II 

115TH CONGRESS 

1ST SESSION S. 1738 

To amend title XVIII of the Social Security Act to provide for a home 

infusion therapy services temporary transitional payment under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 3, 2017 

Mr. WARNER (for himself, Mr. ISAKSON, Mr. CARDIN, Mr. GRASSLEY, Mr. 

BENNET, Mr. PORTMAN, Ms. KLOBUCHAR, Mr. ROBERTS, Mr. 

BLUMENTHAL, Mr. PERDUE, Mrs. GILLIBRAND, Mrs. SHAHEEN, Mr. 

COCHRAN, Mr. BROWN, Mr. WICKER, Ms. BALDWIN, Mr. KING, and Mr. 

COONS) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for a home infusion therapy services temporary transitional payment under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Home Infu5 sion Therapy Access Act of 2017’’. 


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1 SEC. 2. HOME INFUSION THERAPY SERVICES TEMPORARY 

2 TRANSITIONAL PAYMENT. 

3 (a) IN GENERAL.—Section 1834(u) of the Social Se4 curity Act (42 U.S.C. 1395m(u)) is amended, by adding 

5 at the end the following new paragraph: 

6 ‘‘(7) HOME INFUSION THERAPY SERVICES TEM7 PORARY TRANSITIONAL PAYMENT.— 

8 ‘‘(A) TEMPORARY TRANSITIONAL PAY9 MENT.— 

10 ‘‘(i) IN GENERAL.—The Secretary 

11 shall, in accordance with the payment 

12 methodology described in subparagraph 

13 (B) and subject to the provisions of this 

14 paragraph, provide a home infusion ther15 apy services temporary transitional pay16 ment under this part to an eligible home 

17 infusion supplier (as defined in subpara18 graph (F)) for items and services described 

19 in subparagraphs (A) and (B) of section 

20 1861(iii)(2) furnished during the period 

21 specified in clause (ii) by such supplier in 

22 coordination with the furnishing of transi23 tional home infusion drugs (as defined in 

24 clause (iii)). 

25 ‘‘(ii) PERIOD SPECIFIED.—For pur26 poses of clause (i), the period specified in 


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1 this clause is the period beginning on Jan2 uary 1, 2019, and ending on the day be3 fore the date of the implementation of the 

4 payment system under paragraph (1)(A). 

5 ‘‘(iii) TRANSITIONAL HOME INFUSION

6 DRUG DEFINED.—For purposes of this 

7 paragraph, the term ‘transitional home in8 fusion drug’ has the meaning given to the 

9 term ‘home infusion drug’ under section 

10 1861(iii)(3)(C), except that clause (ii) of 

11 such section shall not apply if a drug de12 scribed in such clause is identified in 

13 clause (i), (ii), (iii) or (iv) of subparagraph 

14 (C) as of the date of the enactment of this 

15 paragraph. 

16 ‘‘(B) PAYMENT METHODOLOGY.—For pur17 poses of this paragraph, the Secretary shall es18 tablish a payment methodology, with respect to 

19 items and services described in subparagraph 

20 (A)(i). Under such payment methodology the 

21 Secretary shall— 

22 ‘‘(i) create the three payment cat23 egories described in clauses (i), (ii), and 

24 (iii) of subparagraph (C); 


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1 ‘‘(ii) assign drugs to such categories, 

2 in accordance with such clauses; 

3 ‘‘(iii) assign appropriate Healthcare 

4 Common Procedure Coding System 

5 (HCPCS) codes to each payment category; 

6 and 

7 ‘‘(iv) establish a single payment 

8 amount for each such payment category, in 

9 accordance with subparagraph (D), for 

10 each infusion drug administration calendar 

11 day in the individual’s home for drugs as12 signed to such category. 

13 ‘‘(C) PAYMENT CATEGORIES.— 

14 ‘‘(i) PAYMENT CATEGORY 1.—The 

15 Secretary shall create a payment category 

16 1 and assign to such category drugs which 

17 are covered under the Local Coverage De18 termination on External Infusion Pumps 

19 (LCD number L33794) and billed with the 

20 following HCPCS codes (as identified as of 

21 July 1, 2017, and as subsequently modi22 fied by the Secretary): J0133, J0285, 

23 J0287, J0288, J0289, J0895, J1170, 

24 J1250, J1265, J1325, J1455, J1457, 


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1 J1570, J2175, J2260, J2270, J2274, 

2 J2278, J3010, or J3285. 

3 ‘‘(ii) PAYMENT CATEGORY 2.—The 

4 Secretary shall create a payment category 

5 2 and assign to such category drugs which 

6 are covered under such local coverage de7 termination and billed with the following 

8 HCPCS codes (as identified as of July 1, 

9 2017, and as subsequently modified by the 

10 Secretary): J1559 JB, J1561 JB, J1562 

11 JB, J1569 JB, or J1575 JB. 

12 ‘‘(iii) PAYMENT CATEGORY 3.—The 

13 Secretary shall create a payment category 

14 3 and assign to such category drugs which 

15 are covered under such local coverage de16 termination and billed with the following 

17 HCPCS codes (as identified as of July 1, 

18 2017, and as subsequently modified by the 

19 Secretary): J9000, J9039, J9040, J9065, 

20 J9100, J9190, J9200, J9360, or J9370. 

21 ‘‘(iv) INFUSION DRUGS NOT OTHER22 WISE INCLUDED.—With respect to drugs 

23 that are not included in payment category 

24 1, 2, or 3 under clause (i), (ii), or (iii), re25 spectively, the Secretary shall assign to the 


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1 most appropriate of such categories, as de2 termined by the Secretary, drugs which 

3 are— 

4 ‘‘(I) covered under such local cov5 erage determination and billed under 

6 HCPCS code J7799 or J7999 (as 

7 identified as of July 1, 2017, and as 

8 subsequently modified by the Sec9 retary); or 

10 ‘‘(II) billed under any code that 

11 is implemented after the date of the 

12 enactment of this paragraph and in13 cluded in such local coverage deter14 mination or included in subregulatory 

15 guidance as a home infusion drug de16 scribed in subparagraph (A)(i). 

