Deeper dive: New infusion bill should be 'attractive’ 

WASHINGTON – Home infusion stakeholders are back with a revamped bill that they say could be “a substantial saver” to Medicare and expand access for beneficiaries. 

The “Preserving Patient Access to Home Infusion Act,” introduced in March, contains many of the same provisions as previous versions of the bill, but it has three main changes, including bundling disposable supplies related to catheter administration into CMS's pharmacy per day payment, similar to commercial home infusion services. 

“We believe this policy could be a substantial saver to Medicare,” said Connie Sullivan, president and CEO of the National Home Infusion Association. 

As with previous versions, the new legislation would also provide technical clarifications that would remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home; and acknowledge the full scope of professional services as covered under the benefit. 

Another change in the new legislation: Expanding the home infusion benefit to include anti-infectives billed to either Part B or Part D. 

“The nice thing is that it doesn’t require moving the drug into Part B to make the patient eligible,” Sullivan said. “That’s important because Part B has no cap on the patient’s out-of-pocket, so the cost is a lot higher than if you leave it in Part D.” 

The new legislation also calls for a five-year transition period during which the current nursing rate would be maintained, giving providers time to enroll, get accredited and receive education, and giving stakeholders time to develop a workable reimbursement rate, says Sullivan. 

“It’s difficult when there’s so much uncertainty round how CMS might interpret the policy and how they might price it,” she said. “This is intended to remove the uncertainty and give it a fair chance to launch.” 

As far as getting the bill over the finish line, the NHIA is looking at several opportunities, including a reconciliation bill currently being worked on, as well as funding bills expected in September. Sullivan says having new leadership at both CMS and the Department of Health and Human Services could work in the industry’s favor. 

“There are a lot of things we feel that we bring to the table that are attractive to this administration,” she said. “To the extent that we can help them understand how home infusion saves health care dollars, we feel we can make some progress with our policies.”