,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #edce  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #aj1 #bjad  
,mr4 ,engel 7= himself1 ,mr4 ,tib]i1    
,mr4 ,l>son ( ,connecticut1 ,mr4 ,h>p]1 
,mr4 ,meehan1 ,ms4 ,p+ree ( ,ma9e1 &    
,mr4 ,pet]son7 introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committee 
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = ! cov]age ( home z a site (   
c>e = infusion !rapy "u ! ,m$ic>e       
,program4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$ic>e ,home ,infusion    
,site ( ,c>e ,act ( #bjad4  #b4 ,f9d+s  
,congress f9ds ! foll[+3  7#a7 ,!       
,m$ic>e fee-=-s]vice program cov]s      
infusion !rapy 9 ! hospital1 skill$     
nurs+ facility1 physician (fice1 &      
hospital outpati5t dep>tm5t1 b does n   

cov] ! full range ( s]vices = !         
provision ( infusion !rapies 9 a        
pati5t's home4  7#b7 ,! ,m$ic>e program 
is pres5tly ! only major heal? c>e pay] 
9 ! ,unit$ ,/ates t does n provide      
compreh5sive cov]age ( home infusion    
!rapy4  7#c7 ,z a result ( ! ,m$ic>e    
program n provid+ = compreh5sive cov]age
 ( home infusion !rapy1 _m ,m$ic>e      
b5efici>ies are unable to obta9 infusion
 !rapy 9 ! mo/ co/-effective & conv5i5t 
sett+ ( _! home1 & physicians are       
depriv$ ( ! ability to select ! be/ site
 ( c>e = _! pati5ts4  7#d7 ,! ,m$ic>e   
program is pay+ = in/itutional c>e = !  
provision ( infusion !rapy 9 _m in/ances
 :5 su* in/itutional c>e c\ld be avoid$ 
if ! ,m$ic>e program provid$ cov]age =  
home infusion !rapy4  7#e7 ,! ,gov]nm5t 
,acc\ntability ,(fice f\nd 9 a #bjaj    
report t home infusion !rapy is utiliz$ 
widely by private pay]s provid+ heal?   
insurance cov]age = individuals enroll$ 
"u su* cov]age & t su* private pay]s    
g5]ally are satisfi$ ) ! quality ( c>e &

 ! sav+s !y a*ieve ?r\gh avoid$         
in/itutionalizations4  7#f7 ,a rec5t    
/udy has report$ a pot5tial sav+s =     
,m$ic>e if infusion !rapies 7 cov]$ 9 ! 
home site ( c>e4  #c4 ,m$ic>e cov]age ( 
home infusion !rapy  7a7 ,9 g5]al       
,section #ahfa ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7 is am5d$--  
7#a7 9 subsection 7s77#b7--  7,a7 by    
/rik+ & at ! end ( subp>agraph 7,,ee72  
7,b7 by ins]t+ & at ! end ( subp>agraph 
7,,ff72 &  7,c7 by ins]t+ at ! end !    
foll[+ new subp>agraph3  7,,gg7 home    
infusion !rapy 7z def9$ 9 subsection    
7iii77#a772  2 &  7#b7 by add+ at ! end 
! foll[+ new subsection3  7iii7 ,home   
,infusion ,!rapy  7#a7 ,! t]m home      
infusion !rapy means ! items & s]vices  
describ$ 9 p>agraph 7#b7 furni%$ to an  
individual1 :o is "u ! c>e ( a          
physician1 :i* are provid$ by a qualifi$
 home infusion !rapy suppli] "u a plan  
7= furni%+ su* items & s]vices to su*   
individual7 e/abli%$ & p]iodically      
review$ by a physician1 :i* items &     

