Preserving Patient Access to Home Infusion Act
- Sponsor
- Rep. Buchanan, Vern [R-FL-16]
- Committees
- Ways and Means Committee (primary)
- Last action
- Mar 18, 2025
Bottom line
The bill aims to clarify and expand Medicare coverage for home infusion therapy, enhancing patient access to these services while adjusting payment mechanisms for providers.
What it actually does
This bill expands Medicare coverage for home infusion therapy services by explicitly including pharmacy services and certain non-pump administered drugs. It also modifies payment rules, introducing a transitional payment rate based on 5 hours of infusion and a reduced payment for days when a supplier is not physically present in the patient's home. Additionally, it allows nurse practitioners and physician assistants to establish and review home infusion plans of care and bundles payment for certain supplies into the home infusion therapy rate.
Proponents argue
Supporters argue that this bill is crucial for preserving and expanding patient access to essential home infusion therapy, which can be more convenient and cost-effective than inpatient care. They contend that clarifying coverage for pharmacy services and non-pump drugs addresses existing gaps in Medicare policy, while payment adjustments ensure the financial viability of home infusion providers, thereby supporting integrated home care models and reducing hospitalizations.
Opponents contend
Critics may raise concerns that expanding coverage and adjusting payment rates could lead to increased Medicare spending without sufficient oversight, potentially creating opportunities for fraud or abuse. Some might also argue that a 50% payment for days without a physical presence could compromise the quality or safety of care, or that the bundled supply payments might not adequately cover provider costs, leading to reduced access in the long run.
The bill is relatively short and focused, making it accessible for an informed reader to evaluate its provisions within a reasonable timeframe.
Section 2(a)
Expanding Covered Home Infusion Services to Include Pharmacy Services
This provision amends the Social Security Act to explicitly include "pharmacy services" within the definition of home infusion therapy services covered by Medicare. It further clarifies that these services encompass drug preparation and compounding, as well as the coordination and documentation of infusion therapy services within the patient's plan of care. This aims to ensure comprehensive coverage for all aspects of home infusion.
Supporters argue
Proponents argue that explicitly including pharmacy services ensures that Medicare beneficiaries receive comprehensive, integrated care at home, reflecting the full scope of services required for safe and effective home infusion therapy. This clarification supports modern home care models and reduces ambiguity for providers.
Critics contend
Opponents might express concern that expanding the definition of covered services without clear guidelines could lead to increased costs for the Medicare program if not properly managed. However, specific opposition to including pharmacy services is generally low given their integral role in infusion therapy.
Tradeoffs
The primary tradeoff is ensuring comprehensive patient care by covering all necessary services versus managing potential increases in Medicare expenditures due to expanded definitions.
Section 2(b)
Modifying Medicare Payment for Home Infusion Therapy
This section clarifies that Medicare payment for home infusion therapy is made for each day a drug is administered, regardless of whether a qualified supplier is physically present. It establishes a transitional rule for 2026-2030, ensuring the single payment amount reflects 5 hours of infusion. Crucially, it introduces a special rule for days when a supplier is not physically present, setting the payment at 50% of the amount that would apply if a supplier were present.
Section 2(c)
Permitting Nurse Practitioners and Physician Assistants To Establish and Review Home Infusion Plans of Care
This provision amends the Social Security Act to allow nurse practitioners (NPs) and physician assistants (PAs) to establish and periodically review a patient's home infusion plan of care. Previously, this responsibility was solely assigned to physicians. This change expands the pool of qualified healthcare professionals who can manage these plans.
Section 3
Expanding Home Infusion Coverage to Include Certain Non-Pump Drugs and Biologicals
This section modifies the definition of a "home infusion drug" to include "specified non-pump drugs or biologicals." These are defined as drugs or biologicals administered intravenously but not through a durable medical equipment pump, specifically categorizing them as antibacterials, antifungals, or antivirals. It also clarifies that associated services for these non-pump drugs are payable under Medicare, addressing a previous coverage gap.
This section adds a new paragraph to Section 1834(a) of the Social Security Act, which generally governs payment for durable medical equipment. The new paragraph prohibits separate Medicare payment for specific home infusion supplies (including tubing, catheters, dressings, needles, and syringes, identified by HCPCS codes A4221, A4222, or K0552) when they are furnished on the same day as home infusion therapy and for the same drug, and payment for that therapy is already made under the bundled home infusion payment system (subsection (u)).
Section 4
Why it matters:This is standard legislative practice for amending relevant sections of existing code, but the technical nature of the amendment and the use of specific codes make it less obvious to a casual reader. It functions as a technical fix to prevent potential duplicate payments.
Case for: Supporters argue that this provision streamlines billing and prevents potential duplicate payments for supplies that are integral to home infusion therapy. By bundling these costs into the existing home infusion payment, it ensures a comprehensive payment approach and reduces administrative burden.
Case against: Critics might contend that if the bundled home infusion payment rate under subsection (u) does not adequately account for the cost of these specific supplies, this provision could lead to under-reimbursement for home infusion therapy suppliers. This could negatively impact their financial viability and, consequently, patient access.
Estimated impact: This provision is likely a cost-saving or cost-neutral measure for Medicare, aiming to prevent overpayment. Its impact on providers depends on the adequacy of the bundled home infusion payment rates.