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