John W. Walsh Alpha-1 Home Infusion Act of 2023

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4438 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 4438

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

                             June 30, 2023

   Ms. Salazar (for herself, Ms. Pingree, Mr. Posey, Mr. Tonko, Ms. 
  Wasserman Schultz, Mr. Keating, Mr. Panetta, Mr. Connolly, and Mr. 
Higgins of New York) 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 2023''.

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 
                (II);
                    (B) by inserting ``and'' at the end of subparagraph 
                (JJ); and
                    (C) by inserting at the end the following new 
                subparagraph:
                    ``(KK) Alpha-1 Antitrypsin Deficiency Disorder 
                treatment (as defined in subsection (nnn));''; and
            (2) by adding at the end the following new subsection:
    ``(nnn) 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:
    ``(aa) 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(nnn)(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(nnn)(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 ``(HH)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (II) with respect to intravenous 
                administration kits and nursing services described in 
                section 1834(aa) for Alpha-1 Antitrypsin Disorder 
                treatment (as defined in subsection (nnn)(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(aa)''.
            (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(aa), payment shall be made to the 
                qualified home infusion therapy supplier (as defined in 
                section 1861(nnn)(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(aa) for Alpha-1 
        Antitrypsin Deficiency Disorder treatment (as defined in 
        subsection (nnn)(1))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2025.
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