U.S. House Passes Landmark Legislation for Medicare Home Infusion Reimbursement

Legislation for Medicare Home Infusion Reimbursement-03In July, the U.S. House of Representatives made strides in improving Medicare programs by passing H.R. 3178, the Medicare Part B Improvement Act of 2017. This legislation consists of three titles with several smaller measures.

If approved by the Senate and signed into law, H.R. 3178 will accelerate the 21st Century Cures Act that was passed in December 2016. While the Cures Act aimed to add new home therapy reimbursement benefits starting in 2021, H.R. 3178 will allow reimbursement to begin two years sooner, in January 2019.

The Medicare Part B Improvement Act marks the first of its kind for helping to improve the quality of life for people with chronic conditions who rely on home infusion to achieve their best care outcomes. It’s projected to benefit patients, care providers, and industry stakeholders, as well as lower Medicare spend by $4 million over 10 years.

Bridging the Policy Gap

The Medicare Part B Improvement Act will be a critical catalyst for faster implementation of the 21st Century Cures Act. By 2021, the Cures Act is set to finalize a payment structure for reimbursement of Medicare Part B Durable Medical Equipment (DME) infusion drug services.

However, if signed into law, the Medicare Part B Improvement Act will expedite the process two years by providing a temporary transitional payment starting in 2019. This will help bridge any potential care gaps for Medicare beneficiaries while helping to ensure that home infusion providers continue administering therapy without facing the risk of bankruptcy.

H.R. 3178 ElementsLegislation for Medicare Home Infusion Reimbursement-02

The Medicare Part B Improvement Act consists of three titles, broken into sections:

  • Title I: Improvements in Provision of Home Infusion Therapy
    • Section 101: Provision of temporary transitional Medicare payments
    • Section 102: Extension of the Medicare Intravenous Immune Globulin demonstration project
    • Section 103: Orthotist or prosthetist documentation to be considered part of a patient’s medical record
  • Title II: Improvements in Dialysis Services
    • Section 201: CMS-approved Medicare accreditation of renal dialysis facilities
    • Section 202: Allowance of monthly telehealth visits for end-stage renal disease (ESRD) Medicare beneficiaries
  • Title III: Improvements in Application of Stark Rule
    • Section 301: Codification of certain signature requirements and holdover arrangements relating to physician self-referral prohibitions
    • Section 302: Reduction in funding for Medicare Improvement Fund starting FY2021

Projected Benefits

Supporters assert that the Medicare Part B Improvement Act will have a significant impact on the health outcomes of seniors and other Medicare beneficiaries. Ultimately, these individuals will have greater access to critical care in the comfort of their own homes. In some cases, care will be accessible to a number of people who currently aren’t eligible for treatment due to provider access issues, such as those located in needy or rural areas.

Stay tuned as the Senate reviews and votes on the Act, determining whether it will go into effect.