Home Infusion Fix Trapped by Deadlocked Congress

Home infusion providers were hoping to get a reimbursement provision through the minefield of the House and Senate, but were ultimately unsuccessful in doing so before the government shut down at 12 a.m. on Jan. 20.

Though the Medicare Home Infusion Therapy Access Act (HI Therapy Access Act) has bipartisan support, it needs to be passed early this year for the Centers for Medicare & Medicaid Services (CMS) to be able to implement the temporary payment for home therapy services by early next year. And that won’t be an easy task in the current climate, assuming it’s possible at all.

“[The act] hasn’t languished, it hasn’t gotten lost,” Tyler Wilson, the president and CEO of the National Home Infusion Association, told Home Health Care News. “There’s just not a lot getting through Congress these days.”

With the Senate voting down a funding measure that would have fended off a shutdown for a month on Friday, it’s not clear what will be next for the HI Therapy Access Act.

Reimbursement gap

When the 21st Century Cures Act was passed in late 2016, it stipulated that a new home infusion therapy clinical services benefit for Medicare Part B would begin in 2021.

However, the act also reduced the reimbursement rate for home infusion therapy.

The changes, which took effect Jan. 1, 2017, included altering the cost of infusion drugs to average sale price (ASP) plus 6%, compared with Medicare reimbursement to 95% of the average wholesale price (AWP) of infusion drugs before the Cures Act.

“When the 21st Century Cures bill was passed, one of the ways that they funded [it] was to reduce the reimbursement for device infusions, for medical device infusions,” Lawrence LaMotte, vice president of public policy at the Immune Deficiency Foundation, told HHCN. The foundation advocates for patients with primary immunodeficiency (PI) diseases, who can be treated with immunoglobulin, or antibodies.

The treatment makes use of a pump that was characterized as Part B of Medicare under the medical device infusions component, LaMotte explained.

Though the drugs are covered, the services associated with the therapy are not, he said.

The number of people who depend on home infusion in the Medicare space for Part B drugs is estimated at about 25,000, Wilson told HHCN. But they are exceptionally acute patients, he added.

Don Powell, president of Middleton, Wisconsin-based Chartwell Wisconsin Enterprises, agreed.

“The level of care that’s necessary for these patients is significant and most infusion providers are providing a much higher level of care for these patients,” he told HHCN. “With that high level of care comes the costs associated with it.”

A package deal

The Therapy Access Act, which passed the House and has a Senate version, is intended to provide a temporary payment under Medicare for home infusion therapy. It passed the House as part of a Medicare Part B legislative package in July 2017, but never made it through the Senate. With a government shutdown now in effect, the path and timing for it becoming law remain uncertain.

Medicare provisions, including the HI Therapy Access Act, were not part of the spending bill that passed the House Jan. 18 and failed to pass the Senate, precipitating the shutdown.

“The patients are going to feel the repercussions if Congress does not act,” Wilson told HHCN on Jan. 19.

There is some talk that a Medicare provision should be put in as part of a renegotiated spending package, Wilson said, but he once again stressed the uncertainty of the process. The current state of politics certainly isn’t helping.

“There’s an awful lot of atmospherics that are taking place that have perhaps distracted from a focus on health care,” he said.

Written by Maggie Flynn

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Maggie Flynn on Linkedin
Maggie Flynn
Business reporter at Aging Media Network
When she's not working, Maggie enjoys running, reading, writing and sports, in no particular order. Favorite things include murder mysteries, Lake Michigan and the Pittsburgh Penguins.

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