I 111th CONGRESS 1st Session H. R. 2049 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.

1.

Short title

This Act may be cited as the Ambulatory Surgical Center Access Act of 2009.

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.

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.

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.

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.