Alexandria, VA (November 12, 2024)—A diverse group of more than 35 patient and stakeholder groups are calling on Congress to address Medicare beneficiary access to home infusion services. In a letter to lawmakers, which brings together stakeholders from across the care continuum, the groups urge congressional leaders to advance the Preserving Patient Access to Home Infusion Act (S. 1976/H.R. 4104) and increase access to home infusion therapy for Medicare beneficiaries.

“Medicare beneficiaries with chronic conditions such as dysautonomia are often unable to access home infusion services, leaving them without essential treatments that help manage their disease. For these individuals, the physical toll of traveling to outpatient infusion clinics is often too great, leading to poorly managed symptoms and, ultimately, more emergency room visits,” said Lauren Stiles, JD, President & CEO of Dysautonomia International. “Congress has the opportunity to address this urgent need by passing the Preserving Patient Access to Home Infusion Act, ensuring that Medicare beneficiaries can receive critical care in the comfort of their homes and avoid unnecessary hospitalizations.”

“Home infusion services have long been a critical component of patient-centered care, allowing individuals to receive necessary intravenous (IV) and subcutaneous therapies at home,” the groups write. “Despite these clear benefits, the current Medicare home infusion therapy (HIT) benefit is failing to function as Congress intended and is not meeting the needs of Medicare beneficiaries.”

“Home infusion improves patient outcomes, prevents unnecessary hospital and long-term care stays, and leads to substantial efficiencies for both patients and the Medicare program.,” said Connie Sullivan, BSPharm, President & CEO of the National Home Infusion Association. “By aligning Medicare policy with the successful models already in use by commercial insurers we can expand home infusion access to those who need it most – America’s seniors and those living with disabilities.”

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 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.

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. 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.

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