Legislative Updates

The Preserving Patient Access to Home Infusion Act (S.1058/H.R. 2172) aims to enhance access to home-based infusion therapies for Medicare beneficiaries by:

• Requiring CMS to compensate home infusion providers for professional services on each day the drug is administered, acknowledging the comprehensive pharmacy services provided remotely.
• Specifying the services included in reimbursement to ensure clarity and adequacy of coverage.
• Permitting physician assistants (PAs) and nurse practitioners (NPs) to establish and review home infusion care plans for Medicare patients to expand the pool of qualified healthcare professionals who can oversee such treatments.

The DMEPOS Relief Act of 2025 (H.R.2005) is a bipartisan bill that seeks to reestablish a 75/25 blended Medicare reimbursement rate for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in non-rural, non-competitive bidding areas (non-CBAs) through December 31, 2025.

The payment rates would be calculated based on 75% of the adjusted fee schedule rates and 25% of the unadjusted fee schedule rates. This blended rate had previously been implemented under the CARES ACT with an extension under the 2022 Omnibus Appropriations bill that expired on January 1, 2024. The expiration of this blended rate led to significant reimbursement cuts of over 30% for many DME products.

This legislation aims to provide financial relief to DME suppliers facing increased operational costs due to supply chain issues, rising raw material prices, higher labor costs, and inflation. By reinstating the blended rates, the bill intends to ensure continued access to essential DME products and services for Medicare beneficiaries.

S.652/H.R.2630
The purpose of this legislation is to improve step therapy protocols and ensure patients are able to safely and efficiently access the best treatment for them. The bill requires a group health plan to establish an exception to medication step-therapy protocol in specified cases. The bill also requires a group health plan to implement and make readily available a clear process for an individual to request an exception to the protocol, including required information and criteria for granting an exception. The bill further specifies timelines under which plans must respond to such requests. More information about the Safe Step Act can be found here.

 S.1976/H.R.4104
This bipartisan, bicameral legislation will ensure Medicare patients maintain access to home infusion therapies that require the use of an infusion pump. The Preserving Patient Access to Home Infusion Act provides technical clarifications that removes the physical presence requirement from Medicare’s current home infusion therapy benefit, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services delivered by home infusion clinicians, including essential pharmacist services. The act also permits nurse practitioners and physician assistants to establish and review a home infusion plan of care, in addition to a physician.

S.3297/H.R.6407
This companion bill expands Medicare coverage of medical nutrition therapy (MNT) services. Currently, Medicare covers MNT only for individuals with diagnosed diabetes or kidney disease and post-kidney transplant and requires a physician referral. The bill extends coverage to individuals with other diseases and conditions, including malnutrition, prediabetes, obesity, eating disorders, cancer, renal diseases,  HIV, AIDS, hypertension, dyslipidemia, gastrointestinal diseases, cardiovascular disease, and other conditions causing unintended weight loss, services for which the Secretary determines the services to be medically necessary and appropriate for the prevention, management, or treatment of such disease or condition, consistent with any applicable recommendations of the United States Preventive Services Task Force; or services for which the Secretary determines the services are medically necessary, consistent either with protocols established by registered dietitian or nutrition professional organizations or with accepted clinical guidelines identified by the Secretary. In addition to physicians, this legislation allows nurse practitioners, physician assistants, clinical nurse specialists, and psychologists to refer patients for MNT.

H.R.6892
The bill seeks to expand coverage of medically necessary food and vitamins and individual amino acids for digestive and inherited metabolic disorders under Medicare, Medicaid and other federal health care programs and private health insurance to ensure State and Federal protection for existing coverage, and other purposes. MNEA FactSheet

New LCDs for EN and PN were updated in September 2021. Additional information can be found here:

• Medicare Coverage for Home Parenteral Nutrition: Policy Change After Almost Four Decades. Nutrition Issues in Gastroenterology, Series #215, Practical Gastroenterology, October 2021. Penny Allen, RD, CNSC, Chair, ASPEN Public Policy Committee.