Medicare Coverage of External Infusion Pumps and Non-Self-Administrable Home Infusion Drugs
Section 6222 · Sec. 6222 ·
What this chapter is about
This part lets a pump used at home count as home equipment even if it would not otherwise meet the home use test. Three things must all be true. It also tells the health chief to make sure patients know what home infusion costs them.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6222 in the PDF
What the document says
“an external infusion pump and associated home infusion drug (as defined in subsection (iii)(3)(C)) or other associated supplies that do not meet the appropriate for use in the home requirement applied to the definition of durable medical equipment under section 414.202 of title 42, Code of Federal Regulations (or any successor to such regulation) shall be treated as meeting such requirement if each of the following criteria is satisfied:”
Subsection (a) of section 6222 adds a sentence to section 1861(n) of the Social Security Act. Beginning with the first calendar quarter starting on or after one year from enactment, an external infusion pump and its associated home infusion drug or supplies that do not meet the appropriate for use in the home requirement are treated as meeting it where all three criteria are satisfied.
What the document actually says
“an external infusion pump and associated home infusion drug (as defined in subsection (iii)(3)(C)) or other associated supplies that do not meet the appropriate for use in the home requirement applied to the definition of durable medical equipment under section 414.202 of title 42, Code of Federal Regulations (or any successor to such regulation) shall be treated as meeting such requirement if each of the following criteria is satisfied:”
That sentence, in plain words
A pump and its drug may not pass the test for home use gear. They still count as passing if all the things listed next are true.
What this is about
An infusion pump pushes a drug into the body over time. Some drugs need a trained person to run it. That once kept the pump from counting as home gear.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “requires”Who acts: qualified home infusion therapy suppliersHow: statuteSec. 6222 in the PDF
What the document says
“``(2) A qualified home infusion therapy supplier (as defined in subsection (iii)(3)(D)) administers or supervises the administration of the drug or biological in a safe and effective manner in the patient's home (as defined in subsection (iii)(3)(B)).”
The three criteria are that the prescribing information approved by the Food and Drug Administration says the drug should be given by or under the supervision of a health care professional, that a qualified home infusion therapy supplier gives or supervises the drug safely and effectively in the patient's home, and that the prescribing information calls for at least 12 infusions a year, either into a vein or under the skin or at rates the Secretary finds would need an external pump.
What the document actually says
“``(2) A qualified home infusion therapy supplier (as defined in subsection (iii)(3)(D)) administers or supervises the administration of the drug or biological in a safe and effective manner in the patient's home (as defined in subsection (iii)(3)(B)).”
That sentence, in plain words
A qualified home infusion supplier gives the drug or watches over it. This happens in the patient's home. It must be done in a safe way.
What this is about
The first test is what the drug label says. The second is who runs the pump. The third is how often the drug is given in a year.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6222 in the PDF
What the document says
“The Secretary of Health and Human Services shall ensure that patients are notified of the cost sharing for electing home infusion therapy compared to other applicable settings of care for the furnishing of infusion drugs under the Medicare program.”
Subsection (b) of section 6222 requires the Secretary of Health and Human Services to ensure that patients are told what cost sharing applies if they choose home infusion therapy, set against what applies in other settings of care.
What the document actually says
“The Secretary of Health and Human Services shall ensure that patients are notified of the cost sharing for electing home infusion therapy compared to other applicable settings of care for the furnishing of infusion drugs under the Medicare program.”
That sentence, in plain words
The health chief must make sure patients are told what home care costs them. The cost is set next to what other places would cost.
What this is about
Cost sharing is the part a patient pays. The same drug can cost different amounts in different places. A patient choosing needs to know that.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The two things the section does: add a sentence to section 1861(n) of the Social Security Act deeming the home use requirement met where three criteria are satisfied, and require notification of cost sharing.
Nothing else in the section.
The section amends the Social Security Act and points at a section of the Code of Federal Regulations for the definition of durable medical equipment. Neither is indexed here.
