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HR 8528

PI Post Acute Access Act

119th Congress Introduced by Josh Gottheimer and 3 co-sponsors

Extends Medicare SNF coverage to include IVIG for primary immunodeficiency patients, enabling post-acute treatment in SNFs starting Oct 1, 2026.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 8528

Bill Overview

  • Bill: H.R. 8528
  • Session: 119th Congress
  • Title: PI Post Acute Access Act
  • Core aim: Amend Medicare law to improve access to skilled nursing facilities (SNFs) for patients with primary immunodeficiency diseases (PI).

Purpose and Intent

  • The bill seeks to expand coverage under title XVIII of the Social Security Act (Medicare) to ensure that individuals with primary immunodeficiency (PI) have greater access to SNF services and related items and services after acute care.
  • Specifically, it adds intravenous immune globulin (IVIG) indicated for the treatment of PI as a covered item, along with items and services necessary to furnish IVIG, under the SNF benefit.

Key Provisions

  • Amendment to: Section 1888(e)(2)(A)(iii) of the Social Security Act (Medicare SNF billing/coverage provisions).
  • New addition (sub-clause VII) to the list of covered items and services:
    • Intravenous immune globulin indicated for the treatment of primary immune deficiency disease (PI).
    • HCPCS codes identified as of January 1, 2026: J1561, J1569, J1576, J1568, J1459, J1554, J1557, J1566.
    • Authority for the Secretary to modify these codes as needed.
    • Coverage extends to items and services related to furnishing IVIG for PI treatment.
  • Effective date:
    • Applies to items and services furnished on or after October 1, 2026.

Who/What Is Affected

  • Beneficiaries: Medicare beneficiaries diagnosed with primary immunodeficiency diseases who require IVIG therapy and post-acute SNF care.
  • Providers: Skilled nursing facilities and other covered entities furnishing SNF services that include IVIG administration and related supplies/services.
  • Payers/Administrators: Medicare program (Medicare Advantage plans providers may reference) implementing coverage for IVIG under SNF post-acute care.

Procedural and Timeline Aspects

  • Referred to: House Ways and Means Committee and House Energy and Commerce for consideration (jurisdictional review and potential further action).
  • Introduction/date: April 27, 2026.
  • Effective implementation: Coverage changes take effect for services furnished on or after October 1, 2026.
  • Administrative note: The Secretary is tasked with maintaining and updating the HCPCS codes as needed to reflect current coding standards and practice.

Potential Impact and Considerations

  • Access: Potentially improves access to SNF care for PI patients by ensuring IVIG therapy and related services are covered within the SNF benefit.
  • Cost and utilization: Could affect Medicare expenditure for SNF stays involving PI treatment with IVIG; may influence length of stay, treatment planning, and SNF resource needs.
  • Administrative: Requires ongoing coding updates by the Secretary to align with evolving IVIG products and PI treatment guidelines.
  • Equity and clinical alignment: Aims to align Medicare coverage with clinical practice for PI management, reducing barriers to post-acute IVIG therapy in SNFs.

If you’d like, I can add a plain-language FAQs section or compare this bill to current Medicare policy on PI treatment and SNF coverage.

Compiled from official sources — confirm details with the bill’s official record.

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