What This Bill Does
This bill changes how Medicare pays ambulatory surgical centers (surgery facilities where patients go home same day). It aligns the payment updates ambulatory surgical centers receive with the payment updates that hospital outpatient departments receive. The bill also requires Medicare to show quality comparisons between ambulatory surgical centers and hospital outpatient departments on Medicare.gov.
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Who It Affects
- Ambulatory surgical centers (medical facilities that perform outpatient surgeries)
- Hospital outpatient departments
- Medicare beneficiaries (people covered by Medicare, the federal health program for seniors and some disabled people)
- The Secretary of Health and Human Services (the federal official who runs Medicare)
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Key Provisions
- Ambulatory surgical centers will receive annual payment updates equal to the outpatient department fee schedule increase factor, starting in 2024 (Sec. 2)
- Medicare must post quality measure data on Medicare.gov allowing side-by-side comparisons between ambulatory surgical centers and hospital outpatient departments in the same geographic area (Sec. 3)
- Ambulatory surgical centers and hospitals must have the opportunity to review and correct their data before it becomes public (Sec. 3)
- Medicare must ensure at least one ambulatory surgical center representative serves on the advisory panel that discusses hospital outpatient payments (Sec. 4)
- When the government excludes a procedure from the ambulatory surgical center approved list, it must explain which criteria from federal regulations it used and cite research if applicable (Sec. 5)
- Patient copayments for ambulatory surgical center procedures cannot exceed the amount of the inpatient hospital deductible (the money patients must pay before insurance covers hospital stays) (Sec. 6)
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What Changes
Starting in 2024, ambulatory surgical centers will receive the same payment increase percentages as hospital outpatient departments each year. Medicare will display comparative quality information about both types of facilities on its public website so patients can compare them. The government must give written reasons when it rejects requests to add new procedures to what ambulatory surgical centers can perform. Patient cost-sharing for ambulatory surgical center procedures will have a cap based on the hospital deductible amount.
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Important Definitions
- **Ambulatory surgical center:** A medical facility where patients have surgery and go home the same day without staying overnight
- **Outpatient department:** A hospital department where patients receive care without staying overnight
- **Copayment:** Money a patient pays directly for a medical service
- **Deductible:** The amount of money a patient must pay before insurance coverage begins
- **Prospective payment system:** A method of paying healthcare providers based on predicted costs rather than actual costs
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Effective Date
The amendment requiring ambulatory surgical center representation on the advisory panel takes effect on the date the bill becomes law (Sec. 4). All other provisions take effect on the date the bill becomes law or on specific dates described for their respective sections (Sec. 2, 5, 7).
II
118TH CONGRESS
1ST SESSION
S. 312
To amend title XVIII of the Social Security Act to modernize payments
for ambulatory surgical centers under the Medicare program, and for
other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY 9, 2023
Mr. BLUMENTHAL (for himself and Mr. CASSIDY) introduced the following
bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to modernize
payments for ambulatory surgical centers under the
Medicare program, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Outpatient Surgery
4
Quality and Access Act of 2023’’.
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SEC. 2. ALIGNING UPDATES FOR AMBULATORY SURGICAL
1
CENTER SERVICES WITH UPDATES FOR OPD
2
SERVICES.
3
Section 1833(i)(2)(D) of the Social Security Act (42
4
U.S.C. 1395l(i)(2)(D)) is amended—
5
(1) in clause (v)—
6
(A) in the first sentence, by inserting be-
7
fore the period the following: ‘‘and, in the case
8
of 2024 or a subsequent year, by the adjust-
9
ment described in subsection (t)(3)(G) for the
10
respective year’’; and
11
(B) by moving the margin 6 ems to the
12
left;
13
(2) by redesignating clause (vi) as clause (vii);
14
and
15
(3) by inserting after clause (v) the following
16
new clause:
17
‘‘(vi) In implementing the system described in clause
18
(i) for 2024 and each subsequent year, there shall be an
19
annual update under such system for the year equal to
20
the OPD fee schedule increase factor specified under sub-
21
section (t)(3)(C)(iv) for such year, adjusted in accordance
22
with clauses (iv) and (v).’’.
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SEC. 3. TRANSPARENCY OF QUALITY REPORTING AND
1
MEDICARE BENEFICIARY INFORMATION.
2
Paragraph (7) of section 1833(i) of the Social Secu-
3
rity Act (42 U.S.C. 1395l(i)) is amended by adding at the
4
end the following new subparagraphs:
5
‘‘(C) To the extent that quality measures imple-
6
mented by the Secretary under this paragraph for ambula-
7
tory surgical centers and under section 1833(t)(17) for
8
hospital outpatient departments are applicable to the pro-
9
vision of surgical services in both ambulatory surgical cen-
10
ters and hospital outpatient departments, the Secretary
11
shall make reported data on such centers and departments
12
available on the website ‘Medicare.gov’ in a manner that
13
will permit side-by-side comparisons on such measures for
14
ambulatory surgical centers and hospital outpatient de-
15
partments in the same geographic area.
