H.R. 8032

[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

_______________________________________________________________________

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).''.
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