New bill seeks to facilitate in-home infusion reimbursements
The bill would remove the requirement that a provider has to be physically present when a patient receives their infusions.
Photo: Jasmin Merdan/Getty Images
New bipartisan legislation, introduced this week by Representatives Vern Buchanan (R-FL), Terri Sewell (AL-07), Fred Upton (R-MI) and Debbie Dingell (D-MI), seeks to smooth the path for provider reimbursement for in-home infusion treatments for ailments such as cancer, heart failure and immune diseases.
The bill, the Preserving Patient Access to Home Infusion Act, would change a new benefit under Medicare Part B, removing the requirement that a provider has to be physically present when a patient receives their infusions.
It provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a healthcare professional is present in the patient's home. The legislation also acknowledges the full scope of professional services provided in home infusion – including pharmacist services – into the reimbursement structure.
Research from the British Journal of Nursing found that up to 95% of patients would prefer receiving infusions at home, suggesting patients overwhelmingly prefer to receive their infused drugs in a comfortable setting.
Lawmakers said the changes outlined in the bill are especially important given the ongoing COVID-19 pandemic.
WHAT'S THE IMPACT?
According to the bill's sponsors, the Centers for Medicare and Medicaid Services improperly implemented the benefit by requiring a nurse to be physically present in the patient's home in order for providers to be reimbursed.
As a practical matter, they said, the current home infusion therapy benefit only acknowledges face-to-face visits from a nurse and fails to account for the extensive clinical and administrative services that are provided remotely by home infusion clinicians.
Participation in Medicare's home infusion benefit has dropped sharply, and beneficiaries have experienced reduced access to home infusion over the last several years, according to research from the National Home Infusion Association. The study showed that 15,905 Part B beneficiaries were served in 2018, compared to 21,624 in 2014.
Dingell said via statement that the proposed legislation will save Medicare millions of dollars, cut patient costs and increase quality.
"The COVID-19 pandemic has highlighted the importance of access to quality, affordable health care – especially in home healthcare," she said.
The legislation has been endorsed by the National Home Infusion Therapy Association and Vital Care Infusion Services.
"Home-based infusion services stand out as high-value resources that improve patient quality of life and add capacity to the health care system while providing cost-savings for the Medicare program," said NHIA President and CEO Connie Sullivan, BSPharm, via statement.
"Passage of the Preserving Patient Access to Home Infusion Act is critical to ensuring the Medicare program maintains access to home infusion, allowing beneficiaries to safely receive treatment in the setting they overwhelmingly prefer: their homes."
THE LARGER TREND
In July, the Centers for Medicare and Medicaid Services issued a proposed home health rule aimed at accelerating the shift to value by expanding the Home Health Value-Based Purchasing Model nationwide.
Along with routine updates to the Home Health Prospective Payment System, CMS proposed home infusion-therapy services payment rates for 2022, as well as making permanent changes to the home health conditions of participation implemented during the COVID-19 pandemic.
A 2016 study by the CVS Health Research Institute found that home infusion care is safe and clinically effective and that it improves quality of life. When compared with infusion care delivered in a hospital or clinic, it may also reduce healthcare costs.
ON THE RECORD
"While the COVID-19 pandemic certainly took so much from so many, it also gave us the opportunity to rethink the way that we care for the most vulnerable among us," said Upton. "Home infusion, in particular, is a perfect example of how we can bring healthcare services into folks' homes while keeping both patients, their families, and medical professionals safe and healthy. I am proud to cosponsor this important legislation and will continue to work with my colleagues on both sides of the aisle to expand access to quality, affordable healthcare."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
