Outpatient Surgery Quality and Access Act of 2023
This bill establishes and modifies certain requirements relating to Medicare payments for ambulatory surgical center (ASC) services.
Specifically, the bill (1) requires the payment system for ASC services to feature certain positive annual adjustments equivalent to those made with respect to hospital outpatient department (OPD) services; (2) revises quality reporting requirements to permit publicly available, side-by-side comparisons of quality measures for ASCs and OPDs in the same geographic area; and (3) requires the Centers for Medicare & Medicaid Services (CMS), when excluding requested procedures from the list of those approved to be performed in ASCs, to cite specified reasons for doing so.
With respect to excluding procedures from the approved list for ASCs, the CMS may not cite as a basis for exclusion that a procedure can only be reported using an unlisted surgical procedure code. (Physicians sometimes use unlisted codes when performing new procedures or services if no existing code is adequately descriptive.)
The bill also limits the copayment amount for ASC services under Medicare to that of the inpatient hospital deductible.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 972 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 972
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 HOUSE OF REPRESENTATIVES
February 9, 2023
Mr. Wenstrup (for himself and Mr. Larson of Connecticut) 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, and for
other purposes.
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 ``Outpatient Surgery Quality and
Access Act of 2023''.
SEC. 2. ALIGNING UPDATES FOR AMBULATORY SURGICAL CENTER SERVICES WITH
UPDATES FOR OPD SERVICES.
Section 1833(i)(2)(D) of the Social Security Act (42 U.S.C.
1395l(i)(2)(D)) is amended--
(1) in clause (v)--
(A) in the first sentence, by inserting before the
period the following: ``and, in the case of 2024 or a
subsequent year, by the adjustment described in
subsection (t)(3)(G) for the respective year''; and
(B) by moving the margin 6 ems to the left;
(2) by redesignating clause (vi) as clause (vii); and
(3) by inserting after clause (v) the following new clause:
``(vi) In implementing the system described in clause (i) for 2024
and each subsequent year, there shall be an annual update under such
system for the year equal to the OPD fee schedule increase factor
specified under subsection (t)(3)(C)(iv) for such year, adjusted in
accordance with clauses (iv) and (v).''.
SEC. 3. TRANSPARENCY OF QUALITY REPORTING AND MEDICARE BENEFICIARY
INFORMATION.
Paragraph (7) of section 1833(i) of the Social Security Act (42
U.S.C. 1395l(i)) is amended 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 make reported data on such centers and departments 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) The Secretary shall ensure that an ambulatory surgery center
and a hospital has the opportunity to review, and submit any
corrections for, the data to be made public with respect to the
ambulatory surgery center under subparagraph (C) prior to such data
being made public.
``(E) The Secretary shall develop materials and inform
beneficiaries under this title of publicly available comparisons
provided for in subparagraph (C).''.
SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT 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. REASONS FOR EXCLUDING ADDITIONAL PROCEDURES FROM ASC APPROVED
LIST.
(a) In General.--Section 1833(i)(1) of the Social Security Act (42
U.S.C. 1395l(i)(1)) is amended by adding at the end the following: ``In
updating such lists for application in years beginning after the date
of the enactment of this sentence, for each procedure that was
requested to be included in such lists during the public comment period
but which the Secretary does not propose (in the final rule updating
such lists) to so include in such lists, the Secretary shall cite in
such final rule the specific criteria in paragraph (b) or (c) of
section 416.166 of title 42, Code of Federal Regulations, based on
which the procedure was excluded. If paragraph (b) of such section is
cited for exclusion of a procedure, the Secretary shall identify the
peer reviewed research or the evidence upon which such determination is
based.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to lists of ambulatory surgery procedures for application in
years beginning after the date of the enactment of this Act.
SEC. 6. LIMITATION ON AMBULATORY SURGERY CENTER COPAYMENT FOR A
PROCEDURE TO THE HOSPITAL DEDUCTIBLE AMOUNT.
Section 1833(a)(1)(G) of the Social Security Act (42 U.S.C.
1395l(a)(1)(G)) is amended by inserting the following before the comma
at the end: ``, except that in no case shall the copayment amount for
such services furnished in a year exceed the amount of the inpatient
hospital deductible established under section 1813(b) for the year
(and, notwithstanding any other provision of this section, the amount
of payment for such services shall be increased by the amount of any
reduction in the copayment amount for such services pursuant to this
subparagraph)''.
SEC. 7. ALIGNMENT OF BUDGET NEUTRALITY ADJUSTMENT FOR OUTPATIENT
SURGICAL PROCEDURES.
(a) Prohibiting Unauthorized Agency Action.--Section
1833(i)(2)(D)(ii) of the Social Security Act (42 U.S.C.
1395l(i)(2)(D)(ii)) is amended by adding at the end the following:
``The preceding sentence shall only apply to the first year the system
described in clause (i) was implemented and shall not apply to any year
after 2024.''.
(b) Combining Volume for Budget Neutrality Calculation.--Section
1833(t)(9)(B) of the Social Security Act (42 U.S.C. 1395l(t)(9)(B)) is
amended by inserting ``taking into account the volume of procedures
paid under this subsection combined with the volume of procedures paid
under subsection (i),'' after ``subparagraph (A),''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply in years beginning after the date of the enactment of this
Act.
<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 Subcommittee on Health.
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