IB 

Union Calendar No. 585 

115TH CONGRESS 

2D SESSION H. R. 5804 

[Report No. 115–752, Part I] 

To amend title XVIII of the Social Security Act to provide for modifications 

in payment for certain outpatient surgical services. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. SHIMKUS (for himself, Mr. KRISHNAMOORTHI, and Mr. ROSKAM) 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 

JUNE 13, 2018 

Additional sponsor: Mr. WALDEN

JUNE 13, 2018 

Reported from the Committee on Energy and Commerce 

JUNE 13, 2018 

Committee on Ways and Means discharged; committed to the Committee of 

the Whole House on the State of the Union and ordered to be printed 


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•HR 5804 RH

A BILL 

To amend title XVIII of the Social Security Act to provide 

for modifications in payment for certain outpatient surgical services. 


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•HR 5804 RH

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 ‘‘Post-Surgical Injec5 tions as an Opioid Alternative Act’’. 

6 SEC. 2. MODIFICATION OF PAYMENT FOR CERTAIN OUT7 PATIENT SURGICAL SERVICES. 

8 (a) FREEZE OF PAYMENT FOR CERTAIN SERVICES

9 FURNISHED IN AMBULATORY SURGICAL CENTERS.—Sec10 tion 1833(i)(2) of the Social Security Act (42 U.S.C. 

11 1395l(i)(2)) is amended by adding at the end the following 

12 new subparagraph: 

13 ‘‘(F)(i) With respect to a targeted procedure 

14 (as defined in clause (ii)) furnished during 2020 or 

15 a subsequent year (before 2025) to an individual in 

16 an ambulatory surgical center, the payment amount 

17 for such procedure that would otherwise be deter18 mined under the revised payment system under sub19 paragraph (D), without application of this subpara20 graph, shall be equal to the payment amount for 

21 such procedure furnished in 2016. 

22 ‘‘(ii) For purposes of clause (i), the term ‘tar23 geted procedure’ means a procedure to which 

24 Healthcare Common Procedure Coding System 

25 62310 (or, for years beginning after 2016, 62321), 


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•HR 5804 RH

1 62311 (or, for years beginning after 2016, 62323), 

2 62264, 64490, 64493, or G0260 (or any successor 

3 code) applies. 

4 ‘‘(iii) This subparagraph shall not be applied in 

5 a budget-neutral manner.’’. 

6 (b) DATA COLLECTION.— 

7 (1) IN GENERAL.—The Comptroller General 

8 shall collect data relating to the cost differential be9 tween targeted procedures (as defined in section 

10 1833(i)(2)(F)(ii) of the Social Security Act, as 

11 added by subsection (a)) that are performed in a 

12 hospital operating room and such procedures that 

13 are performed in an office setting within a hospital 

14 in order to determine whether such procedures are 

15 being properly coded for claims, based on setting, for 

16 payment under section 1833(i)(2)(D) of the Social 

17 Security Act (42 U.S.C. 1395l(i)(2)(D)) and to de18 termine if further changes are needed in the classi19 fication system for covered outpatient department 

20 services (as described in section 1833(t)(2)(A) of the 

21 Social Security Act (42 U.S.C. 1395l(t)(2)(A)). 

22 (2) REPORT.—Not later than 4 years after the 

23 date of the enactment of this Act, the Comptroller 

24 General shall submit a report to the Committee on 

25 Energy and Commerce and the Committee on Ways 


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1 and Means of the House of Representatives and the 

2 Committee on Finance of the Senate containing— 

3 (A) a determination of whether procedures 

4 described in paragraph (1) are being properly 

5 coded for claims, based on setting, for payment 

6 under section 1833(i)(2)(D) of the Social Secu7 rity Act (42 U.S.C. 1395l(i)(2)(D)); and 

8 (B) recommendations on any changes the 

9 Comptroller General determines are needed in 

10 the classification system for covered outpatient 

11 department services (as described in section 

12 1833(t)(2)(A) of the Social Security Act (42 

13 U.S.C. 1395l(t)(2)(A)). 

14 (c) STUDY.—Not later than 3 years after the date 

15 of the enactment of this Act, the Secretary of Health and 

16 Human Services shall conduct a study and submit to Con17 gress a report on the extent to which procedures described 

18 in section 1833(i)(2)(F)(ii) of the Social Security Act, as 

19 added by subsection (a), are effective at preventing the 

20 need for opioids for individuals furnished such procedures. 


daltland on DSKBBV9HB2PROD with BILLS
Union Calendar No. 585 

115TH CONGRESS 

2D SESSION H. R. 5804 

[Report No. 115–752, Part I] 

A BILL 

To amend title XVIII of the Social Security Act to 

outpatient surgical services. provide for modifications in payment for certain 

JUNE 13, 2018 

Reported from the Committee on Energy and Commerce 

JUNE 13, 2018 

Committee on Ways and Means discharged; committed to 

Union and ordered to be printed the Committee of the Whole House on the State of the 


daltland on DSKBBV9HB2PROD with BILLS