I 
117TH CONGRESS 
1ST SESSION H. R. 5818 
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 HOUSE OF REPRESENTATIVES 
NOVEMBER 2, 2021 
Mr. LARSON of Connecticut (for himself and Mr. NUNES) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Outpatient Surgery 
Quality and Access Act of 2021’’. 
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SEC. 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)) is amended— 
(1) in clause (v)— 
(A) in the first sentence, by inserting be-
fore the period the following: ‘‘and, in the case 
of 2022 or a subsequent year, by the adjust-
ment described in subsection (t)(3)(G) for the 
respective year’’; and 
(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 sub-
section (t)(3)(C)(iv) for such year, adjusted in accordance 
with clauses (iv) and (v).’’. 
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SEC. 3. TRANSPARENCY OF QUALITY REPORTING AND 
MEDICARE BENEFICIARY INFORMATION. 
Paragraph (7) of section 1833(i) of the Social Secu-
rity Act (42 U.S.C. 1395l(i)) is amended by adding at the 
end the following new subparagraphs: 
‘‘(C) To the extent that quality measures imple-
mented by the Secretary under this paragraph for ambula-
tory surgical centers and under section 1833(t)(17) for 
hospital outpatient departments are applicable to the pro-
vision of surgical services in both ambulatory surgical cen-
ters and hospital outpatient departments, the Secretary 
shall make reported data on such centers and departments 
available on the website ‘Medicare.gov’ in a manner that 
will permit side-by-side comparisons on such measures for 
ambulatory surgical centers and hospital outpatient de-
partments in the same geographic area. 
‘‘(D) The Secretary shall ensure that an ambulatory 
surgery center and a hospital has the opportunity to re-
view, 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 in-
form beneficiaries under this title of publicly available 
comparisons provided for in subparagraph (C).’’. 
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SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAY-
MENT 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)) is amended by inserting ‘‘and sup-
pliers subject to the prospective payment system (includ-
ing at least one ambulatory surgical center representa-
tive)’’ after ‘‘an appropriate selection of representatives of 
providers’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act. 
SEC. 5. REASONS FOR EXCLUDING ADDITIONAL PROCE-
DURES FROM ASC APPROVED LIST. 
(a) IN GENERAL.—Section 1833(i)(1) of the Social 
Security Act (42 U.S.C. 1395l(i)(1)) is amended by add-
ing at the end the following: ‘‘In updating such lists for 
application in years beginning after the date of the enact-
ment of this sentence, for each procedure that was re-
quested to be included in such lists during the public com-
ment 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 pro-
cedure was excluded. If paragraph (b) of such section is 
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cited for exclusion of a procedure, the Secretary shall iden-
tify 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. 
SEC. 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)) is amended by inserting the fol-
lowing before the comma at the end: ‘‘, except that in no 
case shall the copayment amount for such services fur-
nished in a year exceed the amount of the inpatient hos-
pital deductible established under section 1813(b) for the 
year (and, notwithstanding any other provision of this sec-
tion, the amount of payment for such services shall be in-
creased by the amount of any reduction in the copayment 
amount for such services pursuant to this subparagraph)’’. 
SEC. 7. ALIGNMENT OF BUDGET NEUTRALITY ADJUSTMENT 
FOR OUTPATIENT SURGICAL PROCEDURES. 
(a) PROHIBITING
UNAUTHORIZED
AGENCY
AC-
TION.—Section 1833(i)(2)(D)(ii) of the Social Security 
Act (42 U.S.C. 1395l(i)(2)(D)(ii)) is amended by adding 
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at the end the following: ‘‘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 Se-
curity Act (42 U.S.C. 1395l(t)(9)(B)) is amended by in-
serting ‘‘taking into account the volume of procedures paid 
under this subsection combined with the volume of proce-
dures paid under subsection (i),’’ after ‘‘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. 
Æ 
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