What does Preamble of S 1058 do?

This bill, formally titled 'To amend title XVIII of the Social Security Act to clarify congressional intent and preserve patient access to home infusion therapy under the Medicare program, and for other purposes,' aims to amend title XVIII of the Social Security Act. The bill intends to clarify congressional intent regarding home infusion therapy. The bill seeks to preserve patient access to home infusion therapy under the Medicare program.

What does SHORT TITLE. of S 1058 do?

This Act is formally titled the Preserving Patient Access to Home Infusion Act.

What does PRESERVATION OF PATIENT ACCESS TO HOME INFUSION THERAPY UNDER of S 1058 do?

This section amends the Social Security Act to include pharmacy services within the definition of home health services under Medicare. It modifies payment regulations for home infusion therapy services under the Medicare program, including adjustments to the single payment amount. The legislation establishes a transitional rule for home infusion therapy furnished between January 1, 2026, and January 1, 2030, requiring the Secretary to ensure the single payment amount reflects 5 hours of infusion therapy per calendar day. It introduces a special rule for situations where a qualified home infusion therapy supplier is not physically present in the individual's home, reducing the single payment amount to 50% of the standard amount. The section expands the types of healthcare professionals who can establish and review a home infusion plan of care to include nurse practitioners and physician assistants. These amendments apply to items and services furnished on or after January 1, 2026.

What does ACCESS TO HOME INFUSION FOR NON-PUMP DRUGS AND BIOLOGICALS. of S 1058 do?

This section modifies the definition of a 'home infusion drug' under the Social Security Act. It introduces the term 'specified non-pump drug or biological' to include intravenously administered antibacterials, antifungals, or antivirals not delivered via a durable medical equipment pump. The section clarifies billing procedures for qualified home infusion suppliers furnishing items and services alongside specified non-pump drugs or biologicals. Payment for these items and services will be made regardless of the drug's usual payment status under the Social Security Act. The amendments will apply to items and services furnished on or after January 1, 2026.

What does MODIFICATION OF PAYMENT FOR HOME INFUSION SUPPLIES. of S 1058 do?

This section modifies payment for home infusion supplies under the Social Security Act. Beginning January 1, 2026, payment will be prohibited for specific items and services furnished on the same day as home infusion therapy and related to the same drug. The 'applicable items and services' include tubing, catheters, dressings, needles, syringes, and supplies identified by HCPCS codes A4221, A4222, or K0552 (or successor codes).

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Preserving Patient Access to Home Infusion Act — S. 1058

Last updated: 3/13/2025 · Introduced: 3/13/2025

Author: Mark Warner (D-VA)

TL;DR (AI)

The bill amends the Social Security Act to include pharmacy services within the definition of home health services under Medicare and modifies payment regulations for home infusion therapy.
It expands the types of healthcare professionals who can establish and review a home infusion plan of care to include nurse practitioners and physician assistants.
The bill modifies payment for home infusion supplies, prohibiting payment for certain items and services furnished on the same day as home infusion therapy starting January 1, 2026.

119th Congressin committeeHR. 2172(In Committee)Official page

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Includes provisions on preamble, short title., and 3 more.

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