As U.S. health care continues to trend toward supporting more medically complex patients in their homes, home infusion stands poised to answer the call. Once again, home infusion bills in the U.S. House and Senate seek to affirm access to home infusion for Medicare beneficiaries.
But with this bill and this time around, home infusion professionals also mean to break new ground. Yes, Connie Sullivan, CEO of the National Home Infusion Association (NHIA), wants to seize the opportunity to serve more patients, including those with complex needs, right in their homes — a model that would reduce the time-consuming visits to infusion centers that strain patients’ daily routines and health care’s finite resources.
But Sullivan also believes home infusion can achieve all that while saving money for Medicare.
And Sullivan and her peers are sounding an alarm over reduced access to parenteral nutrition. Here’s another group of patients with complex needs who could be supported at home, but would likely be forced into medical facilities if the process of parenteral nutrition provision isn’t significantly changed.
A new bill with greater goals
In March, the Preserving Patient Access to Home Infusion Act, H.R. 2172 and S. 1058, was introduced to the U.S. House and Senate, respectively.
And not for the first time.
“We’ve introduced a bill by the same name for several years now,” Sullivan said. “But it’s a very different bill this time from where we started many years ago. It’s a much broader bill in terms of who would be impacted by it. In its structure, it just does so much more.”
Sullivan explained that as the bill is written, “The foundation of it is still the DME [durable medical equipment] benefit in a lot of ways, and it lives in part B. But when I take a look at this bill and what it would do for home infusion access, it’s a whole different ballgame compared to where we were five, six, seven years ago, when we first started trying to fix this broken benefit in part B. So that’s exciting to me.”
There are many reasons for the bill’s evolution over the years, she added. “Our main goal has been to try to get a bill that creates access, but also accomplishes the goal of cutting spending from a government standpoint, so that it will save the government money while it does all those things that you talked about in terms of improving quality of life for patients.
“What [the new bill] does primarily that the old bill did not do is it creates a home infusion benefit for all IV [intravenous] anti-infectives. So it would apply to more drugs than just those in the DME benefit now. And that’s really important because it can cross over from part B to part D drugs, which the other bills did not do. So when we look at this bill in terms of its potential impact, it’s a lot more impactful than our previous versions.”
Sullivan urged stakeholders to educate their representatives and senators about the bills, adding, “In particular, it’s important for them to hear from people who work in hospital settings and other settings where these patients end up” for lack of proper home infusion access. The NHIA is also asking for lobbying help from health-care professionals working in skilled nursing facilities, or discharge planners who have patients who could easily go home, but can’t due to the lack of the infusion support once they leave the medical facility.
Advocates can emphasize, Sullivan said, that such patients are destined to go to more costly sites of care that strain their families. “I hear stories all the time,” she said. “Husband and wife end up separated, because the only way to get this [infusion treatment] covered is to go to the nursing home, which is hours away from where their spouse lives.”
Improved home infusion access could spare families those hardships, Sullivan said.
“We have the systems and the technology to provide this in the home, with the equipment that we use, with the nursing support we collaborate with,” she said. “This has been done for 40 years. It’s the standard of care, except for Medicare. Tell those stories and give real-world examples of how patients are impacted literally on a daily basis because there’s no Medicare benefit for home infusion. Antibiotics are the number-one therapy we still provide in the home today from a volume standpoint.”
In an overtaxed health-care system, Sullivan added, home infusion could give health-care professionals and facilities greater bandwidth to care for patients who truly need to be treated in medical environments.
Home infusion “frees up the capacity of health-care providers in those settings,” she said. “There’s a limited number of seats for infusions in those settings. And there are much more complex patients — oncology patients or patients who need a biologic where there’s a higher risk for a reaction of some sort — who need to be in those settings. A patient needing a five-minute IV push of Daptomycin does not need to be taking up that chair.”
Reduced access for parenteral nutrition patients
Elsewhere on the access front, the NHIA is preparing to publish a white paper on the state of parenteral nutrition (PN), Sullivan said.
“For the last several years, particularly I’d say the last five to eight years, the shortages of ingredients in parental nutrition have caused the cost to make a bag of parental nutrition to skyrocket,” Sullivan said. “It’s about 75% more expensive today to make a bag of PN than it was in 2016. Insurance payment rates have not gone up 75%. In fact, the data we have from 2022 to 2024 [shows] that reimbursement has gone down 5%.”
Sullivan pointed to the complexity of supporting parenteral nutrition services, as well.
“Providers are just saying this is a difficult therapy to provide,” she said. “It takes a clean room, which is expensive to operate and maintain because now there are higher clean room standards because of USP <797> standards that have changed.”
Ironically, the specialty that led to the creation of home infusion is now under dire threat itself. “Home infusion started around the need for PN patients to get out of facilities,” Sullivan said. “That’s how home infusion began. The very first patient was a parental nutrition patient, a young man who was living in a nursing home.”
The patient’s physician worked with a pharmacist to develop a way for the patient to receive parenteral nutrition in his home so the patient could be discharged. “That’s how home infusion literally began,” Sullivan said. “And to see where we are now: Parental nutrition is a therapy that providers are saying, ‘We can’t afford to keep doing this. We’re losing money on every bag we make.’”
Additionally, Sullivan noted, parenteral nutrition provision is “clinically intense. It requires a lot of nursing support, it requires a lot of pharmacy support. You need a dietitian on your team. There’s so much work and collaboration that goes into helping these patients stay out of the hospital.”
