The "Preserving Patient Access to Home Infusion Act" aims to safeguard Medicare beneficiaries' access to home infusion therapy by clarifying coverage, modifying payment rules, and expanding access to include certain non-pump drugs and biologicals, effective January 1, 2026.
Vern Buchanan
Representative
FL-16
The "Preserving Patient Access to Home Infusion Act" aims to safeguard Medicare beneficiaries' access to home infusion therapy by clarifying coverage to include pharmacy services, modifying payment rules, and including nurse practitioners and physician assistants in establishing a home infusion plan of care. It also expands the definition of "home infusion drug" to include certain intravenously administered drugs or biologicals not delivered through a durable medical equipment pump and modifies payment rules for home infusion therapy supplies. These changes are set to take effect on or after January 1, 2026.
Home Infusion Bill Aims to Preserve Medicare Access Post-2026, Adjusts Payment Rules and Provider Roles
This bill, the "Preserving Patient Access to Home Infusion Act," focuses on shoring up Medicare coverage for therapy administered intravenously at home, set to take effect January 1, 2026. It clarifies what services are included, who can manage patient care plans, and adjusts how providers are paid, including specific rules for drugs given without an infusion pump.
Keeping the IV Drip Flowing at Home
The core aim here is ensuring patients can continue receiving necessary IV treatments outside of a hospital setting under Medicare. Section 2 explicitly brings pharmacy services—like patient assessments, drug preparation, compounding, and care coordination—under the umbrella of covered home infusion therapy. Think of it as recognizing the essential background work that goes into safe home treatment. Additionally, the bill expands the list of professionals who can establish and review a patient's home infusion plan, adding nurse practitioners (NPs) and physician assistants (PAs) alongside physicians. This could streamline care, especially in areas where physician access might be limited.
The Dollars and Cents of Home Infusion
Payment rules get a significant update. Section 2 clarifies that payment is tied to each calendar day a drug is administered. It also sets a temporary standard (January 1, 2026, to January 1, 2030) assuming 5 hours of infusion work per day for payment calculations. A key change introduces a special rule: if a qualified home infusion supplier isn't physically present in the patient's home when the drug is administered, the payment drops to 50% of the standard amount. This raises practical questions about how 'presence' will be defined and could impact suppliers relying on remote monitoring or telehealth check-ins. Furthermore, Section 4 eliminates separate Medicare payments for certain supplies (like tubing, catheters, specific needles/syringes) starting in 2026, if they're provided on the same day as a home infusion therapy service already being paid for under existing rules. This could simplify billing but might also squeeze margins for suppliers providing these essential items.
Beyond the Pump: Covering More Infusions
Section 3 tackles drugs given intravenously without a pump, like certain antibacterials, antifungals, or antivirals (termed "specified non-pump drugs or biologicals"). The bill modifies the definition of a "home infusion drug" to ensure the services related to administering these non-pump drugs are covered and billable by qualified suppliers, even if the drug itself isn't paid under that specific Medicare part. This aims to close a potential coverage gap, ensuring patients needing these common IV treatments at home aren't left without support for the necessary administration services, effective January 1, 2026.