Preserving Patient Access to Home Infusion Act
Sponsored By: Senator Mark Warner
Introduced
Summary
Expands Medicare coverage and payment rules for home infusion therapy by including pharmacy services and clarifying when and how providers get paid. It also lets nurse practitioners and physician assistants establish and review home infusion plans of care and sets changes to take effect on January 1, 2026.
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- Patients and families: Pharmacy activities like assessments, drug preparation, compounding, coordination, and documentation are now part of a home infusion plan of care. These changes apply to items and services furnished on or after January 1, 2026.
- Providers and suppliers: The bill creates a reworked single payment that treats an infusion day as reflecting 5 hours of infusion per calendar day for transition years and pays 50 percent of that amount when the qualified supplier is not physically present in the home.
- Program integrity and billing: It clarifies that certain non‑pump IV drugs and biologics can be billed under the home infusion framework and prohibits duplicate Medicare payments on the same day for enumerated supplies such as tubing, catheters, dressings, needles, syringes, and HCPCS codes A4221, A4222, and K0552.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Medicare home infusion payment rules
If enacted, Medicare would change how it pays and bills for home infusion therapy starting January 1, 2026. A day when the qualified home infusion supplier is not physically in your home would be paid at 50% of the regular single‑day amount. From January 1, 2026 through December 31, 2029, each paid infusion day would be set to reflect five hours of infusion for that therapy. Certain IV drugs given without a pump (antibacterial, antifungal, or antiviral DME drugs) would be paid under the home infusion rules when the supplier provides pharmacy and nursing services. Medicare could not also pay separately the same‑day supplies (for example tubing, catheters, dressings, needles, syringes, or items billed under HCPCS A4221, A4222, or K0552 or successor codes) for the same drug and day.
Expanded home infusion plan rules
If enacted, the home infusion plan of care would have to include pharmacy services, assessments, drug preparation and compounding, coordination, and documentation. Nurse practitioners and physician assistants, not just physicians, could establish and periodically review the plan. This change would apply to items and services furnished on or after January 1, 2026.
Sponsors & CoSponsors
Sponsor
Mark Warner
VA • D
Cosponsors
Tim Scott
SC • R
Sponsored 3/13/2025
Roll Call Votes
No roll call votes available for this bill.
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