Sponsors (55)
The bill enables home-based augmentation therapy for Medicare FFS beneficiaries—improving access and lowering some patient burdens—but increases Medicare spending and leaves Medicare Advantage enrollees and some providers exposed to coverage or payment gaps.
Medicare fee-for-service beneficiaries with Alpha-1 will be able to receive augmentation therapy at home, reducing travel burden and improving timely access to needed treatment.
Home infusion suppliers can bill Medicare directly for IV kits and up to two hours of nursing care, which should improve provider payment flows and make home infusion services more available.
Covering home-based augmentation therapy is likely to lower patient and family costs by avoiding facility-based infusion fees and transportation expenses.
The benefit is limited to fee-for-service Medicare enrollees, leaving Medicare Advantage beneficiaries without the same guaranteed federal payment for home augmentation therapy.
Paying Medicare for IV kits and nursing time will increase Medicare program spending, creating additional federal costs or pressures elsewhere in the Medicare budget (and ultimately for taxpayers).
Payment is capped at 80% of the lesser of charge or statutory amount, which could leave suppliers with unpaid costs, discourage provider participation, or shift costs back to patients through balance billing.
Based on analysis of 2 sections of legislative text.
Adds Medicare coverage and a payment pathway for home-based augmentation therapy for Alpha-1, covering infusion kits and limited nursing services.
Creates a new Medicare benefit that pays for home-based augmentation therapy for people with Alpha-1 antitrypsin deficiency and for limited associated infusion supplies and up to two hours of nursing care per infusion. The law defines that the therapy must be furnished by qualified home infusion therapy suppliers in a beneficiary’s home, applies to traditional Medicare Part A/B enrollees (not Medicare Advantage), establishes payment and billing rules directing payment to the supplier, and takes effect for items and services furnished on or after January 1, 2027.
Introduced March 25, 2025 by Maria Elvira Salazar · Last progress March 25, 2025