U.S. Sen. Ron Wyden, D-Ore. applauded President Obama for signing a bipartisan bill into law that will help push Medicare to cover in-home intravenous treatments for patients suffering with primary immune deficiency disease (PIDD).
Wyden was an original co-sponsor of the Senate version of the Medicare IVIG Access Act along with Senators John Kerry, D-Mass., and Lamar Alexander, R-Tenn. The bill directs the Department of Health and Human Services (HHS) to examine the benefits of providing Medicare coverage and payments for intravenous immune globulin (IVIG) at home.
“Medicare beneficiaries have been effectively forced to go out for IVIG services even when the lowest cost and most appropriate setting is at home,” Wyden said. “The Medicare IVIG Access Act is a critical step toward making sure that patients with primary immunodeficiency diseases can access care where it makes the most sense for them.”
The new law authorizes a three-year demonstration project allowing for the payment of home infusion services for patients with PIDD. The law also authorizes the study of other obstacles to accessing IVIG care.
The law also includes Wyden’s Strengthening Medicare and Repaying Taxpayers (SMART) Act, which will streamline third-party reimbursements for Medicare and beneficiaries. Wyden sponsored that bipartisan legislation along with Senators Rob Portman, R-Ohio, Ben Nelson, D-Neb., and Richard Burr, R-N.C. in an effort to make the Medicare Secondary Payer (MSP) Program more efficient and cost effective to taxpayers.
Currently, under the MSP program, if a Medicare beneficiary is injured by a third party and a settlement is pursued as a result of that injury, the third party is responsible for paying for the individual’s medical expenses. If Medicare, now the “secondary payer,” pays any of the costs associated with the injury, it is entitled to reimbursement.
Several problems exist with the reimbursement process under this scenario. Under current law, Medicare does not have a way to disclose the MSP amount before settlement, creating unnecessary uncertainty that makes it hard to settle cases. Second, there are times when Medicare spends more money pursuing an MSP payment than they actually end up receiving in payment. MSP reporting requirements also require beneficiaries to submit sensitive personal information to the settlement company, causing privacy concerns. Finally, there is no clear statute of limitations on all MSP claims.
The SMART Act will address these issues by creating a process that allows CMS to disclose the MSP amount before settlement so it can be factored into the settlement; requiring Medicare to no longer pursue MSP claims that do not cover their own expenses; directing Medicare to establish an alternative method of identifying individuals so that they don’t have to provide sensitive personal information; and setting a three-year statute of limitations for most claims.
