More Members of Congress Sign-On to Home Infusion Legislation
Following NHIA’s Hill Day, eight more members of Congress have signed on as legislative sponsors of the Preserving Patient Access to Home Infusion Act. To date, Rep. Blake Moore (R-UT), Rep. Madeleine Dean (D-PA), Rep. Burgess Owens (R-UT), Rep. Danny Davis (D-IL), Rep. Doris Matsui (D-CA), Rep. Greg Stanton (D-AZ), Rep. Darren Soto (D-IL), and Rep. Ted Lieu (D-CA) have joined the bipartisan, geographically diverse coalition supporting Medicare home infusion coverage. Thanks to these champions and to the NHIA members who reach out to their representatives for support. Learn more. | Write a letter to your representatives.
NY Gov. Hochul Signs Pharmacy Technician Bill into Law
New York Governor Kathy Hochul has signed legislation that expands sterile compounding capabilities to pharmacy technicians in all pharmacy sites, under the supervision of a licensed pharmacist. Previously, only technicians working in hospitals, or hospital-owned entities were able to perform sterile compounding. NHIA led efforts in NY state for the past several years to expand the sites where technicians can perform compounding to include home infusion providers. Ultimately, pressure from multiple groups led to a full exemption being enacted. Learn more.
CMS to Terminate ESRD Treatment Choices Model
CMS issued a final rule to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2026. After reviewing multiple years of evaluation reports, the agency determined that the ESRD Treatment Choices Model was not showing the quality results around home dialysis and transplant waitlisting or the expenditure savings that were initially projected, leading it to propose model termination. Read the announcement.
Medi-Cal Rx Reverses PAD Policy
Medi-Cal Rx, the prescription drug program for California Medicaid, has implemented changes to its physician-administered drugs (PAD) policy. The changes were effective on October 17; pharmacy providers can resubmit previously denied claims that were initially submitted on or after October 17, 2025, for which there was a prior paid claim within the 450-day lookback period. If the claim continues to be denied, submit a new prior authorization (PA) request or submit the claim to the member’s medical benefit for coverage considerations. Read the announcement.
2026 MA Plans Increase OOP Limits, Decrease Supplemental Benefits
A new analysis of 2026 Medicare Advantage plans found that while premiums are holding steady, some seniors will face higher out-of-pocket limits, fewer lower-cost options, and scaled-back supplemental benefits. The national median maximum out-of-pocket (MOOP) increased 9.3% from $5,400 in 2025 to $5,900 in 2026. Median MOOP levels will increase in 38 states and Washington, DC. In addition, the percent of individual plans offering at least one special supplemental benefit for the chronically ill, such as food, non-medical transportation, and housing, will decrease in 2026, while the percent of special needs plans offering at least one of these benefits will be consistent with 2025. Access the report.