S. 1058

119th CONGRESS 1st Session

To amend title XVIII of the Social Security Act to clarify congressional intent and preserve patient access to home infusion therapy under the Medicare program, and for other purposes.

IN THE SENATE OF THE UNITED STATES · March 13, 2025 · Sponsor: Mr. Warner · Committee: Committee on Finance

Table of contents

• S. 1058
  • SEC. 1. Short title
  • SEC. 2. Preservation of patient access to home infusion therapy under Medicare program
  • SEC. 3. Access to home infusion for non-pump drugs and biologicals
  • SEC. 4. Modification of payment for home infusion supplies

SEC. 1. Short title

• This Act may be cited as the Preserving Patient Access to Home Infusion Act.

SEC. 2. Preservation of patient access to home infusion therapy under Medicare program

• (a) Inclusion of pharmacy services
  • Section 1861(iii)(2) of the Social Security Act () is amended— 42 U.S.C. 1395x(iii)(2)
    • in subparagraph (A), by inserting after ; and
    • in subparagraph (B), by inserting after .
• (b) Payment
  • Section 1834(u)(1)(A) of the Social Security Act () is amended— 42 U.S.C. 1395m(u)(1)(A)
    • in clause (i), by striking clause (iii)and inserting clauses (iii) and (iv);
    • in clause (ii) by inserting after the first sentence the following new sentence: ; and
    • in clause (iii)—
      • by striking and inserting the following:
        • Subject to subclause (II), the single payment amount
        • For home infusion therapy furnished on or after January 1, 2026, and before January 1, 2030, the Secretary shall ensure that the single payment amount determined under this subparagraph reflects 5 hours of infusion for a particular therapy in a calendar day.
      • by adding at the end the following new subclause:
        • (iv) In the case where a qualified home infusion therapy supplier is not physically present in the individual's home on the day the home infusion drug is administered to the individual, the single payment amount under this subsection for items and services described in clause (i) furnished on such day to such individual shall be an amount equal to 50 percent of the amount that would have applied under this subsection for such items and services if such a supplier had been physically present.
    • by adding at the end the following new clause:
• (c) Permitting nurse practitioners and physician assistants To establish and review a home infusion plan of care
  • Section 1861(iii)(1)(B) of the Social Security Act () is amended by striking physician (as defined in subsection (r)(1)) and is periodically reviewed by a physicianand inserting physician (as defined in subsection (r)(1)) or a nurse practitioner or physician assistant (as those terms are defined in subsection (aa)(5)) and is periodically reviewed by a physician, nurse practitioner, or physician assistant. 42 U.S.C. 1395x(iii)(1)(B)
• (d) Effective date
  • The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026.

SEC. 3. Access to home infusion for non-pump drugs and biologicals

• (a) Modification of definition of home infusion drug
  • Section 1861(iii)(3) of the Social Security Act () is amended— 42 U.S.C. 1395x(iii)(3)
    • in subparagraph (C), by inserting before ; and
    • by adding at the end the following new subparagraph:
• (b) Clarification on billing
  • Section 1834(u) of the Social Security Act () is amended by adding at the end the following new paragraph: 42 U.S.C. 1395m(u)
    • (8) Clarification on billing for a specified non-pump drug or biological
      • In the case of a qualified home infusion supplier (as defined in section 1861(iii)(3)(D)) that furnishes items and services described in subparagraphs (A) and (B) of section 1861(iii)(2) in coordination with the furnishing of a home infusion drug (as defined in section 1861(iii)(3)(C)) that is a specified non-pump drug or biological (as defined in section 1861(iii)(3)(E)) where the method of infusion utilized in furnishing such drug or biological does not involve a pump that is an item of durable medical equipment, payment under this subsection for the items and services described in subparagraphs (A) and (B) of section 1861(iii)(2) shall be made with respect to such drug or biological regardless of whether such drug or biological so furnished is payable under this part.
• (c) Effective date
  • The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026.

SEC. 4. Modification of payment for home infusion supplies

• Section 1834(a) of the Social Security Act () is amended by adding at the end the following new paragraph: 42 U.S.C. 1395m(a)
  • (23) Special payment rule for items and supplies furnished in conjunction with home infusion therapy
    • (A) In general
      • Notwithstanding the preceding provisions of this subsection, no payment may be made under this subsection with respect to applicable items and services (as defined in subparagraph (B)) that are furnished on or after January 1, 2026, in conjunction home infusion therapy (as defined in section 1861(iii)(1)) for which payment is made under subsection (u) and which are so furnished on the same day as such home infusion therapy and with respect to the same home infusion drug (as defined in section 1861(iii)(3)(C)) for which such payment was so made.
    • (B) Applicable items and services defined
      • For purposes of subparagraph (A), the term means tubing, catheters, dressings, needles, syringes, and other supplies identified by HCPCS code A4221, A4222, or K0552 (or any successor code). applicable items and services