Groups push fix to keep infusion therapy at home

Two groups are leading an effort to urge congressional leaders to quickly pass a temporary patch that would ensure patients can continue to receive a critical medical treatment at home.

In a letter sent to House and Senate leaders Tuesday, the Immune Deficiency Foundation said time is of the essence to fix what they say is a problem created by the 21st Century Cures Act, which was signed into law in 2016.

Advocates are concerned about the impact the law is having on Medicare beneficiaries with heart failure and with disorders where their immune system does not function properly.

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“Because of the payment gap created in late 2016, some Medicare beneficiaries with [primary immunodeficiency diseases] were notified last year that their home infusion provider would no longer be offering such services,” John Boyle, the foundation’s president and CEO, wrote in the letter.

“As this issue continues to linger, we are very concerned that additional home infusion providers will soon reach similar conclusions resulting in sizeable access challenges for our population of immune-compromised beneficiaries,” he wrote.

The foundation’s effort follows a letter the National Home Infusion Association sent Thursday to congressional leaders, echoing the same concerns over Medicare beneficiaries being able to receive infusion therapies at home.

A provision in the biomedical innovation law created a new Medicare home infusion benefit effective 2021. But the issue, the groups say, is that reimbursement for the drugs changed as of January 2017.

This created a “four-year gap,” where the amount Medicare reimburses providers for the treatment is “largely insufficient to cover nursing, education, training and monitoring services that are needed to ensure beneficiaries safely and effectively self-administer life-saving therapies,” according to the letter.

The House passed a measure by voice vote in July that would establish a temporary payment for these services in 2019 and 2020. The Senate hasn’t passed its bill, which has netted nearly 30 bipartisan co-sponsors.

Tyler Wilson, National Home Infusion Association’s president and CEO, said the measures are noncontroversial, and as for a legislative vehicle, “we’ve put ourselves in a position to be swept up in the first thing to happen on health care.”

The issue needs to be passed by early this year, he said, as the Centers for Medicare and Medicaid Services would need about a year to implement the temporary payment. And it’s imperative that Medicare beneficiaries continue to receive the treatment at home, Wilson said.

“They face longer stays in the hospitals or being sent to the skilled nurses facility — and these are compromised patients, these are fragile patients, they can ill afford in terms of their health conditions to be in an institution because of the risk of infection and other risks that the institution setting present,” he said. “And they need to be at home.”