Sacramento Standard

WASHINGTON, D.C. – On April 28, Congresswoman Doris Matsui (D-CA) and Congressman Adrian Smith (R-NE) introduced the PI Post Acute Access Act, legislation to expand access to intravenous immunoglobulin (IVIG) treatment for Medicare beneficiaries with primary immunodeficiencies (PI) in skilled nursing facilities (SNF). 

“For those living with primary immunodeficiencies, access to the best medical care and treatment is critical,” said Congresswoman Matsui. “Without timely care, even the most common infections can present the risk of serious illness or death. That is why I have long advocated to ensure access to life sustaining IVIG treatments, which provide an essential lifeline to enable people with PI to live healthy, productive lives. The PI Post Acute Access Act builds on this work andensures that Medicare beneficiaries who need these treatments in skilled nursing facilities aren’t left behind.”

“We must ensure Medicare’s payment structure aligns with the therapeutics patients need, particularly patients with rare conditions who often have single or few treatment options. IVIG is essential for patients with Primary Immunodeficiency, but Medicare’s bundled payment structure often restricts where and when PI patients can access this critical treatment,” said Congressman Smith. “I’m glad to join Congresswoman Matsui to ensure PI patients can access this care, and I thank her for her leadership on this important bill.”

“This bill will help ensure Medicare beneficiaries with PIs are not forced to choose between rehabilitation care and their life-sustaining Ig medications by enabling skilled nursing facilities to bill Medicare separately for Ig medications and services. We thank Congresswoman Matsui and Congressman Smith for leading this legislation, and we look forward to helping them build support so it will be enacted into law,” said Lynn Albizo, Vice President of Public Policy for the Immune Deficiency Foundation.

Under the congressionally enacted Consolidated Billing model, when a Medicare beneficiary requires rehabilitation in a SNF, Medicare pays the SNF one payment for the patient's care. Unfortunately, this model does not provide adequate funding to ensure beneficiaries with a PI can receive necessary IVIG therapy.

The result is that beneficiaries are either admitted to a SNF but unable to access essential treatment or are not accepted for admission – even if they are an ideal rehabilitation candidate – because the SNF cannot afford to administer IVIG treatments. The PI Post Acute Access Act would address this problem by separating out payments for IVIG treatments in SNF.

Congresswoman Matsui has long led the effort to ensure access to lifesaving IVIG treatments. The Medicare IVIG demonstration project was originally created by the Medicare IVIG Access Act, co-authored by Congresswoman Matsui and former Rep. Kevin Brady, and passed into law in 2013. The demonstration began in October 2014 and was extended in September 2017 and again in December 2020, based upon legislation led by Rep. Matsui. In December 2022, Congress passed legislation as part of the omnibus making the in-home IVIG benefit for Medicare beneficiaries with a PI permanent, thanks to Rep. Matsui’s work.

Original source can be found here