WASHINGTON—On Tuesday, Sept. 19, the House Energy & Commerce Health Subcommittee held a legislative hearing, “Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology.” Home infusion was discussed at least 3 times throughout the hearing, with a consensus that Medicare needs to improve beneficiary access to home infusion services, the National Home Infusion Association (NHIA) reported.
Rep. Debbie Dingell (D-MI) brought to light two bills—the Expanding Care in the Home Act and the Preserving Patient Access to Home Infusion Act—aimed at modernizing Medicare reimbursement and increasing access to home infusion services for Medicare beneficiaries. Dingell shared a personal story of a time she required several weeks of IV antibiotics through a PICC line and was able to self-administer but was shocked that this more cost-effective and sensible method was not covered by Medicare. She also said that, unlike Medicare, commercial health plans almost universally cover home infusion services.
NHIA said it supports the comprehensive solution to home infusion coverage laid out in the Expanding Care in the Home Act and appreciated Rep. Dingell’s efforts and awareness around the issue.
Rep. Larry Buchon (R-IN) later aligned himself with Rep. Dingell’s comments on home infusion therapy, saying “Medicare’s policy on this has been wrong for decades.” As a cardiovascular surgeon, he said he could keep people in the hospital for 10 days and give them antibiotics but couldn’t get the IV therapy paid for if the patient went home.
Finally, Rep. Neal Dunn (R-FL) commented on new legislation that would expand the number of drugs and biologics covered under the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) home infusion benefit which requires the use of a pump. NHIA previously expressed serious concerns to Centers for Medicare and Medicaid Services (CMS) regarding this piecemeal expansion of the DMEPOS home infusion benefit and questioned the logic of adding drugs to a benefit where the service component is failing to attract providers.
“Though NHIA appreciates the multi-faceted focus on Medicare home infusion legislation, the common sense approaches outlined in Rep. Dingell’s message have the potential to provide seniors the broadest access to home infusion services while reducing costs and modernizing Medicare,” said John Rademacher, NHIA Board chair and CEO of Option Care Health.
“The Expanding Care in the Home Act clearly outlines how to close the gaps in the current Medicare benefit for patients who prefer to access infusion services in their homes. NHIA appreciates and shares Rep. Dingell’s passion for common sense, cost-effective ways to modernize Medicare, such as adding coverage for home infusion,” said Connie Sullivan, NHIA president and CEO.
NHIA said that while the Expanding Care in the Home Act illustrates a well-defined vision of what a workable home infusion benefit could and should look like, Congress can take immediate steps to permanently fix the existing Part B home infusion benefit by passing the Preserving Patient Access to Home Infusion Act. Re-introduced in the 118th Congress (HR 4014), the Preserving Patient Access to Home Infusion Act would require CMS to pay home infusion providers for professional services each day the drug is administered and remove the requirement that a skilled professional be present in the home for billing to occur.
