Updated bill aims to split home IV coverage

Sunday, June 10, 2007

WASHINGTON - A revamped home infusion bill now seeks coverage of supplies and services under Medicare Part B and drugs under Part D.

Introduced in the House of Representatives June 5, H.R. 2567 is an updated version of last year's H.R. 5791, which sought to consolidate home infusion drugs, supplies and services under Part B.

Splitting coverage between parts B and D makes sense, said Russ Bodoff, executive director of the National Home Infusion Association (NHIA).

"We've already got the pharmaceuticals in Part D," said Bodoff. "This willput coverage on services, supplies and equipment. Also in Part B, there is a better capability of developing quality standards that go along with the delivery of service. Part D doesn't have that capability."

Because drugs cost less under Part D, the new plan would save Medicare money, said Bodoff, increasing its chance of passing. The Infectious Disease Society of America and B.I.O., a biopharmaceutical trade association, have joined NHIA to get the bill passed.

Currently, the Medicare Part D drug program, launched in January of 2006, offers only a small dispensing fee for services and supplies.

John Russell, director of infusion for Associated Healthcare in Williamsville, N.Y., said the company has turned away Medicare patients.

"Part D doesn't cover supplies," said Russell. "What good is the drug if you can't administer it? The program is a mess."

Other complaints include too many drug plans, drugs covered on one formulary but not another, and drugs covered for certain diagnoses and not others. New York alone has more than 150 drug plans.

Only duel eligible Medicaid patients have coverage for services.

"We take dual eligibles, but we're not going to solicit Medicare-only patients," said Greg Lopresti, COO of Kirkland, N.Y.-based Upstate Home Care. "We don't get paid for any per diem."

While no one in Washington disapproves of improving home infusion coverage, the issue is mired in bureaucracy, said David Franklin, vice president of business operations for Advanced Care Infusion in Shelby Township, Mich.

"CMS says, 'We need legislation,' while Congress says, "You just need a regulatory fix,'" said Franklin. "Both sides are pointing at each other."

Reps. Eliot Engel, D-NY; Kay Granger, R-TX; Tammy Baldwin, D-WI; Chip Pickering, R-MS; Randy Kuhl, R-NY; and John Tierney, D-MA introduced the bill.