The Preserving Patient Access to Home Infusion Act protects access to Medicare’s home infusion benefit by making clear that pharmacy services for home infusion therapy can be reimbursed.
The legislation sets an appropriate rate for such services and ensures that Medicare pays for all services needed to deliver home infusion therapy.
U.S. Sens. Mark R. Warner of Virginia and Tim Scott of South Carolina were joined by U.S. Reps. Vern Buchanan of Florida, Chairman of the House Ways & Means Health Subcommittee Debbie Dingell of Michigan, Diana Harshbarger of Tennessee and Terri Sewell of Alabama yesterday to reintroduce the legislation.
“We have seen for years that patients are better off when they can receive quality care from the comfort of their own homes,” Warner said. “This legislation would ensure that millions of Americans who suffer from life threatening conditions such as immune diseases, cancer, serious infections, and heart failure can receive the care they need without having to make frequent, sometimes costly trips to the hospital.”
Scott said that high-risk patients are more susceptible to contracting disease and should not have to visit a hospital to receive life-saving treatment.
“This commonsense legislation ensures that millions of Americans have the option to receive the care they need in the comfort and safety of their own homes,” Scott said.
The Preserving Patient Access to Home Infusion Act provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services provided in home infusion, including essential pharmacist services, into the reimbursement structure.
The legislation would:
- include pharmacy services as part of covered home infusion therapy under Medicare, encompassing assessments, drug preparation and compounding, and care coordination and documentation;
- direct CMS to pay 50 percent of the nursing rate on home infusion days when a nurse is not present;
- allow nurse practitioners and physician assistants to establish and review the plan of care for home infusion therapy.
Buchanan said that the COVID-19 pandemic taught everyone how invaluable home health services are for seniors in his district and in the United States.
“The aptly-named Preserving Patient Access to Home Infusion Act will ensure that Medicare recipients can continue to receive life-saving drugs in a safe and effective way from the comfort and convenience of their own home,” Buchanan said.
Dingell said the majority of patients would prefer to receive care in their homes when possible.
“The legislation’s commonsense reforms will expand access to home infusion services for Medicare beneficiaries, saving the Medicare program millions of dollars, cutting patient costs, and ensuring people receive safe and adequate care in the comfort of their own home. I look forward to working with my colleagues to move this bipartisan legislation forward so we can effectively care for people and save money by doing so in a home setting,” Dingell said.
Regular visits to healthcare providers can be costly and burdensome for Medicare patients who live in rural areas.
“It is critical that common-sense reforms are passed to address CMS’ flawed implementation of home-based care for Medicare patients, which is why I am proud to co-sponsor the Preserving Patient Access to Home Infusion Act. This legislation is vital to our many seniors who receive infusion treatments, ensuring patients have access to effective therapies from the safety and comfort of their homes, while producing cost-savings for both the Medicare program and patient,” Harshberger said.
Sewell said that countless Alabamians rely on home infusion services, especially in rural communities.
“It has never been more critical to ensure that patients continue to receive this care safely in their homes. I’m so proud to introduce this bipartisan bill and urge my colleagues on both sides of the aisle to give it their full support,” Sewell said.
Warner included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 to create a professional services benefit for Medicare Part B home infusion drugs to maintain patient access to home infusion by covering professional services including assessments, education on administration and access device care, monitoring and remote monitoring, coordination with the patient, caregivers and other health care providers and nursing visits.
However, the Centers for Medicare and Medicaid Services (CMS) improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed. Medicare’s home infusion benefit saw a decrease in participation, as a result, and beneficiaries experienced reduced access in the last several years.
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Rebecca Barnabi
