Medicare to pay same rate for same care, regardless of setting

What it does

This bill requires Medicare to pay the same rate for the same medical services regardless of where they are performed—whether in a hospital outpatient department, an ambulatory surgical center, or another appropriate setting—starting in 2027. The Secretary of Health and Human Services must identify at least 66 types of services eligible for this 'site-neutral' payment approach, with exceptions for emergency and critical care visits, and must consider recommendations from the Medicare Payment Advisory Commission.

Why we flagged it

The bill is a straightforward structural reform of Medicare's ambulatory payment system, designed to align reimbursement rates across different care settings and reduce cost-shifting incentives. It is not a carve-out, subsidy, or narrow beneficiary provision—it is a broad payment-policy change affecting how Medicare reimburses services.

What the text implies

• Hospital outpatient departments may face revenue pressure if site-neutral rates are set below current HOPD payment levels, potentially affecting hospital financial margins and investment in outpatient infrastructure.
• Ambulatory surgical centers (ASCs) may gain market share if site-neutral rates are set closer to ASC levels, which are typically lower than HOPD rates, creating competitive advantage for independent surgical centers.
• The Secretary's discretion to identify 'other settings' and add services via rulemaking creates ongoing regulatory uncertainty for providers and may lead to phased implementation disputes.
• Emergency and critical care carve-outs preserve higher payment for hospital-based emergency services, potentially creating a two-tier system where emergency/trauma care remains location-dependent while routine services become site-neutral.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Patients and Medicare beneficiaries benefit from lower payment rates for the same services, reducing out-of-pocket costs and slowing Medicare spending growth. The policy removes financial incentives for hospitals to perform procedures in higher-cost outpatient settings, directing care to more efficient venues and improving price transparency across settings.

Who stands to gain

• Medicare beneficiaries (lower cost-sharing on affected services)
• Ambulatory surgical centers (potential market-share gain if rates favor ASC pricing)
• Federal government / Medicare Trust Fund (reduced spending on site-neutral services)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare Payment Advisory Commission (MedPAC), Hospital outpatient departments (HOPDs), Ambulatory surgical centers (ASCs), Social Security Act Section 1834, 1833, 1848

Where it stands

• May 6, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• May 6, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 2 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $650,000 in lobbying spend. A filing names 24 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

John Kennedy, the sponsor, reported $113,800 in PAC receipts in the 2026 cycle.

• Blood Cancer United (fka the Leukemia & Lymphoma Society) — $590,000 on 1 filing
• Ambulatory Surgery Center Association — $60,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.