Legislation Introduced to Preserve Home Infusion Therapy Benefit

ALEXANDRIA, Va. (August 9, 2021)—The National Home Infusion Association (NHIA) applauded the introduction of bipartisan legislation in the U.S. Senate that will ensure Medicare patients maintain access to home infusion therapies that require the use of an infusion pump. The Preserving Patient Access to Home Infusion Act—introduced by Sen. Mark Warner (D-Virginia) and Sen. Tim Scott (R-South Carolina)—would ensure patients with serious viral and fungal infections, heart failure, immune diseases, cancer and other conditions can receive the intravenous (IV) medications they need while at home.
 
“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 them to receive their care in a more expensive and less convenient hospital or nursing home setting,” said Sen. Warner. “This legislation will ensure that patients in need of home infusion therapy can get the care they need in a more affordable and commonsense way.”
 
“Americans deserve the flexibility needed to seek medical treatment from the comfort of their own home,” said Sen. Scott. “As we progress through the pandemic, high-risk patients who are more susceptible to contracting the coronavirus and other diseases should not be limited to hospital visits that could further risk their health. With the introduction of this bill, millions of Americans will be one step closer to having peace of mind as they seek life-saving treatment in their own homes.”
 
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 proven model of care is overwhelmingly preferred by patients while also being cost-effective compared to other sites of care. Research shows that up to 95% of patients who are dependent on IV medications prefer to be treated at home, and nearly 98% of patients recently indicated they are highly satisfied with their home infusion services.

Legislative Background

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 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—as detailed in multiple letters to the agency—the Centers for Medicare & 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 practical matter, the current home infusion therapy benefit only acknowledges face-to-face visits from a nurse and fails 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 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.
 
“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 NHIA President and CEO Connie Sullivan, BSPharm. “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.”
 
Preliminary analysis of the legislation from The Moran Company suggests that the measure will create savings for patients and taxpayers by moving care into more cost-effective home settings. “Our model estimates on balance that the legislation would produce more savings than costs—with an estimated savings over 10 years of $93 million,” the report concludes.

Visit nhia.org for more information.