John W. Walsh Alpha-1 Home Infusion Act of 2022
Bill: H.R.7346 | Sponsor: Rep. Salazar, Maria Elvira (R-FL)
Policy area: Health

Summary:
John W. Walsh Alpha-1 Home Infusion Act of 2022
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.

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``John W. Walsh Alpha-1 Home Infusion 
Act of 2022''.

SEC. 2. MEDICARE COVERAGE OF ALPHA-1 ANTITRYPSIN DISORDER TREATMENT.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (GG);
                    (B) by inserting ``and'' at the end of subparagraph 
                (HH); and
                    (C) by inserting at the end the following new 
                subparagraph:
                    ``(II) Alpha-1 Antitrypsin Deficiency Disorder 
                treatment (as defined in subsection (lll));''; and
            (2) by adding at the end the following new subsection:
                            ``(lll) Alpha-1 antitrypsin deficiency 
                        disorder treatment.--(1) The term `Alpha-1 
                        Antitrypsin Deficiency Disorder treatment' 
                        means augmentation therapy (as defined in 
                        paragraph (2)(C)) furnished by qualified home 
                        infusion therapy suppliers (as defined in 
                        paragraph (2)(D)) which are furnished in the 
                        individual's home (as defined in paragraph 
                        (2)(B)) to an individual--
                    ``(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' means--
                            ``(i) a physician;
                            ``(ii) a nurse practitioner; and
                            ``(iii) a physician assistant.
                    ``(B) The term `home' means a place of residence 
                used as the home of an individual (as defined for 
                purposes of subsection (n)).
                    ``(C) The term `augmentation therapy' means an 
                Alpha-1 Proteinase Inhibitor indicated for chronic 
                augmentation and maintenance therapy in adults with 
                clinical evidence of emphysema due to severe hereditary 
                deficiency of Alpha-1 Antitrypsin.
                    ``(D) The term `qualified home infusion therapy 
                supplier' has the meaning given such term in subsection 
                (iii)(3)(D)(i).''.
    (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) is amended by 
adding at the end the following new subsection:
    ``(z) 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(lll)(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(lll)(2)(C)).''.
    (c) Conforming Amendments.--
            (1) Payment reference.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (EE) with respect to intravenous 
                administration kits and nursing services described in 
                section 1834(z) for Alpha-1 Antitrypsin Disorder 
                treatment (as defined in subsection (lll)(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(z)''.
            (2) Direct payment.--The first sentence of section 
        1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6)) 
        is amended--
                    (A) by striking ``and'' before ``(J)''; and
                    (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(z), payment shall be made to the qualified 
                home infusion therapy supplier (as defined in section 
                1861(lll)(2)(D))''.
            (3) Exclusion from home health services.--Section 1861(m) 
        of the Social Security Act (42 U.S.C. 1395x(m)) is amended, in 
        the first sentence, by inserting the following before the 
        period at the end: ``and intravenous administration kits and 
        nursing services described in section 1834(z) for Alpha-1 
        Antitrypsin Deficiency Disorder treatment (as defined in 
        subsection (lll)(1))''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2023.
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