[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8032 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 8032
To amend title XVIII of the Social Security Act to ensure equitable
payment for, and preserve Medicare beneficiary access to, cancer
treatments under the Medicare hospital outpatient prospective payment
system.
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IN THE HOUSE OF REPRESENTATIVES
March 20, 2026
Mr. Dunn of Florida (for himself and Mr. Soto) 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
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A BILL
To amend title XVIII of the Social Security Act to ensure equitable
payment for, and preserve Medicare beneficiary access to, cancer
treatments under the Medicare hospital outpatient prospective payment
system.
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 ``Facilitating Access to Innovation in
Cancer Care Act'' or the ``FAIC Act''.
SEC. 2. SEPARATE PAYMENT FOR CERTAIN CANCER TREATMENTS.
Section 1833(t)(16) of the Social Security Act (42 U.S.C.
1395(t)(16)) is amended by adding at the end the following new
subparagraph:
``(H) Separate payment for certain cancer
treatments.--
``(i) In general.--Notwithstanding any
other provision of this subsection, with
respect to a specified cancer treatment (as
defined in clause (v)) furnished during a year
(beginning with 2026), the Secretary shall not
package payment for such treatment into a
payment for a covered OPD service (or group of
services), and shall make a separate payment as
specified in clause (ii) for such treatment, if
such treatment has an estimated mean per day
product cost equal to or exceeding the
threshold specified in clause (iii) for such
year.
``(ii) Separate payment.--For purposes of
clause (i), the separate payment specified in
this clause for a specified cancer treatment is
a payment in an amount equal to--
``(I) the average sales price for
such treatment established under
section 1847A, as calculated and
adjusted by the Secretary to the extent
such adjustment is adopted for other
specified covered outpatient drugs
under paragraph (14)(A)(iii)(II); or
``(II) if the data necessary to
calculate such average sales price for
such treatment is not available, the
wholesale acquisition cost (as defined
in subsection 1847A(c)(6)(B)) for such
treatment, as calculated and adjusted
by the Secretary to the extent such
adjustment is adopted for other
specified covered outpatient drugs
under paragraph (14)(A), or, if such
wholesale acquisition cost is not
available, the mean unit cost for such
treatment (as derived from hospital
claims data).
``(iii) Threshold.--For purposes of clause
(i), the threshold specified in this clause
is--
``(I) for 2026, $350; and
``(II) for a subsequent year, the
amount specified in this clause for the
preceding year, increased by the OPD
fee schedule increase factor under
paragraph (3)(C)(iv) for the year.
``(iv) Budget neutrality.--The Secretary
shall make such adjustments as are necessary
under this subsection to ensure that the amount
of expenditures under this subsection for a
year with application of this subparagraph is
equal to the amount of expenditures that would
be made under this subsection for such year
without application of this subparagraph.
``(v) Definition.--For purposes of this
subparagraph, the term `specified cancer
treatment' means a drug or biological that--
``(I) is approved by the Food and
Drug Administration on or after January
1, 2008, for use in the detection or
treatment of cancer;
``(II) does not receive
transitional pass-through payments
under paragraph (6); and
``(III) has payment that would, but
for application of this subparagraph,
be packaged into a payment for a
covered OPD service (or group of
services).''.
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