Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB1058 Compare Versions

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Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 1058
5	5	To amend title XVIII of the Social Security Act to clarify congressional
6	6	intent and preserve patient access to home infusion therapy under the
7	7	Medicare program, and for other purposes.
8	8	IN THE SENATE OF THE UNITED STATES
9	9	MARCH13, 2025
10	10	Mr. W
11	11	ARNER(for himself and Mr. SCOTTof South Carolina) introduced the
12	12	following bill; which was read twice and referred to the Committee on Finance
13	13	A BILL
14	14	To amend title XVIII of the Social Security Act to clarify
15	15	congressional intent and preserve patient access to home
16	16	infusion therapy under the Medicare program, and for
17	17	other purposes.
18	18	Be it enacted by the Senate and House of Representa-1
19	19	tives of the United States of America in Congress assembled, 2
20	20	SECTION 1. SHORT TITLE. 3
21	21	This Act may be cited as the ‘‘Preserving Patient Ac-4
22	22	cess to Home Infusion Act’’. 5
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25	25	•S 1058 IS
26	26	SEC. 2. PRESERVATION OF PATIENT ACCESS TO HOME IN-1
27	27	FUSION THERAPY UNDER MEDICARE PRO-2
28	28	GRAM. 3
29	29	(a) I
30	30	NCLUSION OFPHARMACYSERVICES.—Section 4
31	31	1861(iii)(2) of the Social Security Act (42 U.S.C. 5
32	32	1395x(iii)(2)) is amended— 6
33	33	(1) in subparagraph (A), by inserting ‘‘and 7
34	34	pharmacy services’’ after ‘‘nursing services’’; and 8
35	35	(2) in subparagraph (B), by inserting ‘‘, assess-9
36	36	ments, drug preparation and compounding, coordi-10
37	37	nation and documentation of infusion therapy serv-11
38	38	ices in the plan of care’’ after ‘‘subsection (n))’’. 12
39	39	(b) P
40	40	AYMENT.—Section 1834(u)(1)(A) of the Social 13
41	41	Security Act (42 U.S.C. 1395m(u)(1)(A)) is amended— 14
42	42	(1) in clause (i), by striking ‘‘clause (iii)’’ and 15
43	43	inserting ‘‘clauses (iii) and (iv)’’; 16
44	44	(2) in clause (ii) by inserting after the first sen-17
45	45	tence the following new sentence: ‘‘For purposes of 18
46	46	the previous sentence, a reference to payment to a 19
47	47	qualified home infusion therapy supplier for an infu-20
48	48	sion drug administration calendar day in the home 21
49	49	of such individual shall refer to payment for each 22
50	50	day on which such a drug was administered to the 23
51	51	individual (regardless of whether a qualified home 24
52	52	infusion therapy supplier was physically present in 25
53	53	the home of such individual on such date).’’; and 26
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56	56	•S 1058 IS
57	57	(3) in clause (iii)— 1
58	58	(A) by striking ‘‘The single payment 2
59	59	amount’’ and inserting the following: 3
60	60	‘‘(I) I
61	61	N GENERAL.—Subject to 4
62	62	subclause (II), the single payment 5
63	63	amount’’; and 6
64	64	(B) by adding at the end the following new 7
65	65	subclause: 8
66	66	‘‘(II) T
67	67	RANSITIONAL RULE.—For 9
68	68	home infusion therapy furnished on or 10
69	69	after January 1, 2026, and before 11
70	70	January 1, 2030, the Secretary shall 12
71	71	ensure that the single payment 13
72	72	amount determined under this sub-14
73	73	paragraph reflects 5 hours of infusion 15
74	74	for a particular therapy in a calendar 16
75	75	day.’’; and 17
76	76	(4) by adding at the end the following new 18
77	77	clause: 19
78	78	‘‘(iv) S
79	79	PECIAL RULE WHEN A QUALI -20
80	80	FIED HOME INFUSION THERAPY SUPPLIER 21
81	81	NOT PHYSICALLY PRESENT IN THE INDI -22
82	82	VIDUAL’S HOME.—In the case where a 23
83	83	qualified home infusion therapy supplier is 24
84	84	not physically present in the individual’s 25
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87	87	•S 1058 IS
88	88	home on the day the home infusion drug is 1
89	89	administered to the individual, the single 2
90	90	payment amount under this subsection for 3
91	91	items and services described in clause (i) 4
92	92	furnished on such day to such individual 5
93	93	shall be an amount equal to 50 percent of 6
94	94	the amount that would have applied under 7
95	95	this subsection for such items and services 8
96	96	if such a supplier had been physically 9
97	97	present.’’. 10
98	98	(c) P
99	99	ERMITTINGNURSEPRACTITIONERS ANDPHYSI-11
100	100	CIANASSISTANTSTOESTABLISH ANDREVIEW AHOME 12
101	101	I
102	102	NFUSIONPLAN OFCARE.—Section 1861(iii)(1)(B) of the 13
103	103	Social Security Act (42 U.S.C. 1395x(iii)(1)(B)) is 14
104	104	amended by striking ‘‘physician (as defined in subsection 15
105	105	(r)(1)) and is periodically reviewed by a physician’’ and 16
