Attention Enrollees in the IVIG Demonstration
The Medicare IVIG Demonstration is a three-year demonstration that will end September 30, 2017. No payment will be made for demonstration services (supplies and related nursing services to administer IVIG in your home) provided after that date.
The traditional Medicare fee-for-service program will continue to pay for IVIG, but once the demonstration ends, it will no longer pay for the services and supplies to administer the drug unless you are receiving covered Medicare home health services.
Talk to your doctor to determine what options are available for you to continue to receive IVIG after September 30, 2017. You may be able to arrange to receive the drug at your doctor's office or other outpatient setting or, if medically appropriate, switch to a subcutaneous form of immune globulin that can be self-administered.
If you plan to continue receiving IVIG in your home, contact your Medicare supplier who provides the medication to explain that Medicare will no longer cover the costs for supplies and related nursing services to administer IVIG in your home. You will be responsible for all costs related to the administration of the IVIG.
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.
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 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 on September 30, 2017 (the last day to apply for coverage under this demonstration is August 15, 2017).
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 Jul 11, 2016