With many Medicare benefits hanging in the balance, Congress must not forget home infusion therapy

January is supposed to be about new beginnings, but for many Medicare patients it could mark the beginning of the end of their ability to access critical health care services like ambulance rides, chronic care treatments and other therapies.

While lawmakers prepare legislation to address the looming government shutdown, they must not forget about the need to fix a dangerous Medicare policy that threatens some of the country’s most vulnerable patients.

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At issue is a looming gap in reimbursement for home infusion treatment due to an unintended consequence of legislation Congress passed in late 2016. Home infusion therapy—which involves the administration of medication through a needle or catheter— is essential for patients whose illnesses are so severe that they do not respond to oral medication. Treatment at home keeps them out of the hospital or an outpatient health care facility where they would be at risk of infection and other dangerous complications.

When Congress passed the 21st Century Cures Act in 2016, it changed the way Medicare reimburses home infusion therapy drugs to be more reflective of the cost of the actual medicines. But lawmakers realized the new system did not adequately cover the critical clinical services around the administration of those drugs and Congress directed the Center for Medicare Services (CMS) to deploy a new reimbursement system for this clinical piece in 2021. 

In so doing, they created a four-year gap for covering the costs of medical professionals providing home infusion therapy. Reimbursing for the drugs but not the clinical services is tantamount to reimbursing for neither since providers cannot be expected to continue providing these services at a financial loss.

CMS has said it can get the new system in place by early next year but needs Congress to let it do so. Fortunately, the House responded and fixed this problem in the Medicare Part B Improvement Act last year. This bipartisan bill will adjust reimbursement benefits on a temporary basis for home infusion therapy treatments until permanent services payments kick in. The Senate version of the bill has similarly strong bipartisan support with 26 co-sponsors, but must still clear a final vote.

This is must-pass legislation and Congress should include this fix in whatever deal it reaches to avoid the looming government shutdown.

The reduction in reimbursement for the drugs without a services reimbursement has led to home infusion patients increasingly being forced to access care in institutional settings like emergency clinics, hospitals and nursing facilities, placing them at greater risk for complications and significantly increasing costs for the Medicare system.

The Congressional Budget Office has determined that home infusion is the most cost-effective therapy for these patients. The treatment is also less expensive, improves the patient’s quality of life and is most often a patient’s preferred site of care. Medicare beneficiaries who depend on this therapy cannot afford inaction from Congress. If lawmakers do not act in early 2018, CMS may not be able to correct the reimbursement shortfall for this critical therapy.

In a year that is sure to be fraught with contentious legislative debate and endless political posturing, this is an issue that transcends partisanship. Lawmakers should resolve this life-or-death issue immediately before the window of opportunity for doing so closes.

Tyler Wilson is President of the National Home Infusion Association, which represents the companies that provide infusion therapy to home-based patients as well as companies that manufacture and supply infusion and specialty pharmacy products.