FAIC Act

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 8032 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 8032

To amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, cancer treatments under the Medicare hospital outpatient prospective payment system.

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IN THE HOUSE OF REPRESENTATIVES

March 20, 2026

Mr. Dunn of Florida (for himself and Mr. Soto) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To amend title XVIII of the Social Security Act to ensure equitable payment for, and preserve Medicare beneficiary access to, cancer treatments under the Medicare hospital outpatient prospective payment system.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Facilitating Access to Innovation in Cancer Care Act'' or the ``FAIC Act''.

SEC. 2. SEPARATE PAYMENT FOR CERTAIN CANCER TREATMENTS.

Section 1833(t)(16) of the Social Security Act (42 U.S.C. 1395(t)(16)) is amended by adding at the end the following new subparagraph: ``(H) Separate payment for certain cancer treatments.-- ``(i) In general.--Notwithstanding any other provision of this subsection, with respect to a specified cancer treatment (as defined in clause (v)) furnished during a year (beginning with 2026), the Secretary shall not package payment for such treatment into a payment for a covered OPD service (or group of services), and shall make a separate payment as specified in clause (ii) for such treatment, if such treatment has an estimated mean per day product cost equal to or exceeding the threshold specified in clause (iii) for such year. ``(ii) Separate payment.--For purposes of clause (i), the separate payment specified in this clause for a specified cancer treatment is a payment in an amount equal to-- ``(I) the average sales price for such treatment established under section 1847A, as calculated and adjusted by the Secretary to the extent such adjustment is adopted for other specified covered outpatient drugs under paragraph (14)(A)(iii)(II); or ``(II) if the data necessary to calculate such average sales price for such treatment is not available, the wholesale acquisition cost (as defined in subsection 1847A(c)(6)(B)) for such treatment, as calculated and adjusted by the Secretary to the extent such adjustment is adopted for other specified covered outpatient drugs under paragraph (14)(A), or, if such wholesale acquisition cost is not available, the mean unit cost for such treatment (as derived from hospital claims data). ``(iii) Threshold.--For purposes of clause (i), the threshold specified in this clause is-- ``(I) for 2026, $350; and ``(II) for a subsequent year, the amount specified in this clause for the preceding year, increased by the OPD fee schedule increase factor under paragraph (3)(C)(iv) for the year. ``(iv) Budget neutrality.--The Secretary shall make such adjustments as are necessary under this subsection to ensure that the amount of expenditures under this subsection for a year with application of this subparagraph is equal to the amount of expenditures that would be made under this subsection for such year without application of this subparagraph. ``(v) Definition.--For purposes of this subparagraph, the term `specified cancer treatment' means a drug or biological that-- ``(I) is approved by the Food and Drug Administration on or after January 1, 2008, for use in the detection or treatment of cancer; ``(II) does not receive transitional pass-through payments under paragraph (6); and ``(III) has payment that would, but for application of this subparagraph, be packaged into a payment for a covered OPD service (or group of services).''. <all>