,,ii #aae? ,,congress #a/ ,session ,s4 #agch ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,augu/ #c1 #bjag,mr4 ,w>n] 7= himself1 ,mr4 ,isakson1 ,mr4 ,c>d91 ,mr4 ,grassley1 ,mr4 ,b5net1 ,mr4 ,portman1 ,ms4 ,klobu*>1 ,mr4 ,rob]ts1 ,mr4 ,blum5?al1 ,mr4 ,p]due1 ,mrs4 ,gillibr&1 ,mrs4 ,%ahe51 ,mr4 ,co*ran1 ,mr4 ,br[n1 ,mr4 ,wick]1 ,ms4 ,baldw91 ,mr4 ,k+1 & ,mr4 ,coons7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = a home infusion !rapy s]vices tempor>y transitional paym5t "u ! ,m$ic>e program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,home ,infusion ,!rapy ,access ,act ( #bjag4 #b4 ,home infusion !rapy s]vices tempor>y transitional paym5t 7a7 ,9 g5]al ,section #ahcd7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7u77 is am5d$1 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,home infusion !rapy s]vices tempor>y transitional paym5t 7,a7 ,tempor>y transitional paym5t 7i7 ,9 g5]al ,! ,secret>y %all1 9 accordance ) ! paym5t me?odology describ$ 9 subp>agraph 7,b7 & subject to ! provisions ( ?is p>agraph1 provide a home infusion !rapy s]vices tempor>y transitional paym5t "u ?is "p to an eligible home infusion suppli] 7z def9$ 9 subp>agraph 7,f77 = items & s]vices describ$ 9 subp>agraphs 7,a7 & 7,b7 ( section #ahfa7;iii77#b7 furni%$ dur+ ! p]iod specifi$ 9 clause 7ii7 by su* suppli] 9 coord9ation ) ! furni%+ ( transitional home infusion drugs 7z def9$ 9 clause 7iii774 7ii7 ,p]iod specifi$ ,= purposes ( clause 7i71 ! p]iod specifi$ 9 ?is clause is ! p]iod beg9n+ on ,janu>y #a1 #bjai1 & end+ on ! day be=e ! date ( ! implem5tation ( ! paym5t sy/em "u p>agraph 7#a77;,a74 7iii7 ,transitional home infusion drug def9$ ,= purposes ( ?is p>agraph1 ! t]m transitional home infusion drug has ! mean+ giv5 to ! t]m home infusion drug "u section #ahfa7;iii77#c77;,c71 except t clause 7ii7 ( su* section %all n apply if a drug describ$ 9 su* clause is id5tifi$ 9 clause 7i71 7ii71 7iii7 or 7iv7 ( subp>agraph 7,c7 z ( ! date ( ! enactm5t ( ?is p>agraph4 7,b7 ,paym5t me?odology ,= purposes ( ?is p>agraph1 ! ,secret>y %all e/abli% a paym5t me?odology1 ) respect to items & s]vices describ$ 9 subp>agraph 7,a77i74 ,"u su* paym5t me?odology ! ,secret>y %all-- 7i7 create ! ?ree paym5t categories describ$ 9 clauses 7i71 7ii71 & 7iii7 ( subp>agraph 7,c72 7ii7 assign drugs to su* categories1 9 accordance ) su* clauses2 7iii7 assign appropriate ,heal?c>e ,common ,proc$ure ,cod+ ,sy/em 7,,hcpcs7 codes to ea* paym5t category2 & 7iv7 e/abli% a s+le paym5t am\nt = ea* su* paym5t category1 9 accordance ) subp>agraph 7,d71 = ea* infusion drug adm9i/ration cal5d> day 9 ! individual's home = drugs assign$ to su* category4 7,c7 ,paym5t categories 7i7 ,paym5t category #a ,! ,secret>y %all create a paym5t category #a & assign to su* category drugs :i* are cov]$ "u ! ,local ,cov]age ,det]m9ation on ,ext]nal ,infusion ,pumps 7,,lcd numb] ,l#ccgid7 & bill$ ) ! foll[+ ,,hcpcs codes 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y73 ,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 ,paym5t category #b ,! ,secret>y %all create a paym5t category #b & assign to su* category drugs :i* are cov]$ "u su* local cov]age det]m9ation & bill$ ) ! foll[+ ,,hcpcs codes 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y73 ,j#aeei ,,jb1 ,j#aefa ,,jb1 ,j#aefb ,,jb1 ,j#aefi ,,jb1 or ,j#aege ,,jb4 7iii7 ,paym5t category #c ,! ,secret>y %all create a paym5t category #c & assign to su* category drugs :i* are cov]$ "u su* local cov]age det]m9ation & bill$ ) ! foll[+ ,,hcpcs codes 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y73 ,j#ijjj1 ,j#ijci1 ,j#ijdj1 ,j#ijfe1 ,j#iajj1 ,j#iaij1 ,j#ibjj1 ,j#icfj1 or ,j#icgj4 7iv7 ,infusion drugs n o!rwise includ$ ,) respect to drugs t are n includ$ 9 paym5t category #a1 #b1 or #c "u clause 7i71 7ii71 or 7iii71 respectively1 ! ,secret>y %all assign to ! mo/ appropriate ( su* categories1 z det]m9$ by ! ,secret>y1 drugs :i* are-- 7,i7 cov]$ "u su* local cov]age