text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Home Infusion Site of Care 
  Act of 2014''.
  
  SEC. 2. FINDINGS.
  
      Congress finds the following:
              (1) The Medicare fee-for-service program covers infusion 
          therapy in the hospital, skilled nursing facility, physician 
          office, and hospital outpatient department, but does not cover 
          the full range of services for the provision of infusion 
          therapies in a patient's home.
              (2) The Medicare program is presently the only major health 
          care payer in the United States that does not provide 
          comprehensive coverage of home infusion therapy.
              (3) As a result of the Medicare program not providing for 
          comprehensive coverage of home infusion therapy, many Medicare 
          beneficiaries are unable to obtain infusion therapy in the most 
          cost-effective and convenient setting of their home, and 
          physicians are deprived of the ability to select the best site 
          of care for their patients.
              (4) The Medicare program is paying for institutional care 
          for the provision of infusion therapy in many instances when 
          such institutional care could be avoided if the Medicare 
          program provided coverage for home infusion therapy.
              (5) The Government Accountability Office found in a 2010 
          report that home infusion therapy is utilized widely by private 
          payers providing health insurance coverage for individuals 
          enrolled under such coverage and that such private payers 
          generally are satisfied with the quality of care and the 
          savings they achieve through avoided institutionalizations.
              (6) A recent study has reported a potential savings for 
          Medicare if infusion therapies were covered in the home site of 
          care.
  
  SEC. 3. MEDICARE COVERAGE OF HOME INFUSION THERAPY.
  
      (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
  1395x) is amended--
              (1) in subsection (s)(2)--
                      (A) by striking ``and'' at the end of subparagraph 
                  (EE);
                      (B) by inserting ``and'' at the end of subparagraph 
                  (FF); and
                      (C) by inserting at the end the following new 
                  subparagraph:
              ``(GG) home infusion therapy (as defined in subsection 
          (iii)(1));''; and
              (2) by adding at the end the following new subsection:
  
