I 

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. 

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 Access Act of 2009’’. 


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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 by striking 

5 paragraphs (2) through (6) and inserting the following: 

6 ‘‘(2)(A) Subject to subparagraphs (B) and (C), the 

7 amount of payment to be made under this subsection for 

8 facility services furnished to an individual in an ambula9 tory surgical center in accordance with paragraph (1) shall 

10 be equal to 59 percent of the fee schedule amount deter11 mined under paragraph (3)(D) of subsection (t) for pay12 ment of the same service furnished in hospital outpatient 

13 departments, as adjusted under paragraphs (4)(A), (6), 

14 and (15) of such subsection, less a 20 percent beneficiary 

15 copayment, except that in no case shall the copayment 

16 amount for a procedure performed in a year exceed the 

17 amount of the inpatient hospital deductible established 

18 under section 1813(b) for that year. 

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

20 furnished during calendar year 2010, the amount of pay21 ment under this subsection shall be equal to the sum of— 

22 ‘‘(i) 25 percent of the ambulatory surgical cen23 ter payment amount payable under this subsection 

24 in 2007; and 

25 ‘‘(ii) 75 percent of the payment amount under 

26 subparagraph (A) for 2010. 


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1 ‘‘(C)(i) Notwithstanding subparagraphs (A) and (B), 

2 if a facility service furnished to an individual in an ambu3 latory surgical center includes an implantable medical de4 vice, the amount of payment for that service shall be equal 

5 to the sum of— 

6 ‘‘(I) 100 percent of the hospital OPD fee sched7 ule amount under subsection (t) that the Secretary 

8 determines is associated with the device; and 

9 ‘‘(II) 59 percent of non-device-related compo10 nent of such OPD fee schedule amount; 

11 less a 20 percent beneficiary copayment. 

12 ‘‘(ii) For purposes of clause (i), the term ‘implantable 

13 medical device’ means a device that— 

14 ‘‘(I) is an integral and subordinate part of the 

15 service furnished; 

16 ‘‘(II) is used for one patient only; 

17 ‘‘(III) comes in contact with human tissue; and 

18 ‘‘(IV) is surgically implanted or inserted, 

19 whether or not it remains with the patient when the 

20 patient is released from the ambulatory surgical cen21 ter.’’. 

22 (b) CONFORMING AMENDMENTS.— 

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

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


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1 (A) by striking ‘‘the standard overhead 

2 amount as determined under section 

3 1833(i)(2)(A)’’ and inserting ‘‘the amount de4 termined under section 1833(i)(2)’’; and 

5 (B) by striking all that follows ‘‘as full 

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

7 or’’. 

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

9 U.S.C. 1395l(a)(1)(G)) is amended— 

10 (A) by striking ‘‘for services furnished be11 ginning’’ and all that follows through ‘‘sub12 section (i)(2)(D),’’; and 

13 (B) by striking ‘‘such revised payment sys14 tem’’ and inserting ‘‘subsection (i)(2)’’. 

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

16 1395l(a)(4)) is amended by striking ‘‘or (3)’’. 

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

18 this section shall apply to ambulatory surgical center serv19 ices furnished on or after January 1, 2010. 

20 SEC. 3. QUALITY REPORTING AND COMPARISON. 

21 (a) IN GENERAL.—Paragraph (7) of section 1833(i) 

22 of the Social Security Act (42 U.S.C. 1395l(i)) is amend23 ed— 

24 (1) by redesignating such paragraph as para25 graph (3); 


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1 (2) in subparagraph (A)— 

2 (A) by striking ‘‘For purposes of para3 graph (2)(D)(iv), the’’ and inserting ‘‘The’’; 

4 (B) by striking ‘‘established under para5 graph (2)(D)’’ and inserting ‘‘described in para6 graph (2)’’; and 

7 (C) by adding at the end the following: 

8 ‘‘Data required to be submitted on measures se9 lected under this paragraph must be on meas10 ures that have been selected by the Secretary 

