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† HR 1892 EAS2 
TITLE 
IV—PART 
B 
IMPROVE-
MENT ACT AND OTHER PART 
B ENHANCEMENTS 
Subtitle A—Medicare Part B 
Improvement Act 
SEC. 50401. HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT. 
(a) IN GENERAL.—Section 1834(u) of the Social Secu-
rity Act (42 U.S.C. 1395m(u)) is amended, by adding at 
the end the following new paragraph: 
‘‘(7) HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT.— 
‘‘(A) 
TEMPORARY
TRANSITIONAL
PAY-
MENT.— 
‘‘(i) 
IN
GENERAL.—The 
Secretary 
shall, in accordance with the payment 
methodology described in subparagraph (B) 
and subject to the provisions of this para-
graph, provide a home infusion therapy 
services temporary transitional payment 
under this part to an eligible home infusion 
supplier (as defined in subparagraph (F)) 
for items and services described in subpara-
graphs (A) and (B) of section 1861(iii)(2)) 
furnished during the period specified in
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† HR 1892 EAS2 
clause (ii) by such supplier in coordination 
with the furnishing of transitional home in-
fusion drugs (as defined in clause (iii)). 
‘‘(ii) PERIOD
SPECIFIED.—For pur-
poses of clause (i), the period specified in 
this clause is the period beginning on Janu-
ary 1, 2019, and ending on the day before 
the date of the implementation of the pay-
ment system under paragraph (1)(A). 
‘‘(iii) TRANSITIONAL HOME INFUSION 
DRUG DEFINED.—For purposes of this para-
graph, the term ‘transitional home infusion 
drug’ has the meaning given to the term 
‘home 
infusion 
drug’ 
under 
section 
1861(iii)(3)(C)), except that clause (ii) of 
such section shall not apply if a drug de-
scribed in such clause is identified in 
clauses (i), (ii), (iii) or (iv) of subpara-
graph (C) as of the date of the enactment of 
this paragraph. 
‘‘(B) PAYMENT
METHODOLOGY.—For pur-
poses of this paragraph, the Secretary shall es-
tablish a payment methodology, with respect to 
items and services described in subparagraph
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† HR 1892 EAS2 
(A)(i). Under such payment methodology the 
Secretary shall— 
‘‘(i) create the three payment categories 
described in clauses (i), (ii), and (iii) of 
subparagraph (C); 
‘‘(ii) assign drugs to such categories, in 
accordance with such clauses; 
‘‘(iii) assign appropriate Healthcare 
Common 
Procedure 
Coding 
System 
(HCPCS) codes to each payment category; 
and 
‘‘(iv) 
establish 
a 
single 
payment 
amount for each such payment category, in 
accordance with subparagraph (D), for each 
infusion drug administration calendar day 
in the individual’s home for drugs assigned 
to such category. 
‘‘(C) PAYMENT CATEGORIES.— 
‘‘(i) PAYMENT CATEGORY 1.—The Sec-
retary shall create a payment category 1 
and assign to such category drugs which are 
covered under the Local Coverage Deter-
mination on External Infusion Pumps 
(LCD number L33794) and billed with the 
following HCPCS codes (as identified as of
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† HR 1892 EAS2 
January 1, 2018, and as subsequently 
modified by the Secretary): J0133, J0285, 
J0287, J0288, J0289, J0895, J1170, J1250, 
J1265, J1325, J1455, J1457, J1570, J2175, 
J2260, J2270, J2274, J2278, J3010, or 
J3285. 
‘‘(ii) PAYMENT CATEGORY 2.—The Sec-
retary shall create a payment category 2 
and assign to such category drugs which are 
covered under such local coverage deter-
mination and billed with the following 
HCPCS codes (as identified as of January 
1, 2018, and as subsequently modified by 
the Secretary): J1555 JB, J1559 JB, J1561 
JB, J1562 JB, J1569 JB, or J1575 JB. 
‘‘(iii) PAYMENT
CATEGORY
3.—The 
Secretary shall create a payment category 3 
and assign to such category drugs which are 
covered under such local coverage deter-
mination and billed with the following 
HCPCS codes (as identified as of January 
1, 2018, and as subsequently modified by 
the 
Secretary): 
J9000, 
J9039, 
J9040, 
J9065, J9100, J9190, J9200, J9360, or 
J9370.
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† HR 1892 EAS2 
‘‘(iv) INFUSION
DRUGS
NOT
OTHER-
WISE
INCLUDED.—With respect to drugs 
that are not included in payment category 
1, 2, or 3 under clause (i), (ii), or (iii), re-
spectively, the Secretary shall assign to the 
most appropriate of such categories, as de-
termined by the Secretary, drugs which 
are— 
‘‘(I) covered under such local cov-
erage determination and billed under 
HCPCS codes J7799 or J7999 (as 
identified as of July 1, 2017, and as 
subsequently modified by the Sec-
retary); or 
‘‘(II) billed under any code that is 
implemented after the date of the en-
actment of this paragraph and in-
cluded in such local coverage deter-
mination or included in subregulatory 
guidance as a home infusion drug de-
scribed in subparagraph (A)(i). 
‘‘(D) PAYMENT AMOUNTS.— 
‘‘(i) IN GENERAL.—Under the payment 
methodology, the Secretary shall pay eligible 
home infusion suppliers, with respect to
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† HR 1892 EAS2 
items and services described in subpara-
graph (A)(i) furnished during the period 
described in subparagraph (A)(ii) by such 
supplier to an individual, at amounts equal 
to the amounts determined under the physi-
cian fee schedule established under section 
1848 for services furnished during the year 
for codes and units of such codes described 
in clauses (ii), (iii), and (iv) with respect 
to drugs included in the payment category 
under subparagraph (C) specified in the re-
spective clause, determined without applica-
tion of the geographic adjustment under 
subsection (e) of such section. 
‘‘(ii) PAYMENT AMOUNT FOR CATEGORY 
1.—For purposes of clause (i), the codes and 
units described in this clause, with respect 
to drugs included in payment category 1 
described in subparagraph (C)(i), are one 
unit of HCPCS code 96365 plus three units 
of HCPCS code 96366 (as identified as of 
January 1, 2018, and as subsequently 
modified by the Secretary). 
‘‘(iii) PAYMENT
AMOUNT
FOR
CAT-
EGORY 2.—For purposes of clause (i), the