I 

115TH CONGRESS 

2D SESSION H. R. 5804 

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 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for modifications in payment for certain outpatient surgical services. 

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’’. 


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1 SEC. 2. MODIFICATION OF PAYMENT FOR CERTAIN OUT2 PATIENT SURGICAL SERVICES. 

3 (a) FREEZE OF PAYMENT FOR CERTAIN SERVICES

4 FURNISHED IN AMBULATORY SURGICAL CENTERS.—Sec5 tion 1833(i)(2) of the Social Security Act (42 U.S.C. 

6 1395l(i)(2)) is amended by adding at the end the following 

7 new subparagraph: 

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

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

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

11 an ambulatory surgical center, the payment amount 

12 for such procedure that would otherwise be deter13 mined under the revised payment system under sub14 paragraph (D), without application of this subpara15 graph, shall be equal to the payment amount for 

16 such procedure furnished in 2016. 

17 ‘‘(ii) For purposes of clause (i), the term ‘tar18 geted procedure’ means a procedure to which 

19 Healthcare Common Procedure Coding System 

20 62310 (or, for years beginning after 2016, 62321), 

21 62311 (or, for years beginning after 2016, 62323), 

22 62264, 64490, 64493, or G0260 (or any successor 

23 code) applies. 

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

25 a budget-neutral manner.’’. 

26 (b) DATA COLLECTION.— 


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1 (1) IN GENERAL.—The Comptroller General 

2 shall collect data relating to the cost differential be3 tween targeted procedures (as defined in section 

4 1833(i)(2)(F)(ii) of the Social Security Act, as 

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

6 hospital operating room and such procedures that 

7 are performed in an office setting within a hospital 

8 in order to determine whether such procedures are 

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

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

11 Security Act (42 U.S.C. 1395l(i)(2)(D)) and to de12 termine if further changes are needed in the classi13 fication system for covered outpatient department 

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

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

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

17 date of the enactment of this Act, the Comptroller 

18 General shall submit a report to the Committee on 

19 Energy and Commerce and the Committee on Ways 

20 and Means of the House of Representatives and the 

21 Committee on Finance of the Senate containing— 

22 (A) a determination of whether procedures 

23 described in paragraph (1) are being properly 

24 coded for claims, based on setting, for payment 


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1 under section 1833(i)(2)(D) of the Social Secu2 rity Act (42 U.S.C. 1395l(i)(2)(D)); and 

3 (B) recommendations on any changes the 

4 Comptroller General determines are needed in 

5 the classification system for covered outpatient 

6 department services (as described in section 

7 1833(t)(2)(A) of the Social Security Act (42 

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

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

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

11 Human Services shall conduct a study and submit to Con12 gress a report on the extent to which procedures described 

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

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

15 need for opioids for individuals furnished such procedures. 

Æ 


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