Alpha-1 Home Infusion Act

Summary#

This bill would add Alpha-1 Antitrypsin Deficiency Disorder treatment to the list of medical items and services covered under part B of the Social Security Act. It defines covered treatment as augmentation therapy (an Alpha-1 proteinase inhibitor) given in the patient’s home by a qualified home infusion therapy supplier. The bill allows payment for intravenous administration kits and up to 2 hours of nursing services connected to the infusion. It sets rules for who is eligible, requires direct payment to the home infusion supplier, and says these changes start on January 1, 2027.

What it means for you#

  • Eligible individuals must be enrolled in both Medicare Part A and Part B and not enrolled in a Medicare Advantage (Part C) plan.
  • The treatment must be furnished in the person’s home by a qualified home infusion therapy supplier.
  • The person must be under the care of an applicable provider (physician, nurse practitioner, or physician assistant).
  • Covered augmentation therapy is defined as an Alpha-1 proteinase inhibitor for adults with clinical evidence of emphysema due to severe hereditary alpha-1 antitrypsin deficiency.
  • The effective date for coverage and payment rules is January 1, 2027.

Expenses#

  • The bill requires a payment system under which Medicare pays qualified home infusion therapy suppliers for intravenous administration kits and up to 2 hours of nursing services that accompany augmentation therapy.
  • For these kits and services, the bill specifies the amount paid by Medicare is equal to 80 percent of the lesser of the actual charge or the amount determined under the new payment provision.
  • The bill also directs that payment for these kits and services be made directly to the qualified home infusion therapy supplier.
  • No publicly available information on the total cost or budgetary impact of the bill is provided in the text.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.