Same Care, Lower Cost Act
Sponsored By: Senator John Kennedy
Introduced
Summary
Would create site-neutral Medicare Part B payments for many ambulatory services. It would align payment rates across hospital outpatient departments and ambulatory surgical centers starting in 2027.
Show full summary
- Hospitals, ambulatory surgical centers, and other specified ambulatory settings would be paid a site-neutral rate for services identified in certain ambulatory payment classifications. The Secretary would identify no fewer than 66 APCs for 2027 and may add more as clinically appropriate.
- Emergency department visits, critical care visits, and trauma visits at hospital outpatient departments would be reclassified as Comprehensive APCs. All items and services on the same claim for those visits would be packaged into one payment and excluded from the site-neutral APC list.
- The bill would direct the Secretary to consider the Medicare Payment Advisory Commission recommendations in MedPAC’s June 2023 Chapter 8 report when selecting APCs. It would also prohibit the Secretary from counting spending changes resulting from the site-neutral rule when calculating certain payment adjustments for 2027 and later.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
Medicare: same pay for outpatient care
This bill would make many Medicare outpatient services paid the same no matter where you get them. It would start in 2027. The Secretary would have to pick at least 66 ambulatory payment classifications (APCs) for site-neutral rates. The Secretary could add more APCs as clinically appropriate and must consider MedPAC's June 2023 recommendations. Emergency, critical care, and trauma visits in hospital outpatient departments would be reclassified and excluded from the site-neutral rule. If your service moves to a lower-cost setting, you might pay less in cost-sharing. The bill would also make technical changes so several Medicare payment formulas are treated as subject to the new site-neutral rule.
Sponsors & CoSponsors
Sponsor
John Kennedy
LA • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in