Sponsors (54)
The bill enables and finances home-based augmentation therapy for Medicare fee-for-service beneficiaries—improving access and supporting home-infusion providers—while increasing Medicare spending, excluding Medicare Advantage enrollees, and risking underpayment for some suppliers.
Home infusion suppliers and nurses can bill Medicare directly for IV kits and up to two hours of nursing care, improving provider reimbursement and likely increasing the availability of home infusion services.
Medicare beneficiaries with Alpha-1 will be able to receive augmentation therapy at home, reducing travel burdens and improving timely access to needed treatment.
Patients and families with Alpha-1 are likely to face lower out-of-pocket costs and fewer transportation expenses by shifting from facility-based infusions to home-based augmentation therapy.
Medicare Advantage enrollees are excluded from the new federal payment guarantee, leaving many Medicare beneficiaries without the same guaranteed coverage for home augmentation therapy.
Paying Medicare for IV kits and nursing time will increase Medicare program spending, potentially raising federal costs or creating budgetary pressures elsewhere in Medicare.
Capping payment at 80% of the lesser of charge or statutory amount may leave suppliers unpaid for a portion of costs, which could limit provider participation or lead to balance billing pressures for patients.
Based on analysis of 2 sections of legislative text.
Adds a Medicare benefit covering home-based augmentation therapy for Alpha-1 antitrypsin deficiency, paying suppliers for infusion kits and up to two hours of nursing care.
Adds a Medicare benefit that covers home-based augmentation therapy for people with Alpha-1 antitrypsin deficiency and pays qualified home infusion therapy suppliers for infusion kits and up to two hours of associated nursing care. The treatment must be provided in the patient’s home under the care of a physician, nurse practitioner, or physician assistant and applies to traditional Medicare Part A/Part B enrollees (not Medicare Advantage). Payments are made directly to the home infusion supplier, Medicare covers 80% of the applicable amount, and these items/services are excluded from the home health benefit. The coverage 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