John W. Walsh Alpha-1 Home Infusion Act of 2022
This bill provides for Medicare coverage of treatment for alpha-1 antitrypsin (AAT) deficiency (a protein deficiency that raises the risk of lung and other diseases). Specifically, the bill provides for coverage of at-home augmentation therapy for beneficiaries with emphysema as a result of severe hereditary AAT deficiency. Treatment must be provided through qualified home infusion therapy suppliers; beneficiaries must be under the care of a physician, nurse practitioner, or physician assistant.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7346 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 7346
To amend title XVIII of the Social Security Act to provide for coverage
and payment of Alpha-1 Antitrypsin Deficiency Disorder treatment under
part B of such title, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 31, 2022
Ms. Salazar (for herself and Ms. Pingree) 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 coverage
and payment of Alpha-1 Antitrypsin Deficiency Disorder treatment under
part B of such title, and for other purposes.
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 ``John W. Walsh Alpha-1 Home Infusion
Act of 2022''.
SEC. 2. MEDICARE COVERAGE OF ALPHA-1 ANTITRYPSIN DISORDER TREATMENT.
(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
(GG);
(B) by inserting ``and'' at the end of subparagraph
(HH); and
(C) by inserting at the end the following new
subparagraph:
``(II) Alpha-1 Antitrypsin Deficiency Disorder
treatment (as defined in subsection (lll));''; and
(2) by adding at the end the following new subsection:
``(lll) Alpha-1 antitrypsin deficiency
disorder treatment.--(1) The term `Alpha-1
Antitrypsin Deficiency Disorder treatment'
means augmentation therapy (as defined in
paragraph (2)(C)) furnished by qualified home
infusion therapy suppliers (as defined in
paragraph (2)(D)) which are furnished in the
individual's home (as defined in paragraph
(2)(B)) to an individual--
``(A) who is under the care of an applicable
provider;
``(B) who is enrolled under both parts A and B of
this title, and is not enrolled in an MA plan under
part C of such title; and
``(C) who requires augmentation therapy (as defined
in paragraph (2)(C)).
``(2) For purposes of this subsection:
``(A) The term `applicable provider' means--
``(i) a physician;
``(ii) a nurse practitioner; and
``(iii) a physician assistant.
``(B) The term `home' means a place of residence
used as the home of an individual (as defined for
purposes of subsection (n)).
``(C) The term `augmentation therapy' means an
Alpha-1 Proteinase Inhibitor indicated for chronic
augmentation and maintenance therapy in adults with
clinical evidence of emphysema due to severe hereditary
deficiency of Alpha-1 Antitrypsin.
``(D) The term `qualified home infusion therapy
supplier' has the meaning given such term in subsection
(iii)(3)(D)(i).''.
(b) Payment for Intravenous Administration Kits and Nursing
Services for Alpha-1 Antitrypsin Deficiency Disorder Treatment.--
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
``(z) Payment for Intravenous Administration Kits and Nursing
Services for Alpha-1 Antitrypsin Deficiency Disorder Treatment.--The
Secretary shall implement a payment system under which payment is made
under this title to a qualified home infusion therapy supplier (as
defined in section 1861(lll)(3)(D)) for intravenous administration kits
and nursing services for up to 2 hours of care by a qualified home
infusion therapy supplier in coordination with the furnishing of
augmentation therapy (as defined in section 1861(lll)(2)(C)).''.
(c) Conforming Amendments.--
(1) Payment reference.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (EE) with respect to intravenous
administration kits and nursing services described in
section 1834(z) for Alpha-1 Antitrypsin Disorder
treatment (as defined in subsection (lll)(1)), the
amount paid for such kits and services shall be an
amount equal to 80 percent of the lesser of the actual
charge for the services or the amount determined under
section 1834(z)''.
(2) Direct payment.--The first sentence of section
1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6))
is amended--
(A) by striking ``and'' before ``(J)''; and
(B) by inserting before the period at the end the
following: ``, and (K) in the case of intravenous
administration kits and nursing services described in
section 1834(z), payment shall be made to the qualified
home infusion therapy supplier (as defined in section
1861(lll)(2)(D))''.
(3) Exclusion from home health services.--Section 1861(m)
of the Social Security Act (42 U.S.C. 1395x(m)) is amended, in
the first sentence, by inserting the following before the
period at the end: ``and intravenous administration kits and
nursing services described in section 1834(z) for Alpha-1
Antitrypsin Deficiency Disorder treatment (as defined in
subsection (lll)(1))''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2023.
<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 Subcommittee on Health.
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