Medicare Home Infusion Therapy Consolidated Coverage Act of 2006 - Amends title XVIII (Medicare) of the Social Security Act to provide for the consolidated coverage of home infusion therapy under Medicare part B (Supplementary Medical Insurance).
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5791 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5791
To amend title XVIII of the Social Security Act to provide for the
consolidated coverage of home infusion therapy under part B of the
Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 13, 2006
Ms. Granger (for herself, Mr. Engel, Mr. Kuhl of New York, and Ms.
Baldwin) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for the
consolidated coverage of home infusion therapy under part B of the
Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Home Infusion Therapy
Consolidated Coverage Act of 2006''.
SEC. 2. CONSOLIDATION OF MEDICARE COVERAGE OF HOME INFUSION THERAPY
UNDER PART B.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(2)--
(A) by striking ``and'' at the end of subparagraph
(Z);
(B) by adding ``and'' at the end of subparagraph
(AA); and
(C) by adding at the end the following new
subparagraph:
``(BB) home infusion therapy (as defined in subsection
(ccc)(1));''; and
(2) by adding at the end the following new subsection: ``
``Home Infusion Therapy
``(ccc)(1) The term `home infusion therapy' means the following
items and services furnished to an individual, who is under the care of
a physician, which are provided, except as provided in subparagraph
(B), by a qualified home infusion therapy provider under a plan (for
furnishing such items and services to such individual) established and
periodically reviewed by a physician, which items and services are
provided in an integrated manner in the individual's home in
conformance with clinical standards of care established by the
Secretary (after taking into account the standards commonly used for
home infusion therapy by Medicare Advantage organizations and
accreditation organizations)--
``(A) infusion drugs (as defined in paragraph
(2)(B));
``(B) nursing services provided, directly or by an
accredited homecare organization under arrangements
made, by the qualified home infusion therapy provider,
in connection with such infusion; and
``(C) other professional services (including
pharmacy and care coordination services) and related
items and services (including medical supplies,
intravenous fluids, home delivery, equipment, and other
items and services the Secretary determines
appropriate) to administer infusion drug therapies to
an individual safely and effectively in the home;
except that such term does not include nursing services to the
extent they are covered as home health services.
``(2) For purposes of paragraph (1):
``(A) The term `home' means a place of residence
used as an individual's home and includes such
alternate settings as the Secretary determines.
``(B) The term `infusion drugs' means parenteral
drugs and biologicals administered via an intravenous,
intraspinal, intra-arterial, intrathecal, subcutaneous,
or intramuscular access device inserted into the body.
``(C) The term `qualified home infusion therapy
provider' means any pharmacy that--
``(i) has expertise in the preparation of
compounded sterile preparations in compliance
with enforceable standards of the U.S.
Pharmacopoeia or other nationally recognized
standards that regulate compounding of sterile
preparations as determined by the Secretary;
``(ii) provides infusion therapy to
patients with acute or chronic conditions
requiring parenteral administration of drugs
and biologicals administered through catheters
or needles, or both, in a home; and
``(iii) meets such requirements as the
Secretary determines are necessary to ensure
the safe and effective provision of home
infusion therapy (taking into account the
standards of care for home infusion therapy
established by private payers).''.
(b) Payment for Home Infusion Therapy.--
(1) In general.--Section 1834 of such Act (42 U.S.C. 1395m)
is amended by adding at the end the following new subsection:
``(n) Payment for Home Infusion Therapy.--The payment amount under
this part for home infusion therapy is determined as follows:
``(1) In general.--Except as provided in this subsection,
the Secretary shall determine a per diem schedule for payment
for home infusion therapy (including pharmacy services,
administration services, care coordination services, supplies
and equipment necessary to safely and properly administer a
home infusion drug or biological in accordance with the
requirements and clinical standards commonly used for home
infusion therapy) which reflects the reasonable costs which
must be incurred by efficiently and economically operated
qualified home infusion therapy providers to provide such
therapy in conformity with applicable State and Federal laws,
regulations, and quality and safety standards and to assure
that Medicare beneficiaries have reasonable access to such
therapy.
``(2) Infusion drugs.--
``(A) In general.--Except as provided in
subparagraph (B), the provisions of section 1847A shall
apply to payment under this part for drugs included in
home infusion therapy.
``(B) Special rule.--In applying subparagraph (A),
the determination of average sales prices under section
1847A shall be limited to such prices for infusion drug
sales to home infusion therapy pharmacies.''.
(2) Conforming amendments.--
(A) Section 1833(a)(1) of such Act (42 U.S.C.
1395l(a)(1)) is amended by striking ``and'' before
``(V)'' and by inserting before the semicolon at the
end the following: ``, and (W) with respect to home
infusion therapy, the amounts paid shall be determined
under section 1834(n)''.
(B) The first sentence of section 1842(b)(6) of
such Act (42 U.S.C. 1395u(b)(6)) is amended by striking
``and'' before ``(H)'' and by inserting before the
period at the end the following: ``, and (I) in the
case of home infusion therapy, payment shall be made to
the qualified home infusion therapy provider
responsible for furnishing the therapy''.
(c) Other Conforming Provisions.--
(1) Exclusion from durable medical equipment benefit.--
Section 1861(n) of such Act (42 U.S.C. 1395x(n)) is amended by
adding at the end the following: ``Such term does not include
home infusion therapy.''.
(2) Application of accreditation organization provisions.--
The provisions of section 1865(b) of the Social Security Act
apply to accreditation of qualified home infusion therapy
providers.
(d) Effective Date.--The amendments made by this section shall
apply to home infusion therapy furnished on or after January 1, 2007.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsor introductory remarks on measure. (CR E1438)
Referred to the Subcommittee on Health.
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