S. 1629: Same Care, Lower Cost Act

This bill, known as the Same Care, Lower Cost Act, aims to change how Medicare pays for certain medical services provided in different outpatient facilities, such as hospital outpatient departments and ambulatory surgical centers. The primary focus is to create a more uniform payment system for similar services across various ambulatory settings. Here’s a summary of the key points:

Aligning Medicare Payments

The bill proposes amendments to Section 1834 of the Social Security Act. It introduces a concept called "site neutral payments." This means that for specific medical services provided in various outpatient settings starting in 2027, Medicare will pay the same amount regardless of where the service is delivered, as long as the services meet certain criteria.

Identification of Services

• The Secretary of Health and Human Services will need to determine at least 66 different categories of services that fall under these site neutral payments.
• These categories will include services that can be offered in places like ambulatory surgical centers, hospital outpatient departments, or any other facility deemed appropriate.
• The Secretary may add more services to this list as deemed clinically suitable.

Exceptions

There will be some exceptions to the site neutral payments. For example, comprehensive payments will be used for emergency department visits, critical care visits, and trauma care visits in hospital outpatient departments. In these cases, the payment will cover all related services as a single unit, rather than paying separately for each item or service provided.

Considerations for Service Identification

When identifying which services will receive site neutral payments, the Secretary must consider recommendations from the Medicare Payment Advisory Commission, specifically those related to aligning payment rates across various outpatient settings.

Conforming Amendments