Medicare Eases Home Infusion Restrictions Amid Coronavirus

April 6, 2020

Public health guidance to stay home amid the coronavirus outbreak raises difficult questions for seniors who receive medical treatment via infusion.  A new Medicare policy seeks to preserve access for those patients through changes to Part B.

Often associated with chemotherapy, infusion is increasingly used to administer targeted medications for a wide range of diseases.  Migraine, gout, rheumatoid arthritis, asthma and rare conditions like thyroid eye disease can be treated via infusion. But as public health officials encourage social distancing to fight COVID-19, at-risk patients may find it difficult to visit their local hospital, infusion center or doctor’s office.  Stay-at-home restrictions, transportation limitations and risk of COVID-19 exposure may make infused treatment in the traditional site of care impossible for the time being.

Now the Centers for Medicare and Medicaid Services offers these patients an alternative: home infusion.  In an interim final rule, the agency allows for home infusion services with the use of telehealth. This allows a trained medical professional to administer medication at a patient’s residence, connecting with the prescribing health care provider as needed via phone or video conference.  

The policy is a shift for Medicare, which historically has limited home infusion to only a few medicines.  This rule would expand that list for the duration of President Donald Trump’s emergency declaration. CMS also requires that a physician be in “close proximity” for infusions – a dictate that, to date, has made home infusions unfeasible.  By allowing the proximity requirement to be satisfied virtually, the new rule expands access. CMS will also allow physicians to contract with home health services or independent infusion providers to help make home infusion available for patients.

The changes apply to Medicare beneficiaries who are confined to the home during the COVID-19 pandemic.  Given that the Centers for Disease Control and Prevention has instructed caution for people age 60 or older and those with pre-existing conditions, the policy seemingly covers the majority of Medicare beneficiaries.  

Home infusion flexibility is part of a larger effort to loosen restrictions that make access to care difficult as the country fights COVID-19.  Allowed for under the Social Security Act, these temporary permissions are known as section 1135 waivers.  Such waivers allow the Department of Health and Human Services to dismiss certain requirements in a time of emergency.

Other policy changes include increased telehealth options, flexibility to convert community centers like hotels and conference centers into temporary hospitals, and reduced documentation requirements that free up health care providers for patient care.

Ultimately, this rule would allow physicians and their patients the flexibility to determine which site of care is best for a given patient.  In some cases, it may be the patient’s home.

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