Part B: Home IV's new home?
WASHINGTON - Four members of the U.S. House of Representatives introduced a bill July 13 to consolidate coverage for home infusion drugs and services under Medicare Part B.
"It's a first step in the right direction," said Lorrie Kline Kaplan, executive director of the National Home Infusion Association (NHIA). "The coverage right now is very fragmented and confusing to beneficiaries."
Under the new bill, H.R. 5791--also known as the Medicare Home Infusion Consolidated Coverage Act of 2006--all aspects of home infusion therapy--supplies, drugs, equipment and professional services--would be covered under the Medicare Part B DME benefit for external infusion pumps. Currently, that coverage extends only to 23 infusion drugs. All other infusion drugs are covered under the new Medicare Part D benefit, which includes a small dispensing fee. Neither Part B nor D covers the necessary supplies and services that go along with home infusion therapy.
"That creates access problems for patients," said Brian Simonds, director of Baystate Home Infusion in Springfield, Mass. Patients who could otherwise receive infusion therapy at home are forced to go to nursing homes or remain in hospitals longer in order to receive the therapy.
"We see it every day where people make decisions to go to nursing homes to get their IV therapy," said Simonds. "If a patient has to share the cost of that service, it can be pretty cost prohibitive."
It's a wasteful system, John McGlew, NHIA's assistant director of government relations, agreed.
"It's cheaper to have somebody in the home with a provider visiting them instead of dedicating and entire hospital or nursingg home bed to them," said McGlew. "The private sector has been able to realize for a number of years (that treating patients) in their home where they are likely to be happier and less prone to infections."
H.R. 5791 is sponsored by Kay Granger, R-Texas; Eliot Engel, D-N.Y.; Randy Kuhl, R-N.Y.; and Tammy Baldwin, D-Wis. At press time, the bill had 28 co-sponsors and Denver-based specialty infusion provider Coram has also endorsed the bill.
Kaplin said she hopes to get a companion bill introduced in the Senate soon.