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The bill expands Medicare to cover at-home augmentation therapy for people with AATD—improving access and simplifying supplier payments—but leaves patients facing substantial coinsurance, potentially limited nursing support, and increases program costs.
Medicare beneficiaries with alpha-1 antitrypsin deficiency (AATD) can receive augmentation therapy at home covered by Medicare beginning Jan 1, 2027, reducing travel, facility visits, and improving access to ongoing treatment.
Qualified home infusion suppliers will be paid for IV administration kits and up to 2 hours of nursing, and Medicare may pay suppliers directly, which supports home-infusion provider capacity and simplifies/reduces delays in billing and reimbursement.
The bill defines 'augmentation therapy' and supplier eligibility, clarifying coverage rules and reducing administrative uncertainty for patients, providers, and payers.
Medicare beneficiaries receiving home augmentation therapy will remain responsible for 20% coinsurance on the lesser of the actual charge or the payment amount for kits and services, increasing out-of-pocket costs for patients.
Limiting payment to up to 2 hours of nursing and excluding these kits/services from the home health benefit could leave some patients without sufficient skilled nursing support, shifting care responsibilities and costs to unpaid family caregivers or home health agencies and potentially risking gaps in clinical care.
Providing Medicare coverage for a specialty biologic (augmentation therapy) administered at home could increase overall Medicare spending for this treatment, with budgetary implications for taxpayers and the program.
Based on analysis of 2 sections of legislative text.
Adds Medicare coverage and direct supplier payment for home infusion augmentation therapy (IV kits + up to 2 hours nursing) for AATD in traditional Medicare.
Creates a new Medicare benefit that covers home infusion augmentation therapy for beneficiaries with Alpha-1 Antitrypsin Deficiency (AATD). It requires Medicare to pay qualified home infusion therapy suppliers for intravenous administration kits and up to two hours of nursing services provided in the beneficiary’s home, and excludes those items and services from the Medicare home health benefit. The changes take effect January 1, 2027.
Introduced March 25, 2025 by Maria Elvira Salazar · Last progress March 25, 2025