106	106	inserting ‘‘physician (as defined in subsection (r)(1)) or 17
107	107	a nurse practitioner or physician assistant (as those terms 18
108	108	are defined in subsection (aa)(5)) and is periodically re-19
109	109	viewed by a physician, nurse practitioner, or physician as-20
110	110	sistant’’. 21
111	111	(d) E
112	112	FFECTIVEDATE.—The amendments made by 22
113	113	this section shall apply with respect to items and services 23
114	114	furnished on or after January 1, 2026. 24
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117	117	•S 1058 IS
118	118	SEC. 3. ACCESS TO HOME INFUSION FOR NON-PUMP DRUGS 1
119	119	AND BIOLOGICALS. 2
120	120	(a) M
121	121	ODIFICATION OFDEFINITION OFHOMEINFU-3
122	122	SIONDRUG.—Section 1861(iii)(3) of the Social Security 4
123	123	Act (42 U.S.C. 1395x(iii)(3)) is amended— 5
124	124	(1) in subparagraph (C), by inserting ‘‘and, in 6
125	125	the case of a drug or biological other than a speci-7
126	126	fied non-pump drug or biological (as defined in sub-8
127	127	paragraph (E)),’’ before ‘‘through’’; and 9
128	128	(2) by adding at the end the following new sub-10
129	129	paragraph: 11
130	130	‘‘(E) The term ‘specified non-pump drug or bio-12
131	131	logical’ means a drug or biological that— 13
132	132	‘‘(i) is administered intravenously but not 14
133	133	through a pump that is an item of durable med-15
134	134	ical equipment (as defined in subsection (n)); 16
135	135	and 17
136	136	‘‘(ii) is an antibacterial, antifungal, or 18
137	137	antiviral (as categorized by the United States 19
138	138	Pharmacopeia).’’. 20
139	139	(b) C
140	140	LARIFICATION ONBILLING.—Section 1834(u) 21
141	141	of the Social Security Act (42 U.S.C. 1395m(u)) is 22
142	142	amended by adding at the end the following new para-23
143	143	graph: 24
144	144	‘‘(8) C
145	145	LARIFICATION ON BILLING FOR A SPECI -25
146	146	FIED NON-PUMP DRUG OR BIOLOGICAL .—In the case 26
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149	149	•S 1058 IS
150	150	of a qualified home infusion supplier (as defined in 1
151	151	section 1861(iii)(3)(D)) that furnishes items and 2
152	152	services described in subparagraphs (A) and (B) of 3
153	153	section 1861(iii)(2) in coordination with the fur-4
154	154	nishing of a home infusion drug (as defined in sec-5
155	155	tion 1861(iii)(3)(C)) that is a specified non-pump 6
156	156	drug or biological (as defined in section 7
157	157	1861(iii)(3)(E)) where the method of infusion uti-8
158	158	lized in furnishing such drug or biological does not 9
159	159	involve a pump that is an item of durable medical 10
160	160	equipment, payment under this subsection for the 11
161	161	items and services described in subparagraphs (A) 12
162	162	and (B) of section 1861(iii)(2) shall be made with 13
163	163	respect to such drug or biological regardless of 14
164	164	whether such drug or biological so furnished is pay-15
165	165	able under this part.’’. 16
166	166	(c) E
167	167	FFECTIVEDATE.—The amendments made by 17
168	168	this section shall apply with respect to items and services 18
169	169	furnished on or after January 1, 2026. 19
170	170	SEC. 4. MODIFICATION OF PAYMENT FOR HOME INFUSION 20
171	171	SUPPLIES. 21
172	172	Section 1834(a) of the Social Security Act (42 U.S.C. 22
173	173	1395m(a)) is amended by adding at the end the following 23
174	174	new paragraph: 24
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178	178	‘‘(23) SPECIAL PAYMENT RULE FOR ITEMS AND 1
179	179	SUPPLIES FURNISHED IN CONJUNCTION WITH HOME 2
180	180	INFUSION THERAPY.— 3
181	181	‘‘(A) I
182	182	N GENERAL.—Notwithstanding the 4
183	183	preceding provisions of this subsection, no pay-5
184	184	ment may be made under this subsection with 6
185	185	respect to applicable items and services (as de-7
186	186	fined in subparagraph (B)) that are furnished 8
187	187	on or after January 1, 2026, in conjunction 9
188	188	home infusion therapy (as defined in section 10
189	189	1861(iii)(1)) for which payment is made under 11
190	190	subsection (u) and which are so furnished on 12
191	191	the same day as such home infusion therapy 13
192	192	and with respect to the same home infusion 14
193	193	drug (as defined in section 1861(iii)(3)(C)) for 15
194	194	which such payment was so made. 16
195	195	‘‘(B) A
196	196	PPLICABLE ITEMS AND SERVICES 17
197	197	DEFINED.—For purposes of subparagraph (A), 18
198	198	the term ‘applicable items and services’ means 19
199	199	tubing, catheters, dressings, needles, syringes, 20
200	200	and other supplies identified by HCPCS code 21
201	201	A4221, A4222, or K0552 (or any successor 22
202	202	code).’’. 23
203	203	Æ
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