,,ii #aaeth ,,congress #ast ,session ,s4 #agch ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #c1 #bjag,mr4 ,warner 7for himself1 ,mr4 ,isakson1 ,mr4 ,cardin1 ,mr4 ,grassley1 ,mr4 ,bennet1 ,mr4 ,portman1 ,ms4 ,klobuchar1 ,mr4 ,roberts1 ,mr4 ,blumenthal1 ,mr4 ,perdue1 ,mrs4 ,gillibrand1 ,mrs4 ,shaheen1 ,mr4 ,cochran1 ,mr4 ,brown1 ,mr4 ,wicker1 ,ms4 ,baldwin1 ,mr4 ,king1 and ,mr4 ,coons7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for a home infusion therapy services temporary transitional payment under the ,medicare program4 #a4 ,short title ,this ,act may be cited as the ,medicare ,home ,infusion ,therapy ,access ,act of #bjag4 #b4 ,home infusion therapy services temporary transitional payment 7a7 ,in general ,section #ahcd7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7u77 is amended1 by adding at the end the following new paragraph3 7#g7 ,home infusion therapy services temporary transitional payment 7,a7 ,temporary transitional payment 7i7 ,in general ,the ,secretary shall1 in accordance with the payment methodology described in subparagraph 7,b7 and subject to the provisions of this paragraph1 provide a home infusion therapy services temporary transitional payment under this part to an eligible home infusion supplier 7as defined in subparagraph 7,f77 for items and services described in subparagraphs 7,a7 and 7,b7 of section #ahfa7;iii77#b7 furnished during the period specified in clause 7ii7 by such supplier in coordination with the furnishing of transitional home infusion drugs 7as defined in clause 7iii774 7ii7 ,period specified ,for purposes of clause 7i71 the period specified in this clause is the period beginning on ,january #a1 #bjai1 and ending on the day before the date of the implementation of the payment system under paragraph 7#a77;,a74 7iii7 ,transitional home infusion drug defined ,for purposes of this paragraph1 the term transitional home infusion drug has the meaning given to the term home infusion drug under section #ahfa7;iii77#c77;,c71 except that clause 7ii7 of such section shall not apply if a drug described in such clause is identified in clause 7i71 7ii71 7iii7 or 7iv7 of subparagraph 7,c7 as of the date of the enactment of this paragraph4 7,b7 ,payment methodology ,for purposes of this paragraph1 the ,secretary shall establish a payment methodology1 with respect to items and services described in subparagraph 7,a77i74 ,under such payment methodology the ,secretary shall-- 7i7 create the three payment categories described in clauses 7i71 7ii71 and 7iii7 of subparagraph 7,c72 7ii7 assign drugs to such categories1 in accordance with such clauses2 7iii7 assign appropriate ,healthcare ,common ,procedure ,coding ,system 7,,hcpcs7 codes to each payment category2 and 7iv7 establish a single payment amount for each such payment category1 in accordance with subparagraph 7,d71 for each infusion drug administration calendar day in the individual's home for drugs assigned to such category4 7,c7 ,payment categories 7i7 ,payment category #a ,the ,secretary shall create a payment category #a and assign to such category drugs which are covered under the ,local ,coverage ,determination on ,external ,infusion ,pumps 7,,lcd number ,l#ccgid7 and billed with the following ,,hcpcs codes 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary73 ,j#jacc1 ,j#jbhe1 ,j#jbhg1 ,j#jbhh1 ,j#jbhi1 ,j#jhie1 ,j#aagj1 ,j#abej1 ,j#abfe1 ,j#acbe1 ,j#adee1 ,j#adeg1 ,j#aegj1 ,j#bage1 ,j#bbfj1 ,j#bbgj1 ,j#bbgd1 ,j#bbgh1 ,j#cjaj1 or ,j#cbhe4 7ii7 ,payment category #b ,the ,secretary shall create a payment category #b and assign to such category drugs which are covered under such local coverage determination and billed with the following ,,hcpcs codes 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary73 ,j#aeei ,,jb1 ,j#aefa ,,jb1 ,j#aefb ,,jb1 ,j#aefi ,,jb1 or ,j#aege ,,jb4 7iii7 ,payment category #c ,the ,secretary shall create a payment category #c and assign to such category drugs which are covered under such local coverage determination and billed with the following ,,hcpcs codes 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary73 ,j#ijjj1 ,j#ijci1 ,j#ijdj1 ,j#ijfe1 ,j#iajj1 ,j#iaij1 ,j#ibjj1 ,j#icfj1 or ,j#icgj4 7iv7 ,infusion drugs not otherwise included ,with respect to drugs that are not included in payment category #a1 #b1 or #c under clause 7i71 7ii71 or 