119-s1629

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1629 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1629

 To amend title XVIII of the Social Security Act to align Medicare fee-
 for-service payment rates across ambulatory settings.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 May 6, 2025

 Mr. Kennedy introduced the following bill; which was read twice and 
 referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to align Medicare fee-
 for-service payment rates across ambulatory settings.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Same Care, Lower Cost Act''.

SEC. 2. ALIGNING MEDICARE FEE-FOR-SERVICE PAYMENT RATES ACROSS 
 AMBULATORY SETTINGS.

    (a) In General.--

Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following new subsection:
 ``

    (aa) Site Neutral Payments for Certain Services Furnished in 
Ambulatory Settings.--
 ``

    (1) In general.--For items and services furnished in a 
 specified ambulatory setting during 2027 or a subsequent year 
 and included in an ambulatory payment classifications 
 identified pursuant to paragraph

    (2) for such year, payment 
 under this part shall be made at the applicable site neutral 
 payment rate under this part (as determined by the Secretary) 
 if the requirements for such payment are otherwise met.
 ``

    (2) Identification of services to which site neutral 
 payments apply.--For 2027 and subsequent years:
 ``
        (A) Identification.--
 ``
            (i) In general.--The Secretary shall 
 identify not fewer than 66 ambulatory payment 
 classifications for site neutral payments which 
 are appropriately furnished in either a 
 hospital outpatient department, ambulatory 
 surgical center, or other setting determined 
 appropriate by the Secretary.
 ``
            (ii) Additional apcs.--The Secretary may 
 add additional ambulatory payment 
 classifications to those identified under 
 clause
            (i) as the Secretary determines 
 clinically appropriate
 ``
        (B) Exception.--The Secretary shall reclassify 
 the ambulatory payment classifications for emergency 
 department visits, critical care visits, and trauma 
 care visits at a hospital outpatient department as 
 Comprehensive APCs, in which all the items and services 
 on the same claim are packaged into a single payment 
 unit. Any item or service that is provided with such a 
 visit so reclassified shall not be treated as an item 
 or service identified under subparagraph
        (A) , and shall 
 not be subject to the provisions of paragraph

    (1) . The 
 Secretary may, pursuant to rulemaking, specify 
 exceptions to any reclassification under the first 
 sentence of this subparagraph.
 ``

    (3) Consideration of medpac recommendations.--In carrying 
 out this subsection (including the identification of services 
 under paragraph

    (2) ), the Secretary shall take into 
 consideration the recommendations of the Medicare Payment 
 Advisory Commission in Chapter 8 (entitled `Aligning fee-for-
 service payment rates across ambulatory settings') of its 
 `Medicare and the Health Care Delivery System' report submitted 
 to Congress in June 2023.
 ``

    (4) Definition of specified ambulatory setting.--In this 
 subsection, the term `specified ambulatory setting' means a 
 hospital outpatient department, ambulatory surgical center, or 
 other setting determined appropriate by the Secretary.''.

    (b) Conforming Amendments.--

    (1) Payment system for ambulatory surgical center 
 services.--

Section 1833
            (i) (2)
            (D) 
            (i) of the Social Security Act 
 (42 U.S.C. 1395l
            (i) (2)
            (D) 
            (i) ) is amended by striking ``for 
 payment'' and inserting ``for, subject to 

section 1834

    (aa) , 
 payment''.

    (2) HOPD fee schedule.--

Section 1833

    (t) of the Social 
 Security Act (42 U.S.C. 1395l

    (t) ) is amended--
        (A) in paragraph

    (1)
        (A) , by striking ``the amount 
 of payment'' and inserting ``subject to 

section 1834

    (aa) , the amount of payment''; and
        (B) in paragraph

    (9)
        (B) , by adding at the end the 
 following: ``In determining adjustments under this 
 subparagraph for 2027 or a subsequent year, the 
 Secretary shall not take into account under this 
 subparagraph or paragraph

    (2)
        (E) any changes in 
 expenditures as a result of the application of 

section 1834

    (aa) .''

    (3) Physician fee schedule.--

Section 1848

    (a)

    (1)
        (B) of the 
 Social Security Act (42 U.S.C. 1395w-4

    (a)

    (1)
        (B) ) is amended by 
 inserting ``and 

section 1834

    (aa) '' after ``succeeding 
 provisions of this subsection''.
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