Patient, Stakeholder Group Urges Congress to Address Medicare Home Infusion Benefit

ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA), a home infusion therapy community and manufacturer, reported that a collective of more than 35 patient and stakeholder groups are calling on Congress to address Medicare beneficiary access to home infusion services. In the letter sent to lawmakers, which brings together stakeholders from across the care continuum, the group urged congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S 1976/HR 4104) and increase access to home infusion therapy for Medicare beneficiaries.

The Preserving Patient Access to Home Infusion Act would ensure Medicare beneficiaries have access to care at home, consistent with the coverage provided by commercial insurers, Medicaid plans, TRICARE, Veterans Affairs and more.

“Medicare beneficiaries with chronic conditions, such as dysautonomia, are often unable to access home infusion services, leaving them without essential treatments that help manage their disease,” said Lauren Stiles, president and CEO of Dysautonomia International, a nonprofit seeking to improve the lives of individuals with autonomic nervous system disorders. “For these individuals, the physical toll of traveling to outpatient infusion clinics is often too great, leading to poorly managed symptoms and, ultimately, more emergency room visits. Congress has the opportunity to address this urgent need by passing the Preserving Patient Access to Home Infusion Act, ensuring that Medicare beneficiaries can receive critical care in the comfort of their homes and avoid unnecessary hospitalizations.”

“Home infusion services have long been a critical component of patient-centered care, allowing individuals to receive necessary intravenous (IV) and subcutaneous therapies at home,” the group wrote. “Despite these clear benefits, the current Medicare home infusion therapy (HIT) benefit is failing to function as Congress intended and is not meeting the needs of Medicare beneficiaries.”

“Home infusion improves patient outcomes, prevents unnecessary hospital and long-term care stays and leads to substantial efficiencies for both patients and the Medicare program,” said Connie Sullivan, president and CEO of NHIA. “By aligning Medicare policy with the successful models already in use by commercial insurers, we can expand home infusion access to those who need it most—America’s seniors and those living with disabilities.”

Background on the Preserving Patient Access to Home Infusion Act

Congress included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 aimed at creating 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, such as 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.
The group said despite Congress’ intent—as detailed in multiple letters to the agency—the Centers for Medicare and Medicaid Services improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed. Currently, the home infusion therapy benefit only acknowledges face-to-face visits from a nurse, which does not account for the 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 many beneficiaries have experienced challenges in accessing home infusion.

The Preserving Patient Access to Home Infusion Act would provide technical clarifications to remove the physical presence requirement, as well as ensure payment, regardless of whether a health care professional is present in the patient’s home. The legislation would acknowledge the full scope of professional services provided in home infusion—including essential pharmacist services—into the reimbursement structure. If implemented, this legislation could increase provider participation in the benefit and improve patient access to home infusion.