“A bill to amend title XVIII of the Social Security Act to align Medicare fee-for-service payment rates across ambulatory settings.”
No CRS summary available for this bill.
This section establishes site-neutral Medicare Part B payment rates (i.e., uniform rates across care settings such as hospital outpatient departments, ambulatory surgical centers, or other appropriate settings) for items and services in at least 66 ambulatory payment classifications (APCs) identified by the Secretary beginning in 2027. (1) requires the Secretary to identify APCs appropriately furnished in such settings and consider MedPAC recommendations from its June 2023 report, with authority to add more APCs; (2) excludes and reclassifies emergency department visits, critical care visits, and trauma care visits as Comprehensive APCs (packaging all claim items and services into a single payment); and (3) makes conforming amendments to the ASC payment provision (42 U.S.C. 1395l(i)), HOPD prospective payment system (42 U.S.C. 1395l(t))—directing that 2027+ expenditure changes from site-neutral payments not affect certain adjustments—and physician fee schedule (42 U.S.C. 1395w-4(a)). (As background, site-neutral payments address Medicare's historically higher rates for equivalent services furnished in hospital outpatient departments compared to physician offices or ASCs.)