On December 29, 2022, President Biden signed the Fiscal Year 2023 Omnibus legislation (H.R.2617) passed by Congress that included a provision mandating coverage for the supplies and services required for Medicare beneficiaries with PI to receive IVIG at home beginning January 1, 2024.
A: Yes. The Medicare IVIG Demonstration Project was created in 2014 as the result of IDF advocacy. This demonstration project, which has been renewed twice, allows enrolled individuals with PI to receive Medicare coverage for the medication, services, and supplies needed for home IVIG. The demonstration will expire on December 31, 2023. See the instructions below on how to enroll.
A: Make sure to consult with your medical provider to assist you with the application. You and your physician will need to sign the form. To be eligible for the demonstration, the beneficiary must:
The program is managed by Noridian Healthcare Solutions, which has online resources on the Medicare IVIG Demonstration aimed at beneficiaries and applicants.
A: If you submit a fully completed application to Noridian healthcare services, the CMS contractor, by the 15th of the month and if you are determined eligible, then you will have coverage effective the first of the next month. For example, if an application is received on September 15, coverage will be effective October 1.
If your completed application is received after the 15th of the month and if you are determined eligible, you will have coverage effective the fifteenth of the next month. For example, if an application is received on September 20, coverage will be effective October 15.
A: The Medicare permanent benefit will begin on January 1, 2024. Those who are already enrolled in the demonstration project will be able to receive ongoing coverage through Medicare B without having to re-enroll.
A: No. SCIG infusions are covered under Medicare B or D, depending on your diagnosis code. If you have a Medicare B qualifying diagnosis, you do not need to be enrolled in the IVIG Demonstration Project as Medicare and your supplemental (secondary, MediGap) plan already cover supplies and administration services. The IVIG Demonstration Project only applies to individuals on IVIG, not SCIG, who have a Medicare Part B qualifying diagnosis.
A: Consult with your medical provider and apply for IVIG demonstration enrollment. Noridian will work with you to find a specialty pharmacy in your area that will provide services through the demonstration.
A: Beneficiaries with any IVIG Demonstration inquiries may contact Noridian Healthcare Solutions at 1-844-625-6284, Monday-Friday, 8:30 a.m. – 4 p.m. CT. Please notify your specialty pharmacy’s billing department once you receive acceptance into the program so it can be added to your billing profile.
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