I 
109TH CONGRESS 
2D SESSION 
H. R. 5791 
To amend title XVIII of the Social Security Act to provide for the consoli-
dated coverage of home infusion therapy under part B of the Medicare 
Program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 13, 2006 
Ms. GRANGER (for herself, Mr. ENGEL, Mr. KUHL of New York, and Ms. 
BALDWIN) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for the consolidated coverage of home infusion therapy 
under part B of the Medicare Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Home Infu-
sion Therapy Consolidated Coverage Act of 2006’’. 
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SEC. 2. CONSOLIDATION OF MEDICARE COVERAGE OF 
HOME INFUSION THERAPY UNDER PART B. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (Z); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (AA); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(BB) home infusion therapy (as defined in 
subsection (ccc)(1));’’; and 
(2) by adding at the end the following new sub-
section: ‘‘ 
‘‘Home Infusion Therapy 
‘‘(ccc)(1) The term ‘home infusion therapy’ means 
the following items and services furnished to an individual, 
who is under the care of a physician, which are provided, 
except as provided in subparagraph (B), by a qualified 
home infusion therapy provider under a plan (for fur-
nishing such items and services to such individual) estab-
lished and periodically reviewed by a physician, which 
items and services are provided in an integrated manner 
in the individual’s home in conformance with clinical 
standards of care established by the Secretary (after tak-
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ing into account the standards commonly used for home 
infusion therapy by Medicare Advantage organizations 
and accreditation organizations)— 
‘‘(A) infusion drugs (as defined in para-
graph (2)(B)); 
‘‘(B) nursing services provided, directly or 
by an accredited homecare organization under 
arrangements made, by the qualified home infu-
sion therapy provider, in connection with such 
infusion; and 
‘‘(C) other professional services (including 
pharmacy and care coordination services) and 
related items and services (including medical 
supplies, intravenous fluids, home delivery, 
equipment, and other items and services the 
Secretary determines appropriate) to administer 
infusion drug therapies to an individual safely 
and effectively in the home; 
except that such term does not include nursing serv-
ices to the extent they are covered as home health 
services. 
‘‘(2) For purposes of paragraph (1): 
‘‘(A) The term ‘home’ means a place of 
residence used as an individual’s home and in-
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cludes such alternate settings as the Secretary 
determines. 
‘‘(B) The term ‘infusion drugs’ means par-
enteral drugs and biologicals administered via 
an 
intravenous, 
intraspinal, 
intra-arterial, 
intrathecal, subcutaneous, or intramuscular ac-
cess device inserted into the body. 
‘‘(C) The term ‘qualified home infusion 
therapy provider’ means any pharmacy that— 
‘‘(i) has expertise in the preparation 
of compounded sterile preparations in com-
pliance with enforceable standards of the 
U.S. Pharmacopoeia or other nationally 
recognized 
standards 
that 
regulate 
compounding of sterile preparations as de-
termined by the Secretary; 
‘‘(ii) provides infusion therapy to pa-
tients with acute or chronic conditions re-
quiring parenteral administration of drugs 
and biologicals administered through cath-
eters or needles, or both, in a home; and 
‘‘(iii) meets such requirements as the 
Secretary determines are necessary to en-
sure the safe and effective provision of 
home infusion therapy (taking into account 
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the standards of care for home infusion 
therapy established by private payers).’’. 
(b) PAYMENT FOR HOME INFUSION THERAPY.— 
(1) IN GENERAL.—Section 1834 of such Act 
(42 U.S.C. 1395m) is amended by adding at the end 
the following new subsection: 
‘‘(n) PAYMENT FOR HOME INFUSION THERAPY.— 
The payment amount under this part for home infusion 
therapy is determined as follows: 
‘‘(1) IN GENERAL.—Except as provided in this 
subsection, the Secretary shall determine a per diem 
schedule for payment for home infusion therapy (in-
cluding pharmacy services, administration services, 
care coordination services, supplies and equipment 
necessary to safely and properly administer a home 
infusion drug or biological in accordance with the re-
quirements and clinical standards commonly used 
for home infusion therapy) which reflects the reason-
able costs which must be incurred by efficiently and 
economically operated qualified home infusion ther-
apy providers to provide such therapy in conformity 
with applicable State and Federal laws, regulations, 
and quality and safety standards and to assure that 
Medicare beneficiaries have reasonable access to 
such therapy. 
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‘‘(2) INFUSION DRUGS.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the provisions of section 
1847A shall apply to payment under this part 
for drugs included in home infusion therapy. 
‘‘(B) SPECIAL
RULE.—In applying sub-
paragraph (A), the determination of average 
sales prices under section 1847A shall be lim-
ited to such prices for infusion drug sales to 
home infusion therapy pharmacies.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1833(a)(1) of such Act (42 
U.S.C. 1395l(a)(1)) is amended by striking 
‘‘and’’ before ‘‘(V)’’ and by inserting before the 
semicolon at the end the following: ‘‘, and (W) 
with respect to home infusion therapy, the 
amounts paid shall be determined under section 
1834(n)’’. 
(B) 
The 
first 
sentence 
of 
section 
1842(b)(6) 
of 
such 
Act 
(42 
U.S.C. 
1395u(b)(6)) is amended by striking ‘‘and’’ be-
fore ‘‘(H)’’ and by inserting before the period 
at the end the following: ‘‘, and (I) in the case 
of home infusion therapy, payment shall be 
made to the qualified home infusion therapy 
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provider responsible for furnishing the ther-
apy’’. 
(c) OTHER CONFORMING PROVISIONS.— 
(1) EXCLUSION
FROM
DURABLE
MEDICAL 
EQUIPMENT BENEFIT.—Section 1861(n) of such Act 
(42 U.S.C. 1395x(n)) is amended by adding at the 
end the following: ‘‘Such term does not include home 
infusion therapy.’’. 
(2) APPLICATION OF ACCREDITATION ORGANI-
ZATION
PROVISIONS.—The provisions of section 
1865(b) of the Social Security Act apply to accredi-
tation of qualified home infusion therapy providers. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to home infusion therapy furnished 
on or after January 1, 2007. 
Æ 
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