News & Updates

April 22, 2021

Alliance Commends Site Neutral Provisions in H.R. 19

Advocacy group announces support for the site neutral provisions in the Lower Costs, More Cures Act, which will lower out-of-pocket costs for seniors

WASHINGTON— The Alliance for Site Neutral Payment Reform (Alliance) today lauded House leaders for including site neutral provisions in the recently-introduced Lower Costs, More Cures Act (H.R. 19). The bill – sponsored by Energy and Commerce Committee Republican Leader Cathy McMorris Rodgers (R-WA), Ways and Means Committee Republican Leader Kevin Brady (R-TX), and Education and Labor and Committee Republican Leader Virginia Foxx (R-NC) – would help address serious payment disparities across different sites of service. If passed, the site neutral payment provision would reduce healthcare spending and allow seniors to enjoy lower out-of-pocket costs.

Specifically, Section 105 of the bill would require Medicare Part B drugs to be administered at the lower physician fee schedule rate rather than the rate paid to hospitals. Because Medicare beneficiary cost-sharing is directly related to the Medicare payment rate for the drug and the administration of the drug, this provision will have an immediate impact on out-of-pocket costs for seniors.

Section 101 would also help address payment disparities by expanding information included in an online tool for Medicare beneficiaries to compare costs across hospital outpatient departments (HOPDs), ambulatory surgical centers, and the outpatient prospective payment system. This will help patients better understand the variations in cost by site of care and the impact on their out-of-pocket costs.

Physician-administered drugs treat chronic and complex conditions like cancer, rheumatoid arthritis, multiple sclerosis, and HIV. Costs for physician administration of these treatments vary dramatically according to the site of service. Currently, HOPDs that are exempt from site neutral policies under the Bipartisan Budget Act of 2015 and the 21st Century Cures Act of 2015 are reimbursed at significantly higher rates than independent physician practices for providing the exact same services. For the administration of chemotherapy drugs, for example, the payment to a hospital outpatient facility is more than double the rate paid to a community cancer clinic ($311 vs $148). Consequently, patients are forced to pay higher out-of-pocket costs and employers, Medicare, and taxpayers are burdened by higher costs to the healthcare system.

The Alliance commends the inclusion of the site neutral policies in the Lower Costs, More Cures Act as a commonsense way to lower the cost of prescription drugs. If enacted into law, the site neutral provisions will go a long way towards increasing transparency, lowering out-of-pocket costs for seniors, helping Medicare beneficiaries make more informed decisions about their healthcare, and ending payment disparities that have led to consolidation across the healthcare marketplace.

To read the full text of the bill, CLICK HERE.

To read a summary of each provision in the bill, CLICK HERE.


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