WASHINGTON — Reintroduced June 15, the Medicare Home Infusion Therapy Coverage Act of 2011 would close a gap that currently exists in coverage where the medications used in infusions to treat serious diseases are covered, but not the medical services or equipment needed to deliver the home therapy.
The proposed legislation — introduced by Sens. Olympia Snowe, R-Maine, and John Kerry, D-Mass.; and Reps. Eliot Engel, D-N.Y., and Tim Murphy, R-Pa. — calls for coverage of infusion-related services, supplies and equipment under Medicare Part B, while coverage of the drugs would remain under Part D.
According to the National Home Infusion Association, which applauded the bill, private insurers, including many state Medicaid programs, Medicare Advantage, the Veteran's Administration and the Federal Employee Health Benefits Plan, have covered home infusion for decades. Medicare is the only major payer that does not cover all the essential components of home infusion therapy.
When Congress passed the Medicare Modernization Act in 2003, lawmakers added coverage for home infusion drugs. But CMS interpreted the law to cover only the drugs and not the services and supplies associated with the therapy.
As it stands now, Medicare beneficiaries must enter a hospital or nursing home for the infusion treatment to be covered.
"It's wrong and stupid to drag senior citizens out of their homes for medical care when they can get safer, more cost-effective infusion therapy right at home," Kerry said in an NHIA release.
Infusion therapy involves the administration of medication through a needle or catheter, and is prescribed for infections unresponsive to oral antibiotics, cancer-related pain, dehydration, gastrointestinal disorders, congestive heart failure, Crohn's Disease, hemophilia, immune deficiencies, multiple sclerosis and rheumatoid arthritis, among many other conditions, the NHIA said. The group also pointed to the efficiencies of home infusion, saying it costs less, produces better results and does not carry the risk of hospital-acquired infections.
Last year, the General Accountability Office generally supported the industry's assertions.
"Health insurer officials we talked to asserted that infusion therapy at home generally costs less than treatment in other settings," the GAO said in a June 2010 report. "Hospital inpatient care was recognized as the most costly setting. One insurer estimated that infusion therapy in a hospital could cost up to three times as much as the same therapy provided in the home."
NHIA President and CEO Russell Bodoff urged Congress to take note of the GAO report, which he said "clearly demonstrated that home infusion therapy provides costs savings and quality patient care, with no unusual utilization."
Since an unsuccessful attempt by New York's Engel to consolidate all components of home infusion under the Part B DME benefit in 2006, he and other lawmakers have continued a legislative push for full Medicare coverage for the therapy. A bipartisan bill introduced by Engel in 2007 went nowhere; a 2009 bill championed by Engel and Snowe picked up 104 cosponsors in the House and 31 in the Senate.
Commenting on reintroduction of the legislation, Pennsylvania's Murphy said, "Medicare still forces patients to enter a hospital for treatment where it costs Medicare thousands of dollars versus only hundreds within the home. Entering a hospital for infusion therapy is also less convenient for the patient who is then needlessly exposed to more health risks. There is a better way, and by passing this bill we can save taxpayers money and improve the quality of life of Medicare beneficiaries."
The Senate version of the bill (S. 1203) has been referred to the Finance Committee, and the House bill (H.R. 2195) has been referred to the Energy & Commerce and Ways & Means committees.