[Congressional Record (Bound Edition), Volume 152 (2006), Part 11]
[Extensions of Remarks]
[Pages 14612-14613]
[From the U.S. Government Publishing Office, www.gpo.gov]




    MEDICARE HOME INFUSION THERAPY CONSOLIDATED COVERAGE ACT OF 2006

                                 ______
                                 

                          HON. ELIOT L. ENGEL

                              of new york

                    in the house of representatives

                         Monday, July 17, 2006

  Mr. ENGEL. Mr. Speaker, I am delighted to join with my colleagues Kay 
Granger, Tammy Baldwin, and Randy Kuhl in introducing the Medicare Home 
Infusion Therapy Consolidated Coverage Act of 2006. This bill would 
correct long-standing gaps in Medicare coverage for home infusion 
therapy, and will enable thousands of beneficiaries to obtain these 
often life-saving therapies in the most convenient and cost-effective 
setting--their homes.
  Under current Medicare coverage rules, beneficiaries who have severe 
infections, cancer, or congestive heart disease and many other 
diagnoses, are needlessly admitted into hospitals or nursing homes to 
receive the care they need. This is most unfortunate, Mr. Speaker, 
because in many cases, infusion therapy administered in the patient's 
home is

[[Page 14613]]

clearly the preferred alternative. Commercial health plans have long 
recognized the clinical value and cost-effectiveness of home infusion 
therapy, and full and proper coverage of home infusion therapy is 
commonplace among these payers. Medicare stands virtually alone in its 
antiquated coverage policies that discourage the use of a therapy that 
in actuality should be promoted for its cost savings, safety, clinical 
effectiveness, and convenience. At a time when there is a growing 
awareness of the need to prevent or limit inpatient hospital stays for 
our Nation's elderly, we believe this legislation is extremely timely.
  Our bill is very simple in its approach. Currently, whatever coverage 
exists for home infusion therapy is divided between part B and part D. 
Part B coverage is based on the durable medical equipment benefit, 
because an item of DME--the infusion pump--is sometimes needed to 
administer home infusion therapy. That coverage, however, is limited to 
about 23 drugs. Part D, the outpatient prescription drug benefit, 
covers more infusion drugs than part B, but does not cover the 
services, supplies and equipment necessary to safely and appropriately 
administer these therapies in the home. As a result, both part B and 
part D coverage of home infusion are very limited. Under part B, 
Medicare beneficiaries do not have access to many of the most common 
infusion drugs covered by commercial health plans. Under part D, many 
beneficiaries have to pay for the infusion services, supplies, and 
equipment with out-of-pocket funds. The clear result is that access to 
home infusion therapy, despite its potential for cost savings and good 
clinical outcomes, is needlessly limited.
  Our bill would consolidate coverage for home infusion therapy under 
part B, so that coverage would be centered in one benefit and coverage 
would be designed to appropriately and accurately reflect what is 
involved in the safe and effective provision of home infusion therapy. 
The Secretary of HHS would apply quality standards that are consistent 
with prevailing community standard of care commonly utilized by 
commercial health plans. Both beneficiaries and the Medicare program 
itself would reap the benefits of broader access to these important 
medical treatments in the home.
  I introduced a similar bill in 2001 that would have established a 
home infusion therapy benefit under part B. Since then Congress enacted 
the Medicare Modernization Act of 2003 which created the part D 
prescription drug benefit. While I appreciate the efforts to broaden 
coverage of the drug portion of home infusion therapy, the problems I 
have described still persist because CMS believes it does not have the 
authority to cover anything beyond the drugs. Thus, effective coverage 
of home infusion therapy has remained elusive. We can fix this now.
  Along with my colleagues, I urge early consideration of this long-
overdue bill.

                          ____________________