The National Home Infusion Association (NHIA) has lauded the reintroduction of the Preserving Patient Access to Home Infusion Act, described by the organization as “bipartisan, bicameral legislation that will ensure Medicare patients can receive the intravenous medications they need while at home.”
The legislation was introduced by Rep. Vern Buchanan (R-Fla.), Rep. Diana Harshbarger (R-Tenn.), Rep. Debbie Dingell (D-Mich.), and Rep. Terri Sewell (D-Ala.) in the House, and by Sen. Mark Warner (D-Va.) and Sen. Tim Scott (R-S.C.) in the Senate.
“Home infusion pharmacies have been safely and effectively providing a wide range of IV medications to patients in their homes for over 40 years,” the NHIA said in a March 13 statement. “This proven model of care is critically important for patients living in rural areas, who are disabled, or have transportation challenges. Additionally, home infusion has shown to be a cost-effective alternative when compared to other sites of care.”
Medicare home infusion benefit is being under utilized
But the NHIA said Medicare’s home infusion therapy (HIT) benefit “has failed to achieve its promise of delivering patient access to home infusion.”
The organization said that according to CMS’s [Centers for Medicare & Medicaid Services] own data, several U.S. states haven’t registered even one home infusion service visit.
“The same report found that less than 1,500 Medicare beneficiaries are receiving home infusion services each calendar quarter — and provider participation in the benefit has steadily declined since implementation,” the NHIA said.
“Home-based infusion services are a vital component in improving access to life-sustaining IV treatments and enhancing the quality of life for patients and their families, while adding capacity to the health-care system,” said NHIA President/CEO Connie Sullivan, BSPharm, in the announcement. “Passage of the Preserving Patient Access to Home Infusion Act will modernize Medicare’s coverage of home infusion, bringing it in line with the commercial sector, and finally achieve Congress’ intent with creating the benefit.”
Unintended restrictions on the home infusion benefit
The NHIA said Congress has attempted — via provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 — to create a professional services benefit for Medicare Part B home infusion drugs.
“The intent in establishing this benefit was to ensure patient access to home infusion was maintained after Part B drug payments were significantly reduced with the conversion to average sales price methodology,” the NHIA said. “ The benefit was intended to provide a per-infusion-day payment to support all professional services (both remote and in-person) including assessments, education on administration and access device care, clinical monitoring, coordination with the patient, caregivers and other health-care providers, and nursing visits.
“Despite Congress’ intent, CMS improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home for providers to be reimbursed.”
Because of that, Medicare patients’ access to home infusion has reduced.
“The Preserving Patient Access to Home Infusion Act provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health-care professional is present in the patient’s home,” the NHIA said. “The legislation also acknowledges the full scope of professional services and maintains the current reimbursement rate for in-person nursing visits for at least five years.
“Additionally, the legislation would expand the availability of home infusion to additional patients by making IV anti-infectives available under Medicare’s HIT benefit, a key step in aligning Medicare with commercial market best practices.”
The legislation would improve patient access to home infusion and “increase provider participation in the benefit — effectively diverting care to the home that would otherwise be delivered in more expensive institutional settings.”
