Seniors’ Access to Critical Medications Act of 2024

Seniors’ Access to Critical Medications Act of 2024

This bill temporarily allows physicians to dispense outpatient prescription drugs and related supplies under the Medicare prescription drug benefit to patients via mail or to their caregivers without violating certain prohibitions under the Stark law (i.e., the Physician Self-Referral Law), if certain conditions are met. It also allows for coverage of certain external infusion pumps and associated home infusion drugs under Medicare.

Current law requires physicians to dispense outpatient prescription drugs and related supplies to patients in their office buildings in order to qualify for an exception (the in-office ancillary services exception) under the Stark law. The bill specifies that, from January 1, 2025 to December 31, 2029, physicians may dispense outpatient prescription drugs and related supplies to their patients via mail, and individuals or their family members or caregivers may pick up such items at the physician's office building, if the individual (1) had a face-to-face visit with the prescriber in the prior year, not including telehealth visits; (2) the prescriber furnished other items or services to the individual in the prior year; and (3) the prescriber has an ongoing professional relationship with the individual. 

In addition, the bill specifies that external infusion pumps and associated home infusion drugs may be covered under Medicare even if they don't meet certain regulatory requirements, if these items are provided in accordance with the bill's specified criteria, including that the drug is administered under the supervision of a qualified home infusion therapy supplier.

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5526 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 5526

    To amend title XVIII of the Social Security Act to clarify the 
   application of the in-office ancillary services exception to the 
   physician self-referral prohibition for drugs furnished under the 
                           Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2023

Mrs. Harshbarger (for herself, Ms. Wasserman Schultz, Mr. Fleischmann, 
  Mr. Davis of North Carolina, Mrs. Miller-Meeks, and Mr. Balderson) 
 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 clarify the 
   application of the in-office ancillary services exception to the 
   physician self-referral prohibition for drugs furnished under 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 ``Seniors' Access to Critical 
Medications Act of 2023''.

SEC. 2. CLARIFYING THE APPLICATION OF THE IN-OFFICE ANCILLARY SERVICES 
              EXCEPTION TO THE PHYSICIAN SELF-REFERRAL PROHIBITION FOR 
              DRUGS FURNISHED UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1877(b)(2) of the Social Security Act (42 
U.S.C. 1395nn(b)(2)) is amended by adding at the end the following new 
sentence: ``With respect to services consisting of drugs, and any 
supplies necessary to administer such drugs, furnished on or after May 
11, 2023, the requirement that such drugs and supplies be furnished in 
accordance with subparagraph (A)(ii) in order to qualify as a case 
described in this paragraph shall not apply.''.
    (b) Withdrawal of FAQs.--The Secretary of Health and Human Services 
shall remove the frequently asked questions and answers published on 
the website of the Centers for Medicare & Medicaid Services on 
September 20, 2021, and May 19, 2023, which prohibit or seek to 
prohibit the arrangement described in the amendment made by subsection 
(a) and those frequently asked questions and answers shall be deemed to 
have never been published.
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