Ambulatory Surgical Center Medicare Payment Modernization Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to revise the requirements and the formula for payments for services furnished to individuals in ambulatory surgical centers.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4042 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 4042
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
October 7, 2005
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 Medicare
Payment Modernization Act of 2005''.
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 to read as follows:
``(i)(1) Payment shall be made under this part in the amount
specified under paragraph (2) for facility services furnished to an
individual in an ambulatory surgical center in connection with any
outpatient surgical procedure covered under this part as a hospital
outpatient department service, except for those procedures that the
Secretary designates, in consultation with appropriate trade and
professional organizations (including those having direct experience
with ambulatory surgical centers) as posing a significant safety risk
or requiring an overnight stay when performed in ambulatory surgical
centers. Not less frequently than once every two years the Secretary
shall review and, may, after public comment, make appropriate
adjustments to this list of procedures excluded from coverage when
performed in ambulatory surgical centers as the Secretary deems
necessary.
``(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 75 percent of the fee
schedule amount determined under paragraph (3)(A) 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.
``(B) For covered ambulatory surgical center services furnished on
or after January 1, 2008, and before January 1, 2012, for which the
ambulatory surgical center payment amount payable under this subsection
in 2007 (in this subsection referred to as the `2007 ASC payment
amount') is less than 75 percent of the hospital OPD fee schedule
amount under subsection (t) in 2007 for the same services, the amount
of payment under this subsection shall be calculated as follows:
``(i) For services furnished during 2008, the amount shall
be equal to the sum of--
``(I) 80 percent of the 2007 ASC payment amount, as
increased by the percentage increase in the consumer
price index for all urban consumers (United States city
average) as estimated by the Secretary for the 12-month
period ending with December 31, 2006; and
``(II) 20 percent of the payment amount under
paragraph (2)(A) for 2008.
``(ii) For services furnished during 2009, the amount shall
be equal to the sum of--
``(I) 60 percent of the 2007 ASC payment amount as
increased under clause (i)(I) and as further increased
by the percentage increase in the consumer price index
for all urban consumers (United States city average) as
estimated by the Secretary for the 12-month period
ending with December 31, 2007; and
``(II) 40 percent of the payment amount under
paragraph (2)(A) for 2009.
``(iii) For services furnished during 2010, the amount
shall be equal to the sum of--
``(I) 40 percent of the 2007 ASC payment amount as
increased under clauses (i)(I) and (ii)(I) and as
further increased by the percentage increase in the
consumer price index for all urban consumers (United
States city average) as estimated by the Secretary for
the 12-month period ending with December 31, 2008; and
``(II) 60 percent of the payment amount under
paragraph (2)(A) for 2010.
``(iv) For services furnished during 2011, the amount shall
be equal to the sum of--
``(I) 20 percent of the 2007 ASC payment amount as
increased under clauses (i)(I), (ii)(I), and (iii)(I)
and as further increased by the percentage increase in
the consumer price index for all urban consumers
(United States city average) as estimated by the
Secretary for the 12-month period ending with December
31, 2009; and
``(II) 80 percent of the payment amount under
paragraph (2)(A) for 2011.
``(C) For covered ambulatory surgical center services for which the
2007 ASC payment amount is--
``(i) greater than 75 percent, but less than 100 percent,
of the hospital OPD fee schedule amount under subsection (t) in
2007 for the same services, the amount of payment under this
subsection shall be the greater of the 2007 ASC payment amount
or--
``(I) for services furnished in 2008, the payment
amount under subparagraph (B)(i);
``(II) for services furnished in 2009, the payment
amount under subparagraph (B)(ii);
``(III) for services furnished in 2010, the payment
amount under subparagraph (B)(iii);
``(IV) for services furnished in 2011, the payment
amount under subparagraph (B)(iv); or
``(V) in 2012 and subsequent years, the payment
amount under subparagraph (A),
but in no case in excess of the then applicable hospital OPD
fee schedule amount; or
``(ii) greater than the hospital OPD fee schedule amount
under subsection (t) in 2007 for the same services, the amount
of payment under this subsection--
``(I) for services furnished during 2008, is equal
to the midpoint between the 2007 ASC payment amount and
100 percent of such 2007 hospital OPD fee schedule
amount; or
``(II) for services furnished in a subsequent year
is equal to the greater of the 2007 hospital OPD fee
schedule amount or the payment amount specified under
subclause (I) through (V) of clause (i) for the year
involved, but but in no case in excess of the then
applicable hospital OPD fee schedule amount.''.
(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 ``section 1833(i)(1)(A)'' and
inserting ``section 1833(i)(1)'';
(B) 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
(C) 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 ``subsection (i)(1)(A)'' and
inserting ``subsection (i)(1)'';
(B) by striking ``for services furnished
beginning'' and all that follows through ``subsection
(i)(2)(D)''; and
(C) by striking ``such revised payment system'' and
inserting ``under subsection (i)(2)''.
(3) Section 1833(a)(4) of such Act (42 U.S.C. 1395l(a)(4))
is amended--
(A) by striking ``section 1833(i)(1)(A)'' and
inserting ``subsection (i)(1)''; and
(B) by striking ``paragraph (2) or (3) of
subsection (i)'' and inserting ``subsection (i)(1)''.
(c) Effective Date.--The amendments made by this section shall
apply to ambulatory surgical center services furnished on or after
January 1, 2008.
<all>
Introduced in House
Introduced in House
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.
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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