CMS Announces In-Home IVIG Demonstration Project
August 18, 2014 08:31 AM
The Centers for Medicare & Medicaid Services (CMS) has announced a three-year demonstration to evaluate the benefits of providing payment for items and services needed for the in-home administration of intravenous immunoglobulin (IVIG) for the treatment of Primary Immune Deficiency Disease (PIDD). The Medicare IVIG Demonstration was authorized under the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012.”
CMS has designed the IVIG demonstration to pay a bundled payment for items and services needed for the in-home administration of IVIG for the treatment of PIDD. The demonstration will begin paying for services as of October 1, 2014, and will continue for three years, as long as funding remains available.
Medicare Part B covers IVIG for persons with PIDD who wish to receive the drug at home. However, Medicare does not separately pay for any services or supplies to administer the drug if the person is not homebound and otherwise eligible to receive the associated supplies and services under the Medicare home health benefit. As a result, many beneficiaries have chosen to receive the drug at their doctor's office, in an outpatient hospital setting, or to self-administer the drug subcutaneously.
Under this demonstration, Medicare will provide a bundled payment under Part B for items and services that are necessary to administer IVIG in the home to enrolled beneficiaries who are not otherwise homebound and or receiving home health care.
Services covered under the demonstration are to be provided and billed by the specialty pharmacies that provide the immune globulin drug. The new demonstration covered services will be paid as a single bundle and will be subject to coinsurance and deductible in the same manner as other Part B services. Home health agencies are not eligible to bill for services covered under the demonstration but may still bill for services related to the administration of IVIG that are covered under the payment for a home health episode of care.
Beneficiaries participating in the demonstration will not be restricted in any way from receiving Medicare covered IVIG, and non-demonstration Medicare covered related services from different providers at different times.. For example, a beneficiary receiving services under the demonstration at home may choose to switch and receive them at a doctor's office or outpatient department at any time. The beneficiary may switch back to receiving services under the demonstration as long as they are otherwise still eligible, and funding remains available.
Beneficiaries covered under a home health episode of care may apply to participate in the demonstration but will not be eligible to have services paid for under the demonstration until after the home health episode of care has ended. Similarly, beneficiaries who are participating in the demonstration and subsequently become eligible to receive services under a home health episode of care will not be eligible to have services paid for under the demonstration for the period of time they are covered under such episodes.
Although the demonstration is limited to IVIG for PIDD, it is a positive step in developing payment models to increase access for home infusion therapy for Medicare beneficiaries who are not eligible for services under the home health benefit.