17 ‘‘(D) PAYMENT AMOUNTS.— 

18 ‘‘(i) IN GENERAL.—Under the pay19 ment methodology, the Secretary shall pay 

20 eligible home infusion suppliers, with re21 spect to items and services described in 

22 subparagraph (A)(i) furnished during the 

23 period described in subparagraph (A)(ii) by 

24 such supplier to an individual, at amounts 

25 equal to the amounts determined under the 


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1 physician fee schedule established under 

2 section 1848 for services furnished during 

3 the year for codes and units of such codes 

4 described in clauses (ii), (iii), and (iv) with 

5 respect to drugs included in the payment 

6 category under subparagraph (C) specified 

7 in the respective clause, determined with8 out application of any adjustment under 

9 such section. 

10 ‘‘(ii) PAYMENT AMOUNT FOR CAT11 EGORY 1.—For purposes of clause (i), the 

12 codes and units described in this clause, 

13 with respect to drugs included in payment 

14 category 1 described in subparagraph 

15 (C)(i), are one unit of HCPCS code 96365 

16 plus four units of HCPCS code 96366 (as 

17 identified as of July 1, 2017, and as subse18 quently modified by the Secretary). 

19 ‘‘(iii) PAYMENT AMOUNT FOR CAT20 EGORY 2.—For purposes of clause (i), the 

21 codes and units described in this clause, 

22 with respect to drugs included in payment 

23 category 2 described in subparagraph 

24 (C)(i), are one unit of HCPCS code 96369 

25 plus four units of HCPCS code 96370 (as 


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1 identified as of July 1, 2017, and as subse2 quently modified by the Secretary). 

3 ‘‘(iv) PAYMENT AMOUNT FOR CAT4 EGORY 3.—For purposes of clause (i), the 

5 codes and units described in this clause, 

6 with respect to drugs included in payment 

7 category 3 described in subparagraph 

8 (C)(i), are one unit of HCPCS code 96413 

9 plus four units of HCPCS code 96415 (as 

10 identified as of July 1, 2017, and as subse11 quently modified by the Secretary). 

12 ‘‘(E) CLARIFICATIONS.— 

13 ‘‘(i) INFUSION DRUG ADMINISTRATION

14 DAY.—For purposes of this subsection, a 

15 reference, with respect to the furnishing of 

16 transitional home infusion drugs or home 

17 infusion drugs to an individual by an eligi18 ble home infusion supplier, to payment to 

19 such supplier for an infusion drug adminis20 tration calendar day in the individual’s 

21 home shall refer to payment only for the 

22 date on which professional services (as de23 scribed in section 1861(iii)(2)(A)) were 

24 furnished to administer such drugs to such 

25 individual. For purposes of the previous 


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1 sentence, an infusion drug administration 

2 calendar day shall include all such drugs 

3 administered to such individual on such 

4 day. 

5 ‘‘(ii) TREATMENT OF MULTIPLE

6 DRUGS ADMINISTERED ON SAME INFUSION

7 DRUG ADMINISTRATION DAY.—In the case 

8 that an eligible home infusion supplier, 

9 with respect to an infusion drug adminis10 tration calendar day in an individual’s 

11 home, furnishes to such individual transi12 tional home infusion drugs which are not 

13 all assigned to the same payment category 

14 under subparagraph (C), payment to such 

15 supplier for such infusion drug administra16 tion calendar day in the individual’s home 

17 shall be a single payment equal to the 

18 amount of payment under this paragraph 

19 for the drug, among all such drugs so fur20 nished to such individual during such cal21 endar day, for which the highest payment 

22 would be made under this paragraph. 

23 ‘‘(F) ELIGIBLE HOME INFUSION SUP24 PLIERS.—In this paragraph, the term ‘eligible 

25 home infusion supplier’ means a supplier that is 


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1 enrolled under this part as a pharmacy that 

2 provides external infusion pumps and external 

3 infusion pump supplies and that maintains all 

4 pharmacy licensure requirements in the State in 

5 which the applicable infusion drugs are admin6 istered. 

7 ‘‘(G) IMPLEMENTATION.—Notwithstanding 

8 any other provision of law, the Secretary may 

9 implement this paragraph by program instruc10 tion or otherwise.’’. 

11 (b) CONFORMING AMENDMENT.—Section 

12 1842(b)(6)(I) of the Social Security Act (42 U.S.C. 

13 1395u(b)(6)(I)) is amended by inserting ‘‘or, in the case 

14 of items and services described in clause (i) of section 

15 1834(u)(7)(A) furnished to an individual during the pe16 riod described in clause (ii) of such section, payment shall 

17 be made to the eligible home infusion therapy supplier’’ 

18 after ‘‘payment shall be made to the qualified home infu19 sion therapy supplier’’. 

Æ 


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