II 

118TH CONGRESS 

1ST SESSION S. 312 

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 SENATE OF THE UNITED STATES 

FEBRUARY 9, 2023 

Mr. BLUMENTHAL (for himself and Mr. CASSIDY) 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, and for other purposes. 

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 ‘‘Outpatient Surgery 

5 Quality and Access Act of 2023’’. 


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1 SEC. 2. ALIGNING UPDATES FOR AMBULATORY SURGICAL 

2 CENTER SERVICES WITH UPDATES FOR OPD 

3 SERVICES. 

4 Section 1833(i)(2)(D) of the Social Security Act (42 

5 U.S.C. 1395l(i)(2)(D)) is amended— 

6 (1) in clause (v)— 

7 (A) in the first sentence, by inserting be8 fore the period the following: ‘‘and, in the case 

9 of 2024 or a subsequent year, by the adjust10 ment described in subsection (t)(3)(G) for the 

11 respective year’’; and 

12 (B) by moving the margin 6 ems to the 

13 left; 

14 (2) by redesignating clause (vi) as clause (vii); 

15 and 

16 (3) by inserting after clause (v) the following 

17 new clause: 

18 ‘‘(vi) In implementing the system described in clause 

19 (i) for 2024 and each subsequent year, there shall be an 

20 annual update under such system for the year equal to 

21 the OPD fee schedule increase factor specified under sub22 section (t)(3)(C)(iv) for such year, adjusted in accordance 

23 with clauses (iv) and (v).’’. 


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1 SEC. 3. TRANSPARENCY OF QUALITY REPORTING AND 

2 MEDICARE BENEFICIARY INFORMATION. 

3 Paragraph (7) of section 1833(i) of the Social Secu4 rity Act (42 U.S.C. 1395l(i)) is amended by adding at the 

5 end the following new subparagraphs: 

6 ‘‘(C) To the extent that quality measures imple7 mented by the Secretary under this paragraph for ambula8 tory surgical centers and under section 1833(t)(17) for 

9 hospital outpatient departments are applicable to the pro10 vision of surgical services in both ambulatory surgical cen11 ters and hospital outpatient departments, the Secretary 

12 shall make reported data on such centers and departments 

13 available on the website ‘Medicare.gov’ in a manner that 

14 will permit side-by-side comparisons on such measures for 

15 ambulatory surgical centers and hospital outpatient de16 partments in the same geographic area. 

17 ‘‘(D) The Secretary shall ensure that an ambulatory 

18 surgery center and a hospital has the opportunity to re19 view, and submit any corrections for, the data to be made 

20 public with respect to the ambulatory surgery center under 

21 subparagraph (C) prior to such data being made public. 

22 ‘‘(E) The Secretary shall develop materials and in23 form beneficiaries under this title of publicly available 

24 comparisons provided for in subparagraph (C).’’. 


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1 SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAY2 MENT REPRESENTATION. 

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

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

5 U.S.C. 1395l(t)(9)(A)) is amended by inserting ‘‘and sup6 pliers subject to the prospective payment system (includ7 ing at least one ambulatory surgical center representa8 tive)’’ after ‘‘an appropriate selection of representatives of 

9 providers’’. 

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

11 subsection (a) shall take effect on the date of the enact12 ment of this Act. 

13 SEC. 5. REASONS FOR EXCLUDING ADDITIONAL PROCE14 DURES FROM ASC APPROVED LIST. 

15 (a) IN GENERAL.—Section 1833(i)(1) of the Social 

16 Security Act (42 U.S.C. 1395l(i)(1)) is amended by add17 ing at the end the following: ‘‘In updating such lists for 

18 application in years beginning after the date of the enact19 ment of this sentence, for each procedure that was re20 quested to be included in such lists during the public com21 ment period but which the Secretary does not propose (in 

22 the final rule updating such lists) to so include in such 

23 lists, the Secretary shall cite in such final rule the specific 

24 criteria in paragraph (b) or (c) of section 416.166 of title 

25 42, Code of Federal Regulations, based on which the pro26 cedure was excluded. If paragraph (b) of such section is 


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1 cited for exclusion of a procedure, the Secretary shall iden2 tify the peer reviewed research or the evidence upon which 

3 such determination is based.’’. 

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

5 subsection (a) shall apply to lists of ambulatory surgery 

6 procedures for application in years beginning after the 

7 date of the enactment of this Act. 

8 SEC. 6. LIMITATION ON AMBULATORY SURGERY CENTER 

9 COPAYMENT FOR A PROCEDURE TO THE 

10 HOSPITAL DEDUCTIBLE AMOUNT. 

11 Section 1833(a)(1)(G) of the Social Security Act (42 

12 U.S.C. 1395l(a)(1)(G)) is amended by inserting the fol13 lowing before the comma at the end: ‘‘, except that in no 

14 case shall the copayment amount for such services fur15 nished in a year exceed the amount of the inpatient hos16 pital deductible established under section 1813(b) for the 

17 year (and, notwithstanding any other provision of this sec18 tion, the amount of payment for such services shall be in19 creased by the amount of any reduction in the copayment 

20 amount for such services pursuant to this subparagraph)’’. 

21 SEC. 7. ALIGNMENT OF BUDGET NEUTRALITY ADJUSTMENT 

22 FOR OUTPATIENT SURGICAL PROCEDURES. 

23 (a) PROHIBITING UNAUTHORIZED AGENCY AC24 TION.—Section 1833(i)(2)(D)(ii) of the Social Security 

25 Act (42 U.S.C. 1395l(i)(2)(D)(ii)) is amended by adding 


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1 at the end the following: ‘‘The preceding sentence shall 

2 only apply to the first year the system described in clause 

3 (i) was implemented and shall not apply to any year after 

4 2023.’’. 

5 (b) COMBINING VOLUME FOR BUDGET NEUTRALITY

6 CALCULATION.—Section 1833(t)(9)(B) of the Social Se7 curity Act (42 U.S.C. 1395l(t)(9)(B)) is amended by in8 serting ‘‘taking into account the volume of procedures paid 

9 under this subsection combined with the volume of proce10 dures paid under subsection (i),’’ after ‘‘subparagraph 

11 (A),’’. 

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

13 subsections (a) and (b) shall apply in years beginning after 

14 the date of the enactment of this Act. 

Æ 


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