,,ii  #aaith ,,congress  #ast ,session  
,s4 #afbi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #f1 #bjbe 
,mr4 ,kennedy introduced the following  
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to amend title ,,xviii of the ,social
 ,security ,act to align ,medicare      
fee-for-service payment rates across    
ambulatory settings4  #a4  ,short title 
,this ,act may be cited as the ,same    
,care1 ,lower ,cost ,act4  #b4          
,aligning ,medicare fee-for-service     
payment rates across ambulatory settings
  7a7  ,in general  ,section #ahcd of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7 is amended by adding  
at the end the following new subsection3
  7aa7  ,site neutral payments for      
certain services furnished in ambulatory
 settings  7#a7  ,in general  ,for items
 and services furnished in a specified  
ambulatory setting during #bjbg or a    
subsequent year and included in an      
ambulatory payment classifications      

identified pursuant to paragraph 7#b7   
for such year1 payment under this part  
shall be made at the applicable site    
neutral payment rate under this part 7as
 determined by the ,secretary7 if the   
requirements for such payment are       
otherwise met4  7#b7  ,identification of
 services to which site neutral payments
 apply  ,for #bjbg and subsequent years3
  7,a7  ,identification  7i7  ,in       
general  ,the ,secretary shall identify 
not fewer than #ff ambulatory payment   
classifications for site neutral        
payments which are appropriately        
furnished in either a hospital          
outpatient department1 ambulatory       
surgical center1 or other setting       
determined appropriate by the           
,secretary4  7ii7  ,additional ,a,p,cs  
,the ,secretary may add additional      
ambulatory payment classifications to   
those identified under clause 7i7 as the
 ,secretary determines clinically       
appropriate  7,b7  ,exception  ,the     
,secretary shall reclassify the         

ambulatory payment classifications for  
emergency department visits1 critical   
care visits1 and trauma care visits at a
 hospital outpatient department as      
,comprehensive ,a,p,cs1 in which all the
 items and services on the same claim   
are packaged into a single payment unit4
 ,any item or service that is provided  
with such a visit so reclassified shall 
not be treated as an item or service    
identified under subparagraph 7,a71 and 
shall not be subject to the provisions  
of paragraph 7#a74 ,the ,secretary may1 
pursuant to rulemaking1 specify         
exceptions to any reclassification under
 the first sentence of this             
subparagraph4  7#c7  ,consideration of  
,med,p,a,c recommendations  ,in carrying
 out this subsection 7including the     
identification of services under        
paragraph 7#b771 the ,secretary shall   
take into consideration the             
recommendations of the ,medicare        
,payment ,advisory ,commission in       
,chapter #h 7entitled ,aligning         

fee-for-service payment rates across    
ambulatory settings7 of its ,medicare   
and the ,health ,care ,delivery ,system 
report submitted to ,congress in ,june  
#bjbc4  7#d7  ,definition of specified  
ambulatory setting  ,in this subsection1
 the term specified ambulatory setting  
means a hospital outpatient department1 
ambulatory surgical center1 or other    
setting determined appropriate by the   
,secretary4  4  7b7  ,conforming        
amendments  7#a7  ,payment system for   
ambulatory surgical center services     
,section #ahcc7;i77#b77;,d77i7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7i77#b77;,d77i77 is amended by    
striking for payment and inserting for1 
subject to section #ahcd7;aa71 payment4 
7#b7  ,,hopd fee schedule  ,section     
#ahcc7t7 of the ,social ,security ,act  
7#db ,u4,s4,c4 #aciel7t77 is amended--  
7,a7 in paragraph 7#a77;,a71 by striking
 the amount of payment and inserting    
subject to section #ahcd7;aa71 the      
amount of payment2 and  7,b7 in         

paragraph 7#i77;,b71 by adding at the   
end the following3 ,in determining      
adjustments under this subparagraph for 
#bjbg or a subsequent year1 the         
,secretary shall not take into account  
under this subparagraph or paragraph    
7#b77;,e7 any changes in expenditures as
 a result of the application of section 
#ahcd7;aa74  7#c7  ,physician fee       
schedule  ,section #ahdh7;a77#a77;,b7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#d7;a77#a77;,b77 is    
amended by inserting and section        
#ahcd7;aa7 after succeeding provisions  
of this subsection4