HR2172-119

What This Bill Does

The Preserving Patient Access to Home Infusion Act changes several Medicare payment rules for home infusion therapy. It adds pharmacy services, assessments, drug preparation and compounding, coordination, and documentation to covered home infusion services. For 2026 through 2029, CMS must set the single payment amount to reflect five hours of infusion for a therapy day. If a qualified home infusion therapy supplier is not physically present in the patient's home on the administration day, Medicare pays 50 percent of the in-person amount. The bill also lets nurse practitioners and physician assistants order and review home infusion plans, pays qualified suppliers for specified non-pump intravenous antibacterial, antifungal, or antiviral drugs, and prevents duplicate durable medical equipment payment for tubing, catheters, dressings, needles, syringes, and related supplies when home infusion payment is already made.

Who Benefits and How

Medicare home infusion patients benefit because more therapy can be supported at home, including non-pump intravenous antibacterial, antifungal, and antiviral drugs. Qualified home infusion suppliers benefit from Medicare payment for pharmacy services, assessments, drug preparation, coordination, documentation, and certain remote service days. Home infusion pharmacies benefit because drug preparation and compounding are expressly included in the service package. Advanced practice clinicians benefit because nurse practitioners and physician assistants may order and periodically review home infusion plans.

Who Bears the Burden and How

CMS must update home infusion payment rules, supplier billing logic, and the 2026 through 2029 transitional five-hour payment policy. Medicare contractors must distinguish in-person infusion days, 50 percent remote service days, and non-pump drug claims. Durable medical equipment suppliers lose separate payment for specified infusion supplies when those supplies are bundled with paid home infusion therapy. Federal taxpayers bear the cost of expanded home infusion service payment, partly offset by the anti-duplication supply rule.

Key Provisions

• Expands covered Medicare home infusion services to include pharmacy services, assessments, drug preparation, coordination, and documentation.
• Requires the 2026 through 2029 payment amount to reflect five hours of infusion for a therapy day.
• Provides a 50 percent payment rule when the supplier is not physically present in the home on the administration day.
• Adds specified non-pump intravenous antibacterial, antifungal, and antiviral drugs to home infusion payment access.
• Blocks separate DME payment for tubing, catheters, dressings, needles, syringes, and related supplies when home infusion payment is made.