Sec. 3. Medicare coverage of home infusion therapy
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/bill/113/hr/5435/ih/section-3A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (s)(2)— by striking and at the end of subparagraph (EE); by inserting and at the end of subparagraph (FF); and by inserting at the end the following new subparagraph: home infusion therapy (as defined in subsection (iii)(1)); ; and by adding at the end the following new subsection: The term home infusion therapy means the items and services described in paragraph
(2)furnished to an individual, who is under the care of a physician, which are provided by a qualified home infusion therapy supplier under a plan (for furnishing such items and services to such individual) established and periodically reviewed by a physician, which items and services are provided in an integrated manner in the individual’s home in conformance with uniform standards of care established by the Secretary and in coordination with the provision of covered infusion drugs under part D. The Secretary shall establish such standards after taking into account the standards commonly used for home infusion therapy by Medicare Advantage plans and in the private sector and after consultation with all interested stakeholders. The items and services described in this paragraph are the following: Professional services, including nursing services (other than nursing services covered as home health services), provided in accordance with the plan (including administrative, compounding, dispensing, distribution, clinical monitoring, and care coordination services) and all necessary supplies and equipment (including medical supplies such as sterile tubing and infusion pumps). Other items and services the Secretary determines appropriate to administer infusion drug therapies to an individual safely and effectively in the home. For purposes of this subsection: The term home means a place of residence used as an individual’s home and includes such other alternate settings as the Secretary determines. The term qualified home infusion therapy supplier means any pharmacy, physician, or other provider licensed by the State in which the pharmacy, physician, or provider resides or provides services, whose State authorized scope of practice includes dispensing authority and that— has expertise in the preparation of parenteral medications in compliance with enforceable standards of the United States Pharmacopoeia and other nationally recognized standards that regulate preparation of parenteral medications as determined by the Secretary and meets such standards; provides infusion therapy to patients with acute or chronic conditions requiring parenteral administration of drugs and biologicals administered through catheters or needles, or both, in a home; and meets such other uniform requirements as the Secretary determines are necessary to ensure the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour basis (taking into account the standards of care for home infusion therapy established by Medicare Advantage plans and in the private sector), and the efficient administration of the home infusion therapy benefit. A qualified home infusion therapy supplier may subcontract with a pharmacy, physician, provider, or supplier to meet the requirements of paragraph (3)(B). . Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following new subsection: The Secretary shall determine a per diem schedule for payment for the professional services (including nursing services), supplies, and equipment described in section 1861(iii)(2)(A) for each infusion therapy type that reflects the reasonable costs which must be incurred by efficiently and economically operated qualified home infusion therapy suppliers to provide such services, supplies, and equipment in conformity with applicable State and Federal laws, regulations, and the uniform quality and safety standards developed under section 1861(iii)(1) and to assure that Medicare beneficiaries have reasonable access to such therapy. In developing the per diem schedule under this subsection, the Secretary shall consider recent credible studies about the costs of providing infusion therapy in the home, consult with home infusion therapy suppliers, consider payment amounts established by Medicare Advantage plans and private payers for home infusion therapy, and, if necessary, conduct a statistically valid national market analysis involving the costs of administering infusion drugs and of providing professional services necessary for the drugs’ administration. The Secretary shall update such schedule from year to year by the percentage increase in the Consumer Price Index for all urban consumers (United States city average) for the 12-month period ending with June of the preceding year. The Secretary may modify the per diem schedule with respect to beneficiaries who qualify for home infusion therapy services under section 1861(iii)(1) but who receive nursing services as home health services. . Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 13951(a)(1) ) is amended— by striking and before
(Z); and by inserting before the semicolon at the end the following: , and
(AA)with respect to home infusion therapy, the amounts paid shall be determined under section 1834(p) . The first sentence of section 1842(b)(6) of the Social Security Act ( 42 U.S.C. 1395u(b)(6) ) is amended— by striking and before
(H); and by inserting before the period at the end the following: , and
(I)in the case of home infusion therapy, payment shall be made to the qualified home infusion therapy supplier . Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in subsection (m)(5)— by striking and before durable medical equipment and inserting a comma; and by inserting before the semicolon at the end the following: , and supplies used in the provision of home infusion therapy after excluding other drugs and biologicals ; and in subsection (n), by adding at the end the following: Such term does not include home infusion therapy, other than equipment and supplies used in the provision of insulin. . The provisions of section 1865(a) of the Social Security Act ( 42 U.S.C. 1395bb(a) ) apply to the accreditation of qualified home infusion therapy suppliers in the same way as they apply to other suppliers.
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Sec. 3
Medicare coverage of home infusion therapy
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