If demonstration extension legislation does not pass before the end of the year, will I be able to continue to get my medications?
Several options are discussed in this post from October 12, 2020.
I think I may be eligible for home infusion services under the temporarily more flexible homebound rules to address the current state of emergency. What do I need to do to apply?
To receive home infusions under the homebound rules, you need to secure a homebound certification, which will require the following:
- To qualify for Medicare coverage as a homebound patient, a physician must complete and then fax the signed and dated Home Health Certification and Plan of Care (form CMS-485-P) to the Medicare Administrative Contractor (MAC) for Home Health and Hospice for their state.
- The MAC for Home Health and Hospice for every state can be found here>>
- Any contact with the MAC, fax, or phone, must come from your physician to the contractor, not from the patient. If your physician’s office needs assistance in locating the correct contact number for the MAC for Home Health and Hospice in your state, they can contact Noridian, the manager of the Medicare IVIG Home Infusion Demonstration, at 1-844-625-6284.
- The MAC for Home Health and Hospice will determine eligibility. If the patient is determined eligible, it will then manage the process of assigning a home health care agency to the patient and arranging for the regular distribution of each patient’s immunoglobulin and related supplies.
- Please note, every person is different, and there is no guarantee that you will qualify. Your doctor will need to make the call regarding your need for home health, and the MAC will make the determination. As with all Medicare service applications, there is an opportunity to appeal a denial
If I am not eligible for alternative services, can I still receive IVIG at home under Medicare if legislation doesn’t pass before the end of the year?
You can receive IVIG at home, but Medicare will cover only the medication, and you will be billed separately for the services and supplies by your home infusion provider. Your provider may be willing to provide a discount or temporarily cover the costs of these services and supplies if you are not able to cover those costs.
I have heard that there are new proposed regulations that may allow for a permanent benefit for IVIG in the home; will demo recipients benefit from that?
There are proposed rules that are very promising for having a long-term solution to IVIG home coverage. Unfortunately, these are still in the draft stage and, if adopted, will not be implemented until April 2021. IDF is submitting comments on these proposals and is strongly urging the Centers for Medicare and Medicaid to provide permanent Medicare coverage of the services, supplies, and medication required for home IVIG.