I 

110TH CONGRESS 

1ST SESSION H. R. 1823 

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 

MARCH 29, 2007 

Mr. MEEK of Florida (for himself, Mr. HERGER, Mr. BISHOP of Georgia, Mr. 

HALL of Texas, Mr. SAM JOHNSON of Texas, Mr. MILLER of Florida, 

Mr. ORTIZ, Mr. PAUL, Mr. REYES, Mr. SESSIONS, Mr. SOUDER, Mr. 

MICHAUD, Mr. LATHAM, Mr. MARCHANT, Mr. LEWIS of Kentucky, and 

Ms. CORRINE BROWN of Florida) 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 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ambulatory Surgical 

5 Center Medicare Payment Modernization Act of 2007’’. 


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1 SEC. 2. MEDICARE PAYMENT FOR AMBULATORY SURGICAL 

2 CENTER SERVICES. 

3 (a) IN GENERAL.—Section 1833(i) of the Social Se4 curity Act (42 U.S.C. 1395l(i)) is amended to read as fol5 lows: 

6 ‘‘(i)(1) Payment shall be made under this part in the 

7 amount specified under paragraph (2) for facility services 

8 furnished to an individual in an ambulatory surgical cen9 ter in connection with any outpatient surgical procedure 

10 covered under this part as a hospital outpatient depart11 ment service, except for those procedures that the Sec12 retary designates, in consultation with appropriate trade 

13 and professional organizations (including those having di14 rect experience with ambulatory surgical centers), as pos15 ing a significant safety risk or requiring an overnight stay 

16 when performed in ambulatory surgical centers. Absent an 

17 identifiable safety risk specific to the performance of a 

18 particular procedure in an ambulatory surgical center, the 

19 Secretary shall presume that an outpatient surgical proce20 dure covered under this part as a hospital outpatient de21 partment service does not pose a significant safety risk 

22 when performed in ambulatory surgical centers. Not less 

23 frequently than once every two years the Secretary shall 

24 review and, may, after public comment, make appropriate 

25 adjustments to this list of procedures excluded from covVerDate Aug 31 2005 05:53 Apr 05, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1823.IH H1823

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1 erage when performed in ambulatory surgical centers as 

2 the Secretary deems necessary. 

3 ‘‘(2)(A) Subject to subparagraphs (B) (C), and (D) 

4 the amount of payment to be made under this subsection 

5 for facility services furnished to an individual in an ambu6 latory surgical center in accordance with paragraph (1) 

7 shall be equal to 75 percent of the fee schedule amount 

8 determined under paragraph (3)(A) of subsection (t) for 

9 payment of the same service furnished in hospital out10 patient departments, as adjusted under paragraphs 

11 (4)(A), (6), and (15) of such subsection, less a 20 percent 

12 beneficiary copayment. 

13 ‘‘(B) For covered ambulatory surgical center services 

14 furnished on or after January 1, 2008, and before Janu15 ary 1, 2012, for which the ambulatory surgical center pay16 ment amount payable under this subsection in 2007 (in 

17 this subsection referred to as the ‘2007 ASC payment 

18 amount’) is less than 75 percent of the hospital OPD fee 

19 schedule amount under subsection (t) in 2007 for the 

20 same services, the amount of payment under this sub21 section shall be calculated as follows: 

22 ‘‘(i) For services furnished during 2008, the 

23 amount shall be equal to the sum of— 

24 ‘‘(I) 80 percent of the 2007 ASC payment 

25 amount, as increased by the market basket perVerDate Aug 31 2005 05:53 Apr 05, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1823.IH H1823

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1 centage increase applicable under subsection 

2 (t)(3)(C)(iv) for OPD services occurring during 

3 the fiscal year ending in such year; and 

4 ‘‘(II) 20 percent of the payment amount 

5 under paragraph (2)(A) for 2008. 

6 ‘‘(ii) For services furnished during 2009, the 

7 amount shall be equal to the sum of— 

8 ‘‘(I) 60 percent of the 2007 ASC payment 

9 amount as increased under clause (i)(I) and as 

10 further increased by the market basket percent11 age increase applicable under subsection 

12 (t)(3)(C)(iv) for OPD services occurring during 

13 the fiscal year ending in such year; and 

14 ‘‘(II) 40 percent of the payment amount 

15 under paragraph (2)(A) for 2009. 

16 ‘‘(iii) For services furnished during 2010, the 

17 amount shall be equal to the sum of— 

18 ‘‘(I) 40 percent of the 2007 ASC payment 

19 amount as increased under clauses (i)(I) and 

20 (ii)(I) and as further increased by the market 

21 basket percentage increase applicable under 

22 subsection (t)(3)(C)(iv) for OPD services occur23 ring during the fiscal year ending in such year; 

24 and 


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1 ‘‘(II) 60 percent of the payment amount 

2 under paragraph (2)(A) for 2010. 

