[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2049 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2049

 To amend title XVIII of the Social Security Act to modernize payments 
      for ambulatory surgical centers under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 22, 2009

    Mr. Meek of Florida (for himself and Mr. Herger) 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 modernize payments 
      for ambulatory surgical centers under the Medicare Program.

    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 ``Ambulatory Surgical Center Access 
Act of 2009''.

SEC. 2. MEDICARE PAYMENT FOR AMBULATORY SURGICAL CENTER SERVICES.

    (a) In General.--Section 1833(i) of the Social Security Act (42 
U.S.C. 1395l(i)) is amended by striking paragraphs (2) through (6) and 
inserting the following:
    ``(2)(A) Subject to subparagraphs (B) and (C), the amount of 
payment to be made under this subsection for facility services 
furnished to an individual in an ambulatory surgical center in 
accordance with paragraph (1) shall be equal to 59 percent of the fee 
schedule amount determined under paragraph (3)(D) of subsection (t) for 
payment of the same service furnished in hospital outpatient 
departments, as adjusted under paragraphs (4)(A), (6), and (15) of such 
subsection, less a 20 percent beneficiary copayment, except that in no 
case shall the copayment amount for a procedure performed in a year 
exceed the amount of the inpatient hospital deductible established 
under section 1813(b) for that year.
    ``(B) For covered ambulatory surgical center services furnished 
during calendar year 2010, the amount of payment under this subsection 
shall be equal to the sum of--
            ``(i) 25 percent of the ambulatory surgical center payment 
        amount payable under this subsection in 2007; and
            ``(ii) 75 percent of the payment amount under subparagraph 
        (A) for 2010.
    ``(C)(i) Notwithstanding subparagraphs (A) and (B), if a facility 
service furnished to an individual in an ambulatory surgical center 
includes an implantable medical device, the amount of payment for that 
service shall be equal to the sum of--
            ``(I) 100 percent of the hospital OPD fee schedule amount 
        under subsection (t) that the Secretary determines is 
        associated with the device; and
            ``(II) 59 percent of non-device-related component of such 
        OPD fee schedule amount;
        less a 20 percent beneficiary copayment.
    ``(ii) For purposes of clause (i), the term `implantable medical 
device' means a device that--
            ``(I) is an integral and subordinate part of the service 
        furnished;
            ``(II) is used for one patient only;
            ``(III) comes in contact with human tissue; and
            ``(IV) is surgically implanted or inserted, whether or not 
        it remains with the patient when the patient is released from 
        the ambulatory surgical center.''.
    (b) Conforming Amendments.--
            (1) Section 1832(a)(2)(F)(i) of such Act (42 U.S.C. 
        1395k(a)(2)(F)(i)) is amended--
                    (A) by striking ``the standard overhead amount as 
                determined under section 1833(i)(2)(A)'' and inserting 
                ``the amount determined under section 1833(i)(2)''; and
                    (B) by striking all that follows ``as full payment 
                for such services'' and inserting ``, or''.
            (2) Section 1833(a)(1)(G) of such Act (42 U.S.C. 
        1395l(a)(1)(G)) is amended--
                    (A) by striking ``for services furnished 
                beginning'' and all that follows through ``subsection 
                (i)(2)(D),''; and
                    (B) by striking ``such revised payment system'' and 
                inserting ``subsection (i)(2)''.
            (3) Section 1833(a)(4) of such Act (42 U.S.C. 1395l(a)(4)) 
        is amended by striking ``or (3)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to ambulatory surgical center services furnished on or after 
January 1, 2010.

SEC. 3. QUALITY REPORTING AND COMPARISON.

    (a) In General.--Paragraph (7) of section 1833(i) of the Social 
Security Act (42 U.S.C. 1395l(i)) is amended--
            (1) by redesignating such paragraph as paragraph (3);
            (2) in subparagraph (A)--
                    (A) by striking ``For purposes of paragraph 
                (2)(D)(iv), the'' and inserting ``The'';
                    (B) by striking ``established under paragraph 
                (2)(D)'' and inserting ``described in paragraph (2)''; 
                and
                    (C) by adding at the end the following: ``Data 
                required to be submitted on measures selected under 
                this paragraph must be on measures that have been 
                selected by the Secretary after consideration of public 
                comments and that have consensus endorsement from 
                affected parties.'';
            (3) in subparagraph (B)--
                    (A) by striking ``Except as the Secretary may 
                otherwise provide, the'' and inserting ``The''; and
                    (B) by inserting before the period at the end the 
                following: ``, except that the form and manner of 
                reporting by ambulatory surgical centers shall include 
                the option of submitting data with claims for 
                payment''; and
            (4) by adding at the end the following new subparagraphs:
    ``(C) To the extent that quality measures implemented by the 
Secretary under this paragraph for ambulatory surgical centers and 
under section 1833(t)(17) for hospital outpatient departments are 
applicable to the provision of surgical services in both ambulatory 
surgical centers and hospital outpatient departments, the Secretary 
shall--
            ``(i) require that both ambulatory surgical centers and 
        hospital outpatient departments report data on such measures; 
        and
            ``(ii) make reported data available on the website 
        `Medicare.gov' in a manner that will permit side-by-side 
        comparisons on such measures for ambulatory surgical centers 
        and hospital outpatient departments in the same geographic 
        area.
    ``(D) For each procedure covered for payment in an ambulatory 
surgical center, the Secretary shall publish, along with the quality 
reporting comparisons provided for in subparagraph (C), comparisons of 
the Medicare payment and beneficiary copayment amounts for the 
procedure when performed in ambulatory surgical centers and hospital 
outpatient departments in the same geographic area.''.
    (b) MedPAC Study.--
            (1) In general.--The Medicare Payment Advisory Commission 
        shall conduct a study of outpatient surgical services covered 
        under section 1833 of the Social Security Act (42 U.S.C. 
        1395l). The study shall compare beneficiaries' use of different 
        settings across geographic areas, spending implications for the 
        Medicare program for such services when provided in different 
        settings, and out-of-pocket liability for beneficiaries for 
        such services when provided in different settings.
            (2) Report.--Not later than one year after the date of the 
        enactment of this Act, the Commission shall submit to Congress 
        a report on the findings of the study conducted under paragraph 
        (1). Where appropriate, such report shall include 
        recommendations on modifications in coverage and payment 
        policies under part B of title XVIII of the Social Security Act 
        needed to optimize the economical utilization of outpatient 
        surgical services.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2010.

SEC. 4. APC PANEL REPRESENTATION.

    (a) ASC Representative.--The second sentence of section 
1833(t)(9)(A) of the Social Security Act (42 U.S.C. 1395l(t)(9)(A)) is 
amended by inserting ``and suppliers subject to the prospective payment 
system (including at least one ambulatory surgical center 
representative)'' after ``an appropriate selection of representatives 
of providers''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act.

SEC. 5. ENSURING ACCESS TO SAME DAY SERVICES.

    The conditions for coverage of ambulatory surgical center services 
specified by the Secretary of Health and Human Services pursuant to 
section 1832(a)(2)(F)(i) of the Social Security Act (42 U.S.C. 
1395k(a)(2)(F)(i)) shall not prohibit ambulatory surgical centers from 
providing individuals with any notice of rights or other required 
notice on the date of a procedure if more advance notice is not 
feasible under the circumstances, including when a procedure is 
scheduled and performed on the same day.
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