On the move: Bill would provide some relief from payment gap

WASHINGTON - It's not a perfect fix, but a new bill that would create a “temporary transitional payment” for home infusion drugs is a step in the right direction, say industry leaders.

Per the bill, introduced by Reps. Pat Tiberi, R-Ohio, and Bill Pascrell, D-N.J., the payment would kick in Jan. 1, 2019, helping to provide some relief from a payment gap created by the 21^st Century Cures Act.

“It's in line with what we were looking for,” said Ken van Pool, vice president of legislative affairs for the National Home Infusion Association. “We had originally asked if we could just move the services payment forward, but there were some ramifications of getting CMS up and running.”

The Cures Act requires Medicare to pay for services associated with providing Part B home infusion drugs, but not until 2021. Meanwhile, a second provision cut payments for those drugs on Jan. 1 of this year by shifting from an average wholesale price to an average sales price model.

While it still leaves providers struggling under steep cuts for two years, H.R. 3163 is a big nod to the services they provide.

“As a provider, and as an industry, we need to keep servicing those patients, but by doing that, we are at a significant loss,” said Drew Walk CEO of McKinney, Texas-based Soleo Health. “Still, this is a positive step toward recognizing the care we provide.”

Getting anything accomplished on health care in the current Congress is difficult, so the speed with which the bill is moving—it went to mark up in the House Ways & Means Committee July 13—is heartening, says Walk.

“We've got the support of key leadership, so that's great,” he said.

NHIA has begun reaching out to House members to seek their support for the bill and will lobby Senate members for a companion bill. While H.R. 3163 could move forward as a standalone bill, there are several Medicare packages that need to be passed by Sept. 30 that could serve as a vehicle, says van Pool.

“There's a slew of bipartisan bills that the committees of jurisdiction are looking to move so we hope we are in that bucket so we can move on this quicker, but if necessary, we can attach ourselves to one of those vehicles,” he said. “Frankly, I think everyone in the Medicare world is eyeing the September process.”