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Preserving Patient Access to Home Infusion Act Whack-a-Mole Bill

Are you familiar with the Preserving Patient Access to Home Infusion Act (PPAHIA)?

You probably should be.  It has been kicking around the halls of Congress since 2021…. without passage.  However, like Whack-a-Mole, it keeps popping up in each new Congress because it has popular appeal and even bipartisan support, at least in the Senate.

If it ever gets passed, the bill will clarify that drugs shall be reimbursement and at what rates.  No small achievement for the home health industry. There’s a big  sticking point however ….. hospitals. The more home infusions the fewer hospital outpatient infusions and related hospital revenues….. and the hospital lobby is on guard. As we know, hospital outpatient infusions generally cost multiples of the same service delivered in the home. 

Besides being able to save millions for patients and Medicare/Medicaid, the bill seeks to correct some changes that were included in the 2018 Cures and Bipartisan Budget Acts to create a professional services benefit for Medicare Part B home infusion drugs. That tinkering “resulted in CMS improperly implementing the benefit by requiring a nurse to be physically present in the patient’s home in order for providers to be reimbursed. 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.”

Since little legislation seems to be leaking out of Washington these days this bill may have to wait another year…. or more…. before it ever gets passage as common sense might dictate. 

Oh well…

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Lawmakers Reintroduce Bipartisan, Bicameral Legislation to Increase Access to Medicare Home Infusion Benefit

Jun 14 2023 — WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Tim Scott (R-SC) joined by U.S. Reps. Vern Buchanan (R-FL-16), Chairman of the House Ways & Means Health Subcommittee, Debbie Dingell (D-MI-06), Diana Harshbarger (R-TN-01), and Terri Sewell (D-AL-07) today reintroduced legislation that will ensure patients maintain access to home infusion therapy. The Preserving Patient Access to Home Infusion Act protects access to Medicare’s home infusion benefit by making clear that pharmacy services for home infusion therapy can be reimbursed and sets an appropriate rate for such services.

“We have seen for years that patients are better off when they can receive quality care from the comfort of their own homes,” said Sen. Warner.   “This legislation would ensure that……..

…………..press release continues

CLICK HERE to read the full press release

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