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H.R.5597 - To establish a Medicare patient IVIG access demonstration project.
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Ms. MATSUI (for herself, Mr. RUSH, Mr. BRALEY of Iowa, Mr. VAN HOLLEN, Mr. GERLACH, Mr. TERRY, Mr. BRADY of Texas, and Mr. PITTS) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink
SECTION 1. MEDICARE PATIENT IVIG ACCESS DEMONSTRATION PROJECT.
(a) Establishment- The Secretary shall establish and implement a demonstration project under title XVIII of the Social Security Act to evaluate the benefits of providing payment for items and services needed for the administration, within the homes of Medicare beneficiaries, of intravenous immune globin for the treatment of primary immune deficiency diseases.CommentsClose CommentsPermalink
(2) SCOPE- The Secretary shall enroll not greater than 4,000 Medicare beneficiaries who have been diagnosed with primary immunodeficiency disease for participation in the demonstration project. A Medicare beneficiary may participate in the demonstration project on a voluntary basis and may terminate participation at any time.CommentsClose CommentsPermalink
(c) Reimbursement- The Secretary shall establish an hourly rate for payment for items and services needed for the administration of intravenous immune globin based on the low-utilization payment adjustment under the prospective payment system for home health services established under section 1895 of the Social Security Act (
(1) INTERIM EVALUATION AND REPORT- Not later than 24 months after the date of enactment of this Act, the Secretary shall submit to Congress a report that contains the following:CommentsClose CommentsPermalink
(A) An interim evaluation of the impact of the demonstration project on access for Medicare beneficiaries to items and services needed for the administration of intravenous immune globin within the home.CommentsClose CommentsPermalink
(B) An analysis of the appropriateness of 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 (
(C) An analysis of the feasability of reducing the lag time with respect to data used to determine the average sales price under section 1847A of the Social Security Act (
(D) An update to the report entitled ‘Analysis of Supply, Distribution, Demand, and Access Issues Associated with Immune Globulin Intravenous (IGIV)’, issued in February 2007 by the Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services.CommentsClose CommentsPermalink
(2) FINAL EVALUATION AND REPORT- Not later than July 1, 2014, the Secretary shall submit to Congress a report that contains a final evaluation of the impact of the demonstration project on access for Medicare beneficiaries to items and services needed for the administration of intravenous immune globin within the home.CommentsClose CommentsPermalink
(1) IN GENERAL- Section 1861(n) of the Social Security Act (
(2) MEDICARE BENEFICIARY- The term ‘Medicare beneficiary’ means an individual who is entitled to, or enrolled for, benefits under part A of title XVIII of the Social Security Act or enrolled for benefits under part B of such title.CommentsClose CommentsPermalink