IIB 

118TH CONGRESS 

2D SESSION H. R. 5526 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 24, 2024 

Received; read twice and referred to the Committee on Finance 

AN ACT 

To amend title XVIII of the Social Security Act to clarify 

the application of the in-office ancillary services exception 

to the physician self-referral prohibition for covered outpatient drugs furnished under the Medicare program, 

and to provide coverage of external infusion pumps and 

non-self-administrable home infusion drugs under such 

program. 


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HR 5526 RFS

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 ‘‘Seniors’ Access to Crit5 ical Medications Act of 2024’’. 

6 SEC. 2. CLARIFYING THE APPLICATION OF THE IN-OFFICE 

7 ANCILLARY SERVICES EXCEPTION TO THE 

8 PHYSICIAN SELF-REFERRAL PROHIBITION 

9 FOR COVERED OUTPATIENT DRUGS FUR10 NISHED UNDER THE MEDICARE PROGRAM. 

11 (a) IN GENERAL.—Section 1877(b)(2) of the Social 

12 Security Act (42 U.S.C. 1395nn(b)(2)) is amended by 

13 adding at the end the following new sentence: ‘‘With re14 spect to services described in subsection (h)(6)(J) con15 sisting of covered part D drugs (as defined in section 

16 1860D–2(e)) furnished to an individual during the period 

17 beginning on January 1, 2025, and ending on December 

18 31, 2029, such drugs shall be treated as having been fur19 nished in accordance with subparagraph (A)(ii) if such 

20 drugs are picked up in a building described in subclause 

21 (I) or (II) of such subparagraph by such individual, or 

22 a family member or caregiver on behalf of such individual, 

23 or delivered to such individual by a mail, delivery, or cou24 rier service, but only if, during the 1-year period ending 

25 on the date such drugs were so furnished, such individual 


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HR 5526 RFS

1 had a face-to-face encounter with the prescriber of such 

2 drugs (not including any such encounter conducted via 

3 telehealth), and only if such prescriber (or another physi4 cian or practitioner (as described in section 

5 1842(b)(18)(C)) in the same practice as such prescriber 

6 (as determined by tax identification number)) furnished 

7 to such individual, during such 1-year period, another item 

8 or service for which payment was made under this title, 

9 and only if such individual has an ongoing relationship 

10 with such prescriber.’’. 

11 (b) REPORT.—Not later than 3 years after the date 

12 of the enactment of this Act, the Secretary of Health and 

13 Human Services shall submit to Congress a report that 

14 contains— 

15 (1) the number of individuals who were fur16 nished drugs in a manner that would constitute a 

17 violation of section 1877 of the Social Security Act 

18 (42 U.S.C. 1395nn) but for the amendment made by 

19 subsection (a); 

20 (2) an analysis of the change in expenditures 

21 under title XVIII of such Act (42 U.S.C. 1395 et 

22 seq.) attributable to such amendment; 

23 (3) a description of which drugs were furnished 

24 in a manner described in paragraph (1); and 


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HR 5526 RFS

1 (4) such amendment’s impact on prices for such 

2 drugs. 

3 SEC. 3. MEDICARE COVERAGE OF EXTERNAL INFUSION 

4 PUMPS AND NON-SELF-ADMINISTRABLE 

5 HOME INFUSION DRUGS. 

6 Section 1861(n) of the Social Security Act (42 U.S.C. 

7 1395x(n)) is amended by adding at the end the following 

8 new sentence: ‘‘Beginning with the first calendar quarter 

9 beginning on or after the date that is one year after the 

10 date of the enactment of the ‘Seniors’ Access to Critical 

11 Medications Act of 2024’, an external infusion pump and 

12 associated home infusion drug (as defined in subsection 

13 (iii)(3)(C)) or other associated supplies that do not meet 

14 the appropriate for use in the home requirement applied 

15 to the definition of durable medical equipment under sec16 tion 414.202 of title 42, Code of Federal Regulations (or 

17 any successor to such regulation) shall be treated as meet18 ing such requirement if each of the following criteria is 

19 satisfied: 

20 ‘‘(1) The prescribing information approved by 

21 the Food and Drug Administration for the home in22 fusion drug associated with the pump instructs that 

23 the drug should be administered by or under the su24 pervision of a health care professional. 


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HR 5526 RFS

1 ‘‘(2) A qualified home infusion therapy supplier 

2 (as defined in subsection (iii)(3)(D)) administers or 

3 supervises the administration of the drug or biologi4 cal in a safe and effective manner in the patient’s 

5 home (as defined in subsection (iii)(3)(B)). 

6 ‘‘(3) The prescribing information described in 

7 paragraph (1) instructs that the drug should be in8 fused at least 12 times per year— 

9 ‘‘(A) intravenously or subcutaneously; or 

10 ‘‘(B) at infusion rates that the Secretary 

11 determines would require the use of an external 

12 infusion pump.’’. 

13 SEC. 4. MEDICARE IMPROVEMENT FUND. 

14 Section 1898(b)(1) of the Social Security Act (42 

15 U.S.C. 1395iii(b)(1)) is amended by striking ‘‘$0’’ and in16 serting ‘‘$114,000,000’’. 

Passed the House of Representatives September 23, 

2024. 

Attest: KEVIN F. MCCUMBER, 

Clerk. 


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