HR-2172-119
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.
Sponsored by Vern Buchanan (R-FL)
What it does
This bill would amend the Medicare program (Title XVIII of the Social Security Act) to expand coverage and adjust payment rules for home infusion therapy — the administration of drugs intravenously in a patient's home. It would add pharmacy services to the list of covered home infusion services, allow nurse practitioners and physician assistants (in addition to physicians) to establish and review home infusion care plans, and set a transitional payment rate based on 5 hours of infusion per day from 2026 through 2029. It would also extend coverage to certain antibacterial, antifungal, and antiviral drugs administered without a pump, and clarify that suppliers are paid 50% of the standard rate on days when no clinician is physically present in the home.
Who benefits
Medicare beneficiaries who require intravenous drug therapy at home, particularly elderly and disabled patients with chronic or serious infections, immune conditions, or other illnesses requiring IV antibiotics, antifungals, or antivirals. Patients in rural or underserved areas where in-home clinician visits are less frequent would benefit from the non-presence payment clarification. Nurse practitioners and physician assistants gain expanded authority to manage care plans. Home infusion therapy suppliers and specialty pharmacies would receive clearer and potentially more stable reimbursement. Patients who prefer home-based care over hospital or infusion center visits would have broader access.
Who is hurt
Hospital outpatient infusion centers and freestanding infusion clinics may see reduced patient volume as more care shifts to the home setting. Medicare's Hospital Outpatient Prospective Payment System could see lower utilization revenue. The Medicare program itself — and by extension taxpayers and future beneficiaries — would bear increased costs from expanded coverage and the transitional 5-hour payment floor. Durable medical equipment (DME) suppliers who currently bill separately for infusion-related supplies (tubing, catheters, syringes) would lose those separate payments when furnished on the same day as home infusion therapy. Physicians may see a modest reduction in their exclusive authority over care plan oversight.
Supporters argue
Supporters argue that home infusion therapy is clinically proven to be safe and cost-effective compared to hospital-based infusion, and that current Medicare payment rules have created gaps that threaten patient access — particularly for beneficiaries needing IV antibiotics or antivirals who cannot easily travel to infusion centers. They contend that allowing nurse practitioners and physician assistants to oversee care plans reflects modern clinical practice and addresses physician shortages, especially in rural areas, and that the 5-hour transitional payment standard corrects an underpayment that has caused some suppliers to exit the Medicare market, leaving patients without viable home-based options.
Opponents argue
Opponents argue that expanding the 5-hour payment floor and broadening coverage to non-pump drugs without rigorous cost controls could increase Medicare spending without sufficient evidence that outcomes improve proportionally, adding fiscal pressure to an already strained program. They contend that allowing non-physician providers to independently establish and review infusion care plans — which involve complex drug regimens and serious infection risks — may reduce clinical oversight in ways that could compromise patient safety, and that the 50% payment rate for days without a clinician present may still incentivize suppliers to bill for days when meaningful professional services are not being rendered.
Constitutional context
Congress regulates Medicare under the Taxing and Spending Clause (Art. I, §8, cl. 1), which grants broad authority to set conditions on federal healthcare spending. No active constitutional tension is raised by this bill; it modifies an existing federal spending program rather than compelling private action or imposing conditions on states. NFIB v. Sebelius (2012) affirmed Congress's broad authority to structure Medicare benefits and payments as a spending program.
Checks and balances
Congress sets the coverage and payment rules; the Secretary of Health and Human Services (HHS) implements them through CMS rulemaking; the Medicare Payment Advisory Commission (MedPAC) provides independent oversight of payment adequacy; federal courts retain jurisdiction over legal challenges to implementing regulations.
Historical precedent
The 21st Century Cures Act (2016) and subsequent rulemaking first established Medicare's home infusion therapy benefit under Part B, effective 2021; this bill would modify and expand that existing framework.