FOR IMMEDIATE RELEASE
Contact: Shea McCarthy
Director of Legislative Affairs
Alexandria, VA (August 24, 2022) — Dozens of health systems, hospitals, and group purchasing organizations — collectively representing over 600 hospitals and over 5,000 sites of care across all 50 states — are calling on Congress to address Medicare beneficiary access to home infusion services and pass legislation that would increase access to home-based care. The letter, signed by many of the nation’s marquee health systems, urges congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S. 2652/H.R. 5067) to encourage access to home infusion therapy for Medicare beneficiaries.
As the letter explains, “while commercial insurance plans provide comprehensive coverage for home infusion therapy (HIT) services, seniors who are covered under traditional Medicare often do not have the option to remain at home.” The letter goes on to cite a report released by the Centers for Medicare and Medicaid Services (CMS) in January 2022 confirming that utilization of the benefit has been low, which “creates challenges in our ability to transition patients from inpatient care to the home setting.” CMS’ data reveals that less than 1,300 Medicare beneficiaries accessed the benefit each calendar quarter between the first quarter of 2019 and the first quarter of 2021 — an anomaly compared to the estimated 3.2 million patients served annually by home infusion pharmacies.
“Hospitals and health systems understand that Medicare patients with underlying health conditions often require access to infused medications after a recent hospital stay,” said Connie Sullivan, BSPharm, President & CEO of the National Home Infusion Association. “NHIA appreciates the support of our hospital and health system partners in expressing the urgent need for comprehensive access to home infusion services.”
Background on the ‘Preserving Patient Access to Home Infusion Act’
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. The intent in establishing this benefit was to facilitate patient access to home infusion by covering professional services including assessments, education on administration and access device care, monitoring and remote monitoring, coordination with the patient, caregivers and other health care providers, and nursing visits.
Despite Congress’ intent — as detailed in multiple letters to the agency — the Centers for Medicare and Medicaid Services (CMS) 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, the current home infusion therapy benefit only acknowledges face-to-face visits from a nurse, failing to account for the extensive clinical and administrative services that are provided remotely by home infusion clinicians. As a result, provider participation in Medicare’s home infusion benefit has been limited and beneficiaries have experienced challenges in accessing home infusion over the last several years.
The Preserving Patient Access to Home Infusion Act provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services provided in home infusion — including essential pharmacist services — into the reimbursement structure. If implemented, this legislation 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.
About the National Home Infusion Association
NHIA is a trade association that represents companies that provide infusion therapy to patients in their homes, as well as companies that manufacture and supply infusion and specialty pharmacy products. The association’s mission is to provide advocacy, education, and resources to the home and specialty infusion community so the patients they serve can lead healthy, independent lives. Infusion therapy involves patient-specific compounded medications, supplies, and a range of pharmacy, nursing, and other clinical services for delivering care to patients in the home setting. For more information, visit www.nhia.org
NHIA submitted comments on a CMS proposed rule (CMS-1770-P) that would affect Medicare payments and coverage of COVID-19 vaccines and monoclonal antibodies (mAbs) and coding and billing requirements related to the use of single dose containers and drug waste.
The National Home Infusion Association (NHIA) will hold its first-ever home and specialty infusion payor summit November 2 in Dallas, TX. The event is designed to bring together leaders from commercial health insurance plans with home and specialty infusion experts to discuss how payors can better leverage home infusion to lower the total cost of care.