S. 1058 — Preserving Patient Access to Home Infusion Act

This section revises Medicare home infusion therapy (HIT) coverage, payment, and plan of care requirements under the Part B benefit for parenteral drugs and services furnished in the home by qualified suppliers, effective January 1, 2026. Specifically, it (1) expands the definition of HIT services to explicitly include pharmacy services (i.e., assessments, drug preparation and compounding, coordination, and documentation of infusion therapy in the plan of care); (2) clarifies that the single payment to suppliers applies for each calendar day a drug is administered (regardless of supplier presence); (3) requires the single payment amount, as a transitional rule for services furnished from January 1, 2026, through December 31, 2029, to reflect 5 hours of infusion for a particular therapy in a calendar day; (4) reduces the single payment to 50% of the otherwise applicable amount on days when the supplier is not physically present in the home; and (5) permits nurse practitioners or physician assistants (in addition to physicians) to establish and periodically review the HIT plan of care.

This section modifies the definition of home infusion drug under Medicare to exclude specified non-pump drugs or biologicals (i.e., intravenous antibacterials, antifungals, or antivirals not administered through a durable medical equipment pump, as categorized by the United States Pharmacopeia) and clarifies that payment is available under the home infusion therapy benefit for associated professional services, training, and monitoring furnished by qualified suppliers on or after January 1, 2026, regardless of whether the drug or biological itself is payable under Medicare Part B. (As background, the home infusion therapy benefit under SSA §1861(iii) covers such services for parenteral drugs typically infused via a DME pump.)

This section establishes a special payment rule prohibiting Medicare payment under the durable medical equipment (DME) provision for applicable items and services (i.e., tubing, catheters, dressings, needles, syringes, and related supplies identified by HCPCS codes A4221, A4222, or K0552, or successor codes) furnished on or after January 1, 2026, in conjunction with home infusion therapy (as defined in SSA section 1861(iii)(1)) for which payment is made under subsection (u) on the same day and with respect to the same home infusion drug (as defined in SSA section 1861(iii)(3)(C)). (Thus, such supplies are bundled into the home infusion therapy payment.)