The Preserving Patient Access to Home Infusion Act would amend title XVIII of the Social Security Act to preserve patient access to home infusion therapy under Medicare. It expands the scope of services to include pharmacy services linked to infusion plans, revises the payment structure for home infusion days, and allows nurse practitioners and physician assistants to establish and review the home infusion plan of care.
The bill also broadens access to certain non-pump drugs and clarifies related billing, with a staged effective date beginning in 2026.
At a Glance
What It Does
The bill expands home infusion care to include pharmacy services and drug preparation, adjusts the per-day payment framework for infusion therapy (including a transitional rule for 2026–2030), and enables non-physician clinicians to establish and review the care plan.
Who It Affects
Medicare beneficiaries receiving home infusion therapy, home infusion suppliers, and clinicians (physicians, nurse practitioners, physician assistants) who oversee infusion plans.
Why It Matters
These changes aim to reduce access barriers and ensure sustainable reimbursement for in-home infusion, a care modality that can reduce hospitalizations and support patient convenience.
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What This Bill Actually Does
The legislation broadens what Medicare covers for home infusion therapy, explicitly adding pharmacy services to the in-home care package so patients receive not just nursing care but also drug preparation and coordination as part of the plan of care. It revises how payment for home infusion days is calculated, moving toward a per-day payment model and introducing a transitional rule that the daily amount reflects five hours of infusion work for each calendar day during 2026–2030.
If a qualified home infusion therapy supplier is not physically present in the patient’s home on a given infusion day, payment for that day would be limited to 50 percent of the amount that would apply if the supplier had been present. The bill also allows nurse practitioners and physician assistants to establish and periodically review the home infusion plan of care, expanding beyond physician-only oversight.
The Non-Pump Drug and Biologicals section creates a pathway to treat certain non-pump drugs intravenously (as defined by USP categories) and clarifies how such infusions should be billed. Finally, a separate provision limits duplicate payments for items used in conjunction with home infusion therapy on the same day as the infusion, strengthening the connection between the infusion drug administration and related supplies.
The effective date for these changes is January 1, 2026, with most provisions applying to items and services furnished on or after that date.
The Five Things You Need to Know
Adds pharmacy services to the home infusion care bundle (drug preparation, coordination, and documentation in the plan of care).
Changes payment rules to a per-day basis and introduces a 5-hour infusion transition rule for 2026–2030.
Allows nurse practitioners and physician assistants to establish and review home infusion plans of care.
Expands coverage to specified non-pump drugs and clarifies related billing for non-pump infusions.
Imposes a special payment rule to avoid double payment for supplies used with home infusion therapy on the same day as the infusion (effective 2026).
Section-by-Section Breakdown
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Inclusion of Pharmacy Services and Payment Reforms
Section 2 broadens the scope of home infusion therapy by adding pharmacy services to the set of covered activities under 1861(iii)(2)(A) and (B). This includes drug preparation, compounding, and the coordination and documentation of infusion therapy services in the patient’s plan of care. It also revises payment under 1834(u) to treat payment per infusion day as applicable regardless of a supplier’s physical presence, and inserts a transitional rule for 2026–2030 to ensure the single payment amount reflects five hours of infusion per calendar day. Finally, it authorizes non-physician clinicians (NPs and PAs) to establish and periodically review the home infusion plan of care, and sets January 1, 2026 as the effective date for these changes.
Access to Home Infusion for Non-Pump Drugs and Biologics
Section 3 expands the definition of ‘home infusion drug’ to include certain non-pump drugs or biologicals, defined as intravenously administered drugs that do not require a durable medical equipment pump, specifically antibacterial, antifungal, or antiviral agents. It also adds a billing clarification under 1834(u)(8) that when a qualified home infusion supplier furnishes non-pump drugs in coordination with infusion therapy, the payment for those items shall be treated under this part even if there is no pump involved. These changes take effect for items and services furnished on or after January 1, 2026.
Modification of Payment for Home Infusion Supplies
Section 4 adds a new paragraph to 1834(a) establishing a special payment rule for items and supplies furnished with home infusion therapy. No payment may be made for items such as tubing, catheters, dressings, needles, syringes, and similar supplies on the same day as the infusion if payment is already made under subsection (u) for the same home infusion drug, thereby preventing double payment. The defined applicable items and services are identified by HCPCS codes A4221, A4222, or K0552 (or successors). The effective date for these restrictions is January 1, 2026.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries relying on home infusion therapy, who gain broader service coverage and improved access to in-home care.
- Home infusion suppliers and service providers, who gain clearer payment pathways and a broader service scope that includes pharmacy services and drug preparation.
- Pharmacists and pharmacy services involved in infusion therapy, who gain formal inclusion in the care plan and reimbursement structure.
- Physicians, nurse practitioners, and physician assistants, who gain more flexible, team-based oversight of infusion plans of care.
Who Bears the Cost
- The Medicare program, due to updated payment methodologies and potential transitional costs.
- Home infusion suppliers, who may face reduced reimbursement on days when the supplier is not physically present (50% rule) and increased administrative requirements.
- Administrative entities (Medicare Administrative Contractors) and providers, who will bear added compliance and billing complexity to implement the new rules.
Key Issues
The Core Tension
Balancing patient access with payment accuracy: expanding coverage and flexibility for home infusion while ensuring that reimbursements align with actual services provided and avoiding double payments or improper incentives.
The bill carefully ties access to payment design, creating a policy tension between rapid access expansion and payer-stringent controls. While expanding the service bundle to include pharmacy services and enabling NP/PA oversight can improve patient outcomes and care coordination, the per-day and presence-based payment rules may incentivize reduced in-home activity on days when a supplier isn’t present or when a five-hour infusion rule is newly phased in.
The non-pump drug expansion creates a broader treatment option but relies on definitions that hinge on USP categorizations, which could evolve with drug approvals and infusion technologies. Finally, the added requirement to avoid duplicative payments for supplies on infusion days concentrates administrative effort on precise coding and scheduling, potentially increasing paperwork for clinicians and suppliers.
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