Sponsors (27)
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Adds a new paragraph (22) to subsection (a) that prohibits payment under subsection (a) for specified supplies (tubing, catheters, dressings, needles, syringes, and items identified by HCPCS codes A4221, A4222, or K0552, or successor codes) furnished on or after January 1, 2026 in conjunction with home infusion therapy for which payment is made under subsection (u) when furnished the same day and for the same home infusion drug; defines 'applicable items and services.'
Adds a new subparagraph (E) to the definition of home infusion drug to define a 'specified non-pump drug or biological' that is administered intravenously without a pump that is DME and that is an antibacterial, antifungal, or antiviral as categorized by the United States Pharmacopeia; also makes a minor insertion in subparagraph (C).
Adds a new paragraph (8) to subsection (u) clarifying that when a qualified home infusion supplier furnishes items and services described in 1861(iii)(2)(A) and (B) in coordination with a home infusion drug that is a specified non-pump drug or biological and the infusion does not involve a pump that is DME, payment under this subsection for those items and services shall be made with respect to such drug or biological regardless of whether the drug or biological is payable under this part.
Amends 42 U.S.C. 1395x(iii)(2) by inserting additional text into subparagraphs (A) and (B) to include pharmacy services.
Modifies the special payment rules in 42 U.S.C. 1395m(u)(1)(A) by (1) changing cross-reference language to add a new clause (iv), (2) inserting an additional sentence into clause (ii), (3) revising clause (iii) to add a two-part subclause including a transitional rule requiring the single payment amount to reflect 5 hours of infusion for certain dates, and (4) adding a new clause (iv) that sets the single payment amount at 50 percent when a qualified home infusion therapy supplier is not physically present in the individual's home.
Amends 42 U.S.C. 1395x(iii)(1)(B) to permit a nurse practitioner or physician assistant to establish and to periodically review a home infusion plan of care in addition to a physician.
Expands and clarifies what Medicare pays for when patients receive home infusion therapy. It adds pharmacy services, lets nurse practitioners and physician assistants set and review plans of care, covers certain IV anti‑infective drugs given without a pump, and bundles related supplies into the home infusion payment.
Updates how and how much Medicare pays: creates a transitional payment policy from 2026 through 2029 and establishes a 50% payment for home‑infusion days when the supplier is not physically present. Most changes begin January 1, 2026.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced March 18, 2025 by Vernon G. Buchanan · Last progress March 18, 2025
