Vital Signs Blog

Home infusion therapy Medicare payment may return in 2019, if Congress acts by year-end

Providers are trying to get Congress to change a provision in the 2016 21st Century Cures Act that essentially ended Medicare Part B reimbursements for home infusion therapy until 2021.

If they succeed in passing into law a temporary reimbursement patch before year-end, then the therapies can get reimbursed starting in 2019. The House has already passed the change, as has the Senate Money Committee, so it just needs to get a full Senate floor vote.

Advocates and providers say Congress has to act on it before the end of the year because the CMS requires a full year to set up implementation and launch the reimbursements on Jan. 1, 2019.

Until the fix is made, Medicare infusion therapy patients—about 25,000 patients were affected as of 2015, according to CMS data—have to go to a provider to get their treatment, a more costly alternative. Also, the patients include the critically ill, such as heart transplant recipients, said lobbyist Cybil Roehrenbeck of Polsinelli.

Providers are backing the push. "As physicians, we cannot do it all; we require a team approach to the management of the critically ill cardiac population," says Andrew Darlington of the Piedmont Heart Institute in Atlanta. "The type of relationships we forge with home infusion therapy providers is the glue that holds the care for this patient population together."


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