Preserving Patient Access to Home Infusion Act
- Bill Number
- H.R. 2172
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-03-18: 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.
- Last Updated
- 2026-07-08T20:06:15Z
AI-Generated Summary
Purpose of the Legislation
The Preserving Patient Access to Home Infusion Act (H.R. 2172) aims to clarify congressional intent regarding Medicare coverage for home infusion therapy. Home infusion therapy involves administering medications, like antibiotics or antivirals, directly into a patient's bloodstream at home rather than in a hospital or clinic. The bill seeks to preserve and expand patient access to this therapy by updating definitions, payment rules, and eligibility under Medicare Part B (which covers outpatient services).
Key Provisions
- Inclusion of Pharmacy Services: Expands the definition of home infusion therapy to explicitly include pharmacy services, such as drug preparation, compounding (mixing medications), assessments, and coordination of care in the patient's treatment plan.
- Payment Adjustments:
- Clarifies that Medicare payments are made for each day a home infusion drug is administered, even if the supplier (e.g., a pharmacy or provider) is not physically present in the home.
- Introduces a transitional payment rule from 2026 to 2029, ensuring payments reflect a standard of 5 hours of infusion per day for specific therapies.
- Establishes a special rule: If the supplier is not physically present on the administration day, payment is reduced to 50% of the standard amount for related services.
- Expanded Professional Roles: Allows nurse practitioners (advanced practice nurses) and physician assistants (healthcare providers who work under physician supervision) to create and periodically review a patient's home infusion plan of care, in addition to physicians.
- Coverage for Non-Pump Drugs: Broadens the definition of covered "home infusion drugs" to include certain intravenous (IV) medications—specifically antibacterials, antifungals, or antivirals—that do not require a pump (a type of durable medical equipment). This ensures billing and payment for related services even if the drug itself is not separately reimbursable under Medicare.
- Bundled Payment for Supplies: Prohibits separate Medicare payments under the durable medical equipment (DME) benefit for specific supplies (e.g., tubing, catheters, dressings, needles, syringes—identified by codes like A4221 or K0552) when they are used the same day as paid home infusion therapy for the same drug. These costs are instead bundled into the home infusion payment.
- Effective Date: All changes apply to services provided on or after January 1, 2026.
Significant Changes to Existing Law
- From the Social Security Act (Title XVIII, Medicare):
- Amends Section 1861(iii) to include pharmacy services and non-pump drugs in the home infusion therapy definition, which previously focused more on pump-based infusions and nursing oversight.
- Updates Section 1834(u) payment rules to allow flexible administration without on-site presence, introduce reduced payments for remote scenarios, and clarify billing for non-pump drugs—addressing gaps that may have limited access.
- Modifies Section 1861(iii)(1)(B) to expand who can certify and review care plans beyond just physicians.
- Adds a new rule in Section 1834(a) to bundle supply payments, preventing double reimbursement under DME rules that could inflate costs.
- These changes build on the 21st Century Cures Act (2016), which first established temporary home infusion benefits, by making them more permanent and inclusive.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update payment systems, codes, and guidelines by 2026, potentially simplifying administration but requiring short-term adjustments. This could lead to modest Medicare savings through bundled payments and reduced separate claims for supplies.
- On Citizens: Medicare beneficiaries (primarily elderly or disabled individuals needing IV therapies for infections or other conditions) gain better access to convenient home-based care, reducing hospital visits and improving quality of life. It may lower out-of-pocket costs by clarifying coverage for a wider range of drugs and services.
- On International Relations: No direct impacts, as this is a domestic healthcare policy focused on U.S. Medicare.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary beneficiaries, especially those with chronic conditions requiring IV drugs, who benefit from expanded home care options.
- Healthcare Providers: Physicians, nurse practitioners, physician assistants, and home health agencies gain flexibility in managing care plans.
- Suppliers and Pharmacies: Qualified home infusion therapy suppliers (e.g., specialty pharmacies) see clarified payments and new opportunities for non-pump drugs, but face reduced reimbursements for remote services and bundled supplies.
- Government: CMS and Congress, as overseers of Medicare spending and policy.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's statutory framework by resolving ambiguities in prior laws, potentially reducing future disputes over coverage denials. No challenges to enforceability are evident, as it aligns with existing congressional authority over federal programs.
- Constitutional: No significant issues; it operates within Congress's spending power under Article I, Section 8, to regulate interstate commerce and provide for public welfare through programs like Medicare.
- Political: Bipartisan support (introduced by representatives from both parties) reflects a focus on healthcare access amid rising costs. It could influence broader debates on Medicare sustainability, emphasizing home-based care to control expenses without cutting benefits, though implementation costs for CMS updates may draw scrutiny in budget discussions.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (28)
Rep. Dingell, Debbie [D-MI-6], Rep. Harshbarger, Diana [R-TN-1], Rep. Sewell, Terri A. [D-AL-7], Rep. Steube, W. Gregory [R-FL-17], Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. DelBene, Suzan K. [D-WA-1], Rep. Crenshaw, Dan [R-TX-2], Rep. Mrvan, Frank J. [D-IN-1], Rep. Tenney, Claudia [R-NY-24], Rep. Ruiz, Raul [D-CA-25], Rep. Miller, Carol D. [R-WV-1], Rep. Crow, Jason [D-CO-6], Rep. Tonko, Paul [D-NY-20], Rep. Panetta, Jimmy [D-CA-19], Rep. Dean, Madeleine [D-PA-4], Rep. Moore, Blake D. [R-UT-1], Rep. Owens, Burgess [R-UT-4], Rep. Matsui, Doris O. [D-CA-7], Rep. Davis, Danny K. [D-IL-7], Rep. Soto, Darren [D-FL-9], Rep. Lieu, Ted [D-CA-36], Rep. Stanton, Greg [D-AZ-4], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Mannion, John W. [D-NY-22], Rep. Trahan, Lori [D-MA-3], Rep. Schneider, Bradley Scott [D-IL-10], Rep. Smith, Adrian [R-NE-3], Rep. Langworthy, Nicholas A. [R-NY-23]
Recent Actions
- 2025-03-18: 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.
- 2025-03-18: 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.
- 2025-03-18: Introduced in House
- 2025-03-18: Introduced in House
Bill Versions
- Preserving Patient Access to Home Infusion Act — issued 2025-03-18 — PDF (7 pages)