Medicare Home Infusion Overhaul: NPs and PAs Gain Authority, New Payment Rules Start 2026

This bill, officially titled the “Preserving Patient Access to Home Infusion Act,” is a major update to how Medicare pays for and regulates home infusion therapy—that’s when patients receive IV medications, often complex ones, at home instead of in a clinic. Starting January 1, 2026, the law explicitly includes pharmacy services (like drug mixing and preparation) as a core part of home infusion care and updates the payment system to better reflect the costs of providing this care.

Your Care Team Just Got Bigger

One of the most practical changes is who gets to manage your care plan. Before, only a doctor could formally establish and regularly review the plan for home infusion. This bill expands that authority, allowing Nurse Practitioners (NPs) or Physician Assistants (PAs) to take on this role (Sec. 2). For patients, especially those in rural areas or dealing with specialist shortages, this is a huge win for convenience and access. It means less waiting around for a doctor’s sign-off and smoother coordination of complex treatments.

The New Rules of Payment: Why Your Supplier Cares

For the companies that provide these services—the home infusion suppliers—the bill sets up clear, but complex, new payment boundaries. First, it clarifies that if a supplier provides an infusion drug on a given day, that counts as a full day for payment (Sec. 2). More importantly, it creates a Transitional Payment Rule running from 2026 through 2029, ensuring the standard payment reflects up to five hours of infusion service per day. This is an attempt to stabilize payments as the system shifts.

However, there’s a significant catch for suppliers and potentially for patients: if the qualified supplier is not physically present in the patient’s home when the drug is administered that day, the payment for their services is cut in half—to 50% (Sec. 2). This provision is likely designed to prevent overpaying for days when only remote monitoring occurs, but it could put pressure on suppliers to prioritize in-person visits, even when a remote check-in might be sufficient. If you live far away, this could affect how readily a supplier agrees to take you on.

Fixing Gaps for Non-Pump IV Drugs

The legislation also cleans up a specific coverage issue for certain common IV treatments. It creates a new category called “specified non-pump drugs or biologicals,” which are IV antibacterial, antifungal, or antiviral medications that don’t require a durable medical equipment (DME) infusion pump (Sec. 3). Think of drugs administered manually via a simple IV drip instead of a machine. The bill ensures that home infusion suppliers get paid for the associated services (like nursing and supplies) when delivering these specific non-pump medications, closing a previous gap that could have made it financially difficult to provide these necessary treatments at home.

No More Double Dipping on Supplies

Finally, the bill streamlines billing by preventing “double payments” for certain supplies (Sec. 4). If Medicare is already paying the supplier for the overall home infusion therapy session, they will no longer pay separately for common items like tubing, catheters, dressings, and needles (specifically those identified by codes A4221, A4222, or K0552) used during that same session. The intent here is administrative—to bundle the cost of these routine items into the main therapy payment—which should make the billing process cleaner for Medicare, but means suppliers must now account for those supply costs within the primary service fee.