s]vices are provid$ 9 an integrat$ mann]
 9 ! individual's home 9 con=mance )    
uni=m /&>ds ( c>e e/abli%$ by !         
,secret>y & 9 coord9ation ) ! provision 
( cov]$ infusion drugs "u "p ,d4 ,!     
,secret>y %all e/abli% su* /&>ds aft]   
tak+ into acc\nt ! /&>ds commonly us$ = 
home infusion !rapy by ,m$ic>e          
,advantage plans & 9 ! private sector & 
aft] consultation ) all int]e/$         
/akehold]s4  7#b7 ,! items & s]vices    
describ$ 9 ?is p>agraph are ! foll[+3   
7,a7 ,pr(essional s]vices1 includ+ nurs+
 s]vices 7o!r ?an nurs+ s]vices cov]$ z 
home heal? s]vices71 provid$ 9          
accordance ) ! plan 7includ+            
adm9i/rative1 comp\nd+1 disp5s+1        
di/ribution1 cl9ical monitor+1 & c>e    
coord9ation s]vices7 & all necess>y     
supplies & equipm5t 7includ+ m$ical     
supplies su* z /]ile tub+ & infusion    
pumps74  7,b7 ,o!r items & s]vices !    
,secret>y det]m9es appropriate to       
adm9i/] infusion drug !rapies to an     
individual safely & effectively 9 !     

home4  7#c7 ,= purposes ( ?is           
subsection3  7,a7 ,! t]m home means a   
place ( resid5ce us$ z an individual's  
home & includes su* o!r alt]nate sett+s 
z ! ,secret>y det]m9es4  7,b7 ,! t]m    
qualifi$ home infusion !rapy suppli]    
means any ph>macy1 physician1 or o!r    
provid] lic5s$ by ! ,/ate 9 :i* !       
ph>macy1 physician1 or provid] resides  
or provides s]vices1 ^: ,/ate au?oriz$  
scope ( practice includes disp5s+       
au?ority & t--  7i7 has exp]tise 9 !    
prep>ation ( p>5t]al m$ications 9       
compliance ) en=ceable /&>ds ( ! ,unit$ 
,/ates ,ph>macopoeia & o!r nationally   
recogniz$ /&>ds t regulate prep>ation ( 
p>5t]al m$ications z det]m9$ by !       
,secret>y & meets su* /&>ds2  7ii7      
provides infusion !rapy to pati5ts )    
acute or *ronic conditions requir+      
p>5t]al adm9i/ration ( drugs &          
biologicals adm9i/]$ ?r\gh ca!t]s or    
ne$les1 or bo?1 9 a home2 &  7iii7 meets
 su* o!r uni=m requirem5ts z ! ,secret>y
 det]m9es are necess>y to ensure ! safe 

& effective provision & adm9i/ration (  
home infusion !rapy on a #g-;day-a-week1
 #bd-;h\r basis 7tak+ into acc\nt !     
/&>ds ( c>e = home infusion !rapy       
e/abli%$ by ,m$ic>e ,advantage plans & 9
 ! private sector71 & ! effici5t        
adm9i/ration ( ! home infusion !rapy    
b5efit4  7#d7 ,a qualifi$ home infusion 
!rapy suppli] may subcontract ) a       
ph>macy1 physician1 provid]1 or suppli] 
to meet ! requirem5ts ( p>agraph        
7#c77;,b74  4  7b7 ,paym5t = ,home      
,infusion ,!rapy ,section #ahcd ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7p7 ,paym5t =   
home infusion !rapy  7#a7 ,9 g5]al ,!   
,secret>y %all det]m9e a p] diem s*$ule 
= paym5t = ! pr(essional s]vices        
7includ+ nurs+ s]vices71 supplies1 &    
equipm5t describ$ 9 section             
#ahfa7;iii77#b77;,a7 = ea* infusion     
!rapy type t reflects ! reasonable co/s 
:i* mu/ be incurr$ by effici5tly &      
economically op]at$ qualifi$ home       

