HR2343-119

What This Bill Does

The John W. Walsh Alpha-1 Home Infusion Act creates a Medicare benefit for a narrow rare-disease treatment setting. It adds Alpha-1 Antitrypsin Deficiency Disorder treatment to covered medical services for beneficiaries enrolled in Medicare Parts A and B who are not in Medicare Advantage, are under a physician, nurse practitioner, or physician assistant's care, and require Alpha-1 Proteinase Inhibitor augmentation therapy for adults with emphysema due to severe hereditary Alpha-1 deficiency. It also directs Medicare to pay qualified home infusion therapy suppliers for intravenous administration kits and up to two hours of nursing services, with payment equal to 80 percent of the lesser of actual charges or the amount set under the new payment system, for items and services furnished on or after January 1, 2027.

Who Benefits and How

Medicare beneficiaries with severe Alpha-1 deficiency benefit because augmentation therapy can be furnished in the home instead of only in facility-based settings. Qualified home infusion suppliers benefit from a new Medicare payment stream for kits and nursing services tied to Alpha-1 augmentation therapy. Pulmonary care clinicians benefit because physicians, nurse practitioners, and physician assistants can coordinate home therapy for eligible patients. Caregivers of Alpha-1 patients benefit if home infusion reduces travel and scheduling burdens for chronic therapy.

Who Bears the Burden and How

CMS payment policy staff must implement a new payment system for Alpha-1 infusion kits and up to two hours of nursing services. Medicare Part B financing bears added payment obligations for covered administration supplies and nursing support. Medicare Advantage enrollees do not receive this specific new fee-for-service benefit because eligibility excludes MA plan enrollment. Home infusion suppliers must meet qualification rules and coordinate services with the beneficiary's applicable provider.

Key Provisions

• Adds Alpha-1 Antitrypsin Deficiency Disorder treatment to Medicare-covered medical services.
• Limits eligibility to Parts A and B beneficiaries who are not enrolled in Medicare Advantage and who require augmentation therapy.
• Defines augmentation therapy as Alpha-1 Proteinase Inhibitor for adults with emphysema due to severe hereditary deficiency.
• Requires Medicare payment for intravenous administration kits and up to two hours of nursing services by qualified home infusion suppliers.
• Applies the amendments to items and services furnished on or after January 1, 2027.