Preserving Patient Access to Home Infusion Act

I 118TH CONGRESS 1ST SESSION H. R. 4104 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 HOUSE OF REPRESENTATIVES JUNE 14, 2023 Mr. BUCHANAN (for himself, Mrs. DINGELL, Mrs. HARSHBARGER, and Ms. SEWELL) introduced the following bill; which was referred to the Com- mittee 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 A BILL 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. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Preserving Patient Ac- 4 cess to Home Infusion Act’’. 5 VerDate Sep 11 2014 18:42 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4104.IH H4104 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 4104 IH SEC. 2. PRESERVATION OF PATIENT ACCESS TO HOME IN- 1 FUSION THERAPY UNDER MEDICARE PRO- 2 GRAM. 3 (a) INCLUSION OF PHARMACY SERVICES.—Section 4 1861(iii)(2) of the Social Security Act (42 U.S.C. 5 1395x(iii)(2)) is amended— 6 (1) in subparagraph (A), by inserting ‘‘and 7 pharmacy services’’ after ‘‘nursing services’’; and 8 (2) in subparagraph (B), by inserting ‘‘, assess- 9 ments, drug preparation and compounding, coordi- 10 nation and documentation of infusion therapy serv- 11 ices in the plan of care’’ after ‘‘subsection (n))’’. 12 (b) PAYMENT.—Section 1834(u)(1)(A) of the Social 13 Security Act (42 U.S.C. 1395m(u)(1)(A)) is amended— 14 (1) in clause (i), by striking ‘‘clause (iii)’’ and 15 inserting ‘‘clauses (iii) and (iv)’’; 16 (2) in clause (ii) by inserting after the first sen- 17 tence the following new sentence: ‘‘For purposes of 18 the previous sentence, a reference to payment to a 19 qualified home infusion therapy supplier for an infu- 20 sion drug administration calendar day in the home 21 of such individual shall refer to payment for each 22 day on which such a drug was administered to the 23 individual (regardless of whether a qualified home 24 infusion therapy supplier was physically present in 25 the home of such individual on such date).’’; and 26 VerDate Sep 11 2014 18:42 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4104.IH H4104 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 4104 IH (3) by adding at the end the following new 1 clause: 2 ‘‘(iv) SPECIAL RULE WHEN A QUALI- 3 FIED HOME INFUSION THERAPY SUPPLIER 4 NOT PHYSICALLY PRESENT IN THE INDI- 5 VIDUAL’S HOME.—In the case where a 6 qualified home infusion therapy supplier is 7 not physically present in the individual’s 8 home on the day the home infusion drug is 9 administered to the individual, the single 10 payment amount under this subsection for 11 items and services described in clause (i) 12 furnished on such day to such individual 13 shall be an amount equal to 50 percent of 14 the amount that would have applied under 15 this subsection for such items and services 16 if such a supplier had been physically 17 present.’’. 18 (c) PERMITTING NURSE PRACTITIONERS AND PHYSI- 19 CIAN ASSISTANTS TO ESTABLISH AND REVIEW A HOME 20 INFUSION PLAN OF CARE.—Section 1861(iii)(1)(B) of the 21 Social Security Act (42 U.S.C. 1395x(iii)(1)(B)) is 22 amended by striking ‘‘physician (as defined in subsection 23 (r)(1)) and is periodically reviewed by a physician’’ and 24 inserting ‘‘physician (as defined in subsection (r)(1)) or 25 VerDate Sep 11 2014 18:42 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4104.IH H4104 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 4104 IH a nurse practitioner or physician assistant (as those terms 1 are defined in subsection (aa)(5)) and is periodically re- 2 viewed by a physician, nurse practitioner, or physician as- 3 sistant’’. 4 (d) EFFECTIVE DATE.—The amendments made by 5 this section shall apply with respect to items and services 6 furnished on or after January 1, 2024. 7 Æ VerDate Sep 11 2014 18:42 Jul 09, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H4104.IH H4104 pbinns on DSKJLVW7X2PROD with $$_JOB