I 111th CONGRESS 1st Session H. R. 1765 IN THE HOUSE OF REPRESENTATIVES March 26, 2009 Ms. Matsui (for herself and Mr. Tanner) 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 with respect to payment for the furnishing of intravenous immune globulin (IVIG) in a patient’s home for the treatment of primary immune deficiency diseases and to cover certain disposable pumps as durable medical equipment in place of non-disposable pumps under the Medicare Program.

1.

Medicare payment for items and services relating to the furnishing of intravenous immune globulin (IVIG) in a patient’s home for the treatment of primary immune deficiency diseases

(a)

Coverage

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (1)in subsection (s)(2)(Z) by inserting and items and services related to the administration of intravenous immune globulin after globulin; and (2)in subsection (zz), by striking , but not including items or services related to the administration of the derivative,. (b)

Payment

Section 1842(o) of such Act (42 U.S.C. 1395u(o)) is amended— (1)in paragraph (7)— (A)by striking (6) and inserting (7); and (B)by redesignating such paragraph as paragraph (8); and (2)by inserting after paragraph (6) the following new paragraph: (7)(A)Subject to subparagraph (B), in the case of intravenous immune globulins furnished on or after January 1, 2010, under section 1861(s)(2)(Z), the Secretary shall provide for a separate payment for items and services related to the administration of such intravenous immune globulins in an amount that the Secretary determines to be appropriate based on a review of available published and unpublished data and information, including the Study of Intravenous Immune Globulin Administration Options: Safety, Access, and Cost Issues (CMS Contract #500–95–0059). Such payment amount may take into account the following: (i)Pharmacy overhead and related expenses. (ii)Patient service costs. (iii)Supply costs. (B)The separate payment amount under this paragraph for intravenous immune globulins furnished in 2011 or a subsequent year shall be equal to the separate payment amount determined under this paragraph for the previous year increased by the percentage increase in the consumer price index for medical care for the 12-month period ending with June of the previous year. .

2.

Medicare coverage of disposable pumps as items of durable medical equipment in certain cases

(a)

In general

Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended by inserting before the semicolon the following: and includes a disposable pump prescribed, instead of a non-disposable external infusion pump, for administration of a drug used as part of a chemotherapy regimen for the treatment of colorectal cancer if a non-disposable external infusion pump would have been covered under this subsection to administer the same drug for the same indication as of July 1, 2008. (b)

Effective date

The amendment made by subsection (a) shall apply to disposable pumps furnished on or after January 1, 2010.