Stakeholders Urge Congress to Fix Home Infusion Benefit

ALEXANDRIA, Virginia (November 8, 2022)—A group of 30 patient and stakeholder groups have called on Congress to address Medicare beneficiary access to home infusion services. In a letter to lawmakers, which brings together stakeholders from across the care continuum, the groups urge congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S 2652/HR 5067) and increase access to home infusion therapy for Medicare beneficiaries. The letter follows a similar effort from dozens of health systems and hospitals—collectively representing over 600 hospitals and over 5,000 sites of care—who also recently called on Congress to advance this bill.

“Home infusion therapy services have been a lifeline for millions of Americans by delivering lifesaving treatments to patients while reducing costs, infection risks, and unnecessary facility visits,” the groups wrote. “Unfortunately, despite Congress’s efforts to establish a dedicated Medicare home infusion therapy (HIT) benefit, the Centers for Medicare and Medicaid Services (CMS) has implemented it in such a restrictive manner that is it failing to promote patient access.”

The letter goes on to cite a report released by the Centers for Medicare and Medicaid Services (CMS) in January 2022 confirming that utilization of the benefit has been low.

“Recent data released by CMS suggests that less than 1,300 Medicare beneficiaries accessed the home infusion benefit each calendar quarter between Q1 2019 and Q1 2021, a massive outlier compared to the estimated 3.2 million patients served annually by home infusion providers,” the letter states.

“Home-based health care services stand out as high-value resources that can improve patient quality of life and add capacity to the health care system while keeping vulnerable patients away from the threat of infectious disease,” said Connie Sullivan, president and CEO of the National Home Infusion Association. “Passage of the Preserving Patient Access to Home Infusion Act is critical to ensuring the Medicare program maintains access to home infusion, allowing beneficiaries to safely receive treatment in the setting they overwhelmingly prefer: their homes.”

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. The intent in establishing this benefit was to facilitate patient access to home infusion by covering professional services including assessments, education on administration and access device care, monitoring and remote monitoring, coordination with the patient, caregivers and other health care providers, and nursing visits.

However, the Centers for Medicare and Medicaid Services (CMS) required a nurse to be physically present in the patient’s home in order for providers to be reimbursed. The current home infusion therapy benefit only acknowledges face-to-face visits from a nurse, failing to account for the extensive clinical and administrative services that are provided remotely by home infusion clinicians. As a result, provider participation in Medicare’s home infusion benefit has been limited and beneficiaries have experienced challenges in accessing home infusion over the last several years.

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.