Lawmakers Reintroduce Bipartisan, Bicameral Legislation to Increase Access to Medicare Home Infusion Benefit

WASHINGTON—U.S. Sens. Mark R. Warner (D-VA) and Tim Scott (R-SC) joined by U.S. Reps. Vern Buchanan (R-FL-16), Chairman of the House Ways & Means Health Subcommittee, Debbie Dingell (D-MI-06), Diana Harshbarger (R-TN-01) and Terri Sewell (D-AL-07) reintroduced legislation that will ensure patients maintain access to home infusion therapy. The Preserving Patient Access to Home Infusion Act protects access to Medicare’s home infusion benefit by making clear that pharmacy services for home infusion therapy can be reimbursed and sets an appropriate rate for such services.

“We have seen for years that patients are better off when they can receive quality care from the comfort of their own homes,” said Warner. “This legislation would ensure that millions of Americans who suffer from life-threatening conditions such as immune diseases, cancer, serious infections and heart failure can receive the care they need without having to make frequent, sometimes costly trips to the hospital.”

“High-risk patients who are more susceptible to contracting disease shouldn’t have to visit a hospital and further risk their health to receive life-saving treatment,” said Scott. “This commonsense legislation ensures that millions of Americans have the option to receive the care they need in the comfort and safety of their own homes.”

“The coronavirus pandemic taught us that home health services are invaluable for seniors in my district and across the country,” said Buchanan. “The aptly-named Preserving Patient Access to Home Infusion Act will ensure that Medicare recipients can continue to receive life-saving drugs in a safe and effective way from the comfort and convenience of their own home.”

“We know that the majority of people would prefer to receive care in the home when possible, and over the last few years, we have seen the effective expansion of many home care services, which can result in significant savings for patients and providers,” said Dingell. “The legislation’s commonsense reforms will expand access to home infusion services for Medicare beneficiaries, saving the Medicare program millions of dollars, cutting patient costs and ensuring people receive safe and adequate care in the comfort of their own home. I look forward to working with my colleagues to move this bipartisan legislation forward so we can effectively care for people and save money by doing so in a home setting.” 

“For Medicare patients living in rural areas, regular visits to healthcare providers to receive infusion services often prove to be costly and burdensome,” said Harshbarger. “It is critical that common-sense reforms are passed to address CMS’ flawed implementation of home-based care for Medicare patients, which is why I am proud to co-sponsor the Preserving Patient Access to Home Infusion Act. This legislation is vital to our many seniors who receive infusion treatments, ensuring patients have access to effective therapies from the safety and comfort of their homes while producing cost-savings for both the Medicare program and patient.”

“Countless Alabamians, especially those in rural communities, rely on home infusion services for life-saving care,” said Sewell. “It has never been more critical to ensure that patients continue to receive this care safely in their homes. I’m so proud to introduce this bipartisan bill and urge my colleagues on both sides of the aisle to give it their full support.”

Warner originally 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 in order to maintain 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.

Despite Congress’ intent, the Centers for Medicare and Medicaid Services (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. As a result, provider participation in Medicare’s home infusion benefit has dropped sharply and beneficiaries have experienced reduced access to 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. The legislation also acknowledges the full scope of professional services provided in home infusion—including essential pharmacist services—into the reimbursement structure.

Specifically, the legislation would:

• Include pharmacy services as part of covered home infusion therapy under Medicare, encompassing assessments, drug preparation and compounding, and care coordination and documentation.
• Direct CMS to pay 50% of the nursing rate on home infusion days when a nurse is not present.
• Allow nurse practitioners and physician assistants to establish and review the plan of care for home infusion therapy.

“The National Home Infusion Association (NHIA) applauds Senator Warner and Senator Scott for their leadership on common sense legislation that will ensure Medicare patients have access to home infusion therapy,” said Connie Sullivan, NHIA’s president and CEO. “Americans have overwhelmingly demonstrated they prefer to receive medical treatments at home when given the option—and this legislation marks an important step in making that option available to our Medicare beneficiaries.”

According to NHIA, home infusion pharmacies have been safely and effectively providing a wide range of IV medications to patients in their homes for over 40 years. This 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. Home infusion was heavily utilized during the COVID-19 public health emergency which prompted a larger shift to home-based health services that has outlasted the crisis.

“The benefits of this care model were recently highlighted in the findings from a Medicare demonstration project that studied bundled payment for items and services, such as infusion supplies and nursing services, related to IV immune globulin (IVIG) administration in the home,” NHIA said in a press release. “Clinical measures suggest increased medication adherence and better disease management. In addition, enrollees reported reduced transportation barriers, reduced risk of infection, increased treatment compliance, and improved monitoring. By contrast, utilization trends for the Medicare Part B home infusion therapy (HIT) services benefit—as currently implemented—show a lack of sufficient participation from providers and beneficiaries, indicating a lack of equitable access.”

A copy of the bill text is available here.