever comes first."



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Darryl M. Drevna

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Tim Perrin
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