Infusion stakeholders take fight back to Congress

WASHINGTON – Stakeholders are taking another swing at fixing the home infusion benefit, with new legislation introduced and, overall, increased awareness among lawmakers of the value of providing care in the home. 

The Preserving Patient Access to Home Infusion Act, introduced Aug. 5 by Sens. Mark Warner, D-Va., and Tim Scott, R-S.C., provides technical clarifications to remove the requirement that a nurse or other health care professional be present in the patient’s home for the home infusion provider to be paid for those services. It also incorporates the full scope of professional services. 

“Certainly, there is much more attention being paid to home-based care and making it available to more beneficiaries in the scheme of trying to improve access,” said Connie Sullivan, president and CEO of the National Home Infusion Association. “I think our bill aligns perfectly with other initiatives put forward by the administration.” 

Warner introduced similar legislation last year. 

The new legislation comes on the heels of the dismissal in June of a lawsuit filed by the NHIA against the Department of Health and Human Services over the implementation of the professional services benefit for a “lack of subject matter jurisdiction.”   

“We were very disappointed to not even have the issues considered,” said Sullivan. “We feel strongly that if it had been decided on merit, we have a strong case.” 

There’s a lot at stake, stakeholders say: Since the Cures Act created the professional services benefit, the NHIA has seen a reduction in beneficiaries taking advantage of the Part B home infusion benefit and “low interest” among providers to enroll in the program, says Sullivan. 

“The payment, frequently, is very low, and there’s a small number of beneficiaries, so there’s not a lot of upside to paying for accreditation and all the extra work for being an enrolled provider,” she said. 

Sullivan’s observations are in line with what Soleo Health has seen, says CEO Drew Walk.  

“We’ve seen a reduction in the number of beneficiaries accessing home infusion care,” he said. “We still do it, but other providers have to make their own decisions. We can’t always meet requests.” 

Walk says the past 18 months of the COVID-19 pandemic have shown that the last place vulnerable patients should be treated is an institutional setting, which is not only more costly, but more dangerous. 

“There’s a lot of patients that would benefit from access to home care,” he said. “It’s maddening that it does not follow for CMS where it does for commercial payers.” 

With a House companion bill set to drop “any day,” stakeholders are eyeing vehicles to attach their legislation to, including budget reconciliation and end-of-year spending packages. NHIA has met with the committees of jurisdiction to alert them to the bill and will be encouraging its members to reach out to their members, says Sullivan. 

“Senators and representatives are really helping us try to get this fixed,” Walk said. “They recognize the value of what we do, and we hope this bill makes it through Congress.”