det]m9ation & bill$ "u ,,hcpcs code ,j#ggii or ,j#giii 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y72 or 7,,ii7 bill$ "u any code t is implem5t$ aft] ! date ( ! enactm5t ( ?is p>agraph & includ$ 9 su* local cov]age det]m9ation or includ$ 9 subregulatory guidance z a home infusion drug describ$ 9 subp>agraph 7,a77i74 7,d7 ,paym5t am\nts 7i7 ,9 g5]al ,"u ! paym5t me?odology1 ! ,secret>y %all pay eligible home infusion suppli]s1 ) respect to items & s]vices describ$ 9 subp>agraph 7,a77i7 furni%$ dur+ ! p]iod describ$ 9 subp>agraph 7,a77ii7 by su* suppli] to an individual1 at am\nts equal to ! am\nts det]m9$ "u ! physician fee s*$ule e/abli%$ "u section #ahdh = s]vices furni%$ dur+ ! ye> = codes & units ( su* codes describ$ 9 clauses 7ii71 7iii71 & 7iv7 ) respect to drugs includ$ 9 ! paym5t category "u subp>agraph 7,c7 specifi$ 9 ! respective clause1 det]m9$ )\t application ( any adju/m5t "u su* section4 7ii7 ,paym5t am\nt = category #a ,= purposes ( clause 7i71 ! codes & units describ$ 9 ?is clause1 ) respect to drugs includ$ 9 paym5t category #a describ$ 9 subp>agraph 7,c77i71 are "o unit ( ,,hcpcs code #ifcfe plus f\r units ( ,,hcpcs code #ifcff 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y74 7iii7 ,paym5t am\nt = category #b ,= purposes ( clause 7i71 ! codes & units describ$ 9 ?is clause1 ) respect to drugs includ$ 9 paym5t category #b describ$ 9 subp>agraph 7,c77i71 are "o unit ( ,,hcpcs code #ifcfi plus f\r units ( ,,hcpcs code #ifcgj 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y74 7iv7 ,paym5t am\nt = category #c ,= purposes ( clause 7i71 ! codes & units describ$ 9 ?is clause1 ) respect to drugs includ$ 9 paym5t category #c describ$ 9 subp>agraph 7,c77i71 are "o unit ( ,,hcpcs code #ifdac plus f\r units ( ,,hcpcs code #ifdae 7z id5tifi$ z ( ,july #a1 #bjag1 & z subsequ5tly modifi$ by ! ,secret>y74 7,e7 ,cl>ifications 7i7 ,infusion drug adm9i/ration day ,= purposes ( ?is subsection1 a ref]5ce1 ) respect to ! furni%+ ( transitional home infusion drugs or home infusion drugs to an individual by an eligible home infusion suppli]1 to paym5t to su* suppli] = an infusion drug adm9i/ration cal5d> day 9 ! individual's home %all ref] to paym5t only = ! date on :i* pr(essional s]vices 7z describ$ 9 section #ahfa7;iii77#b77;,a77 7 furni%$ to adm9i/] su* drugs to su* individual4 ,= purposes ( ! previ\s s5t5ce1 an infusion drug adm9i/ration cal5d> day %all include all su* drugs adm9i/]$ to su* individual on su* day4 7ii7 ,treatm5t ( multiple drugs adm9i/]$ on same infusion drug adm9i/ration day ,9 ! case t an eligible home infusion suppli]1 ) respect to an infusion drug adm9i/ration cal5d> day 9 an individual's home1 furni%es to su* individual transitional home infusion drugs :i* are n all assign$ to ! same paym5t category "u subp>agraph 7,c71 paym5t to su* suppli] = su* infusion drug adm9i/ration cal5d> day 9 ! individual's home %all be a s+le paym5t equal to ! am\nt ( paym5t "u ?is p>agraph = ! drug1 among all su* drugs s furni%$ to su* individual dur+ su* cal5d> day1 = :i* ! highe/ paym5t w\ld be made "u ?is p>agraph4 7,f7 ,eligible home infusion suppli]s ,9 ?is p>agraph1 ! t]m eligible home infusion suppli] means a suppli] t is enroll$ "u ?is "p z a ph>macy t provides ext]nal infusion pumps & ext]nal infusion pump supplies & t ma9ta9s all ph>macy lic5sure requirem5ts 9 ! ,/ate 9 :i* ! applicable infusion drugs are adm9i/]$4 7,g7 ,implem5tation ,not)/&+ any o!r provision ( law1 ! ,secret>y may implem5t ?is p>agraph by program in/ruction or o!rwise4 4 7b7 ,con=m+ am5dm5t ,section #ahdb7;b77#f77;,i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#f77;,i77 is am5d$ by ins]t+ or1 9 ! case ( items & s]vices describ$ 9 clause 7i7 ( section #ahcd7u77#g77;,a7 furni%$ to an individual dur+ ! p]iod describ$ 9 clause 7ii7 ( su* section1 paym5t %all be made to ! eligible home infusion !rapy suppli] aft] paym5t %all be made to ! qualifi$ home infusion !rapy suppli]4