POLICY AND ADVOCACY

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Tell Congress: Support the Preserving Patient Access to Home Infusion Act

Support the home and specialty infusion industry – help NHIA in our work with congressional champions to permanently fix the Medicare Part B home infusion therapy services benefit. NHIA has drafted legislation (H.R. 6218S. 3457) with the help of our champions to permanently fix the home infusion therapy services benefit. Tell Congress to support the Preserving Patient Access to Home Infusion Act.

As the leading voice for home infusion on Capitol Hill and with the Administration, NHIA is fighting to ensure that federal policy supports equitable access to the full range of home infusion therapies.

Current Policy Initiatives

Preserving Patient Access to Home Infusion Act (116th Congress)

S. 3457. (PDF Full Text)
Sponsor: Senator Mark Warner (VA)
Introduced: March 12, 2020
Original co-sponsor: Senator Tim Scott, (SC)

H.R. 6218 (PDF Full Text)
Sponsor: Representative Eliot Engel, (NY)
Introduced: March 12, 2020

Summary

In 2016, Congress passed the 21st Century Cures Act, which included reforms to the Medicare Part B DMEPOS program including changing the payment methodology for drugs from Average Wholesale Price to Average Sales Price. To ensure home infusion services were not interrupted, Congress added a new Home Infusion Therapy Services benefit to Medicare Part B. Since the new benefit created by Cures does not start until 2021, Congress included a home infusion services temporary, transitional benefit in the Bipartisan Budget Act of 2018, in an effort to bridge the gap until the permanent benefit would begin.

Unfortunately, the Centers for Medicare and Medicaid Services (CMS) has interpreted the home infusion services benefit as one that covers professional services provided in the patient’s home (i.e. nursing) to administer IV or SC medications. Despite a letter from the Congressional sponsors of the home infusion legislation, numerous comments through the rule-making process, and drops in utilization, CMS has not moved from their flawed definition of “home infusion calendar day.”

Letter to HHS from Senate bill sponsors
Letter to HHS from House bill sponsors

NHIA has drafted legislation with the help of our Congressional champions to permanently fix the home infusion therapy services benefit. The legislation (H.R. 6218, S. 3457) was introduced in March 2020 and will accomplish the following if passed:

  • Require CMS to pay home infusion providers for professional services each day the drug is administered.
  • Remove the requirement that a skilled professional be present in the home for billing to occur.
  • Explicitly acknowledge pharmacy professional services.
  • Keep all drugs in the benefit that were part of the transitional program (i.e. Hizentra)

Status:

  • Introduced, pending committee hearings, mark up, and scoring.
  • Recruiting co-sponsors


How you can help

  • Contact your Senators and Representatives and ask them to co-sponsor H.R. 6218 and S. 3457. 
  • Write an op-ed for your local paper about how home infusion has supported patients during the COVID-19 pandemic.
  • Invite patients to share their stories with NHIA about how home infusion has positively impacted their lives. 


Part D Home Infusion Coverage During the Public Health Emergency

During the early days of the COVID-19 pandemic, the need to expand access to home-based care for seniors became readily apparent. NHIA coordinated with members and stakeholders to provide recommendations to CMS, commercial payers, and legislators regarding how to leverage home infusion services in order to support patients, physicians, and hospitals as they responded to the pandemic.

NHIA created draft legislation that would utilize the home infusion therapy services codes created for Part B to provide a bundled payment, similar to the commercial model, for drugs reimbursed under Part D when given at home. The concept legislation accomplishes the following:

  • Establishes a differential payment that reimburses the provider for each day of drug administration, and paying a higher rate for days the nurse visits the home
  • Ensures billing is not dependent on a face-to-face requirement
  • Allows qualifying patients to continue to receive home health nursing under Medicare Part A
  • Explicitly recognizes pharmacy professional services
  • Limits participation to a qualified pharmacy or physician enrolled in the DMEPOS program


Policy Resources
In addition to the work NHIA has done on Medicare Reimbursement, we have been active on issues related to sterile compounding, insanitary conditions, and revisions to USP <797> and <800>. Click here for additional information on these activities.