Washington D.C.  – U.S. Rep. Terri Sewell (AL-07) joined Reps. Fred Upton (R-MI), Debbie Dingell (D-MI), and Vern Buchanan (R-FL) in introducing H.R. 5067, the Preserving Patient Access to Home Infusion Act. This bipartisan bill would ensure patients with serious viral and fungal infections, heart failure, immune diseases, cancer, and other conditions receive the intravenous (IV) medications they need while at home.

“Countless Alabamians, especially those in rural communities, rely on home infusion services for life-saving care,” said Rep. Sewell. “With the risks posed by the COVID-19 pandemic, it has never been more critical to ensure that patients continue to receive this care safely in their homes. I’m so proud to introduce this bipartisan bill and urge my colleagues on both sides of the aisle to give it their full support.”

“While the COVID-19 pandemic certainly took so much from so many, it also gave us the opportunity to rethink the way that we care for the most vulnerable among us,” said Rep. Upton, lead Republican co-sponsor. “Home infusion, in particular, is a perfect example of how we can bring healthcare services into folks’ homes while keeping both patients, their families, and medical professionals safe and healthy. I am proud to cosponsor this important legislation and will continue to work with my colleagues on both sides of the aisle to expand access to quality, affordable healthcare.” 

“The COVID-19 pandemic has highlighted the importance of access to quality, affordable health care – especially in home health care,” said Rep. Dingell, lead Democratic co-sponsor. “The legislation’s commonsense reforms will expand access to home infusion services for Medicare beneficiaries, saving the Medicare program millions of dollars, cutting patient costs, and ensuring people receive safe and adequate care in the comfort of their own home. I look forward to working with my colleagues to move this bipartisan legislation forward so we can effectively care for people and save money by doing so in a home setting.”

“As we have learned from the coronavirus pandemic, home health services have proven to be invaluable for seniors in my district and across the country,” said Rep. Buchanan, lead Republican co-sponsor. “The aptly-named Preserving Patient Access to Home Infusion Act will ensure that Medicare recipients are able to continue to receive life-saving drugs in a safe and effective way from the comfort of their own home.”

Background

Patients with serious infections, cancer, heart failure, immune system diseases, and other conditions who need medications such as IV therapies, can receive these medications in their home rather than institutional settings like hospitals or nursing homes. When given the option, patients would overwhelmingly prefer to receive their infused drugs at home where they are most comfortable and can resume their personal and professional lives. In fact, research shows that up to 95% of patients would prefer receiving their infusions at home. 

Congress included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 to create a professional services benefit for Medicare Part B home infusion drugs. The purpose of this benefit was to maintain patient access to home infusion by covering professional services including assessments, education on administration and access device care, monitoring and remote monitoring, coordination with the patient, caregivers and other health care providers, and nursing visits.

Despite Congress’ intent—as detailed in multiple letters to the agency—the Centers for Medicare and Medicaid Services (CMS) improperly implemented the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed. As a practical matter, the current home infusion therapy benefit only acknowledges face-to-face visits from a nurse and fails to account for the extensive clinical and administrative services that are provided remotely by home infusion clinicians. As a result, provider participation in Medicare’s home infusion benefit has dropped sharply and beneficiaries have experienced reduced access to home infusion over the last several years.

The Preserving Patient Access to Home Infusion Act provides technical clarifications that will remove the physical presence requirement, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services provided in home infusion—including essential pharmacist services—into the reimbursement structure.

The Congressional Budget Office (CBO) has consistently concluded that enhanced patient access to home infusion will create savings for the Medicare program. An analysis from The Moran Company estimates that the bill would save $93 million over 10 years. Cost savings generated through site of care optimization are passed on to the patient in the form of lower copays and reduced out-of-pocket costs. This is especially important in Medicare Part B, where patients pay 20% coinsurance. 

“Home-based infusion services stand out as high-value resources that improve patient quality of life and add capacity to the health care system while providing cost-savings for the Medicare program,” said NHIA President and CEO Connie Sullivan, BSPharm. “Passage of the Preserving Patient Access to Home Infusion Act is critical to ensuring the Medicare program maintains access to home infusion, allowing beneficiaries to safely receive treatment in the setting they overwhelmingly prefer: their homes.”

“Providing IV medications in patients’ homes allows individuals to receive their treatments without major sacrifices in their quality of life and without having to rely on transportation to travel to a facility for their treatments,” said Logan Davis, PharmD, MBA of Vital Care InfusionServices. “This legislation will ensure that the Medicare home infusion therapy benefit is accessible to patients, including many who are located in Alabama’s rural or historically underserved communities.”

Companion legislation was introduced in the U.S. Senate by Sens. Mark Warner (D-VA) and Tim Scott (R-SC).