Section 1 Short title
This Act may be cited as the “Medicare Patient Access to Cancer Treatment Act”.
Medicare Patient Access to Cancer Treatment Act
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.
Sec. 2 Findings; Sense of Congress
Findings— Congress finds the following:
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.
In 2018, national expenditures for cancer care were an estimated $150.8 billion.
The United States is recognized as a leader in developing new cancer treatments and providing high-quality care for patients receiving cancer care.
Cancer survival rates for all rare cancers is 17 percent higher in the United States than in Europe.
More than half of the people in the United States with cancer receive treatment in the community cancer setting.
Over the past 10 years, there has been a shift in outpatient cancer care from the physician’s office to hospital outpatient departments.
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.
This shift in care was partially the result of the increase in consolidation among healthcare providers.
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.
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.
This shift in care has increased costs for patients but has not been accompanied by improved quality of care.
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.
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.
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—
in paragraph (1)(B)—
in clause (iv), by striking “; and” and inserting a semicolon;
in clause (v), by striking the period at the end and inserting “; and”; and
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.”
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).”