Sponsors (7)
The bill expands Medicare-covered access and convenience of home infusion for beneficiaries but increases program spending and may shift costs and revenue in ways that raise taxpayer exposure, risk patient out-of-pocket surprises, and alter provider finances.
Medicare beneficiaries who need certain infusion drugs can receive them at home with those drugs and related pumps/supplies covered as durable medical equipment (DME), expanding access to home-based infusion care.
Medicare beneficiaries receiving home infusion administered or supervised by qualified suppliers will likely have fewer hospital or clinic visits, lowering travel burden and improving convenience and continuity of care.
Medicare beneficiaries will be notified about Medicare cost-sharing for home infusion, enabling them to compare expected out-of-pocket costs between home and other care settings before treatment.
Taxpayers and the federal budget may face higher Medicare spending and increased deficits because pumps and supplies treated as home-appropriate DME could raise program costs.
Some Medicare beneficiaries could still face unexpected or higher out-of-pocket costs for home infusion compared with receiving infusion in other settings, even with notification.
Hospitals and clinics that currently provide infusion services may lose revenue if care shifts to home settings, which could reduce local service availability or financial stability of providers.
Based on analysis of 2 sections of legislative text.
Introduced August 19, 2025 by Brian K. Fitzpatrick · Last progress August 19, 2025
Amends Medicare’s durable medical equipment (DME) home-use rule to treat certain external infusion pumps and their associated home infusion drugs or supplies as appropriate for use in the home when three conditions are met: the drug’s FDA-approved prescribing information calls for administration by or under supervision of a health care professional, a qualified home infusion therapy supplier administers or supervises administration in the patient’s home, and the drug requires infusion at least 12 times per year or at infusion rates that require an external pump. It also directs the HHS Secretary to ensure Medicare patients are notified about cost sharing when choosing home infusion therapy instead of receiving infusion in other settings. The coverage change takes effect beginning with the first calendar quarter that starts on or after one year after enactment and adds statutory definitions for the patient’s home and for a qualified home infusion therapy supplier to support implementation. The measure changes coverage rules and notification requirements but does not itself appropriate funds.