H.R. 2343: John W. Walsh Alpha-1 Home Infusion Act of 2025

This bill, known as the John W. Walsh Alpha-1 Home Infusion Act of 2025, proposes changes to the Medicare coverage related to the treatment of Alpha-1 Antitrypsin Deficiency Disorder. Here is a breakdown of the key provisions:

Coverage for Alpha-1 Antitrypsin Deficiency Disorder Treatment

• The bill aims to amend the Social Security Act to add coverage for Alpha-1 Antitrypsin Deficiency Disorder treatment under Medicare Part B.
• This treatment includes augmentation therapy provided by qualified home infusion therapy suppliers.
• Eligibility for this coverage applies to individuals who:
  • Are under the care of a medical provider (physician, nurse practitioner, or physician assistant).
  • Are enrolled in both Medicare Part A and Part B, but not in a Medicare Advantage plan (Part C).
  • Require augmentation therapy due to their condition.

Payment Provisions

• The bill proposes a new payment system for the following:
  • Intravenous administration kits required for this treatment.
  • Nursing services provided during the administration of augmentation therapy, limited to up to 2 hours of care.
• The Secretary of Health and Human Services would be responsible for implementing this payment system, ensuring that qualified home infusion therapy suppliers receive compensation for the provided services.

Conforming Amendments to the Social Security Act

• Changes to existing sections of the Social Security Act to align with the new treatment coverage and payment systems will be made.
• Specifically, the bill outlines the payment amount for the intravenous administration kits and nursing services to be 80% of either the actual charge or a predetermined payment amount.

Exclusion from Home Health Services

• The bill clarifies that these services will not be classified as home health services, which allows for a separate billing and payment process.

Effective Date

• The amendments proposed by the bill are set to take effect for items and services provided on or after January 1, 2027.

Relevant Companies

• None found