SB1058, titled the Preserving Patient Access to Home Infusion Act, would amend Medicare rules to expand and clarify coverage for home infusion therapy. The bill adds pharmacy services to the statutory definition of home infusion therapy services, allows nurse practitioners and physician assistants to establish and review home infusion plans of care alongside physicians, and revises how Medicare pays qualified home infusion suppliers. It also creates a transitional payment rule for 2026 through 2029 that would base the single payment amount on five hours of infusion time per day for certain therapies, and it reduces payment when the supplier is not physically present in the patient’s home on the day the drug is administered.
The bill further broadens access to home infusion for certain non-pump intravenous drugs and biologics, specifically antibacterial, antifungal, and antiviral products, by clarifying that payment for associated services can still be made even when the drug itself is not separately payable under Medicare Part B. In addition, it changes payment rules for supplies used with home infusion therapy, such as tubing, catheters, dressings, needles, and syringes, by prohibiting separate Medicare payment for those items when they are furnished on the same day and for the same drug as covered home infusion therapy. Most provisions would take effect for services furnished on or after January 1, 2026.
Impact
The bill would amend multiple sections of Title XVIII of the Social Security Act, primarily sections 1861 and 1834, to change Medicare coverage and payment rules for home infusion therapy. It would expand the types of professionals who can establish and review home infusion care plans, redefine certain covered home infusion drugs and services, and alter reimbursement methodology for suppliers and related supplies. These changes would directly affect Medicare beneficiaries receiving infusion therapy at home, qualified home infusion therapy suppliers, pharmacies, and clinicians involved in infusion care.
Sentiment
The available context shows generally supportive and access-oriented intent, with the bill framed as preserving patient access to home infusion therapy. The sponsors are Senators Warner and Scott of South Carolina, suggesting bipartisan backing. No committee transcript or recorded votes are provided, so there is no evidence of formal opposition or amendment debate in the supplied materials.
Contention
The main policy issues embedded in the bill are payment adequacy, supplier presence requirements, and the scope of services eligible for Medicare reimbursement. Potential points of contention include the reduced payment when a supplier is not physically present in the home, the temporary five-hour payment transition rule, and the expansion of authority to nurse practitioners and physician assistants. Another possible area of dispute is the clarification that payment can be made for certain non-pump antimicrobial infusions even when the drug itself is not otherwise payable under Part B, as well as the prohibition on separate payment for infusion supplies when bundled with covered therapy.