Medicare IVIG Access Enhancement Act

To provide for a demonstration project to further examine the benefits of providing coverage and payment for items and services necessary to administer intravenous immune globulin (IVIG) in the home, and for other purposes. 1. Short title This Act may be cited as the Medicare IVIG Access Enhancement Act 2. Medicare Patient IVIG Access Demonstration Project (a) Establishment The Secretary of Health and Human Services (in this section referred to as the Secretary (b) Duration and scope (1) Duration Beginning not later than 1 year after the date of enactment of this Act, the Secretary shall conduct the demonstration project for a period of 5 years. (2) Scope The Secretary shall, subject to subsection (d), enroll not greater than 3,000 Medicare beneficiaries who have been diagnosed with chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy for participation in the demonstration project. Subject to subsection (d), a Medicare beneficiary may participate in the demonstration project on a voluntary basis and may terminate participation at any time. (c) Coverage Except as otherwise provided in this section, items and services for which payment may be made under the demonstration program shall be treated and covered under part B of title XVIII of the Social Security Act in the same manner as similar items and services covered under such part. (d) Eligibility In order to participate in the demonstration project, a Medicare beneficiary must— (1) be covered under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act and not enrolled in a Medicare Advantage plan under part C of such Act; (2) require intravenous immunoglobulin for the treatment of chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy; and (3) meet any other eligibility requirements specified by the Secretary. (e) Payment (1) Intravenous immune globulin For intravenous immune globulin furnished under this section, the Secretary shall make payment using the payment methodology under section 1847A of the Social Security Act ( 42 U.S.C. 1395w–3a (2) Other items and services (A) In general The Secretary shall establish, subject to subparagraph (B), a per-visit payment amount for items and services (other than intravenous immune globulin) needed for the in-home infusion of intravenous immune globulin for the treatment of chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy based on the national per visit low-utilization payment amount under the prospective payment system for home health services established under section 1895 of the Social Security Act ( 42 U.S.C. 1395fff (B) Limitation In establishing the per visit payment amount established under subparagraph (A) for items and services described in such subparagraph, the Secretary shall consider— (i) including a component for requisite nursing care; (ii) establishing an appropriate furnishing fee for intravenous immune globulin similar to the separate payment for clotting factors under section 1842(o)(5) of the Social Security Act ( 42 U.S.C. 1395u(o)(5) (iii) otherwise acknowledging the length of infusions for individuals needing in-home infusion of intravenous globulin for treatment described in subparagraph (A); (iv) that, in total, such amount potentially not being less than at least 2.5 times the payment amount applied under the demonstration project established under section 101 of the Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 ( Public Law 112–242 (v) developing such amount in consultation with stakeholders. (f) Waiver authority The Secretary may waive such requirements of title XVIII of the Social Security Act as may be necessary to carry out the demonstration project. (g) Final evaluation and report Not later than one year after the third year of the demonstration project, the Secretary shall submit to Congress a report that contains— (1) a current and projected evaluation of the impact of the demonstration project on access for Medicare beneficiaries with chronic inflammatory demyelinating polyneuropathy and Medicare beneficiaries with multifocal motor neuropathy to items and services needed for the in-home administration of intravenous immune globin that also draws upon information and data from the ongoing home infusion demonstration project for primary immunodeficiency diseases ( Public Law 112–242 (2) a final analysis of the appropriateness of expanding or extending the demonstration project, or implementing a new methodology for payment for intravenous immune globulins in all care settings under part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395k et seq. (h) Definitions In this section: (1) Demonstration project The term demonstration project (2) Medicare beneficiary The term Medicare beneficiary

Summary: Medicare IVIG Access Enhancement Act This bill requires the Centers for Medicare & Medicaid Services to establish a five-year demonstration project to evaluate the benefits of providing Medicare coverage and payment for items and services needed for the in-home administration of intravenous immune globulin to treat chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy. Beneficiary participation shall be voluntary.