[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4473 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4473
To amend title XVIII of the Social Security Act to provide for site
neutral payment for cancer care services under part B of the Medicare
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 6, 2023
Mr. Arrington (for himself, Mrs. Lesko, and Mr. Burgess) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for site
neutral payment for cancer care services under part B of the Medicare
program.
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 ``Medicare Patient Access to Cancer
Treatment Act''.
SEC. 2. FINDINGS; SENSE OF CONGRESS.
(a) Findings.--Congress finds the following:
(1) In January 2019, there were an estimated 16.9 million
people in the United States with a history of cancer and that
number is expected to increase to 22.2 million in 2030.
(2) In 2018, national expenditures for cancer care were an
estimated $150.8 billion.
(3) The United States is recognized as a leader in
developing new cancer treatments and providing high-quality
care for patients receiving cancer care.
(4) Cancer survival rates for all rare cancers is 17
percent higher in the United States than in Europe.
(5) More than half of the people in the United States with
cancer receive treatment in the community cancer setting.
(6) Over the past 10 years, there has been a shift in
outpatient cancer care from the physician's office to hospital
outpatient departments.
(7) In June 2022, a MedPAC report found that the hospital
outpatient department (HOPD) share of office visits provided to
fee for service beneficiaries grew from 9.6 percent in 2012 to
13.1 percent in 2019, and the HOPD share of chemotherapy
administration services rose from 35.2 percent to 50.9 percent.
(8) This shift in care was partially the result of the
increase in consolidation among healthcare providers.
(9) 48,400 additional physicians left independent practice
and became employees of hospitals or other corporate entities,
and 22,700 of that growth occurred after the onset of COVID-19,
resulting in a 12 percent increase in employment.
(10) The consolidation of healthcare practices and the
resulting shift in care to hospital settings has increased
costs for Medicare beneficiaries by $150 million and the
Medicare program by $615 million between 2015 and 2019.
(11) This shift in care has increased costs for patients
but has not been accompanied by improved quality of care.
(12) A 2019 study found that average price for a level 5
drug administration visit increased 57 percent in outpatient
settings from 2009 to 2017 but only 15 percent in office
settings.
(13) If payment rates between settings were aligned
Medicare program spending in 2019 would have declined by $6.6
billion and beneficiary cost-sharing obligations by $1.7
billion.
(b) Sense of Congress.--It is the sense of Congress that, to ensure
the future of community cancer care, Medicare reimbursement should be
equal for the same service provided to a cancer patient regardless of
whether the service is delivered in the hospital outpatient department
or physician's office.
SEC. 3. SITE NEUTRAL PAYMENT FOR CANCER CARE SERVICES UNDER MEDICARE
PART B.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is
amended--
(1) in paragraph (1)(B)--
(A) in clause (iv), by striking ``; and'' and
inserting a semicolon;
(B) in clause (v), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vi) does not include cancer care
services (as defined in paragraph (23)(A)) that
are furnished during 2025 or a subsequent
year.''; and
(2) by adding at the end the following new paragraph:
``(23) Site neutral payment for cancer care services.--
``(A) Cancer care services defined.--For purposes
of paragraph (1)(B)(vi) and this paragraph, the term
`cancer care services' means services specified by the
Secretary--
``(i) that without application of this
paragraph or paragraph (1)(B)(vi), would be
payable under this subsection or pursuant to
paragraph (21);
``(ii) that are furnished in conjunction
with the diagnosis or treatment of cancer; and
``(iii) for which payment may be made under
section 1848(b) if such services were furnished
in a physician office setting.
``(B) Payment.--Payment for cancer care services
shall be made in the same manner and to the same extent
as payment is made pursuant to paragraph (21)(C) under
the applicable payment system described in such
paragraph with respect to applicable items and services
furnished by an off-campus outpatient department of a
provider that are described in paragraph (1)(B)(v).''.
<all>