Preserving Patient Access to Home Infusion

Full Title:
Preserving Patient Access to Home Infusion Act

Summary#

This bill would change parts of Medicare to support home infusion therapy. It adds "pharmacy services" to the list of covered services, clarifies when suppliers get paid, and defines payment rules for different situations. It lets nurse practitioners and physician assistants establish and review a home infusion plan of care. It clarifies coverage and billing for certain non-pump intravenous antibacterial, antifungal, and antiviral drugs. It also changes how payment is handled for supplies used with home infusion therapy.

What it means for you#

  • Medicare beneficiaries who get infusion medicines at home may see clearer coverage for pharmacy services and related care.
  • Nurse practitioners and physician assistants could create and periodically review the home infusion plan of care, not just physicians.
  • When a home infusion drug is given on a day the supplier is not physically in the home, the supplier would be paid 50% of the normal single payment amount for that day.
  • From January 1, 2026, through 2029, the single payment amount for an infusion therapy day must reflect 5 hours of infusion for that therapy.
  • Certain intravenous drugs given without a pump (specified antibacterial, antifungal, and antiviral drugs) are clarified to allow billing for infusion coordination and related services even when the drug itself may not be separately payable under Medicare.
  • Supplies such as tubing and dressings provided the same day as a home infusion drug paid under the home infusion payment rule would not get a separate payment under the usual supply payment rules.

Expenses#

No publicly available information on costs or budgetary effects is included in the bill text. The bill sets an effective date for most changes of January 1, 2026.

Proponents' View#

The bill's sponsors say it clarifies congressional intent and preserves patient access to home infusion therapy. It aims to ensure payment rules support home infusion care, allow non-physician clinicians to manage plans of care, and prevent gaps in billing for non-pump intravenous anti-infective drugs and for supplies.

Opponents' View#

No publicly available information on opposition or specific objections is included in the bill text or metadata.