HR2172-119

1. Short title This Act may be cited as the Preserving Patient Access to Home Infusion Act.

2. Preservation of patient access to home infusion therapy under Medicare program Section 1861(iii)(2) of the Social Security Act (42 U.S.C. 1395x(iii)(2)) is amended— in subparagraph (A), by inserting and pharmacy services after nursing services; and 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)). Section 1834(u)(1)(A) of the Social Security Act (42 U.S.C. 1395m(u)(1)(A)) is amended— in clause (i), by striking clause (iii) and inserting clauses (iii) and (iv); 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).; in clause (iii)— by striking The single payment amount and inserting the following: Subject to subclause (II), the single payment amount by adding at the end the following new subclause: 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. by adding at the end the following new clause: 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. 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. The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026. (I)In generalSubject to subclause (II), the single payment amount; and (II)Transitional ruleFor 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 (iv)Special rule when a qualified home infusion therapy supplier not physically present in the individual's homeIn 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..

3. Access to home infusion for non-pump drugs and biologicals Section 1861(iii)(3) of the Social Security Act (42 U.S.C. 1395x(iii)(3)) is amended— 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 by adding at the end the following new subparagraph: The term specified non-pump drug or biological means a drug or biological that— is administered intravenously but not through a pump that is an item of durable medical equipment (as defined in subsection (n)); and is an antibacterial, antifungal, or antiviral (as categorized by the United States Pharmacopeia). 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: 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. The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026. (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).. (8)Clarification on billing for a specified non-pump drug or biologicalIn 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..

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: 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. 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). (22)Special payment rule for items and supplies furnished in conjunction with home infusion therapy(A)In generalNotwithstanding 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 definedFor 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)..