US House Votes to Fund Home Infusion, CMS Proposes Cuts to Home Healthcare

This week, the House of Representatives passed the Medicare Part B Improvement Act, a bipartisan bill that, among other provisions, seeks to amend title XVIII of the Social Security Act in order to address the delivery of at-home infusion therapy.

The bill provides for the addition of a temporary home infusion benefit to Medicare, beginning in 2019 and ending in 2021, payment for which would be based on the physician fee schedule. The bill also provides for the following:

• Establishment of payment categories
• Assignment of drugs to those categories
• Assignment of Healthcare Common Procedure Coding System (HCPCS) codes to each payment category
• Establishment of a single payment amount for each category per day of home infusion.

The Congressional Budget Office (CBO) estimated that the act would reduce direct spending by $4 million over the 2018 to 2027 period, and would not affect revenues.

Home infusion trade organizations such as the National Home Infusion Association (NHIA) have publicly supported the act—NHIA’s chairman, Varner Richards, PharmD, provided testimony in support of the bill to the Committee on Energy and Commerce last week—and hope that the Senate will follow the House’s lead.

Many clinicians, however, may prove resistant to the idea of administering infused biologics and biosimilars in home settings. The American College of Rheumatology (ACR)’s official position statement, “Patient Safety and Site of Service for Biologics,” says that, because adverse events are not uncommon—and are potentially severe—with infused biologics, such infusions should be administered in a monitored healthcare setting. ACR’s position goes on to say that infusion should be supervised by a provider with appropriate training, nurse practitioners and physician assistants who supervise infusion centers should work with physicians, and no patient should be forced to receive infusions at home for the purpose of lowering healthcare costs.

Despite the act’s move to encourage home infusion for Medicare patients, CMS has simultaneously proposed a cut to reimbursement to home healthcare agencies (HHAs) in the Medicare program. In the agency’s 2018 Home Health Prospective Payment System Rate Update, CMS proposes a cut of 0.4% (an estimated $80 million) in payments to HHAs. Modern Healthcare reports that most of the cuts proposed were initially provided for in the Affordable Care Act (ACA) in order to address overpayments for home health services, and that payments to HHAs have seen cuts of $260 million in 2016, $60 million in 2015, and $200 million in 2014. These cuts appear to have prompted more than 900 home health providers to drop from the Medicare rolls in the past 3 years.

CMS also proposes to reimburse for home healthcare in 30-day periods beginning in 2019; currently, Medicare pays for home health services for 60-day periods, which may be renewed if the patient’s physician deems further care necessary.

CMS will receive comments on its proposed changes to home health payments until September 25, 2017.