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Requires the Center for Medicare and Medicaid Innovation (CMI) to create and run a test payment model that pays for blood transfusions separately from the Medicare hospice all‑inclusive per diem. The model must be established within one year of enactment, use a comparison group, and measure clinical and transfusion outcomes; the transfusion payment will equal the Medicare amount that would have applied if the transfusion occurred outside hospice.
Adds a sentence to Section 1115A(b)(2)(A) requiring that the models selected under that subparagraph include testing of the model described in the new subsection (h).
Requires the CMI to establish and implement a model under which blood transfusions furnished to an individual receiving hospice care are paid separately from the hospice all‑inclusive per diem payment under section 1814(i).
The CMI must establish and implement the separate‑payment model not later than 1 year after the date of enactment of this subsection.
Specifies that the separate payment amount for a blood transfusion shall be the amount that would apply under title XVIII if the transfusion was not furnished as part of hospice care.
Requires the CMI, when conducting any evaluation of the model pursuant to Section 1115A(b)(4), to compare participants in the model with similar patients outside the model on specified metrics.
Who is affected and how:
Medicare beneficiaries receiving hospice care who need blood transfusions: The pilot could increase access to transfusions by removing the disincentive for hospices to provide costly transfusions under a fixed per diem; beneficiaries in the model may see different patterns of transfusion use and related clinical outcomes depending on CMI design and results.
Hospice providers and other health care providers who furnish transfusions: Participating hospices and transfusion providers would bill separately for transfusions under the model and must support data collection; some providers may see higher reimbursement for transfusions that previously would have been absorbed within the hospice per diem, while administrative burden may increase.
Medicare program and taxpayers: The model is intended to measure effects on utilization, quality, and spending. Depending on outcomes, separate payments could increase spending if transfusions rise or decrease downstream costs by improving patient outcomes; the pilot helps quantify net impacts before broader policy changes.
Blood suppliers and transfusion service units (hospitals, outpatient centers): May see changes in volume and billing patterns for transfusions supplied to hospice patients participating in the model.
Overall effect: The legislation creates a time-limited, evaluative change to payment method for a specific service within hospice care. It aims to generate evidence on whether separate transfusion payments improve access or outcomes and how they affect Medicare spending. Administrative and billing changes will be required for participants; broader system changes depend on CMI findings and any follow-on policy actions.
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Read twice and referred to the Committee on Finance.
Introduced June 3, 2025 by Jacklyn Sheryl Rosen · Last progress June 3, 2025
Read twice and referred to the Committee on Finance.
Introduced in Senate