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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2172 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 2172
To amend title XVIII of the Social Security Act to clarify
congressional intent and preserve patient access to home infusion
therapy under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 18, 2025
Mr. Buchanan (for himself, Mrs. Dingell, Mrs. Harshbarger, and Ms.
Sewell) 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
congressional intent and preserve patient access to home infusion
therapy under the Medicare program, 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 ``Preserving Patient Access to Home
Infusion Act''.
SEC. 2. PRESERVATION OF PATIENT ACCESS TO HOME INFUSION THERAPY UNDER
MEDICARE PROGRAM.
(a) Inclusion of Pharmacy Services.--Section 1861(iii)(2) of the
Social Security Act (42 U.S.C. 1395x(iii)(2)) is amended--
(1) in subparagraph (A), by inserting ``and pharmacy
services'' after ``nursing services''; and
(2) in subparagraph (B), by inserting ``, assessments, drug
preparation and compounding, coordination and documentation of
infusion therapy services in the plan of care'' after
``subsection (n))''.
(b) Payment.--Section 1834(u)(1)(A) of the Social Security Act (42
U.S.C. 1395m(u)(1)(A)) is amended--
(1) in clause (i), by striking ``clause (iii)'' and
inserting ``clauses (iii) and (iv)'';
(2) in clause (ii) by inserting after the first sentence
the following new sentence: ``For purposes of the previous
sentence, a reference to payment to a qualified home infusion
therapy supplier for an infusion drug administration calendar
day in the home of such individual shall refer to payment for
each day on which such a drug was administered to the
individual (regardless of whether a qualified home infusion
therapy supplier was physically present in the home of such
individual on such date).'';
(3) in clause (iii)--
(A) by striking ``The single payment amount'' and
inserting the following:
``(I) In general.--Subject to
subclause (II), the single payment
amount''; and
(B) by adding at the end the following new
subclause:
``(II) Transitional rule.--For home
infusion therapy furnished on or after
January 1, 2026, and before January 1,
2030, the Secretary shall ensure that
the single payment amount determined
under this subparagraph reflects 5
hours of infusion for a particular
therapy in a calendar day.''; and
(4) by adding at the end the following new clause:
``(iv) Special rule when a qualified home
infusion therapy supplier not physically
present in the individual's home.--In the case
where a qualified home infusion therapy
supplier is not physically present in the
individual's home on the day the home infusion
drug is administered to the individual, the
single payment amount under this subsection for
items and services described in clause (i)
furnished on such day to such individual shall
be an amount equal to 50 percent of the amount
that would have applied under this subsection
for such items and services if such a supplier
had been physically present.''.
(c) Permitting Nurse Practitioners and Physician Assistants To
Establish and Review a Home Infusion Plan of Care.--Section
1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 1395x(iii)(1)(B))
is amended by striking ``physician (as defined in subsection (r)(1))
and is periodically reviewed by a physician'' and inserting ``physician
(as defined in subsection (r)(1)) or a nurse practitioner or physician
assistant (as those terms are defined in subsection (aa)(5)) and is
periodically reviewed by a physician, nurse practitioner, or physician
assistant''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to items and services furnished on or after January
1, 2026.
SEC. 3. ACCESS TO HOME INFUSION FOR NON-PUMP DRUGS AND BIOLOGICALS.
(a) Modification of Definition of Home Infusion Drug.--Section
1861(iii)(3) of the Social Security Act (42 U.S.C. 1395x(iii)(3)) is
amended--
(1) in subparagraph (C), by inserting ``and, in the case of
a drug or biological other than a specified non-pump drug or
biological (as defined in subparagraph (E)),'' before
``through''; and
(2) by adding at the end the following new subparagraph:
``(E) The term `specified non-pump drug or biological'
means a drug or biological that--
``(i) is administered intravenously but not through
a pump that is an item of durable medical equipment (as
defined in subsection (n)); and
``(ii) is an antibacterial, antifungal, or
antiviral (as categorized by the United States
Pharmacopeia).''.
(b) Clarification on Billing.--Section 1834(u) of the Social
Security Act (42 U.S.C. 1395m(u)) is amended by adding at the end the
following new paragraph:
``(8) Clarification on billing for a specified non-pump
drug or biological.--In the case of a qualified home infusion
supplier (as defined in section 1861(iii)(3)(D)) that furnishes
items and services described in subparagraphs (A) and (B) of
section 1861(iii)(2) in coordination with the furnishing of a
home infusion drug (as defined in section 1861(iii)(3)(C)) that
is a specified non-pump drug or biological (as defined in
section 1861(iii)(3)(E)) where the method of infusion utilized
in furnishing such drug or biological does not involve a pump
that is an item of durable medical equipment, payment under
this subsection for the items and services described in
subparagraphs (A) and (B) of section 1861(iii)(2) shall be made
with respect to such drug or biological regardless of whether
such drug or biological so furnished is payable under this
part.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to items and services furnished on or after January
1, 2026.
SEC. 4. MODIFICATION OF PAYMENT FOR HOME INFUSION SUPPLIES.
Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is
amended by adding at the end the following new paragraph:
``(22) Special payment rule for items and supplies
furnished in conjunction with home infusion therapy.--
``(A) In general.--Notwithstanding the preceding
provisions of this subsection, no payment may be made
under this subsection with respect to applicable items
and services (as defined in subparagraph (B)) that are
furnished on or after January 1, 2026, in conjunction
home infusion therapy (as defined in section
1861(iii)(1)) for which payment is made under
subsection (u) and which are so furnished on the same
day as such home infusion therapy and with respect to
the same home infusion drug (as defined in section
1861(iii)(3)(C)) for which such payment was so made.
``(B) Applicable items and services defined.--For
purposes of subparagraph (A), the term `applicable
items and services' means tubing, catheters, dressings,
needles, syringes, and other supplies identified by
HCPCS code A4221, A4222, or K0552 (or any successor
code).''.
<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.
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