Bill Summary
The "John W. Walsh Alpha-1 Home Infusion Act of 2025" aims to amend the Social Security Act to ensure that treatment for Alpha-1 Antitrypsin Deficiency Disorder is covered under Medicare Part B. This legislation defines the treatment as augmentation therapy administered at home by qualified suppliers and stipulates that it is available to individuals who are under the care of an applicable provider, enrolled in both parts A and B of Medicare, and not part of a Medicare Advantage plan.
Key provisions include the establishment of a payment system for intravenous administration kits and nursing services related to this treatment, allowing for reimbursement for up to two hours of nursing care in coordination with the therapy. The effective date for these amendments is set for January 1, 2027. Overall, this bill seeks to improve access to essential treatment for patients suffering from this hereditary deficiency.
Possible Impacts
The "John W. Walsh Alpha-1 Home Infusion Act of 2025" has several potential impacts on individuals affected by Alpha-1 Antitrypsin Deficiency Disorder. Here are three examples:
1. **Increased Access to Treatment**: With the legislation providing Medicare coverage for Alpha-1 Antitrypsin Deficiency Disorder treatment, individuals diagnosed with this condition can now access necessary augmentation therapy at home. This means that patients who previously might have faced financial barriers or logistical challenges to receiving treatment in a clinical setting can now receive care in the comfort of their own homes, potentially leading to better health outcomes and improved quality of life.
2. **Financial Relief**: Patients will benefit from the payment systems established under the legislation, which cover intravenous administration kits and nursing services related to their treatment. This financial support, which allows for up to 80% coverage, can significantly alleviate the out-of-pocket costs associated with managing their condition, making treatment more affordable and accessible for those reliant on Medicare.
3. **Coordination of Care**: The requirement for treatment to be administered by qualified home infusion therapy suppliers, in coordination with applicable providers such as physicians, nurse practitioners, or physician assistants, promotes a more integrated approach to patient care. This ensures that patients receive comprehensive support tailored to their specific needs, fostering better communication among healthcare providers and potentially leading to more effective management of their condition.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2343 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 2343
To amend title XVIII of the Social Security Act to provide for coverage
and payment of Alpha-1 Antitrypsin Deficiency Disorder treatment under
part B of such title, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 25, 2025
Ms. Salazar (for herself, Ms. Pingree, Mr. Smith of New Jersey, Mr.
Johnson of Georgia, Mr. Owens, Ms. Norton, Mrs. Kim, Mr. Rouzer, and
Mr. Tonko) 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 coverage
and payment of Alpha-1 Antitrypsin Deficiency Disorder treatment under
part B of such title, and for other purposes.
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 ``John W. Walsh Alpha-1 Home Infusion
Act of 2025''.
SEC. 2. MEDICARE COVERAGE OF ALPHA-1 ANTITRYPSIN DISORDER TREATMENT.
(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
(II);
(B) by inserting ``and'' at the end of subparagraph
(JJ); and
(C) by inserting at the end the following new
subparagraph:
``(KK) Alpha-1 Antitrypsin Deficiency Disorder
treatment (as defined in subsection (nnn));''; and
(2) by adding at the end the following new subsection:
``(nnn) Alpha-1 Antitrypsin Deficiency Disorder Treatment.--(1) The
term `Alpha-1 Antitrypsin Deficiency Disorder treatment' means
augmentation therapy (as defined in paragraph (2)(C)) furnished by
qualified home infusion therapy suppliers (as defined in paragraph
(2)(D)) which are furnished in the individual's home (as defined in
paragraph (2)(B)) to an individual--
``(A) who is under the care of an applicable provider;
``(B) who is enrolled under both parts A and B of this
title, and is not enrolled in an MA plan under part C of such
title; and
``(C) who requires augmentation therapy (as defined in
paragraph (2)(C)).
``(2) For purposes of this subsection:
``(A) The term `applicable provider' means--
``(i) a physician;
``(ii) a nurse practitioner; and
``(iii) a physician assistant.
``(B) The term `home' means a place of residence used as
the home of an individual (as defined for purposes of
subsection (n)).
``(C) The term `augmentation therapy' means an Alpha-1
Proteinase Inhibitor indicated for chronic augmentation and
maintenance therapy in adults with clinical evidence of
emphysema due to severe hereditary deficiency of Alpha-1
Antitrypsin.
``(D) The term `qualified home infusion therapy supplier'
has the meaning given such term in subsection
(iii)(3)(D)(i).''.
(b) Payment for Intravenous Administration Kits and Nursing
Services for Alpha-1 Antitrypsin Deficiency Disorder Treatment.--
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
``(aa) Payment for Intravenous Administration Kits and Nursing
Services for Alpha-1 Antitrypsin Deficiency Disorder Treatment.--The
Secretary shall implement a payment system under which payment is made
under this title to a qualified home infusion therapy supplier (as
defined in section 1861(nnn)(3)(D)) for intravenous administration kits
and nursing services for up to 2 hours of care by a qualified home
infusion therapy supplier in coordination with the furnishing of
augmentation therapy (as defined in section 1861(nnn)(2)(C)).''.
(c) Conforming Amendments.--
(1) Payment reference.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (II) with respect to intravenous
administration kits and nursing services described in
section 1834(aa) for Alpha-1 Antitrypsin Disorder
treatment (as defined in subsection (nnn)(1)), the
amount paid for such kits and services shall be an
amount equal to 80 percent of the lesser of the actual
charge for the services or the amount determined under
section 1834(aa)''.
(2) Direct payment.--The first sentence of section
1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6))
is amended--
(A) by striking ``and'' before ``(J)''; and
(B) by inserting before the period at the end the
following: ``, and (K) in the case of intravenous
administration kits and nursing services described in
section 1834(aa), payment shall be made to the
qualified home infusion therapy supplier (as defined in
section 1861(nnn)(2)(D))''.
(3) Exclusion from home health services.--Section 1861(m)
of the Social Security Act (42 U.S.C. 1395x(m)) is amended, in
the first sentence, by inserting the following before the
period at the end: ``and intravenous administration kits and
nursing services described in section 1834(aa) for Alpha-1
Antitrypsin Deficiency Disorder treatment (as defined in
subsection (nnn)(1))''.
(d) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2027.
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