[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4473 Introduced in House (IH)]

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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).''.
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