Stakeholders work on new home infusion bill

WASHINGTON – Stakeholders, with feedback in hand from the Congressional Budget Office, are working with lawmakers from both sides of the aisle to modify previous bills to improve Medicare’s home infusion benefit. 

Among the potential changes in play: Folding in payment for supplies with the services payment, says Connie Sullivan, president of the National Home Infusion Association. 

“That eliminates an extra payment, but it also structures the benefit more comparably to the commercial market where things are bundled, so that's actually a plus, because it gives us a little more of an aligned structure between Medicare and the commercial market,” she said. “We're also looking at possibly applying the benefit to anti-infective therapies.” 

Previous bills, S. 1976 and H.R. 4104, sought to include pharmacy services as part of the home infusion therapy benefit under Medicare to cover everything from assessments to drug preparation and compounding to care coordination to documentation. 

Stakeholders are already making the rounds on Capitol Hill to solidify widespread, bipartisan support for a new bill, Sullivan says. 

“Everyone is very much enthusiastic about picking up where we left off and continuing to work on this,” she said. “We're having some really good substantive discussions around the policy, so that's kind of where we're at right now is deciding what pieces go into the new bill.”  

The NHIA believes these changes would increase provider participation in the home infusion benefit, which was implemented in 2021, and increase beneficiary access. CMS’s own data points to the benefit being underutilized. The HIT Monitoring Report from February 2023 showed utilization remained basically flat over a 26-month study period, despite growing Medicare enrollment, with only 1,250 beneficiaries, on average, receiving Part B home infusion services per quarter.   

“There's real world evidence of savings and it's just better for patients,” said Sullivan. “They're in their own home. Family members don't have to take time off to drive them to and from a hospital clinic. There are so many advantages. So, for all those reasons, we've been able to continue to push this forward.” 

• Related: Patient and stakeholder groups in November urged lawmakers to pass legislation.  
• Related: Infusion providers say patient access has gone down.