Medicare Intravenous Immune Globulin (IVIG) Demonstration

On Friday, September 29th, the President signed legislation (Public Law No: 115-63) that extended the Medicare IVIG Demonstration through December 31, 2020. Previously, the demonstration had been scheduled to end September 30, 2017.

All beneficiaries enrolled in the demonstration as of September 30th, will automatically be re-enrolled in the demonstration for the extension period and do not need to take any action. Suppliers can continue to provide and be paid for demonstration services to these beneficiaries on or after October 1, 2017.

In accordance with the existing requirements of the demonstration, CMS is continuing to accept new enrollment into the demonstration. Please check the demonstration website for more information regarding new applications.

The Medicare Intravenous Immune Globulin (IVIG) Demonstration is being implemented to evaluate the benefits of providing payment and items for services needed for the in-home administration of intravenous immune globulin for the treatment of primary immune deficiency disease (PIDD).

Background

The Medicare IVIG Demonstration is authorized under Title I, section 101 of the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”. This is a three year demonstration and will enroll up to 4,000 Medicare beneficiaries. Under the demonstration there will be a per-visit payment amount for items and services needed for the in-home administration of IVIG based on the national per visit low-utilization payment amount (LUPA) under the prospective payment system for home health services.

Initiative Details

Under this demonstration, Medicare will provide a bundled payment under Part B for items and services that are necessary to administer IVIG in the home to enrolled beneficiaries who are not otherwise homebound and receiving home health care benefits. The demonstration only applies to situations where the beneficiary requires intravenous immune globulin for the treatment of PIDD, or is currently receiving subcutaneous immune globulin to treat PIDD and wishes to switch to intravenous immune globulin.

In order to participate in this demonstration, beneficiaries must complete and submit an application form. All applications must be signed by the beneficiary as well as his or her physician. Beneficiaries must meet specified eligibility requirements including being covered under the original Medicare fee-for-service program and not enrolled in a Medicare Advantage plan, have Part B, and require IVIG for the treatment of PIDD. Since the number of participants and funding for the demonstration are limited under the law, submission of an application does not guarantee that a beneficiary will be accepted to participate in the demonstration.

Services covered under the demonstration shall be provided and billed by the specialty pharmacies that provide the immune globulin drug, which is already covered under Medicare Part B. The new demonstration covered services will be paid as a single bundle and will be subject to coinsurance and deductible in the same manner as other Part B services. Home health agencies are not eligible to bill for services covered under the demonstration but may still bill for services related to the administration of IVIG that are covered under the payment for a home health episode of care.

To receive the latest news and updates about the Intravenous Immune Globulin Demonstration, subscribe to the Intravenous Immune Globulin Demonstration listserv.

To obtain additional educational materials and information on how to apply to participate in this demonstration, please visit the Noridian implementation support contractor website or call (844)-625-6284.

How to Apply

The initial enrollment period concluded on September 15, 2014. However, because the number of eligible applicants did not exceed the statutory limits, new applications for participation in the IVIG Demonstration are being accepted on a rolling basis until the demonstration reaches or is projected to reach the statutory limit on funding and/or enrollment. Beneficiaries will be notified within 10 calendar days of receipt of a complete application of their status and the effective date of their coverage under the demonstration. Completed applications received by the 15th of the month, if eligible, will have coverage effective the 1st of the next month. Completed applications received after the 15th of the month, if eligible, will have coverage effective the 1st of the second following month. For example, if an application is received on September 15th, coverage will be effective October 1st.  If an application is received on the September 20th, coverage will be effective November 1st.

Additional Information