infusion !rapy suppli]s to provide su*  
s]vices1 supplies1 & equipm5t 9 con=mity
 ) applicable ,/ate & ,f$]al laws1      
regulations1 & ! uni=m quality & safety 
/&>ds develop$ "u section               
#ahfa7;iii77#a7 & to assure t ,m$ic>e   
b5efici>ies h reasonable access to su*  
!rapy4  7#b7 ,consid]ations ,9 develop+ 
! p] diem s*$ule "u ?is subsection1 !   
,secret>y %all consid] rec5t cr$ible    
/udies ab\t ! co/s ( provid+ infusion   
!rapy 9 ! home1 consult ) home infusion 
!rapy suppli]s1 consid] paym5t am\nts   
e/abli%$ by ,m$ic>e ,advantage plans &  
private pay]s = home infusion !rapy1 &1 
if necess>y1 conduct a /ati/ically valid
 national m>ket analysis involv+ ! co/s 
( adm9i/]+ infusion drugs & ( provid+   
pr(essional s]vices necess>y = ! drugs' 
adm9i/ration4  7#c7 ,annual updates ,!  
,secret>y %all update su* s*$ule f ye>  
to ye> by ! p]c5tage increase 9 !       
,consum] ,price ,index = all urban      
consum]s 7,unit$ ,/ates city av]age7 = !
 #ab-mon? p]iod end+ ) ,june ( ! prec$+ 

ye>4 ,! ,secret>y may modify ! p] diem  
s*$ule ) respect to b5efici>ies :o      
qualify = home infusion !rapy s]vices "u
 section #ahfa7;iii77#a7 b :o receive   
nurs+ s]vices z home heal? s]vices4  4  
7c7 ,con=m+ am5dm5ts  7#a7 ,paym5t      
ref]5ce ,section #ahcc7;a77#a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciea7;a77#a77 is am5d$--  7,a7 by     
/rik+ & be=e 7,z72 &  7,b7 by ins]t+    
be=e ! semicolon at ! end ! foll[+3 1 & 
7,,aa7 ) respect to home infusion !rapy1
 ! am\nts paid %all be det]m9$ "u       
section #ahcd7p74  7#b7 ,direct paym5t  
,! fir/ s5t5ce ( section #ahdb7;b77#f7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieu7b77#f77 is am5d$--  7,a7 by     
/rik+ & be=e 7,h72 &  7,b7 by ins]t+    
be=e ! p]iod at ! end ! foll[+3 1 & 7,i7
 9 ! case ( home infusion !rapy1 paym5t 
%all be made to ! qualifi$ home infusion
 !rapy suppli]4  7#c7 ,exclusion f      
durable m$ical equipm5t & home heal?    
s]vices ,section #ahfa ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #aciex7 is

 am5d$--  7,a7 9 subsection 7m77#e7--   
7i7 by /rik+ & be=e durable m$ical      
equipm5t & ins]t+ a comma2 &  7ii7 by   
ins]t+ be=e ! semicolon at ! end !      
foll[+3 1 & supplies us$ 9 ! provision (
 home infusion !rapy aft] exclud+ o!r   
drugs & biologicals2 &  7,b7 9          
subsection 7n71 by add+ at ! end !      
foll[+3 ,su* t]m does n include home    
infusion !rapy1 o!r ?an equipm5t &      
supplies us$ 9 ! provision ( insul944   
7#d7 ,application ( accr$itation        
provisions ,! provisions ( section      
#ahfe7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;bb7a77 apply to !  
accr$itation ( qualifi$ home infusion   
!rapy suppli]s 9 ! same way z !y apply  
to o!r suppli]s4  #d4 ,m$ic>e cov]age ( 
home infusion drugs  ,section           
#ahfj;,d-#b7;e7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77 is 
am5d$--  7#a7 9 p>agraph 7#a7--  7,a7 by
 /rik+ or at ! end ( subp>agraph 7,a72  
7,b7 by /rik+ ! comma at ! end (        
subp>agraph 7,b7 & ins]t+1 2 or2 &  7,c7