                          ``Home Infusion Therapy
  
      ``(iii)(1) The term `home infusion therapy' means the items and 
  services described in paragraph (2) furnished to an individual, who is 
  under the care of a physician, which are provided by a qualified home 
  infusion therapy supplier under a plan (for furnishing such items and 
  services to such individual) established and periodically reviewed by a 
  physician, which items and services are provided in an integrated 
  manner in the individual's home in conformance with uniform standards 
  of care established by the Secretary and in coordination with the 
  provision of covered infusion drugs under part D. The Secretary shall 
  establish such standards after taking into account the standards 
  commonly used for home infusion therapy by Medicare Advantage plans and 
  in the private sector and after consultation with all interested 
  stakeholders.
      ``(2) The items and services described in this paragraph are the 
  following:
              ``(A) Professional services, including nursing services 
          (other than nursing services covered as home health services), 
          provided in accordance with the plan (including administrative, 
          compounding, dispensing, distribution, clinical monitoring, and 
          care coordination services) and all necessary supplies and 
          equipment (including medical supplies such as sterile tubing 
          and infusion pumps).
              ``(B) Other items and services the Secretary determines 
          appropriate to administer infusion drug therapies to an 
          individual safely and effectively in the home.
      ``(3) For purposes of this subsection:
              ``(A) The term `home' means a place of residence used as an 
          individual's home and includes such other alternate settings as 
          the Secretary determines.
              ``(B) The term `qualified home infusion therapy supplier' 
          means any pharmacy, physician, or other provider licensed by 
          the State in which the pharmacy, physician, or provider resides 
          or provides services, whose State authorized scope of practice 
          includes dispensing authority and that--
                      ``(i) has expertise in the preparation of 
                  parenteral medications in compliance with enforceable 
                  standards of the United States Pharmacopoeia and other 
                  nationally recognized standards that regulate 
                  preparation of parenteral medications as determined by 
                  the Secretary and meets such standards;
                      ``(ii) provides infusion therapy to patients with 
                  acute or chronic conditions requiring parenteral 
                  administration of drugs and biologicals administered 
                  through catheters or needles, or both, in a home; and
                      ``(iii) meets such other uniform requirements as 
                  the Secretary determines are necessary to ensure the 
                  safe and effective provision and administration of home 
                  infusion therapy on a 7-day-a-week, 24-hour basis 
                  (taking into account the standards of care for home 
                  infusion therapy established by Medicare Advantage 
                  plans and in the private sector), and the efficient 
                  administration of the home infusion therapy benefit.
      ``(4) A qualified home infusion therapy supplier may subcontract 
  with a pharmacy, physician, provider, or supplier to meet the 
  requirements of paragraph (3)(B).''.
      (b) Payment for Home Infusion Therapy.--Section 1834 of the Social 
  Security Act (42 U.S.C. 1395m) is amended by adding at the end the 
  following new subsection:
      ``(p) Payment for Home Infusion Therapy.--
              ``(1) In general.--The Secretary shall determine a per diem 
          schedule for payment for the professional services (including 
          nursing services), supplies, and equipment described in section 
          1861(iii)(2)(A) for each infusion therapy type that reflects 
          the reasonable costs which must be incurred by efficiently and 
          economically operated qualified home infusion therapy suppliers 
          to provide such services, supplies, and equipment in conformity 
          with applicable State and Federal laws, regulations, and the 
          uniform quality and safety standards developed under section 
          1861(iii)(1) and to assure that Medicare beneficiaries have 
          reasonable access to such therapy.
              ``(2) Considerations.--In developing the per diem schedule 
          under this subsection, the Secretary shall consider recent 
          credible studies about the costs of providing infusion therapy 
          in the home, consult with home infusion therapy suppliers, 
          consider payment amounts established by Medicare Advantage 
          plans and private payers for home infusion therapy, and, if 
          necessary, conduct a statistically valid national market 
          analysis involving the costs of administering infusion drugs 
          and of providing professional services necessary for the drugs' 
          administration.
              ``(3) Annual updates.--The Secretary shall update such 
          schedule from year to year by the percentage increase in the 
          Consumer Price Index for all urban consumers (United States 
          city average) for the 12-month period ending with June of the 
          preceding year. The Secretary may modify the per diem schedule 
          with respect to beneficiaries who qualify for home infusion 
          therapy services under section 1861(iii)(1) but who receive 
          nursing services as home health services.''.
      (c) Conforming Amendments.--
              (1) Payment reference.--Section 1833(a)(1) of the Social 
          Security Act (42 U.S.C. 13951(a)(1)) is amended--
                      (A) by striking ``and'' before ``(Z)''; and
                      (B) by inserting before the semicolon at the end 
                  the following: ``, and (AA) with respect to home 
                  infusion therapy, the amounts paid shall be determined 
                  under section 1834(p)''.
              (2) Direct payment.--The first sentence of section 
          1842(b)(6) of the Social Security Act (42 U.S.C. 1395u(b)(6)) 
          is amended--
                      (A) by striking ``and'' before ``(H)''; and
                      (B) by inserting before the period at the end the 
                  following: ``, and (I) in the case of home infusion 
                  therapy, payment shall be made to the qualified home 
                  infusion therapy supplier''.
              (3) Exclusion from durable medical equipment and home 
          health services.--Section 1861 of the Social Security Act (42 
          U.S.C. 1395x) is amended--
                      (A) in subsection (m)(5)--
                              (i) by striking ``and'' before ``durable 
                          medical equipment'' and inserting a comma; and
                              (ii) by inserting before the semicolon at 
                          the end the following: ``, and supplies used in 
                          the provision of home infusion therapy after 
                          excluding other drugs and biologicals''; and
                      (B) in subsection (n), by adding at the end the 
                  following: ``Such term does not include home infusion 
                  therapy, other than equipment and supplies used in the 
                  provision of insulin.''.
              (4) Application of accreditation provisions.--The 
          provisions of section 1865(a) of the Social Security Act (42 
          U.S.C. 1395bb(a)) apply to the accreditation of qualified home 
          infusion therapy suppliers in the same way as they apply to 
          other suppliers.
  
  SEC. 4. MEDICARE COVERAGE OF HOME INFUSION DRUGS.
  
