This Act updates Medicare coverage and payment rules for home infusion therapy starting in 2026 to ensure continued patient access, clarify covered services, and adjust supplier reimbursement.
Vern Buchanan
Representative
FL-16
The Preserving Patient Access to Home Infusion Act updates Medicare coverage and payment rules for home infusion therapy starting in 2026 to ensure continued patient access. The bill explicitly adds pharmacy services to covered home infusion care and clarifies payment calculations for suppliers, including transitional rules based on infusion hours. Furthermore, it expands who can establish and review patient care plans to include nurse practitioners and physician assistants. Finally, the Act modifies definitions and payment rules for certain non-pump infusion drugs and stops separate Medicare payment for specific disposable supplies when infusion therapy is already being reimbursed.
Medicare Home Infusion Overhaul: Bill Cuts Supplier Pay by 50% for Remote Care, Adds NP/PA Authority
The Preserving Patient Access to Home Infusion Act is an overhaul of how Medicare pays for and defines home infusion therapy, with changes kicking in on January 1, 2026. Put simply, this bill aims to clarify payment rules for suppliers who provide complex IV treatments at home, but it comes with a major catch for remote services and some necessary supplies. It explicitly expands the definition of covered services to include pharmacy services and mandates that care plans must now detail assessments, drug compounding, and coordination, which is a good step toward making sure patients get comprehensive care.
The Fine Print on Payment: 50% Cut for Remote Services
This is where things get interesting for suppliers and potentially tricky for patients, especially those in rural areas. The bill changes the payment structure so suppliers are paid per day the drug is administered. During a transition period (2026–2029), the standard payment will be based on 5 hours of infusion per day. However, Section 2 includes a provision that states if the qualified supplier is not physically present in the patient’s home on the day the drug is administered, the payment for those services is slashed by 50 percent. Think about what this means for a patient with a stable, long-term infusion who only needs remote monitoring and occasional check-ins. If half the pay disappears when the supplier isn't physically there, it creates a massive disincentive for suppliers to offer remote support or serve patients in hard-to-reach areas where a physical visit every day just isn't necessary or practical. This could be a significant barrier to access.
More Flexibility in Care Management
On the positive side for patient convenience and provider workflow, the bill updates who can establish and review a home infusion care plan. Currently, only a physician can do this. The new rules allow a Nurse Practitioner (NP) or a Physician Assistant (PA) to establish and periodically review the plan. This is a smart move that recognizes the expertise of these providers and should make it easier and quicker for patients to get their care plans authorized and managed, especially in clinics or systems where NPs and PAs handle primary care.
No More Separate Payment for Basic Supplies
Section 4 introduces a change that could affect the bottom line for suppliers. Starting in 2026, if Medicare is paying for the infusion service itself, it will stop separately paying for specific disposable supplies used during that session. We’re talking about things like tubing, catheters, dressings, and syringes (specifically identified by HCPCS codes A4221, A4222, or K0552). The idea is likely to bundle the cost of these small items into the main service payment. For suppliers, this means they have to absorb the cost of these essential materials into the primary payment, which may or may not cover the full cost. If the bundled payment is too low, suppliers might face pressure to cut costs elsewhere, which is always a concern when dealing with patient care.
Clarifying Coverage for Non-Pump IVs
Finally, the bill addresses a specific technical gap by creating a new category for "specified non-pump drug or biologicals." This covers certain IV drugs—right now, antibacterial, antifungal, or antiviral medications—that are given without a traditional durable medical equipment (DME) pump. The change ensures that suppliers can still bill for the related services and supplies (like nursing care) even if the drug itself isn't typically covered under Medicare Part B, as long as the delivery method doesn't require a DME pump. This is a good clarification that ensures certain common antibiotic treatments delivered via IV at home remain covered and accessible.