7iii71 respectively1 the ,secretary shall assign to the most appropriate of such categories1 as determined by the ,secretary1 drugs which are-- 7,i7 covered under such local coverage determination and billed under ,,hcpcs code ,j#ggii or ,j#giii 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary72 or 7,,ii7 billed under any code that is implemented after the date of the enactment of this paragraph and included in such local coverage determination or included in subregulatory guidance as a home infusion drug described in subparagraph 7,a77i74 7,d7 ,payment amounts 7i7 ,in general ,under the payment methodology1 the ,secretary shall pay eligible home infusion suppliers1 with respect to items and services described in subparagraph 7,a77i7 furnished during the period described in subparagraph 7,a77ii7 by such supplier to an individual1 at amounts equal to the amounts determined under the physician fee schedule established under section #ahdh for services furnished during the year for codes and units of such codes described in clauses 7ii71 7iii71 and 7iv7 with respect to drugs included in the payment category under subparagraph 7,c7 specified in the respective clause1 determined without application of any adjustment under such section4 7ii7 ,payment amount for category #a ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #a described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifcfe plus four units of ,,hcpcs code #ifcff 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary74 7iii7 ,payment amount for category #b ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #b described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifcfi plus four units of ,,hcpcs code #ifcgj 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary74 7iv7 ,payment amount for category #c ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #c described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifdac plus four units of ,,hcpcs code #ifdae 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary74 7,e7 ,clarifications 7i7 ,infusion drug administration day ,for purposes of this subsection1 a reference1 with respect to the furnishing of transitional home infusion drugs or home infusion drugs to an individual by an eligible home infusion supplier1 to payment to such supplier for an infusion drug administration calendar day in the individual's home shall refer to payment only for the date on which professional services 7as described in section #ahfa7;iii77#b77;,a77 were furnished to administer such drugs to such individual4 ,for purposes of the previous sentence1 an infusion drug administration calendar day shall include all such drugs administered to such individual on such day4 7ii7 ,treatment of multiple drugs administered on same infusion drug administration day ,in the case that an eligible home infusion supplier1 with respect to an infusion drug administration calendar day in an individual's home1 furnishes to such individual transitional home infusion drugs which are not all assigned to the same payment category under subparagraph 7,c71 payment to such supplier for such infusion drug administration calendar day in the individual's home shall be a single payment equal to the amount of payment under this paragraph for the drug1 among all such drugs so furnished to such individual during such calendar day1 for which the highest payment would be made under this paragraph4 7,f7 ,eligible home infusion suppliers ,in this paragraph1 the term eligible home infusion supplier means a supplier that is enrolled under this part as a pharmacy that provides external infusion pumps and external infusion pump supplies and that maintains all pharmacy licensure requirements in the ,state in which the applicable infusion drugs are administered4 7,g7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this paragraph by program instruction or otherwise4 4 7b7 ,conforming amendment ,section #ahdb7;b77#f77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#f77;,i77 is amended by inserting or1 in the case of items and services described in clause 7i7 of section #ahcd7u77#g77;,a7 furnished to an individual during the period described in clause 7ii7 of such section1 payment shall be made to the eligible home infusion therapy supplier after payment shall be made to the qualified home infusion therapy supplier4