Outpatient Surgery Quality and Access Act of 2021

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. Short title This Act may be cited as the Outpatient Surgery Quality and Access Act of 2021 2. Aligning updates for ambulatory surgical center services with updates for OPD services Section 1833(i)(2)(D) of the Social Security Act ( 42 U.S.C. 1395l(i)(2)(D) (1) in clause (v)— (A) in the first sentence, by inserting before the period the following: and, in the case of 2022 or a subsequent year, by the adjustment described in subsection (t)(3)(G) for the respective year (B) by moving the margin 6 ems to the left; (2) by redesignating clause (vi) as clause (vii); and (3) by inserting after clause (v) the following new clause: (vi) In implementing the system described in clause (i) for 2022 and each subsequent year, there shall be an annual update under such system for the year equal to the OPD fee schedule increase factor specified under subsection (t)(3)(C)(iv) for such year, adjusted in accordance with clauses (iv) and (v). . 3. Transparency of quality reporting and Medicare beneficiary information Paragraph (7) of section 1833(i) of the Social Security Act ( 42 U.S.C. 1395l(i) (C) To the extent that quality measures implemented by the Secretary under this paragraph for ambulatory surgical centers and under section 1833(t)(17) for hospital outpatient departments are applicable to the provision of surgical services in both ambulatory surgical centers and hospital outpatient departments, the Secretary shall make reported data on such centers and departments available on the website Medicare.gov (D) The Secretary shall ensure that an ambulatory surgery center and a hospital has the opportunity to review, and submit any corrections for, the data to be made public with respect to the ambulatory surgery center under subparagraph (C) prior to such data being made public. (E) The Secretary shall develop materials and inform beneficiaries under this title of publicly available comparisons provided for in subparagraph (C). . 4. Advisory Panel on Hospital Outpatient Payment Representation (a) ASC representative The second sentence of section 1833(t)(9)(A) of the Social Security Act ( 42 U.S.C. 1395l(t)(9)(A) and suppliers subject to the prospective payment system (including at least one ambulatory surgical center representative) an appropriate selection of representatives of providers (b) Effective date The amendment made by subsection (a) shall take effect on the date of the enactment of this Act. 5. Reasons for excluding additional procedures from ASC approved list (a) In general Section 1833(i)(1) of the Social Security Act ( 42 U.S.C. 1395l(i)(1) In updating such lists for application in years beginning after the date of the enactment of this sentence, for each procedure that was requested to be included in such lists during the public comment period but which the Secretary does not propose (in the final rule updating such lists) to so include in such lists, the Secretary shall cite in such final rule the specific criteria in paragraph (b) or (c) of section 416.166 of title 42, Code of Federal Regulations, based on which the procedure was excluded. If paragraph (b) of such section is cited for exclusion of a procedure, the Secretary shall identify the peer reviewed research or the evidence upon which such determination is based. (b) Effective date The amendment made by subsection (a) shall apply to lists of ambulatory surgery procedures for application in years beginning after the date of the enactment of this Act. 6. Limitation on ambulatory surgery center copayment for a procedure to the hospital deductible amount Section 1833(a)(1)(G) of the Social Security Act ( 42 U.S.C. 1395l(a)(1)(G) , except that in no case shall the copayment amount for such services furnished in a year exceed the amount of the inpatient hospital deductible established under section 1813(b) for the year (and, notwithstanding any other provision of this section, the amount of payment for such services shall be increased by the amount of any reduction in the copayment amount for such services pursuant to this subparagraph) 7. Alignment of budget neutrality adjustment for outpatient surgical procedures (a) Prohibiting unauthorized agency action Section 1833(i)(2)(D)(ii) of the Social Security Act ( 42 U.S.C. 1395l(i)(2)(D)(ii) The preceding sentence shall only apply to the first year the system described in clause (i) was implemented and shall not apply to any year after 2022. (b) Combining volume for budget neutrality calculation Section 1833(t)(9)(B) of the Social Security Act ( 42 U.S.C. 1395l(t)(9)(B) taking into account the volume of procedures paid under this subsection combined with the volume of procedures paid under subsection (i), subparagraph (A), (c) Effective Date The amendments made by subsections (a) and (b) shall apply in years beginning after the date of the enactment of this Act.

Summary: Outpatient Surgery Quality and Access Act of 2021 This bill establishes and modifies certain requirements relating to Medicare payments for ambulatory surgical center (ASC) services. Specifically, the bill (1) requires the payment system for ASC services to feature certain positive annual adjustments equivalent to those made with respect to hospital outpatient department (OPD) services; (2) revises quality reporting requirements to permit publicly available, side-by-side comparisons of quality measures for ASCs and OPDs in the same geographic area; and (3) requires the Centers for Medicare & Medicaid Services (CMS), when excluding requested procedures from the list of those approved to be performed in ASCs, to cite specified reasons for doing so. With respect to excluding procedures from the approved list for ASCs, the CMS may not cite as a basis for exclusion that a procedure can only be reported using an unlisted surgical procedure code. (Physicians sometimes use unlisted codes when performing new procedures or services if no existing code is adequately descriptive.) The bill also limits the copayment amount for ASC services under Medicare to that of the inpatient hospital deductible.