Attention Enrollees in the IVIG Demonstration

December 31, 2020

Earlier Enrollment Dates for IVIG Demonstration

Effective March 31, CMS has instructed that the enrollment dates for the IVIG demonstration will be changed to allow for earlier enrollment. Applications received from the first day through the fifteenth of the month, that are complete and meet the requirements for the IVIG demonstration, will be processed with an enrollment effective date of the first the following month. Applications received from the sixteenth day to the end of the month, will have an enrollment effective date of the 15 of the following month.

Examples

Enrollment application received on April 10. The beneficiary will be enrolled with an effective date of May 1. (This is not a change).

Enrollment application received on April 17. The beneficiary will be enrolled with an effective date of May 15. (In the past, the enrollment date would have been June 1).

This process will continue until we stop enrolling beneficiaries due to the end of this program in 2020, which will be November 15, or until we have enrolled 4,000 beneficiaries, whichever occurs first.

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 Fri, 20 Oct 2017 09:56:38 +0000