3 ‘‘(iv) For services furnished during 2011, the 

4 amount shall be equal to the sum of— 

5 ‘‘(I) 20 percent of the 2007 ASC payment 

6 amount as increased under clauses (i)(I), (ii)(I), 

7 and (iii)(I) and as further increased by the 

8 market basket percentage increase applicable 

9 under subsection (t)(3)(C)(iv) for OPD services 

10 occurring during the fiscal year ending in such 

11 year; and 

12 ‘‘(II) 80 percent of the payment amount 

13 under paragraph (2)(A) for 2011. 

14 ‘‘(C) For covered ambulatory surgical center services 

15 for which the 2007 ASC payment amount is— 

16 ‘‘(i) greater than 75 percent, but less than 100 

17 percent, of the hospital OPD fee schedule amount 

18 under subsection (t) in 2007 for the same services, 

19 the amount of payment under this subsection shall 

20 be the greater of the 2007 ASC payment amount 

21 or— 

22 ‘‘(I) for services furnished in 2008, the 

23 payment amount under subparagraph (B)(i); 

24 ‘‘(II) for services furnished in 2009, the 

25 payment amount under subparagraph (B)(ii); 


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1 ‘‘(III) for services furnished in 2010, the 

2 payment amount under subparagraph (B)(iii); 

3 ‘‘(IV) for services furnished in 2011, the 

4 payment amount under subparagraph (B)(iv); 

5 or 

6 ‘‘(V) in 2012 and subsequent years, the 

7 payment amount under subparagraph (A), 

8 but in no case in excess of the then applicable hos9 pital OPD fee schedule amount; or 

10 ‘‘(ii) greater than the hospital OPD fee sched11 ule amount under subsection (t) in 2007 for the 

12 same services, the amount of payment under this 

13 subsection— 

14 ‘‘(I) for services furnished during 2008, is 

15 equal to the midpoint between the 2007 ASC 

16 payment amount and 100 percent of such 2007 

17 hospital OPD fee schedule amount; or 

18 ‘‘(II) for services furnished in a subsequent 

19 year is equal to the greater of the 2007 hospital 

20 OPD fee schedule amount or the payment 

21 amount specified under subclause (I) through 

22 (V) of clause (i) for the year involved, but in no 

23 case in excess of the then applicable hospital 

24 OPD fee schedule amount. 


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1 ‘‘(D) Notwithstanding subparagraphs (A), (B), 

2 and (C), if a facility service furnished to an indi3 vidual in an ambulatory surgical center includes an 

4 implantable medical device, the amount of payment 

5 for that service shall be equal to the sum of— 

6 ‘‘(i) 100 percent of the hospital OPD fee 

7 schedule amount that the Secretary determines 

8 is associated with the device; and 

9 ‘‘(ii) 75 percent of non-device-related com10 ponent of the OPD fee schedule amount; 

11 less a 20 percent beneficiary copayment.’’. 

12 (b) CONFORMING AMENDMENTS.— 

13 (1) Section 1832(a)(2)(F)(i) of such Act (42 

14 U.S.C. 1395k(a)(2)(F)(i)) is amended— 

15 (A) by striking ‘‘section 1833(i)(1)(A)’’ 

16 and inserting ‘‘section 1833(i)(1)’’; 

17 (B) by striking ‘‘the standard overhead 

18 amount as determined under section 

19 1833(i)(2)(A)’’ and inserting ‘‘the amount de20 termined under section 1833(i)(2)’’; and 

21 (C) by striking all that follows ‘‘as full 

22 payment for such services’’ and inserting ‘‘, 

23 or’’. 

24 (2) Section 1833(a)(1)(G) of such Act (42 

25 U.S.C. 1395l(a)(1)(G)) is amended— 


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1 (A) by striking ‘‘subsection (i)(1)(A)’’ and 

2 inserting ‘‘subsection (i)(1)’’; 

3 (B) by striking ‘‘for services furnished be4 ginning’’ and all that follows through ‘‘sub5 section (i)(2)(D)’’; and 

6 (C) by striking ‘‘such revised payment sys7 tem’’ and inserting ‘‘under subsection (i)(2)’’. 

8 (3) Section 1833(a)(4) of such Act (42 U.S.C. 

9 1395l(a)(4)) is amended— 

10 (A) by striking ‘‘section 1833(i)(1)(A)’’ 

11 and inserting ‘‘subsection (i)(1)’’; and 

12 (B) by striking ‘‘paragraph (2) or (3) of 

13 subsection (i)’’ and inserting ‘‘subsection 

14 (i)(1)’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to ambulatory surgical center serv17 ices furnished on or after January 1, 2008. 

Æ 


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