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Critical Update Now Allows Access to Home Infusions for Medicare Patients

March 31, 2020

Yesterday, the Centers for Medicare and Medicaid Services (CMS), issued guidance and rules to provide flexibilities to healthcare providers during this pandemic. The flexibilities are intended to let providers practice however they need to and wherever patients need to be during this time – whether it is using hospital buildings not normally used for patient care in order to better isolate those with Coronavirus (COVID-19) or allowing providers to better serve patients in their homes.

As we outlined in the March 30 blog post about home infusions, the current COVID-19 pandemic demonstrates just how important it is for those individuals with primary immunodeficiency (PI), and others with compromised immune systems, to avoid potentially dangerous healthcare environments. Many in our community rely on immunoglobulin (Ig) treatment, whether administered intravenously (IVIG) or subcutaneously (SCIG). We are happy to report that in response to strong advocacy by a coalition of patient groups including the Immune Deficiency Foundation (IDF), CMS has expanded access to home health services during this pandemic, providing additional options for individuals with PI to receive home Ig therapies.

In addition, in response to CMS’s actions, private health insurance plans that are part of America’s Health Insurance Plans (AHIP) have committed to matching the waivers provided by Medicare to facilitate access to home care during this time.

If you are a Medicare beneficiary with PI and do not currently receive IVIG therapy at home, there are now multiple options to move your care to the home.

  1. Enroll in the Medicare IVIG demonstration project, which is currently in place through December of this year. Information regarding Medicare IVIG Demonstration is available from CMS, including instructions for enrollment in the demonstration, managed through Noridian Healthcare Solutions.
  2. You may now qualify to receive IVIG in the home through Medicare’s home health benefit. To qualify for home health services, Medicare beneficiaries must be “homebound,” be under the care of a doctor, and need intermittent skilled nursing (which you do need in order to receive IVIG). Medicare has expanded its definition of homebound to people who medically need to stay in their homes due to COVID-19 risk.
  3. You may now also qualify to receive IVIG through the Medicare Part B home infusion therapy services benefit. During this public health emergency, CMS will not enforce clinical indications for coverage under this benefit, including the local coverage determination that says IVIG is excluded from this benefit.

Additionally, CMS has made many allowances for providers to practice telehealth. Therefore, you should be able to receive your infusion in the home by a nurse and any other services that you need via telehealth. Talk to your providers about your options. Medicare beneficiaries already had access to SCIG treatment in the home as a part of the Part B home infusion therapy services benefit, so should continue to have that option during this time.

IDF continues to work with Congress and with CMS to ensure full access to therapeutic options in the home during this pandemic and beyond. While ensuring people are able to stay in their homes during the pandemic is of immediate and utmost priority, we are hopeful that we can extend some of the flexibilities to ensure permanent access to services in the home beyond this crisis and beyond the current expiration of the demonstration project in December of this year.

Join IDF on April 23 for our inaugural virtual Advocacy Day and contact your elected representatives about ensuring in-home access to IVIG for Medicare beneficiaries with PI. Keep an eye on your inbox for information on how to participate!