16
‘‘(D) The Secretary shall ensure that an ambulatory
17
surgery center and a hospital has the opportunity to re-
18
view, and submit any corrections for, the data to be made
19
public with respect to the ambulatory surgery center under
20
subparagraph (C) prior to such data being made public.
21
‘‘(E) The Secretary shall develop materials and in-
22
form beneficiaries under this title of publicly available
23
comparisons provided for in subparagraph (C).’’.
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•S 312 IS
SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAY-
1
MENT REPRESENTATION.
2
(a) ASC REPRESENTATIVE.—The second sentence of
3
section 1833(t)(9)(A) of the Social Security Act (42
4
U.S.C. 1395l(t)(9)(A)) is amended by inserting ‘‘and sup-
5
pliers subject to the prospective payment system (includ-
6
ing at least one ambulatory surgical center representa-
7
tive)’’ after ‘‘an appropriate selection of representatives of
8
providers’’.
9
(b) EFFECTIVE DATE.—The amendment made by
10
subsection (a) shall take effect on the date of the enact-
11
ment of this Act.
12
SEC. 5. REASONS FOR EXCLUDING ADDITIONAL PROCE-
13
DURES FROM ASC APPROVED LIST.
14
(a) IN GENERAL.—Section 1833(i)(1) of the Social
15
Security Act (42 U.S.C. 1395l(i)(1)) is amended by add-
16
ing at the end the following: ‘‘In updating such lists for
17
application in years beginning after the date of the enact-
18
ment of this sentence, for each procedure that was re-
19
quested to be included in such lists during the public com-
20
ment period but which the Secretary does not propose (in
21
the final rule updating such lists) to so include in such
22
lists, the Secretary shall cite in such final rule the specific
23
criteria in paragraph (b) or (c) of section 416.166 of title
24
42, Code of Federal Regulations, based on which the pro-
25
cedure was excluded. If paragraph (b) of such section is
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•S 312 IS
cited for exclusion of a procedure, the Secretary shall iden-
1
tify the peer reviewed research or the evidence upon which
2
such determination is based.’’.
3
(b) EFFECTIVE DATE.—The amendment made by
4
subsection (a) shall apply to lists of ambulatory surgery
5
procedures for application in years beginning after the
6
date of the enactment of this Act.
7
SEC. 6. LIMITATION ON AMBULATORY SURGERY CENTER
8
COPAYMENT FOR A PROCEDURE TO THE
9
HOSPITAL DEDUCTIBLE AMOUNT.
10
Section 1833(a)(1)(G) of the Social Security Act (42
11
U.S.C. 1395l(a)(1)(G)) is amended by inserting the fol-
12
lowing before the comma at the end: ‘‘, except that in no
13
case shall the copayment amount for such services fur-
14
nished in a year exceed the amount of the inpatient hos-
15
pital deductible established under section 1813(b) for the
16
year (and, notwithstanding any other provision of this sec-
17
tion, the amount of payment for such services shall be in-
18
creased by the amount of any reduction in the copayment
19
amount for such services pursuant to this subparagraph)’’.
20
SEC. 7. ALIGNMENT OF BUDGET NEUTRALITY ADJUSTMENT
21
FOR OUTPATIENT SURGICAL PROCEDURES.
22
(a) PROHIBITING
UNAUTHORIZED
AGENCY
AC-
23
TION.—Section 1833(i)(2)(D)(ii) of the Social Security
24
Act (42 U.S.C. 1395l(i)(2)(D)(ii)) is amended by adding
25
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•S 312 IS
at the end the following: ‘‘The preceding sentence shall
1
only apply to the first year the system described in clause
2
(i) was implemented and shall not apply to any year after
3
2023.’’.
4
(b) COMBINING VOLUME FOR BUDGET NEUTRALITY
5
CALCULATION.—Section 1833(t)(9)(B) of the Social Se-
6
curity Act (42 U.S.C. 1395l(t)(9)(B)) is amended by in-
7
serting ‘‘taking into account the volume of procedures paid
8
under this subsection combined with the volume of proce-
9
dures paid under subsection (i),’’ after ‘‘subparagraph
10
(A),’’.
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(c) EFFECTIVE DATE.—The amendments made by
12
subsections (a) and (b) shall apply in years beginning after
13
the date of the enactment of this Act.
14
Æ
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