This bill amends the Social Security Act to include Alpha-1 Antitrypsin Deficiency Disorder treatment under Medicare Part B, covering augmentation therapy, intravenous administration kits, and nursing services, effective January 1, 2027.
Maria Salazar
Representative
FL-27
The "John W. Walsh Alpha-1 Home Infusion Act of 2025" amends the Social Security Act to include Alpha-1 Antitrypsin Deficiency Disorder treatment under Medicare Part B starting January 1, 2027. This covers augmentation therapy provided at home, intravenous administration kits, and associated nursing services for eligible individuals with Alpha-1 Antitrypsin Deficiency. Medicare will cover 80% of the costs for these home infusion services, with payments made directly to qualified suppliers. These services will not be classified as home health services under Medicare.
Medicare Poised to Cover At-Home Alpha-1 Treatment Under New Bill, Effective 2027
This bill, officially the "John W. Walsh Alpha-1 Home Infusion Act of 2025," proposes a significant change for certain Medicare beneficiaries starting January 1, 2027. It aims to add specific coverage under Medicare for the treatment of Alpha-1 Antitrypsin Deficiency Disorder, a genetic condition that can lead to lung disease like emphysema.
Bringing Treatment Home: What's Covered?
The core of the bill is enabling Medicare coverage for augmentation therapy delivered right in a patient's home. This therapy involves receiving Alpha-1 Proteinase Inhibitor, a specific treatment for adults with emphysema caused by a severe hereditary deficiency of Alpha-1 Antitrypsin. To qualify under this proposed coverage, individuals must:
- Be enrolled in Medicare Parts A and B (but not a Part C Medicare Advantage plan).
- Require this specific augmentation therapy.
- Be under the care of a physician, nurse practitioner, or physician assistant.
The therapy itself would need to be provided by a qualified home infusion therapy supplier.
The Nuts and Bolts: Kits, Nursing, and Payments
Beyond the medication, the bill addresses the practicalities of home infusion. It sets up a payment system specifically for the necessary intravenous administration kits and nursing services needed to administer the therapy at home.
Here's the breakdown:
- Nursing Support: Coverage includes up to 2 hours of nursing services associated with the infusion.
- Payment Structure: Medicare would cover 80% of the cost for these kits and nursing services. The actual payment amount would be the lesser of the supplier's actual charge or a rate determined under a specific Medicare payment formula (section 1834(aa) of the Social Security Act).
- Direct Payment: Payments for the kits and nursing go directly to the qualified home infusion supplier, streamlining the process.
- Important Distinction: The bill explicitly states that these specific infusion kits and nursing services are not considered part of standard Medicare "home health services." This clarifies their unique status and payment pathway.
Essentially, this legislation carves out a specific benefit within Medicare to make long-term, necessary home infusion therapy for Alpha-1 deficiency more accessible and financially manageable for eligible patients.