Preservation of patient access to home infusion therapy under Medicare program

(a) Inclusion of pharmacy services Section 1861(iii)(2) of the Social Security Act (42 U.S.C. 1395x(iii)(2)) is amended— (1) in subparagraph (A), by inserting and pharmacy services after nursing services; and (2) in subparagraph (B), by inserting, assessments, drug preparation and compounding, coordination and documentation of infusion therapy services in the plan of care after subsection (n)). (b) Payment Section 1834(u)(1)(A) of the Social Security Act (42 U.S.C. 1395m(u)(1)(A)) is amended— (1) in clause (i), by striking clause (iii) and inserting clauses (iii) and (iv); (2) in clause (ii) by inserting after the first sentence the following new sentence: For purposes of the previous sentence, a reference to payment to a qualified home infusion therapy supplier for an infusion drug administration calendar day in the home of such individual shall refer to payment for each day on which such a drug was administered to the individual (regardless of whether a qualified home infusion therapy supplier was physically present in the home of such individual on such date).; and (3) in clause (iii)— (A) by striking The single payment amount and inserting the following: (I) In general Subject to subclause (II), the single payment amount; and (B) by adding at the end the following new subclause: (II) Transitional rule For home infusion therapy furnished on or after January 1, 2026, and before January 1, 2030, the Secretary shall ensure that the single payment amount determined under this subparagraph reflects 5 hours of infusion for a particular therapy in a calendar day.; and (4) by adding at the end the following new clause: (iv) Special rule when a qualified home infusion therapy supplier not physically present in the individual's home In the case where a qualified home infusion therapy supplier is not physically present in the individual's home on the day the home infusion drug is administered to the individual, the single payment amount under this subsection for items and services described in clause (i) furnished on such day to such individual shall be an amount equal to 50 percent of the amount that would have applied under this subsection for such items and services if such a supplier had been physically present.. (c) Permitting nurse practitioners and physician assistants To establish and review a home infusion plan of care Section 1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 1395x(iii)(1)(B)) is amended by striking physician (as defined in subsection (r)(1)) and is periodically reviewed by a physician and inserting physician (as defined in subsection (r)(1)) or a nurse practitioner or physician assistant (as those terms are defined in subsection (aa)(5)) and is periodically reviewed by a physician, nurse practitioner, or physician assistant. (d) Effective date The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026.