A bipartisan coalition in Congress has introduced new legislation designed to ensure Medicare patients have access to Part B home infusion medications.
A bipartisan coalition in Congress has introduced new legislation, called the Preserving Patient Access to Home Infusion Act, designed to ensure Medicare patients have access to Part B home infusion medications, known as the Preserving Patient Access to Home Infusion Act.
The recent outbreak of the coronavirus has emphasized the importance of home-based treatments for vulnerable patients across the United States. Home infusion therapy keeps high-risk patients with serious infections, heart failure, immune diseases, cancer, and other conditions out of institutional settings, allowing them to receive treatment at home.
The Preserving Patient Access to Home Infusion Act has a goal of ensuring patients with Medicare access to infused medication covered under the Medicare B durable medical equipment benefit.
According to a National Home Infusion Association (NHIA) press release, Congress included 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. Establishing this benefit was meant to maintain patient access to home infusion by covering professional services, including assessments, education for administration, access to device care, monitoring and remote monitoring, coordination with the patient, caregivers, and other health care providers, and nursing visits.
Despite Congress’ intent, the Center for Medicare and Medicaid (CMS) improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed, according to the NHIA.
In response, the NHIA has been working with stakeholders and legislators over the past several months to advocate for Congress’ intended implementation of the 21st Century Cures Act.
“Medicare’s home infusion therapy benefit provides increased access to care for patients with immune diseases, cancer, serious infections, heart failure, and other conditions that might otherwise force these patients to receive their care in a more expensive and less convenient hospital or nursing home setting. This legislation will ensure that Medicare enrollees in need of home infusion therapy can get the care they need in a more comfortable environment and at a more reasonable cost to the federal government,” said Senator Mark Warner (D-VA) in the press release.
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 legislation also acknowledges the full spectrum of professional services provided in home infusion, including pharmacy services, into the reimbursement structure.
Additionally, the legislation will ensure continuity in drug coverage, extending a policy in effect for 2019 and 2020 that allows for home infusion for certain drugs on the self-administered drug exclusion list. Preliminary analyses of the legislation suggest that the measure will create savings for patients and taxpayers by moving care into more cost-effective home settings.
“As public health officials recommend treating patients at home to avoid exposure to COVID-19, the value of home-based care has never been so clear,” said Connie Sullivan, BSPharm, president and CEO of NHIA. “NHIA applauds introduction of the Preserving Patient Access to Home Infusion Act. This legislation is vital to home infusion patients, allowing them to safely receive treatment in the setting they overwhelmingly prefer—their homes.”