Ambulatory Surgical Center Quality and Access Act of 2015

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 Ambulatory Surgical Center Quality and Access Act of 2015 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 2016 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 2016 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) For each procedure covered for payment in an ambulatory surgical center, the Secretary shall publish, along with the quality reporting comparisons provided for in subparagraph (C), comparisons of the Medicare payment and beneficiary copayment amounts for the procedure when performed in ambulatory surgical centers and hospital outpatient departments in the same geographic area. (E) 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. (F) The Secretary shall develop materials and inform beneficiaries under this title of publicly available comparisons provided for in subparagraphs (C) and (D). . 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, 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. The Secretary may not use or cite section 416.166(c)(7) of such title as criteria or a basis for exclusion of a procedure from such lists. (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.

Summary: Ambulatory Surgical Center Quality and Access Act of 2015 Amends title XVIII (Medicare) of the Social Security Act to require alignment of updates for ambulatory surgical center (ASC) services under a revised prospective payment system (PPS) with updates for hospital outpatient department (OPD) services. Revises requirements for the reporting and applying of quality measure data by ASCs and hospital OPDs. Revises requirements for the composition of the expert outside advisory panel the Secretary of Health and Human Services is required to consult during the annual review of the clinical integrity of the groups and payment weights in the PPS for OPD services. Requires the panel to include suppliers subject to the PPS as well as at least one ASC representative. Requires the Secretary, when excluding from a final rule updating ASC lists a procedure whose inclusion was requested during the public comment period, to cite in the final rule specific criteria based on which the procedure was excluded. Requires the Secretary also to identify the peer reviewed research or the evidence upon which the exclusion is based if certain of those criteria are cited for it. Prohibits the Secretary from using or citing as a criterion or a basis for an exclusion that the procedure can only be reported using a Current Procedural Terminology unlisted surgical procedure code.