II 

109TH CONGRESS 

1ST SESSION S. 1884 

To amend title XVIII of the Social Security Act to modernize payments 

for ambulatory surgical centers under the medicare program. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 18, 2005 

Mr. CRAPO introduced the following bill; which was read twice and referred 

to the Committee on Finance 

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 2005’’. 

6 SEC. 2. MEDICARE PAYMENT FOR AMBULATORY SURGICAL 

7 CENTER SERVICES. 

8 (a) IN GENERAL.—Section 1833(i) of the Social Se9 curity Act (42 U.S.C. 1395l(i)) is amended to read as fol10 lows: 
2 

•S 1884 IS

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

2 amount specified under paragraph (2) for facility services 

3 furnished to an individual in an ambulatory surgical cen4 ter in connection with any outpatient surgical procedure 

5 covered under this part as a hospital outpatient depart6 ment service, except for those procedures that the Sec7 retary designates, in consultation with appropriate trade 

8 and professional organizations (including those having di9 rect experience with ambulatory surgical centers) as pos10 ing a significant safety risk or requiring an overnight stay 

11 when performed in ambulatory surgical centers. Not less 

12 frequently than once every two years the Secretary shall 

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

14 adjustments to this list of procedures excluded from cov15 erage when performed in ambulatory surgical centers as 

16 the Secretary deems necessary. 

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

18 amount of payment to be made under this subsection for 

19 facility services furnished to an individual in an ambula20 tory surgical center in accordance with paragraph (1) shall 

21 be equal to 75 percent of the fee schedule amount deter22 mined under paragraph (3)(A) of subsection (t) for pay23 ment of the same service furnished in hospital outpatient 

24 departments, as adjusted under paragraphs (4)(A), (6), 
3 

•S 1884 IS

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

2 copayment. 

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

4 furnished on or after January 1, 2008, and before Janu5 ary 1, 2012, for which the ambulatory surgical center pay6 ment amount payable under this subsection in 2007 (in 

7 this subsection referred to as the ‘2007 ASC payment 

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

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

10 same services, the amount of payment under this sub11 section shall be calculated as follows: 

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

13 amount shall be equal to the sum of— 

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

15 amount, as increased by the percentage increase 

16 in the consumer price index for all urban con17 sumers (United States city average) as esti18 mated by the Secretary for the 12-month period 

19 ending with December 31, 2006; and 

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

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

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

23 amount shall be equal to the sum of— 

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

25 amount as increased under clause (i)(I) and as 
4 

•S 1884 IS

1 further increased by the percentage increase in 

2 the consumer price index for all urban con3 sumers (United States city average) as esti4 mated by the Secretary for the 12-month period 

5 ending with December 31, 2007; and 

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

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

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

9 amount shall be equal to the sum of— 

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

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

12 (ii)(I) and as further increased by the percent13 age increase in the consumer price index for all 

14 urban consumers (United States city average) 

15 as estimated by the Secretary for the 12-month 

16 period ending with December 31, 2008; and 

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

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

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

20 amount shall be equal to the sum of— 

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

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

23 and (iii)(I) and as further increased by the per24 centage increase in the consumer price index for 

25 all urban consumers (United States city aver-
5 

•S 1884 IS

1 age) as estimated by the Secretary for the 12- 

2 month period ending with December 31, 2009; 

3 and 

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

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

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

7 for which the 2007 ASC payment amount is— 

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

9 percent, of the hospital OPD fee schedule amount 

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

11 the amount of payment under this subsection shall 

12 be the greater of the 2007 ASC payment amount 

13 or— 

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

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

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

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

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

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

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

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

22 or 

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

24 payment amount under subparagraph (A), 
6 

•S 1884 IS

1 but in no case in excess of the then applicable hos2 pital OPD fee schedule amount; or 

3 ‘‘(ii) greater than the hospital OPD fee sched4 ule amount under subsection (t) in 2007 for the 

5 same services, the amount of payment under this 

6 subsection— 

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

8 equal to the midpoint between the 2007 ASC 

9 payment amount and 100 percent of such 2007 

10 hospital OPD fee schedule amount; or 

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

12 year is equal to the greater of the 2007 hospital 

13 OPD fee schedule amount or the payment 

14 amount specified under subclause (I) through 

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

16 case in excess of the then applicable hospital 

17 OPD fee schedule amount.’’. 

18 (b) CONFORMING AMENDMENTS.— 

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

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

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

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

23 (B) by striking ‘‘the standard overhead 

24 amount as determined under section 
7 

•S 1884 IS

1 1833(i)(2)(A)’’ and inserting ‘‘the amount de2 termined under section 1833(i)(2)’’; and 

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

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

5 or’’. 

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

7 U.S.C. 1395l(a)(1)(G)) is amended— 

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

9 inserting ‘‘subsection (i)(1)’’; 

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

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

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

16 1395l(a)(4)) is amended— 

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

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

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

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

21 (i)(1)’’. 

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

23 this section shall apply to ambulatory surgical center serv24 ices furnished on or after January 1, 2008. 

Æ