 by ins]t+ aft] subp>agraph 7,b7 !      
foll[+ new subp>agraph3  7,c7 an        
infusion drug 7z def9$ 9 p>agraph 7#e771
  2 &  7#b7 by add+ at ! end ! foll[+   
new p>agraph3  7#e7 ,infusion drug def9$
 ,= purposes ( ?is "p1 ! t]m infusion   
drug means a p>5t]al drug or biological 
adm9i/]$ via an intrav5\s1 intrasp9al1  
intra-art]ial1 intra!cal1 epidural1     
subcutane\s1 or intramuscul> access     
device or injection1 & may include a    
drug us$ = ca!t] ma9t5ance & declott+1 a
 drug conta9$ 9 a device1 additives     
includ+ b n limit$ to vitam9s1 m9]als1  
solutions1 & dilu5ts1 & o!r compon5ts   
us$ 9 ! provision ( home infusion !rapy4
  4  #e4 ,ensur+ b5efici>y access to    
home infusion !rapy  7a7 ,objectives 9  
implem5tation ,! ,secret>y ( ,heal? &   
,human ,s]vices %all implem5t ! ,m$ic>e 
home infusion !rapy b5efit "u ! am5dm5ts
 made by ?is ,act 9 a mann] t ensures t 
,m$ic>e b5efici>ies h timely &          
appropriate access to infusion !rapy 9  
_! homes & t !re is rapid & seamless    

coord9ation betwe5 drug cov]age "u "p ,d
 ( title ,,xviii ( ! ,social ,security  
,act & cov]age = home infusion !rapy    
s]vices "u "p ,b ( su* title to avoid ! 
fil+ ( duplicative or o!rwise improp]   
claims4 ,specifically1 ! ,secret>y %all 
ensure t--  7#a7 ! b5efit is practical &
 workable ) m9imal adm9i/rative burd5 = 
b5efici>ies1 qualifi$ home infusion     
!rapy suppli]s1 physicians1 prescription
 drug plans1 ,,ma-,,pd plans1 & ,m$ic>e 
,advantage plans1 & ! ,secret>y %all    
consid] ! use ( consolidat$ claims      
encompass+ cov]$ "p ,d drugs & "p ,b    
s]vices1 supplies1 & equipm5t "u su* "p 
,b to ensure ! effici5t op]ation ( ?is  
b5efit2  7#b7 any prior au?orization or 
utilization review process is exp$iti\s1
 all[+ ,m$ic>e b5efici>ies mean+ful     
access to home infusion !rapy2  7#c7    
m$ical necessity det]m9ations = home    
infusion !rapy w be made--  7,a7 except 
z provid$ 9 subp>agraph 7,b71 by ,m$ic>e
 adm9i/rative contractors "u su* "p ,b &
 communicat$ to ! appropriate           

prescription drug plans2 or  7,b7 9 !   
case ( an individual enroll$ 9 a ,m$ic>e
 ,advantage plan1 by ! ,m$ic>e          
,advantage organization (f]+ ! plan2 &  
an individual may be initially qualifi$ 
= cov]age = su* b5efit = a #ij-;day     
p]iod & subsequ5t #ij-;day p]iods       
!reaft]2  7#d7 except z o!rwise provid$ 
9 ?is section1 ! b5efit is model$ on    
curr5t private sector cov]age & cod+ =  
home infusion !rapy2 &  7#e7            
prescription drug plans & ,,ma-,,pd     
plans /ructure _! =mul>ies1 utilization 
review protocols1 & policies 9 a mann] t
 ensures t ,m$ic>e b5efici>ies h timely 
& appropriate access to infusion !rapy 9
 _! homes4  7b7 ,report ,n lat] ?an     
,janu>y #a1 #bjah1 ! ,comptroll] ,g5]al 
( ! ,unit$ ,/ates %all submit a report  
to ,congress on ,m$ic>e b5efici>y access
 to home infusion !rapy4 ,su* report    
%all specifically address :e!r !        
objectives specifi$ 9 subsection 7a7 h  
be5 met & %all make recomm5dations to   
,congress & ! ,secret>y ( ,heal? &      

,human ,s]vices on h[ to improve !      
b5efit & bett] ensure t ,m$ic>e         
b5efici>ies h timely & appropriate      
access to infusion !rapy 9 _! homes4    
#f4 ,effective date ,! am5dm5ts made by 
?is ,act %all apply to home infusion    
!rapy furni%$ on or aft] ,janu>y #a1    
#bjae4