Preserving Patient Access to Home Infusion Act | ChamberLight
Bills · S 1058
IN COMMITTEE· 119TH CONGRESS
Senate BillS 1058Health
Preserving Patient Access to Home Infusion Act
INTRO MAR 13· LAST ACTION MAR 13
READING
6MIN
COSPONSORS
1
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed Senate
Passed House
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it addresses current gaps in Medicare's coverage for home infusion therapy, which can be a vital service for many chronically ill or recovering patients. If passed, it would ensure that more comprehensive services, like pharmacy support and certain non-pump medications, are covered, potentially reducing the need for hospital or clinic visits and making it easier for patients to receive care in the comfort of their own homes.
Without this bill, patients might continue to face challenges accessing the full scope of necessary home infusion services, and providers might struggle with inadequate reimbursement for essential care components. By clarifying and expanding coverage and payment, the bill aims to support a more robust and accessible home infusion therapy system, which can significantly improve quality of life for patients and potentially lower overall healthcare costs by preventing more expensive institutional care.
KEY PROVISIONS
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PROVISION 01
Medicare coverage is expanded to explicitly include pharmacy services for home infusion therapy, such as drug preparation, compounding, assessments, coordination, and documentation.
Ensures that all necessary pharmacy-related support for home IV medications is officially covered and reimbursed by Medicare, providing more comprehensive patient care.
PROVISION 02
New payment rules are established for home infusion, including a provision for a 50% payment rate on days when a home infusion supplier is not physically present but the patient still receives their infusion.
Recognizes the ongoing clinical oversight and support required for home infusion even on days without a physical visit, ensuring providers are compensated for continuous patient management.
PROVISION 03
Nurse practitioners and physician assistants are authorized to establish and periodically review a patient's home infusion plan of care, in addition to physicians.
Increases flexibility and access to timely care plan management, potentially reducing delays in initiating or continuing home infusion therapy.
PROVISION 04
The definition of 'home infusion drug' is expanded to include certain intravenous antibacterial, antifungal, or antiviral medications administered without a pump.
Broadens access to home infusion therapy for patients needing these specific non-pump medications, allowing them to receive treatment at home instead of in a facility.
PROVISION 05
Payment for specific home infusion supplies (e.g., tubing, catheters, dressings) will be bundled with the home infusion therapy payment, rather than paid separately under durable medical equipment rules.
Streamlines billing and ensures that essential supplies needed for home infusions are covered as part of the overall therapy payment, improving administrative efficiency.
This bill matters because it addresses current gaps in Medicare's coverage for home infusion therapy, which can be a vital service for many chronically ill or recovering patients. If passed, it would ensure that more comprehensive services, like pharmacy support and certain non-pump medications, are covered, potentially reducing the need for hospital or clinic visits and making it easier for patients to receive care in the comfort of their own homes.
Without this bill, patients might continue to face challenges accessing the full scope of necessary home infusion services, and providers might struggle with inadequate reimbursement for essential care components. By clarifying and expanding coverage and payment, the bill aims to support a more robust and accessible home infusion therapy system, which can significantly improve quality of life for patients and potentially lower overall healthcare costs by preventing more expensive institutional care.
KEY PROVISIONS
AI-extracted
high
Medicare coverage is expanded to explicitly include pharmacy services for home infusion therapy, such as drug preparation, compounding, assessments, coordination, and documentation.
Ensures that all necessary pharmacy-related support for home IV medications is officially covered and reimbursed by Medicare, providing more comprehensive patient care.
high
New payment rules are established for home infusion, including a provision for a 50% payment rate on days when a home infusion supplier is not physically present but the patient still receives their infusion.
Recognizes the ongoing clinical oversight and support required for home infusion even on days without a physical visit, ensuring providers are compensated for continuous patient management.
med
Nurse practitioners and physician assistants are authorized to establish and periodically review a patient's home infusion plan of care, in addition to physicians.
Increases flexibility and access to timely care plan management, potentially reducing delays in initiating or continuing home infusion therapy.
high
The definition of 'home infusion drug' is expanded to include certain intravenous antibacterial, antifungal, or antiviral medications administered without a pump.
Broadens access to home infusion therapy for patients needing these specific non-pump medications, allowing them to receive treatment at home instead of in a facility.
med
Payment for specific home infusion supplies (e.g., tubing, catheters, dressings) will be bundled with the home infusion therapy payment, rather than paid separately under durable medical equipment rules.
Streamlines billing and ensures that essential supplies needed for home infusions are covered as part of the overall therapy payment, improving administrative efficiency.
Effective date for amendments regarding pharmacy services, payment rules, and care plan oversight.
January 1, 2026, and before January 1, 2030
Transitional rule for determining the single payment amount for home infusion therapy, reflecting 5 hours of infusion.
January 1, 2026
Effective date for amendments regarding access to home infusion for non-pump drugs and biologicals.
On or after January 1, 2026
Special payment rule for items and supplies furnished in conjunction with home infusion therapy takes effect.
GLOSSARY
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Home Infusion Therapy
Medical treatment where medications are administered intravenously (through a vein) in a patient's home by a healthcare professional.
Medicare Program
The federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
Social Security Act
A foundational law in the United States that established social insurance programs, including Medicare and Social Security.
Nurse Practitioner (NP)
A registered nurse with advanced academic and clinical experience, able to diagnose and treat illnesses, prescribe medication, and manage patient care, often independently or in collaboration with physicians.
Physician Assistant (PA)
A licensed medical professional who practices medicine under the supervision of a physician, able to diagnose illnesses, develop and manage treatment plans, prescribe medications, and often assist in surgery.
Specified Non-Pump Drug or Biological
A specific type of medication (antibacterial, antifungal, or antiviral) administered intravenously at home without using a mechanical pump, which this bill proposes to cover under Medicare home infusion therapy.
ACTION TIMELINE
2 EVENTS
MAR 13, 25
Introduced in Senate
INTROREFERRAL
MAR 13, 25
Read twice and referred to the Committee on Finance.
Equipment that is durable (can withstand repeated use), used for a medical purpose, appropriate for use in the home, and not usually useful to someone who isn't sick or injured (e.g., wheelchairs, oxygen equipment).
HCPCS code
Healthcare Common Procedure Coding System codes are used to describe services, procedures, and items provided to patients by healthcare professionals, especially for billing purposes.
