Page 296 - Medicare Benefit Policy Manual

320.5 - Plan of Care Requirements
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

In accordance with section 1861(iii)(1)(B) of the Act, the beneficiary must be under a
plan of care, established by a physician (defined at section 1861(r)(1) of the Act as a
doctor of medicine or osteopathy legally authorized to practice medicine and surgery by
the State in which he performs such function or action), prescribing the type, amount, and
duration of infusion therapy services that are to be furnished, and periodically reviewed,
in coordination with the furnishing of home infusion drugs under Part B.

The qualified home infusion therapy supplier must ensure that all patients are under the
care of an applicable provider and have a physician-established plan of care that meets all
of the following requirements:

A. Plan of Care Content - The plan of care must prescribe the type, amount, and
duration of the home infusion therapy services that are to be furnished. The plan
of care would also include the specific medication, the prescribed dosage and
frequency as well as the professional services to be utilized for treatment.

B. Physician's Orders - The physician's orders for services in the plan of care must
specify at what frequency the services will be furnished, as well as the discipline
that will furnish the ordered professional services. Orders for care may indicate a
specific range in frequency of visits to ensure that the most appropriate level of
services is furnished. The plan of care would specify the care and services
necessary to meet the patient specific needs

C. Physician’s Signature - The plan of care must be signed and dated by the ordering
physician prior to submitting a claim for payment. The ordering physician must
sign and date the plan of care upon any changes to the plan of care.

D. Periodic Review - The plan of care for each patient must be periodically reviewed
by the physician. The expectation is that the physician is active in the patient’s
care and can make appropriate decisions related to the course of therapy if
changes are necessary in regards to the progress and goals of the patient’s
infusion therapy.

320.5.1 - Notification of Available Infusion Therapy Options
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

Section 1834(u)(6) of the Act requires that prior to the furnishing of home infusion
therapy to an individual, the physician who establishes the plan of care shall provide
notification of the options available (such as home, physician’s office, hospital outpatient
department) for the furnishing of infusion therapy. Physicians are expected to routinely
discuss these infusion therapy options with their patients and annotate these discussions