New bipartisan bill aims to remove barriers to in-home infusion reimbursements

Home care nurse giving patient physical therapy
Lawmakers want to get rid of the Centers for Medicare & Medicaid Services' requirement that a provider be physically present to qualify for reimbursement for at-home infusion services. (Getty/Photodisc)

New legislation aims to make it easier for providers to get reimbursed for offering in-home infusion treatments such as those for cancer.

The goal of the bill, introduced Tuesday, is to change a new benefit under Medicare Part B for home infusion drugs. The bipartisan Preserving Patient Access to Home Infusion Act would remove a requirement that a provider has to be physically present when a patient takes the infusion drugs, amid other reforms.

Lawmakers say the bill is necessary to help spur greater home care, especially considering the pandemic.

“With the risks posed by the COVID-19 pandemic, it has never been more critical to ensure that patients continue to receive care safely in their homes,” said Rep. Terri Sewell, D-Alabama, one of the lead sponsors, in a statement.

The 21st Century Cures Act and the Bipartisan Budget Act of 2018 included provisions that reimbursed providers under Medicare Part B for home infusion drugs. The goal is to give patients the option to get infusion medications such as IV therapies at home where they are most comfortable.

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However, lawmakers have routinely complained that the Centers for Medicare & Medicaid Services (CMS) has “improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed,” according to a release on the bill.

CMS’ policies have led to a reduction in the number of beneficiaries served by Part B’s home infusion benefit, with 15,905 beneficiaries being served in 2018 compared to 21,624 in 2014, according to a study from the National Home Infusion Association (PDF).

In addition to ensuring payment to providers regardless of whether they are in the home, the bill would also include several services in the reimbursement such as essential pharmacist services, the release said.

“Home-based infusion services stand out as high-value resources that improve patient quality of life and add capacity to the healthcare system while providing cost-savings to the Medicare program,” said Connie Sullivan, president and CEO of the National Home Infusion Association, in a statement.

The legislation comes as more and more providers are aiming to shift care to the home, especially as the pandemic has led to greater use of telehealth.