Coronavirus raises stakes for home infusion therapy

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Friday, April 24, 2020

WASHINGTON – Home infusion stakeholders have asked CMS to issue an 1135 blanket waiver to allow coverage for all home infusion therapies during the current public health emergency.

Without such coverage, hospitals can’t discharge patients to free up hospital beds for COVID-19 patients, and patients go without needed treatment, says Connie Sullivan, president and CEO of the National Home Infusion Association.

“This is not any different than what we have proposed (in the past), but with the PHE, it’s getting more attention,” she said. “There’s a lot of interest in home infusion because patients are concerned about being exposed to COVID-19.”

Specifically, stakeholders are asking CMS to: expand the definition of home infusion drugs to include items and services provided in coordination with an infused drugs covered by Medicare Part D, and allow payment for the date on which a home infusion drug is administered, regardless of whether a qualified home infusion therapy supplier was physically present in the home on such a date.

Commercial payers, including Medicare Advantage plans, have long offered comprehensive coverage for home infusion, but Medicare Part B only covers a limited range of therapies, says Sullivan.

“This is a gap in the health care system that has existed for a long time,” she said. “We have demonstrated success in (treating home infusion patients) in the commercial sector, and it’s one of the few things that would be saving the health care system money.”

More than 160 infusion stakeholders, including the ALS Association, Partners Healthcare System, Massachusetts General Hospital and the National Association for Home Care & Hospice, have announced their support for the waiver, as well as potential draft legislation if regulatory relief isn’t forthcoming.

More than 200 members of Congress have also signed letters calling on HHS and CMS to lift restrictions on home infusion during the pandemic.