Infusion stakeholders send new letter

ALEXANDRIA, Va. — A group of more than 35 patient and stakeholder groups are calling on Congress to address Medicare beneficiary access to home infusion services.  

In a letter to lawmakers, the groups urge congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S. 1976/H.R. 4104), which would include pharmacy services as part of the home infusion therapy benefit under Medicare and cover everything from assessments to drug preparation and compounding to care coordination and documentation. The bills would also direct CMS to pay 50% of the nursing rate on days when home infusion is provided, even when a nurse is not present. 

“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, BSPharm, president & CEO of the National Home Infusion Association. “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.” 

While 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, it improperly implemented the benefit by requiring a nurse to be physically present in the patient's home for providers to be reimbursed, says NCPA. 

If implemented, the Preserving Patient Access to Home Infusion Act would increase provider participation in the benefit and enhance patient access to home infusion, effectively diverting care to the home that would otherwise be delivered in more expensive institutional settings, the groups say. 

“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. 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,” said Lauren Stiles, JD, president & CEO of Dysautonomia International. “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.”