11 after consideration of public comments and that 

12 have consensus endorsement from affected par13 ties.’’; 

14 (3) in subparagraph (B)— 

15 (A) by striking ‘‘Except as the Secretary 

16 may otherwise provide, the’’ and inserting 

17 ‘‘The’’; and 

18 (B) by inserting before the period at the 

19 end the following: ‘‘, except that the form and 

20 manner of reporting by ambulatory surgical 

21 centers shall include the option of submitting 

22 data with claims for payment’’; and 

23 (4) by adding at the end the following new sub24 paragraphs: 


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1 ‘‘(C) To the extent that quality measures imple2 mented by the Secretary under this paragraph for ambula3 tory surgical centers and under section 1833(t)(17) for 

4 hospital outpatient departments are applicable to the pro5 vision of surgical services in both ambulatory surgical cen6 ters and hospital outpatient departments, the Secretary 

7 shall— 

8 ‘‘(i) require that both ambulatory surgical cen9 ters and hospital outpatient departments report data 

10 on such measures; and 

11 ‘‘(ii) make reported data available on the 

12 website ‘Medicare.gov’ in a manner that will permit 

13 side-by-side comparisons on such measures for am14 bulatory surgical centers and hospital outpatient de15 partments in the same geographic area. 

16 ‘‘(D) For each procedure covered for payment in an 

17 ambulatory surgical center, the Secretary shall publish, 

18 along with the quality reporting comparisons provided for 

19 in subparagraph (C), comparisons of the Medicare pay20 ment and beneficiary copayment amounts for the proce21 dure when performed in ambulatory surgical centers and 

22 hospital outpatient departments in the same geographic 

23 area.’’. 

24 (b) MEDPAC STUDY.— 


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1 (1) IN GENERAL.—The Medicare Payment Ad2 visory Commission shall conduct a study of out3 patient surgical services covered under section 1833 

4 of the Social Security Act (42 U.S.C. 1395l). The 

5 study shall compare beneficiaries’ use of different 

6 settings across geographic areas, spending implica7 tions for the Medicare program for such services 

8 when provided in different settings, and out-of-pock9 et liability for beneficiaries for such services when 

10 provided in different settings. 

11 (2) REPORT.—Not later than one year after the 

12 date of the enactment of this Act, the Commission 

13 shall submit to Congress a report on the findings of 

14 the study conducted under paragraph (1). Where ap15 propriate, such report shall include recommendations 

16 on modifications in coverage and payment policies 

17 under part B of title XVIII of the Social Security 

18 Act needed to optimize the economical utilization of 

19 outpatient surgical services. 

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

21 this section shall take effect on January 1, 2010. 

22 SEC. 4. APC PANEL REPRESENTATION. 

23 (a) ASC REPRESENTATIVE.—The second sentence of 

24 section 1833(t)(9)(A) of the Social Security Act (42 

25 U.S.C. 1395l(t)(9)(A)) is amended by inserting ‘‘and supVerDate Nov 24 2008 06:52 Apr 24, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2049.IH H2049

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1 pliers subject to the prospective payment system (includ2 ing at least one ambulatory surgical center representa3 tive)’’ after ‘‘an appropriate selection of representatives of 

4 providers’’. 

5 (b) EFFECTIVE DATE.—The amendment made by 

6 subsection (a) shall take effect on the date of the enact7 ment of this Act. 

8 SEC. 5. ENSURING ACCESS TO SAME DAY SERVICES. 

9 The conditions for coverage of ambulatory surgical 

10 center services specified by the Secretary of Health and 

11 Human Services pursuant to section 1832(a)(2)(F)(i) of 

12 the Social Security Act (42 U.S.C. 1395k(a)(2)(F)(i)) 

13 shall not prohibit ambulatory surgical centers from pro14 viding individuals with any notice of rights or other re15 quired notice on the date of a procedure if more advance 

16 notice is not feasible under the circumstances, including 

17 when a procedure is scheduled and performed on the same 

18 day. 

Æ 


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