I 
118TH CONGRESS 
1ST SESSION H. R. 4473 
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. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 6, 2023 
Mr. ARRINGTON (for himself, Mrs. LESKO, and Mr. BURGESS) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Patient Ac-
cess to Cancer Treatment Act’’. 
SEC. 2. FINDINGS; SENSE OF CONGRESS. 
(a) FINDINGS.—Congress finds the following: 
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(1) In January 2019, there were an estimated 
16.9 million people in the United States with a his-
tory of cancer and that number is expected to in-
crease to 22.2 million in 2030. 
(2) In 2018, national expenditures for cancer 
care were an estimated $150.8 billion. 
(3) The United States is recognized as a leader 
in developing new cancer treatments and providing 
high-quality care for patients receiving cancer care. 
(4) Cancer survival rates for all rare cancers is 
17 percent higher in the United States than in Eu-
rope. 
(5) More than half of the people in the United 
States with cancer receive treatment in the commu-
nity cancer setting. 
(6) Over the past 10 years, there has been a 
shift in outpatient cancer care from the physician’s 
office to hospital outpatient departments. 
(7) 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 admin-
istration services rose from 35.2 percent to 50.9 per-
cent. 
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(8) This shift in care was partially the result of 
the increase in consolidation among healthcare pro-
viders. 
(9) 48,400 additional physicians left inde-
pendent practice and became employees of hospitals 
or other corporate entities, and 22,700 of that 
growth occurred after the onset of COVID–19, re-
sulting in a 12 percent increase in employment. 
(10) 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. 
(11) This shift in care has increased costs for 
patients but has not been accompanied by improved 
quality of care. 
(12) A 2019 study found that average price for 
a level 5 drug administration visit increased 57 per-
cent in outpatient settings from 2009 to 2017 but 
only 15 percent in office settings. 
(13) 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. 
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(b) SENSE OF CONGRESS.—It is the sense of Con-
gress 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 depart-
ment or physician’s office. 
SEC. 3. SITE NEUTRAL PAYMENT FOR CANCER CARE SERV-
ICES UNDER MEDICARE PART B. 
Section 1833(t) of the Social Security Act (42 U.S.C. 
1395l(t)) is amended— 
(1) in paragraph (1)(B)— 
(A) in clause (iv), by striking ‘‘; and’’ and 
inserting a semicolon; 
(B) in clause (v), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) 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 subse-
quent year.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(23) SITE NEUTRAL PAYMENT FOR CANCER 
CARE SERVICES.— 
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‘‘(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 pursu-
ant 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 pursu-
ant 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 depart-
ment of a provider that are described in para-
graph (1)(B)(v).’’. 
Æ 
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