      Section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-
  102(e)) is amended--
              (1) in paragraph (1)--
                      (A) by striking ``or'' at the end of subparagraph 
                  (A);
                      (B) by striking the comma at the end of 
                  subparagraph (B) and inserting, ``; or''; and
                      (C) by inserting after subparagraph (B) the 
                  following new subparagraph:
                      ``(C) an infusion drug (as defined in paragraph 
                  (5)),''; and
              (2) by adding at the end the following new paragraph:
              ``(5) Infusion drug defined.--For purposes of this part, 
          the term `infusion drug' means a parenteral drug or biological 
          administered via an intravenous, intraspinal, intra-arterial, 
          intrathecal, epidural, subcutaneous, or intramuscular access 
          device or injection, and may include a drug used for catheter 
          maintenance and declotting, a drug contained in a device, 
          additives including but not limited to vitamins, minerals, 
          solutions, and diluents, and other components used in the 
          provision of home infusion therapy.''.
  
  SEC. 5. ENSURING BENEFICIARY ACCESS TO HOME INFUSION THERAPY.
  
      (a) Objectives in Implementation.--The Secretary of Health and 
  Human Services shall implement the Medicare home infusion therapy 
  benefit under the amendments made by this Act in a manner that ensures 
  that Medicare beneficiaries have timely and appropriate access to 
  infusion therapy in their homes and that there is rapid and seamless 
  coordination between drug coverage under part D of title XVIII of the 
  Social Security Act and coverage for home infusion therapy services 
  under part B of such title to avoid the filing of duplicative or 
  otherwise improper claims. Specifically, the Secretary shall ensure 
  that--
              (1) the benefit is practical and workable with minimal 
          administrative burden for beneficiaries, qualified home 
          infusion therapy suppliers, physicians, prescription drug 
          plans, MA-PD plans, and Medicare Advantage plans, and the 
          Secretary shall consider the use of consolidated claims 
          encompassing covered part D drugs and part B services, 
          supplies, and equipment under such part B to ensure the 
          efficient operation of this benefit;
              (2) any prior authorization or utilization review process 
          is expeditious, allowing Medicare beneficiaries meaningful 
          access to home infusion therapy;
              (3) medical necessity determinations for home infusion 
          therapy will be made--
                      (A) except as provided in subparagraph (B), by 
                  Medicare administrative contractors under such part B 
                  and communicated to the appropriate prescription drug 
                  plans; or
                      (B) in the case of an individual enrolled in a 
                  Medicare Advantage plan, by the Medicare Advantage 
                  organization offering the plan; and an individual may 
                  be initially qualified for coverage for such benefit 
                  for a 90-day period and subsequent 90-day periods 
                  thereafter;
              (4) except as otherwise provided in this section, the 
          benefit is modeled on current private sector coverage and 
          coding for home infusion therapy; and
              (5) prescription drug plans and MA-PD plans structure their 
          formularies, utilization review protocols, and policies in a 
          manner that ensures that Medicare beneficiaries have timely and 
          appropriate access to infusion therapy in their homes.
      (b) Report.--Not later than January 1, 2018, the Comptroller 
  General of the United States shall submit a report to Congress on 
  Medicare beneficiary access to home infusion therapy. Such report shall 
  specifically address whether the objectives specified in subsection (a) 
  have been met and shall make recommendations to Congress and the 
  Secretary of Health and Human Services on how to improve the benefit 
  and better ensure that Medicare beneficiaries have timely and 
  appropriate access to infusion therapy in their homes.
  
  SEC. 6. EFFECTIVE DATE.
  
      The amendments made by this Act shall apply to home infusion 
  therapy furnished on or after January 1, 2015.
target: Medicare Home Infusion Site of Care Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to authorize Medicare coverage of home infusion therapy and home infusion drugs. Directs the Secretary of Health and Human Services (HHS) to implement the Medicare home infusion therapy benefit in a manner that ensures that: (1) Medicare beneficiaries have timely and appropriate access to infusion therapy in their homes, and (2) there is rapid and seamless coordination between drug coverage under Medicare part D (Voluntary Prescription Drug Benefit Program) and home infusion therapy services coverage under Medicare part B (Supplemental Security Income) (SSI) to avoid the filing of duplicative or otherwise improper claims.
feat_title: Medicare Home Infusion Site of Care Act of 2014