[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5791 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5791

  To amend title XVIII of the Social Security Act to provide for the 
  consolidated coverage of home infusion therapy under part B of the 
                           Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2006

  Ms. Granger (for herself, Mr. Engel, Mr. Kuhl of New York, and Ms. 
   Baldwin) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide for the 
  consolidated coverage of home infusion therapy under part B of 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 
Consolidated Coverage Act of 2006''.

SEC. 2. CONSOLIDATION OF MEDICARE COVERAGE OF HOME INFUSION THERAPY 
              UNDER PART B.

    (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 
                (Z);
                    (B) by adding ``and'' at the end of subparagraph 
                (AA); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(BB) home infusion therapy (as defined in subsection 
        (ccc)(1));''; and
            (2) by adding at the end the following new subsection: ``

                        ``Home Infusion Therapy

    ``(ccc)(1) The term `home infusion therapy' means the following 
items and services furnished to an individual, who is under the care of 
a physician, which are provided, except as provided in subparagraph 
(B), by a qualified home infusion therapy provider under a plan (for 
furnishing such items and services to such individual) established and 
periodically reviewed by a physician, which items and services are 
provided in an integrated manner in the individual's home in 
conformance with clinical standards of care established by the 
Secretary (after taking into account the standards commonly used for 
home infusion therapy by Medicare Advantage organizations and 
accreditation organizations)--
                    ``(A) infusion drugs (as defined in paragraph 
                (2)(B));
                    ``(B) nursing services provided, directly or by an 
                accredited homecare organization under arrangements 
                made, by the qualified home infusion therapy provider, 
                in connection with such infusion; and
                    ``(C) other professional services (including 
                pharmacy and care coordination services) and related 
                items and services (including medical supplies, 
                intravenous fluids, home delivery, equipment, and other 
                items and services the Secretary determines 
                appropriate) to administer infusion drug therapies to 
                an individual safely and effectively in the home;
        except that such term does not include nursing services to the 
        extent they are covered as home health services.
            ``(2) For purposes of paragraph (1):
                    ``(A) The term `home' means a place of residence 
                used as an individual's home and includes such 
                alternate settings as the Secretary determines.
                    ``(B) The term `infusion drugs' means parenteral 
                drugs and biologicals administered via an intravenous, 
                intraspinal, intra-arterial, intrathecal, subcutaneous, 
                or intramuscular access device inserted into the body.
                    ``(C) The term `qualified home infusion therapy 
                provider' means any pharmacy that--
                            ``(i) has expertise in the preparation of 
                        compounded sterile preparations in compliance 
                        with enforceable standards of the U.S. 
                        Pharmacopoeia or other nationally recognized 
                        standards that regulate compounding of sterile 
                        preparations as determined by the Secretary;
                            ``(ii) provides infusion therapy to 
                        patients with acute or chronic conditions 
                        requiring parenteral administration of drugs 
                        and biologicals administered through catheters 
                        or needles, or both, in a home; and
                            ``(iii) meets such requirements as the 
                        Secretary determines are necessary to ensure 
                        the safe and effective provision of home 
                        infusion therapy (taking into account the 
                        standards of care for home infusion therapy 
                        established by private payers).''.
    (b) Payment for Home Infusion Therapy.--
            (1) In general.--Section 1834 of such Act (42 U.S.C. 1395m) 
        is amended by adding at the end the following new subsection:
    ``(n) Payment for Home Infusion Therapy.--The payment amount under 
this part for home infusion therapy is determined as follows:
            ``(1) In general.--Except as provided in this subsection, 
        the Secretary shall determine a per diem schedule for payment 
        for home infusion therapy (including pharmacy services, 
        administration services, care coordination services, supplies 
        and equipment necessary to safely and properly administer a 
        home infusion drug or biological in accordance with the 
        requirements and clinical standards commonly used for home 
        infusion therapy) which reflects the reasonable costs which 
        must be incurred by efficiently and economically operated 
        qualified home infusion therapy providers to provide such 
        therapy in conformity with applicable State and Federal laws, 
        regulations, and quality and safety standards and to assure 
        that Medicare beneficiaries have reasonable access to such 
        therapy.
            ``(2) Infusion drugs.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the provisions of section 1847A shall 
                apply to payment under this part for drugs included in 
                home infusion therapy.
                    ``(B) Special rule.--In applying subparagraph (A), 
                the determination of average sales prices under section 
                1847A shall be limited to such prices for infusion drug 
                sales to home infusion therapy pharmacies.''.
            (2) Conforming amendments.--
                    (A) Section 1833(a)(1) of such Act (42 U.S.C. 
                1395l(a)(1)) is amended by striking ``and'' before 
                ``(V)'' and by inserting before the semicolon at the 
                end the following: ``, and (W) with respect to home 
                infusion therapy, the amounts paid shall be determined 
                under section 1834(n)''.
                    (B) The first sentence of section 1842(b)(6) of 
                such Act (42 U.S.C. 1395u(b)(6)) is amended by striking 
                ``and'' before ``(H)'' and by inserting before the 
                period at the end the following: ``, and (I) in the 
                case of home infusion therapy, payment shall be made to 
                the qualified home infusion therapy provider 
                responsible for furnishing the therapy''.
    (c) Other Conforming Provisions.--
            (1) Exclusion from durable medical equipment benefit.--
        Section 1861(n) of such Act (42 U.S.C. 1395x(n)) is amended by 
        adding at the end the following: ``Such term does not include 
        home infusion therapy.''.
            (2) Application of accreditation organization provisions.--
        The provisions of section 1865(b) of the Social Security Act 
        apply to accreditation of qualified home infusion therapy 
        providers.
    (d) Effective Date.--The amendments made by this section shall 
apply to home infusion therapy furnished on or after January 1, 2007.
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