Attention Enrollees in the IVIG Demonstration

September 30, 2017

On Thursday, September 28, Congress passed legislation which extended the Medicare IVIG Demonstration through December 31, 2020. Without this new legislation, the demonstration had been scheduled to end September 30, 2017. All beneficiaries enrolled in the demonstration as of September 30, 2017, will automatically be re-enrolled in the demonstration 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.

CMS is now accepting new enrollees for this demonstration in accordance with the provisions of the original authorizing legislation (the "Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012"). Please go to the Information for Beneficiaries page on this website to find the application forms.

Intravenous Immune Globulin (IVIG) Demonstration

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). The demonstration started on October 1, 2014.

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 link will take you to an external website.. This is a three year demonstration and may enroll no more than 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.

Noridian Healthcare Solutions, LLC, the DME MAC for Jurisdiction A, is the Implementation Support Contractor for the IVIG Demonstration as of July 1, 2016.

Beneficiary Eligibility for Demonstration Participation

Applications for participation in the IVIG Demonstration will continue to be accepted on a rolling basis until Medicare reaches or projects it will reach the statutory limit on funding ($45 million including all costs for services, implementation and evaluation of the demonstration) and/or enrollment. The demonstration is scheduled to end December 31, 2020 (the last day to apply for coverage under this demonstation is November 15, 2020).

In order to enroll in the IVIG Demonstration, a beneficiary must:

  • Be covered under Medicare Fee-For-Service and enrolled in Part B,
  • Have a diagnosis of Primary Immune Deficiency Disease (PIDD), and
  • Not be currently covered under a home health episode of care.

Visit Information for Beneficiaries to access a copy of the IVIG Enrollment Application and instructions on how to properly complete and submit the form.

Providing and Billing for the In-Home Administration of IVIG

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 as are other Part B services.

View Provider and Supplier for more information.

To ask IVIG questions or send information to Noridian, see the Contact Us webpage.

Last Updated Oct 20, 2017