Same Care, Lower Cost Act
The Same Care, Lower Cost Act would add a new site-neutral payment framework to Medicare fee-for-service (FFS). Beginning in 2027 (and for each year after), certain ambulatory services identified in ambulatory payment classifications (APCs) could be paid the same rate regardless of the setting in which they’re delivered (hospital outpatient departments, ambulatory surgical centers, or other settings the Secretary designates). The Secretary would identify at least 66 APCs suitable for site-neutral payments and may add more as clinically appropriate. An exception exists for emergency department visits, critical care, and trauma care in hospital outpatient departments, which would be reclassified into Comprehensive APCs (a bundled single payment for all items and services on the claim). The bill also directs consideration of MedPAC’s recommendations when implementing these changes and would make corresponding conforming amendments to existing payment provisions. The overall aim is to reduce variation in payments across settings to promote consistent care and lower overall costs.
Key Points
- 1Site-neutral payments: Creates a new 1834(aa) provision to pay certain ambulatory items/services at a single site-neutral rate if the service is in a specified ambulatory setting and meets the requirements.
- 2Identification of covered services: Requires the Secretary to identify at least 66 ambulatory payment classifications (APCs) to which site-neutral payments apply, usable in hospital outpatient departments, ambulatory surgical centers, or other appropriate settings; more APCs can be added as clinically appropriate.
- 3High-acuity exception: Emergency department, critical care, and trauma care visits at hospital outpatient departments would be reclassified as Comprehensive APCs with a single bundled payment; items/services tied to those visits would generally not be treated under the site-neutral APCs.
- 4Advisory input: The Secretary must consider recommendations from the Medicare Payment Advisory Commission (MedPAC), specifically its Chapter 8 discussion on aligning fee-for-service payments across ambulatory settings.
- 5Conforming amendments: Adjustments to the payment framework (ASC services, hospital outpatient department fee schedule, and physician fee schedule) to reflect the site-neutral approach and 2027+ considerations, including how expenditures related to 1834(aa) are treated in payment adjustments.