Despite the immense effort required, “It’s a service that I think most home infusion clinicians would tell you they absolutely love providing and working with these patients because it’s so fulfilling to help them,” Sullivan said. “Because they are very complicated and have a lot of needs, especially when you start looking at pediatrics and things like that. There are a lot of patients that are really concerned that there’s now only one provider left in their area that will take a PN patient. And if that provider can’t stay in business, that’s the end of parental nutrition access. These patients don’t have another option. They’re in a facility or they’re at home. There’s no out-patient [option]. There’s no place to go to get a bag of PN every day.”
Is a value-based model the answer to PN’s challenges?
“Payer rates that were negotiated 10 plus years ago are not sustainable” in today’s parenteral nutrition environment, Sullivan said. That’s led to fewer and fewer PN providers in insurers’ networks.
“We’re going to publish a paper using all the data that we have to show the number of providers is decreasing, the reimbursement rate is decreasing, while the cost to prepare a bag of PN has increased dramatically,” Sullivan said.
She added that current PN challenges extend well beyond what a funding increase alone could address. “I think the solution here isn’t just as simple as ‘You’ve got to pay more,’” she said. “As a payer, you [could] increase the reimbursement rate, but [challenges are] also structural. These patients are on service a long time usually, and they’re very expensive at the front end. It takes a lot of money to onboard these patients, to interpret the orders, get the first deliveries out, to get them independent with their infusions, and there’s a lot of training involved. So it’s a high-risk patient to accept onto service if they don’t stay on long enough for you to recoup that front-end investment.”
To address these challenges, “I want to talk to payers about some pilot programs,” Sullivan said. “This is a great population to look at from a value-based perspective, because I think if home infusion providers had a better incentive to do more on the front end and we could front-load some of the reimbursement, payers would benefit by seeing those patients stay out of the hospital and have fewer infections and just have fewer complications. I do think there are home infusion providers that would bet on themselves to be able to improve those outcomes for patients with a value-based program.”
Sullivan added that while PN patients are complex, “It’s a small population. So the data is potentially more manageable to do some sort of program to measure those benefits and see if we can come up with a different model for how we’re paying for parental nutrition to make it more sustainable for providers. Because we need providers to invest in this space.”
The PN situation got so desperate in Colorado, Sullivan added, “that a physician at Denver Children’s got together with some of her families and passed legislation to say Colorado Medicaid has to pay more for this to make sure pharmacies can cover their cost so that [they] will take Colorado Medicaid patients.
That bill forced Colorado Medicaid to increase their rates. It’s a small impact initially, but it’s a step in the right direction, and it’s also a strong acknowledgement of the problem. I think it’s a wakeup call, for Colorado to say, ‘We have children who are on the other side of the Rocky Mountains dependent on one pharmacy that’s left in the whole state who will take care of these kids.’”
Medicare Advantage challenges
Asked if home infusion providers are experiencing the same problems with Medicare Advantage compared to traditional Medicare, Sullivan said, “It’s a very mixed bag. What members tell me — and I think this is what we’re seeing in some of the claims data that we have access to — is [Medicare Advantage plans] are paying for home infusion better than Medicare [does], but they’re making up all their own rules. It’s this weird mix of Medicare policy, plus policy from the commercial side of things.
“When a Medicare code exists, [Medicare Advantage plans] have to use it. So what we’re seeing is they’re using the Medicare code, but making up all kinds of different rules about how it gets paid. The problem with Medicare Advantage isn’t that you can’t get paid. It’s that what you’re going to get paid is completely unpredictable. There’s no consistency across plans. There’s no consistency within the same plan for two different patients. You’re literally fighting with the plan on a patient-by-patient basis. With as many patients as there are in Medicare Advantage today, that’s not sustainable.”
Looking into home infusion’s future
As American health care adjusts to significant changes this year, such as the reorganization of the Centers for Medicare & Medicaid Services (CMS) under the Trump administration, Sullivan said, “We do think there’s opportunity to work with the new administration at the CMS level. In fact, CMS released their budget for 2026, and there was a mention of home infusion as something they want to explore, which we thought was very promising and encouraging.”
The NHIA referenced comments made by Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. on June 24 during a House Energy & Commerce Committee. “It’s our objective to make sure that infusions can be applied in the home and be used in the home,” Kennedy told Rep. Diana Harshbarger (R-Tenn.), “and we need to change that.” The current Medicare process, he added, “makes no sense. It’s much more expensive for our system.”
What comes next, Sullivan said: “The challenge has been letting them get organized and up to speed so we could sit down and have a meeting with them and talk about what they see as an opportunity for home infusion. How are they thinking about it?”
But even as CMS is being restructured, Sullivan pointed out “the reality that CMS only has authority to go so far. They don’t really have statutory authority to do what our legislation would do.”
Which brings the argument for the Preserving Patient Access to Home Infusion Act full circle.
“We need our legislation for them to be able to create the home infusion benefit that we see as the path to more access,” Sullivan said. “They’re really limited based on the fact that it all is confined by this DME benefit today, and they don’t really have the authority to expand it beyond that. So while we are encouraged that maybe they’d be more supportive of a home infusion benefit today, should our legislation pass, we would hopefully be able to sit down with them and explain why the legislation is structured the way that it is, how we envision it working.
“There are ways to do all of this, and we believe it’s very workable on an administrative level. We also think our legislation is the tip of the iceberg in terms of opportunity for cost savings. We’re going to start with anti-infectives, but the more drugs you move to the home, the more savings are available to CMS.”
So now, it’s all eyes on the Preserving Patient Access to Home Infusion Act.
“Hopefully we can get this legislation through the process, and we’ll have opportunities later this year,” Sullivan said. “We’ve got to wait for Congress to get through reconciliation, and hopefully that will happen this summer.”
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