Ambulatory Surgical Center Access Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to revise the requirements and the formula for payments for services, including an implantable medical device, furnished to individuals in ambulatory surgical centers.
Revises requirements for the reporting of data by ambulatory surgical centers and hospital outpatient departments.
Directs the Medicare Payment Advisory Commission (MEDPAC) to study and report to Congress on outpatient surgical services.
Requires the expert outside advisory panel the Secretary of Health and Human Services is required to consult with respect to the clinical integrity of the groups and payment weights to include at least one ambulatory surgical center representative.
States that the conditions for coverage of ambulatory surgical center services specified by the Secretary 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 advanced notice is not feasible under the circumstances, including when a procedure is scheduled and performed on the same day.
[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.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
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 House Ways and Means
Referred to the Subcommittee on Health.
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