I 
111TH CONGRESS 
1ST SESSION H. R. 2049 
To amend title XVIII of the Social Security Act to modernize payments 
for ambulatory surgical centers under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 22, 2009 
Mr. MEEK of Florida (for himself and Mr. HERGER) 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 sub-
sequently 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 modernize 
payments for ambulatory surgical centers under the 
Medicare Program. 
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 ‘‘Ambulatory Surgical 
Center Access Act of 2009’’. 
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SEC. 2. MEDICARE PAYMENT FOR AMBULATORY SURGICAL 
CENTER SERVICES. 
(a) IN GENERAL.—Section 1833(i) of the Social Se-
curity Act (42 U.S.C. 1395l(i)) is amended by striking 
paragraphs (2) through (6) and inserting the following: 
‘‘(2)(A) Subject to subparagraphs (B) and (C), the 
amount of payment to be made under this subsection for 
facility services furnished to an individual in an ambula-
tory surgical center in accordance with paragraph (1) shall 
be equal to 59 percent of the fee schedule amount deter-
mined under paragraph (3)(D) of subsection (t) for pay-
ment of the same service furnished in hospital outpatient 
departments, as adjusted under paragraphs (4)(A), (6), 
and (15) of such subsection, less a 20 percent beneficiary 
copayment, except that in no case shall the copayment 
amount for a procedure performed in a year exceed the 
amount of the inpatient hospital deductible established 
under section 1813(b) for that year. 
‘‘(B) For covered ambulatory surgical center services 
furnished during calendar year 2010, the amount of pay-
ment under this subsection shall be equal to the sum of— 
‘‘(i) 25 percent of the ambulatory surgical cen-
ter payment amount payable under this subsection 
in 2007; and 
‘‘(ii) 75 percent of the payment amount under 
subparagraph (A) for 2010. 
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‘‘(C)(i) Notwithstanding subparagraphs (A) and (B), 
if a facility service furnished to an individual in an ambu-
latory surgical center includes an implantable medical de-
vice, the amount of payment for that service shall be equal 
to the sum of— 
‘‘(I) 100 percent of the hospital OPD fee sched-
ule amount under subsection (t) that the Secretary 
determines is associated with the device; and 
‘‘(II) 59 percent of non-device-related compo-
nent of such OPD fee schedule amount; 
less a 20 percent beneficiary copayment. 
‘‘(ii) For purposes of clause (i), the term ‘implantable 
medical device’ means a device that— 
‘‘(I) is an integral and subordinate part of the 
service furnished; 
‘‘(II) is used for one patient only; 
‘‘(III) comes in contact with human tissue; and 
‘‘(IV) is surgically implanted or inserted, 
whether or not it remains with the patient when the 
patient is released from the ambulatory surgical cen-
ter.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1832(a)(2)(F)(i) of such Act (42 
U.S.C. 1395k(a)(2)(F)(i)) is amended— 
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(A) by striking ‘‘the standard overhead 
amount 
as 
determined 
under 
section 
1833(i)(2)(A)’’ and inserting ‘‘the amount de-
termined under section 1833(i)(2)’’; and 
(B) by striking all that follows ‘‘as full 
payment for such services’’ and inserting ‘‘, 
or’’. 
(2) Section 1833(a)(1)(G) of such Act (42 
U.S.C. 1395l(a)(1)(G)) is amended— 
(A) by striking ‘‘for services furnished be-
ginning’’ and all that follows through ‘‘sub-
section (i)(2)(D),’’; and 
(B) by striking ‘‘such revised payment sys-
tem’’ and inserting ‘‘subsection (i)(2)’’. 
(3) Section 1833(a)(4) of such Act (42 U.S.C. 
1395l(a)(4)) is amended by striking ‘‘or (3)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to ambulatory surgical center serv-
ices furnished on or after January 1, 2010. 
SEC. 3. QUALITY REPORTING AND COMPARISON. 
(a) IN GENERAL.—Paragraph (7) of section 1833(i) 
of the Social Security Act (42 U.S.C. 1395l(i)) is amend-
ed— 
(1) by redesignating such paragraph as para-
graph (3); 
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(2) in subparagraph (A)— 
(A) by striking ‘‘For purposes of para-
graph (2)(D)(iv), the’’ and inserting ‘‘The’’; 
(B) by striking ‘‘established under para-
graph (2)(D)’’ and inserting ‘‘described in para-
graph (2)’’; and 
(C) by adding at the end the following: 
‘‘Data required to be submitted on measures se-
lected under this paragraph must be on meas-
ures that have been selected by the Secretary 
after consideration of public comments and that 
have consensus endorsement from affected par-
ties.’’; 
(3) in subparagraph (B)— 
(A) by striking ‘‘Except as the Secretary 
may otherwise provide, the’’ and inserting 
‘‘The’’; and 
(B) by inserting before the period at the 
end the following: ‘‘, except that the form and 
manner of reporting by ambulatory surgical 
centers shall include the option of submitting 
data with claims for payment’’; and 
(4) by adding at the end the following new sub-
paragraphs: 
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‘‘(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— 
‘‘(i) require that both ambulatory surgical cen-
ters and hospital outpatient departments report data 
on such measures; and 
‘‘(ii) make reported data available on the 
website ‘Medicare.gov’ in a manner that will permit 
side-by-side comparisons on such measures for am-
bulatory surgical centers and hospital outpatient de-
partments in the same geographic area. 
‘‘(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 pay-
ment and beneficiary copayment amounts for the proce-
dure when performed in ambulatory surgical centers and 
hospital outpatient departments in the same geographic 
area.’’. 
(b) MEDPAC STUDY.— 
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(1) IN GENERAL.—The Medicare Payment Ad-
visory Commission shall conduct a study of out-
patient surgical services covered under section 1833 
of the Social Security Act (42 U.S.C. 1395l). The 
study shall compare beneficiaries’ use of different 
settings across geographic areas, spending implica-
tions for the Medicare program for such services 
when provided in different settings, and out-of-pock-
et liability for beneficiaries for such services when 
provided in different settings. 
(2) REPORT.—Not later than one year after the 
date of the enactment of this Act, the Commission 
shall submit to Congress a report on the findings of 
the study conducted under paragraph (1). Where ap-
propriate, such report shall include recommendations 
on modifications in coverage and payment policies 
under part B of title XVIII of the Social Security 
Act needed to optimize the economical utilization of 
outpatient surgical services. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2010. 
SEC. 4. APC PANEL 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-
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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. ENSURING ACCESS TO SAME DAY SERVICES. 
The conditions for coverage of ambulatory surgical 
center services specified by the Secretary of Health and 
Human Services pursuant to section 1832(a)(2)(F)(i) of 
the Social Security Act (42 U.S.C. 1395k(a)(2)(F)(i)) 
shall not prohibit ambulatory surgical centers from pro-
viding individuals with any notice of rights or other re-
quired notice on the date of a procedure if more advance 
notice is not feasible under the circumstances, including 
when a procedure is scheduled and performed on the same 
day. 
Æ 
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