Recently, there has been a legislative push to increase access to home infusion services under Medicare. Until now, home infusion providers have had trouble providing services to Medicare patients, unable to promote access to home-based care due to inadequate reimbursement rates from Medicare Part B. Often, Medicare’s reimbursement structure for home infusion therapy does not cover the full cost of providing the service. Also, Medicare may not cover some of the necessary professional services like monitoring and patient education, especially when a nurse is not physically present at the patient’s home. A CMS report discusses that only a small portion of eligible providers are actually participating in Medicare’s home infusion therapy (HIT) benefit. According to the report, just 65 providers billed for HIT services in Q1 2022, despite there being nearly 1,000 home infusion pharmacies, 11,000 home health agencies, and a wide range of other providers capable of providing these services. Utilization of the benefit decreased during the covid-era Public Health Emergency despite an increase in utilization of home infusion services among commercial and other government payers.
To date, Medicare does not provide comprehensive coverage for home-based care. Elderly Medicare beneficiaries that would rely on home infusion for routine treatments such as IV antibiotics are often surprised when they find out that Medicare’s benefit does not allow for coverage of the services and/or supplies required for home infusion. Medicare’s benefit structure leaves many elderly individuals without sustainable alternatives for home-based care. Those living in rural areas or without means of reliable transportation are most at risk, living without access to the care they desperately need.
Advocacy organizations, including the National Home Infusion Association (NHIA), have been pushing for reform to this reimbursement structure. A series of pivotal hearings in the House Ways & Means and House Energy & Commerce Committees were held to develop factual records to support legislation. In response, the Preserving Patient Access to Home Infusion Act (H.R. 4104; S. 1976) was introduced on June 14, 2023, and many provider advocates are urging for its passage to increase access to home infusion therapy for Medicare beneficiaries. Currently, this Act has gained momentum with legislators after the recent 2024 Presidential election.
Ultimately, if this Bill is enacted, it would improve patient outcomes, enhance cost-efficiency, and promote patient-centered care. This Bill would also contribute to a more sustainable healthcare system by shifting treatment from expensive institutional settings to the home.
The Bill specifically includes pharmacy services as part of covered home infusion therapy under Medicare Part B, while also allowing nurses and physician assistants to establish and review the plan of care for home infusion therapy. The Preserving Patient Access to Home Infusion Act would ensure Medicare beneficiaries have access to any/all services necessary for safe and effective home infusion, thereby reducing hospitalizations and costly institutional care as well.
Home infusion pharmacies serve as a vital bridge between traditional healthcare settings and patients’ homes, offering a myriad of benefits that significantly enhance patient care. Firstly, it provides a lifeline for individuals with chronic conditions or complex medical needs, enabling them to receive specialized medications and therapies in the comfort and familiarity of their own environment. This not only improves patient comfort and convenience but also promotes better adherence to treatment regimens, ultimately leading to improved health outcomes. Moreover, home infusion pharmacies reduce the burden on hospitals and healthcare facilities by shifting care to less costly settings, thereby alleviating strain on healthcare resources and allowing hospitals to focus on acute care needs.
Additionally, home infusion pharmacies play a pivotal role in empowering patients to take control of their health journey. By receiving treatment at home, patients gain greater autonomy over their healthcare decisions and experience a sense of independence that fosters emotional well-being. Furthermore, home infusion therapy often involves close collaboration between patients, caregivers, and healthcare providers, fostering stronger bonds and promoting personalized care tailored to individual needs. This collaborative approach not only enhances patient satisfaction but also facilitates continuous monitoring and adjustment of treatment plans, ensuring optimal outcomes over the long term. In essence, home infusion pharmacy represents a cornerstone of patient-centered care, combining clinical excellence with compassion to enrich the lives of those in need.
How Frier Levitt Can Help
If this legislation is passed, there will be new rights for providers, as the Preserving Patient Access to Home Infusion Act would: (1) require a reasonable payment to be made every day a medication is infused, regardless of whether a skilled professional is present in the patient’s home; and (2) compute the specific services to be included in the reimbursement, including extensive pharmacy services that are performed remotely.
Of note, even if this legislation does not get passed, providers can still work with our specialized attorneys to ensure compliance with Medicare’s requirements pertaining to home infusion. Frier Levitt has decades of experience representing home infusion providers. Our seasoned healthcare and life sciences attorneys can guide your pharmacy in any legislative change, how it affects patients, and ensuring compliance with applicable laws. If you have questions or would like to discuss further, contact us to speak to an attorney.
