Many patients with complex health conditions rely on home infusion therapy — medication administered via a needle or catheter — provided in the comfort of their own homes. Home infusion is safe, effective and often less costly than inpatient care, and it plays an invaluable role in helping patients maintain their quality of life.
An unintended consequence of the 21st Century Cures Act, passed by the U.S. Congress and signed into law in December 2016, was creation of a gap in Medicare coverage for certain home infusion services, effectively taking away funding for patient access to high quality home infusion.
After months of advocacy outreach, patients, caregivers and providers won a legislative fix. On February 9, 2018, Congress passed legislation that included a temporary payment fix to the reimbursement gap created by the Cures Act. Under the new law, reimbursement for clinical services delivered by home infusion companies to patients under Medicare Part B will now be paid starting on January 1, 2019 – two years earlier than those services were set to be paid under the Cures Act.
What has happened regarding a legislative fix for Medicare Part B home infusion patients who require inotropic therapy?
The U.S. Congress approved a law that includes a fix to the reimbursement gap for clinical services delivered by home infusion companies to Medicare Part B patients.
This great news for heart failure patients receiving home infusion of inotropic therapy is the result of public advocacy efforts to fix a four-year Medicare reimbursement gap that was created in December 2016 with the passage of the 21st Century Cures Act.
What is the 21st Century Cures Act (Cures Act)?
The 21st Century Cures Act was passed by Congress and signed into law in December 2016 with overwhelming bipartisan support. Some of the most publicized parts of the bill include new funding to the National Institutes of Health and the Food and Drug Administration, expedited research and development on debilitating diseases and expedited approval of prescription drugs and medical devices. While the Cures Act will do great good through its major provisions, there are smaller provisions that have unintended negative consequences.
Why is this legislative fix important and how does it help patients?
The new law creates an interim payment starting Jan. 1, 2019 for the vital clinical servicesprovided by home infusion companies for inotropic infusion and subcutaneous immunoglobulin drugs covered under the Medicare Part B Durable Medical Equipment (DME) benefit.
While this fix is not perfect, it accelerates the services payment from 2021, which significantly improves the current situation and ensures the most vulnerable Medicare beneficiaries can maintain access to care at home.
How did the Cures Act affect home infusion?
The 996-page bill, which went into effect January 1, 2017, included a provision that changed the payment structure for certain infusion drugs under the Medicare Part B Durable Medical Equipment (DME) benefit. With that provision, the payment structure went from an Average Whole Price [AWP] metric to an Average Sales Price [ASP] methodology, creating a dramatic reduction in Medicare reimbursement and effectively covering only the drug costs and providing no reimbursement for clinical services to administer the infusion therapy in the home. A separate provision in the law that provided for a clinical services payment was set to begin in 2021. As a result of legislation passed on February 9, 2018, this much-needed services payment start date will go into effect two years earlier – in 2019.
How did the Cures Act affect home infusion patients?
Patients who were already facing difficult health conditions faced a disruption to their care as they transitioned from hospital to home. Some patients who relied on home infusion care to sustain their quality of life lost that access, placing even greater demands on them, their caregivers and family members as they tried to find alternate treatment options.
What is the Keep My Infusion Care at Home coalition?
Keep My Infusion Care at Home represents the voice of concerned patients, family members, caregivers, healthcare providers and related organizations. For full list of coalition partners, please visit the coalition page
of Keep My Infusion Care at Home.
What types of patients were affected?
The patients most affected by the reimbursement gap were those who receive home infusion therapy for the treatment of severe congestive heart failure, heart transplant and blood diseases.
What are the benefits of home infusion therapy?
Home infusion therapy has several benefits. It is safe, effective, often less costly than inpatient care at hospitals or skilled nursing facilities and it plays an invaluable role in helping patients maintain their quality of life.