NHIA applauds ‘momentum’ for home infusion coverage improvements

WASHINGTON — The House of Representatives on Feb. 3 passed a government funding bill that includes a change to the qualifying criteria for drugs under Medicare’s home infusion benefit. The National Home Infusion Association (NHIA) believes the change may expand access to certain health care provider-administered drugs if an infusion pump is required for administration.  

The change, part of H.R. 4993, the Joe Fiandra Access to Home Infusion Act, creates a path to coverage under the Part B Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, & Supplies (DMEPOS) benefit for a narrow set of drugs that require a health care provider and an infusion pump for administration. The current DMEPOS home infusion benefit is limited to approximately 40 drugs and lacks a payment for pharmacy services, which has limited provider participation in the program, the NHIA says.  

“I am encouraged by the momentum in Congress to address the limited access to home infusion that exists for Medicare patients,” said Connie Sullivan, president and CEO of NHIA. “For too long, Medicare has lagged other payers that have recognized the benefits of offering straightforward access to home infusion rather than directing patients to higher cost settings for infusions. Congress needs to take the next step and pass H.R. 2172 and finally establish a benefit that reflects how care is actually delivered. We are ready to support Congress in their efforts to finally fix the broken Medicare home infusion benefit.” 

In January, members of the House Energy and Commerce Health Subcommittee also expressed strong bipartisan support for H.R. 2172, the Preserving Patient Access to Home Infusion Act, which would remove barriers to accessing home infusion by establishing coverage for the full scope of professional services that make the benefit function and allow access for patients needing IV anti-infectives, with or without the use of an infusion pump. By comparison, all other payers utilize a bundled payment model to cover all services and supplies and allow access to more than 300 infusion drugs without restrictions for the use of a pump or a limitation on payments for services unless they are delivered face to face, the NHIA says. 

Related: AAHomecare, NHIA urge lawmakers to act