John W. Walsh Alpha-1 Home Infusion Act of 2023

To amend title XVIII of the Social Security Act to provide for coverage and payment of Alpha-1 Antitrypsin Deficiency Disorder treatment under part B of such title, and for other purposes. 1. Short title This Act may be cited as the John W. Walsh Alpha-1 Home Infusion Act of 2023 2. Medicare coverage of Alpha-1 Antitrypsin Disorder treatment (a) In general Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (1) in subsection (s)(2)— (A) by striking and (B) by inserting and (C) by inserting at the end the following new subparagraph: (KK) Alpha-1 Antitrypsin Deficiency Disorder treatment (as defined in subsection (nnn)); ; and (2) by adding at the end the following new subsection: (nnn) Alpha-1 Antitrypsin Deficiency Disorder treatment (1) The term Alpha-1 Antitrypsin Deficiency Disorder treatment (A) who is under the care of an applicable provider; (B) who is enrolled under both parts A and B of this title, and is not enrolled in an MA plan under part C of such title; and (C) who requires augmentation therapy (as defined in paragraph (2)(C)). (2) For purposes of this subsection: (A) The term applicable provider (i) a physician; (ii) a nurse practitioner; and (iii) a physician assistant. (B) The term home (C) The term augmentation therapy (D) The term qualified home infusion therapy supplier . (b) Payment for intravenous administration kits and nursing services for Alpha-1 Antitrypsin Deficiency Disorder treatment Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (aa) Payment for intravenous administration kits and nursing services for Alpha-1 Antitrypsin Deficiency Disorder treatment The Secretary shall implement a payment system under which payment is made under this title to a qualified home infusion therapy supplier (as defined in section 1861(nnn)(3)(D)) for intravenous administration kits and nursing services for up to 2 hours of care by a qualified home infusion therapy supplier in coordination with the furnishing of augmentation therapy (as defined in section 1861(nnn)(2)(C)). . (c) Conforming amendments (1) Payment reference Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (HH) (B) by inserting before the semicolon at the end the following: , and (II) with respect to intravenous administration kits and nursing services described in section 1834(aa) for Alpha-1 Antitrypsin Disorder treatment (as defined in subsection (nnn)(1)), the amount paid for such kits and services shall be an amount equal to 80 percent of the lesser of the actual charge for the services or the amount determined under section 1834(aa) (2) Direct payment The first sentence of section 1842(b)(6) of the Social Security Act ( 42 U.S.C. 1395u(b)(6) (A) by striking and (J) (B) by inserting before the period at the end the following: , and (K) in the case of intravenous administration kits and nursing services described in section 1834(aa), payment shall be made to the qualified home infusion therapy supplier (as defined in section 1861(nnn)(2)(D)) (3) Exclusion from home health services Section 1861(m) of the Social Security Act ( 42 U.S.C. 1395x(m) and intravenous administration kits and nursing services described in section 1834(aa) for Alpha-1 Antitrypsin Deficiency Disorder treatment (as defined in subsection (nnn)(1)) (d) Effective date The amendments made by this section shall apply to items and services furnished on or after January 1, 2025.

Summary: John W. Walsh Alpha-1 Home Infusion Act of 2023 This bill provides for Medicare coverage of treatment for alpha-1 antitrypsin (AAT) deficiency (a protein deficiency that raises the risk of lung and other diseases). Specifically, the bill provides for coverage of at-home augmentation therapy for beneficiaries with emphysema as a result of severe hereditary AAT deficiency. Treatment must be provided through qualified home infusion therapy suppliers; beneficiaries must be under the care of a physician, nurse practitioner, or physician assistant.