H.R. 2172 — Preserving Patient Access to Home Infusion Act

This section revises Medicare home infusion therapy payment and coverage rules under the Part B benefit (i.e., professional services, including nursing and training, furnished by qualified suppliers associated with administration of parenteral drugs in the home), effective for items and services furnished on or after January 1, 2026, as follows: (1) expands the definition of such services to explicitly include pharmacy services (e.g., assessments, drug preparation and compounding, coordination and documentation of infusion therapy in the plan of care); (2) clarifies that the single per-day payment to suppliers applies for each calendar day a covered drug is administered in the home (regardless of supplier presence); (3) requires a transitional single payment amount, during 2026 through 2029, that reflects 5 hours of infusion for a particular therapy in a calendar day; (4) establishes a special rule reducing such payment to 50% of the full amount on days when the supplier is not physically present in the home; and (5) permits nurse practitioners and physician assistants, in addition to physicians, to establish and periodically review a beneficiary's home infusion therapy plan of care.

This section expands Medicare Part B home infusion therapy payment (i.e., for professional services, patient training and education, and supplies) to include specified non-pump drugs and biologicals—defined as intravenous antibacterials, antifungals, or antivirals (per U.S. Pharmacopeia) not administered through a durable medical equipment pump—effective for items and services furnished on or after January 1, 2026. It achieves this by (1) modifying the definition of home infusion drug to exclude such items from the prior pump requirement and (2) clarifying that payment for associated infusion services is available to qualified suppliers regardless of whether the drug or biological itself is payable under Part B.

This section prohibits Medicare payment under the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule for applicable items and services—tubing, catheters, dressings, needles, syringes, and related supplies identified by HCPCS codes A4221, A4222, or K0552 (or successors)—furnished on or after January 1, 2026, in conjunction with home infusion therapy when such therapy (as defined in SSA section 1861(iii)(1)) for the same home infusion drug (as defined in SSA section 1861(iii)(3)(C)) is furnished on the same day and paid under the home infusion therapy benefit (SSA section 1834(u)). (Thus, these supplies are bundled into the home infusion therapy payment, which covers professional services, patient training and education, and supplies required for certain parenteral drugs administered in the home.)