Title: Medicare Home Infusion Therapy Access Act of 2017
Policy area: Health

Summary:
Medicare Home Infusion Therapy Access Act of 2017
This bill amends title XVIII (Medicare) of the Social Security Act to temporarily provide for transitional Medicare payment with respect to certain home infusion services furnished on or after January 1, 2019. Under current law, the Center for Medicare & Medicaid Services is required to establish a permanent payment system with respect to such services furnished on or after January 1, 2021.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1738 Introduced in Senate (IS)]

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115th CONGRESS
  1st Session
                                S. 1738

 To amend title XVIII of the Social Security Act to provide for a home 
  infusion therapy services temporary transitional payment under the 
                           Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 3, 2017

  Mr. Warner (for himself, Mr. Isakson, Mr. Cardin, Mr. Grassley, Mr. 
 Bennet, Mr. Portman, Ms. Klobuchar, Mr. Roberts, Mr. Blumenthal, Mr. 
  Perdue, Mrs. Gillibrand, Mrs. Shaheen, Mr. Cochran, Mr. Brown, Mr. 
Wicker, Ms. Baldwin, Mr. King, and Mr. Coons) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to provide for a home 
  infusion therapy services temporary transitional payment under the 
                           Medicare program.

    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 ``Medicare Home Infusion Therapy 
Access Act of 2017''.

SEC. 2. HOME INFUSION THERAPY SERVICES TEMPORARY TRANSITIONAL PAYMENT.

    (a) In General.--Section 1834(u) of the Social Security Act (42 
U.S.C. 1395m(u)) is amended, by adding at the end the following new 
paragraph:
            ``(7) Home infusion therapy services temporary transitional 
        payment.--
                    ``(A) Temporary transitional payment.--
                            ``(i) In general.--The Secretary shall, in 
                        accordance with the payment methodology 
                        described in subparagraph (B) and subject to 
                        the provisions of this paragraph, 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 subparagraphs (A) and (B) of 
                        section 1861(iii)(2) furnished during the 
                        period specified in clause (ii) by such 
                        supplier in coordination with the furnishing of 
                        transitional home infusion drugs (as defined in 
                        clause (iii)).
                            ``(ii) Period specified.--For purposes of 
                        clause (i), the period specified in this clause 
                        is the period beginning on January 1, 2019, and 
                        ending on the day before the date of the 
                        implementation of the payment system under 
                        paragraph (1)(A).
                            ``(iii) Transitional home infusion drug 
                        defined.--For purposes of this paragraph, 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 described in such clause is identified 
                        in clause (i), (ii), (iii) or (iv) of 
                        subparagraph (C) as of the date of the 
                        enactment of this paragraph.
                    ``(B) Payment methodology.--For purposes of this 
                paragraph, the Secretary shall establish a payment 
                methodology, with respect to items and services 
                described in subparagraph (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 Secretary 
                        shall create a payment category 1 and assign to 
                        such category drugs which are covered under the 
                        Local Coverage Determination on External 
                        Infusion Pumps (LCD number L33794) and billed 
                        with the following HCPCS codes (as identified 
                        as of July 1, 2017, 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 Secretary 
                        shall create a payment category 2 and assign to 
                        such category drugs which are covered under 
                        such local coverage determination and billed 
                        with the following HCPCS codes (as identified 
                        as of July 1, 2017, and as subsequently 
                        modified by the Secretary): 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 determination and billed 
                        with the following HCPCS codes (as identified 
                        as of July 1, 2017, and as subsequently 
                        modified by the Secretary): J9000, J9039, 
                        J9040, J9065, J9100, J9190, J9200, J9360, or 
                        J9370.
                            ``(iv) Infusion drugs not otherwise 
                        included.--With respect to drugs that are not 
                        included in payment category 1, 2, or 3 under 
                        clause (i), (ii), or (iii), respectively, the 
                        Secretary shall assign to the most appropriate 
                        of such categories, as determined by the 
                        Secretary, drugs which are--
                                    ``(I) covered under such local 
                                coverage determination and billed under 
                                HCPCS code J7799 or J7999 (as 
                                identified as of July 1, 2017, and as 
                                subsequently modified by the 
                                Secretary); or
                                    ``(II) billed under any code that 
                                is implemented after the date of the 
                                enactment of this paragraph and 
                                included in such local coverage 
                                determination or included in 
                                subregulatory guidance as a home 
                                infusion drug described 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 items 
                        and services described in subparagraph (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 physician 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 respective clause, determined 
                        without application of any adjustment under 
                        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 four units of HCPCS code 96366 (as 
                        identified as of July 1, 2017, and as 
                        subsequently modified by the Secretary).
                            ``(iii) Payment amount for category 2.--For 
                        purposes of clause (i), the codes and units 
                        described in this clause, with respect to drugs 
                        included in payment category 2 described in 
                        subparagraph (C)(i), are one unit of HCPCS code 
                        96369 plus four units of HCPCS code 96370 (as 
                        identified as of July 1, 2017, and as 
                        subsequently modified by the Secretary).
                            ``(iv) Payment amount for category 3.--For 
                        purposes of clause (i), the codes and units 
                        described in this clause, with respect to drugs 
                        included in payment category 3 described in 
                        subparagraph (C)(i), are one unit of HCPCS code 
                        96413 plus four units of HCPCS code 96415 (as 
                        identified as of July 1, 2017, and as 
                        subsequently modified by the Secretary).
                    ``(E) Clarifications.--
                            ``(i) Infusion drug administration day.--
                        For purposes of this subsection, a reference, 
                        with respect to the furnishing of transitional 
                        home infusion drugs or home infusion drugs to 
                        an individual by an eligible home infusion 
                        supplier, to payment to such supplier for an 
                        infusion drug administration calendar day in 
                        the individual's home shall refer to payment 
                        only for the date on which professional 
                        services (as described in section 
                        1861(iii)(2)(A)) were furnished to administer 
                        such drugs to such individual. For purposes of 
                        the previous sentence, an infusion drug 
                        administration calendar day shall include all 
                        such drugs administered to such individual on 
                        such day.
                            ``(ii) Treatment of multiple drugs 
                        administered on same infusion drug 
                        administration day.--In the case that an 
                        eligible home infusion supplier, with respect 
                        to an infusion drug administration calendar day 
                        in an individual's home, furnishes to such 
                        individual transitional home infusion drugs 
                        which are not all assigned to the same payment 
                        category under subparagraph (C), payment to 
                        such supplier for such infusion drug 
                        administration calendar day in the individual's 
                        home shall be a single payment equal to the 
                        amount of payment under this paragraph for the 
                        drug, among all such drugs so furnished to such 
                        individual during such calendar day, for which 
                        the highest payment would be made under this 
                        paragraph.
                    ``(F) Eligible home infusion suppliers.--In this 
                paragraph, the term `eligible home infusion supplier' 
                means a supplier that is enrolled under this part as a 
                pharmacy that provides external infusion pumps and 
                external infusion pump supplies and that maintains all 
                pharmacy licensure requirements in the State in which 
                the applicable infusion drugs are administered.
                    ``(G) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.''.
    (b) Conforming Amendment.--Section 1842(b)(6)(I) of the Social 
Security Act (42 U.S.C. 1395u(b)(6)(I)) is amended by inserting ``or, 
in the case of items and services described in clause (i) of section 
1834(u)(7)(A) furnished to an individual during the period described in 
clause (ii) of such section, payment shall be made to the eligible home 
infusion therapy supplier'' after ``payment shall be made to the 
qualified home infusion therapy supplier''.
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