ALEXANDRIA, Va. (March 13, 2020)—A bipartisan coalition in Congress has introduced the Preserving Patient Access to Home Infusion Act, legislation designed to ensure Medicare patients have access to Part B home infusion medications.

With the recent outbreak of the coronavirus (COVID-19), the need to ensure vulnerable patients have access to home-based treatments is more apparent than ever. Home infusion therapy keeps high-risk patients with serious infections, heart failure, immune diseases, cancer and other conditions out of institutional settings and allows them to receive treatment at home. This legislation is a step toward ensuring access to infused medications covered under the Medicare Part B durable medical equipment benefit.

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 for 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), the federal agency responsible for managing the Medicare program, improperly implemented the benefit by requiring a nurse to be physically present in the patient's home in order for providers to be reimbursed.

The National Home Infusion Association (NHIA) has been working with stakeholders and legislators over the past several months to advocate for Congress’ intended implementation of the 21st Century Cures Act. The bill’s lead sponsors include Senators Tim Scott (R-SC) and Mark Warner (D-VA); and Representatives Elliot Engel (D-NY), Terri Sewell (D-AL), Kenny Marchant (R-TX), and Fred Upton (R-MI).

“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 these patients to receive their care in a more expensive and less convenient hospital or nursing home setting,” said Sen. Warner in a statement. “This legislation will ensure that Medicare enrollees in need of home infusion therapy can get the care they need in a more comfortable environment and at a more reasonable cost to the federal government.”

The Preserving Patient Access to Home Infusion Act is significant for the home infusion community and the patients they serve, as it 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 spectrum of professional services provided in home infusion—including essential pharmacy services—into the reimbursement structure.

Additionally, the legislation will ensure continuity in drug coverage, extending a policy in effect for 2019 and 2020 that allows for home infusion for certain drugs on the self-administered drug (SAD) exclusion list. Preliminary analyses of the legislation suggest that the measure will create savings for patients and taxpayers by moving care into more cost-effective home settings.

“As public health officials recommend treating patients at home to avoid exposure to COVID-19, the value of home-based care has never been so clear,” said NHIA President and CEO Connie Sullivan, BSPharm in a press release. “NHIA applauds introduction of the Preserving Patient Access to Home Infusion Act. This legislation is vital to home infusion patients, allowing them to safely receive treatment in the setting they overwhelmingly prefer—their homes.”

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