Another Try for Medicare Home Infusion Coverage

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.