I 
112TH CONGRESS 
1ST SESSION H. R. 2108 
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 
JUNE 3, 2011 
Mr. SESSIONS (for himself, Mr. LARSON of Connecticut, Ms. BERKLEY, and 
Mr. CASSIDY) 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 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 Quality and Access Act of 2011’’. 
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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. 13951(i)) is amended— 
(1) by redesignating clause (vi) as clause (vii); 
(2) in the first sentence of clause (v), by insert-
ing before the period the following: ‘‘and, in the case 
of 2012 or a subsequent year, by the adjustment de-
scribed in subsection (t)(3)(G) for the respective 
year’’; and 
(3) by inserting after clause (v) the following 
new clause: 
‘‘(vi) In implementing the system de-
scribed in clause (i) for 2012 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 ac-
cordance with clauses (iv) and (v).’’. 
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SEC. 3. IMPROVING ASC QUALITY MEASURE REPORTING 
AND APPLYING VALUE-BASED PURCHASING 
TO ASCS. 
(a) QUALITY MEASURES.—Paragraph (7) of section 
1833(i) of the Social Security Act (42 U.S.C. 1395l(i)) 
is amended— 
(1) in subparagraph (A)— 
(A) in the first sentence, by inserting ‘‘(be-
ginning with 2014)’’ after ‘‘with respect to a 
year’’; and 
(B) 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 in 
accordance with the process described in sub-
paragraph (B). Such measures may include 
healthcare acquired infection measures appro-
priate for ambulatory surgery centers, prophy-
lactic IV antibiotic timing, and patient falls. 
Ambulatory surgical centers determined by the 
Secretary to furnish a minimal number of items 
and services under this title with respect to a 
year shall not be subject to a reduction under 
this subparagraph for such year.’’; 
(2) in subparagraph (B)— 
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(A) by striking ‘‘Except as the Secretary 
may otherwise provide, the’’ and inserting ‘‘Ex-
cept as provided in the subsequent sentence, 
the’’; and 
(B) by adding at the end the following: ‘‘In 
carrying out the previous sentence, the Sec-
retary shall— 
‘‘(i) ensure that measures meet the 
definition and process for identifying qual-
ity measures under subsections (a) and (b) 
of section 931 of the Public Health Service 
Act; 
‘‘(ii) ensure that measures are devel-
oped, selected, and modified in accordance 
with the development, selection, and modi-
fication processes for measures established 
under section 1890A and in accordance 
with section 1890; 
‘‘(iii) ensure that measures are se-
lected, and a data submission process is 
implemented, under this paragraph in a 
manner that ensures ambulatory surgical 
centers are able to voluntarily submit data 
under this paragraph not later than Janu-
ary 1, 2013; 
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surgical centers and hospital outpatient depart-
ments 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 cor-
rections for, the data to be made public with re-
spect to the ambulatory surgery center under 
subparagraph (C)(ii) prior to such data being 
made public.’’. 
(b) AMBULATORY SURGICAL CENTER VALUE-BASED 
PURCHASING PROGRAM.—Section 1833(i) is amended by 
adding at the end the following new paragraph: 
‘‘(8) VALUE-BASED PURCHASING PROGRAM.— 
‘‘(A) 
ESTABLISHMENT.—The 
Secretary 
shall establish an ambulatory surgical center 
value-based purchasing program (in this sub-
section referred to as the ‘Program’) under 
which, subject to subparagraph (I), each ambu-
latory surgical center that the Secretary deter-
mines meets (or exceeds) the performance 
standards under subparagraph (D) for the per-
formance period (as established under subpara-
graph (E)) for a calendar year is eligible, from 
the amounts made available in the total shared 
savings pool under subparagraph (I)(iv), for 
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shared savings under subparagraph (I), which 
shall be in the form, after application of the ad-
justments under clauses (iv), (v), and (vi) of 
paragraph (2)(D), of an increase in the amount 
of payment determined under the payment sys-
tem under paragraph (2)(D) for surgical serv-
ices furnished by such center during the subse-
quent year, by the value-based percentage 
amount under subparagraph (H) specified by 
the Secretary for such center and year. 
‘‘(B) PROGRAM
START
DATE.—The Pro-
gram shall apply to payments for procedures 
occurring on or after January 1, 2015. 
‘‘(C) MEASURES.— 
‘‘(i) IN
GENERAL.—For purposes of 
the Program, the Secretary shall select 
measures from the measures specified 
under paragraph (7). 
‘‘(ii) AVAILABILITY OF MEASURE AND 
DATA.—The Secretary may not select a 
measure under this paragraph for use 
under the Program with respect to a per-
formance period for a calendar year unless 
such measure has been included, and the 
reported data available, on the website 
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‘Medicare.gov’, for at least 1 year prior to 
the beginning of such performance period. 
‘‘(iii) MEASURE NOT APPLICABLE UN-
LESS
ASC
FURNISHES
SERVICES
APPRO-
PRIATE TO MEASURE.—A measure selected 
under this paragraph for use under the 
Program shall not apply to an ambulatory 
surgical center if such center does not fur-
nish services appropriate to such measure. 
‘‘(D) PERFORMANCE STANDARDS.— 
‘‘(i) ESTABLISHMENT.—The Secretary 
shall establish performance standards with 
respect to measures selected under sub-
paragraph (C)(i) for a performance period 
for a calendar year. 
‘‘(ii) ACHIEVEMENT
AND
IMPROVE-
MENT.—The performance standards estab-
lished under clause (i) shall include levels 
of achievement and improvement. 
‘‘(iii) TIMING.—The Secretary shall 
establish and announce the performance 
standards under clause (i) not later than 
60 days prior to the beginning of the per-
formance period for the calendar year in-
volved. 
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‘‘(E) PERFORMANCE
PERIOD.—For pur-
poses of the Program, the Secretary shall estab-
lish the performance period for a calendar year. 
Such performance period shall begin and end 
prior to the beginning of such calendar year. 
‘‘(F) ASC PERFORMANCE
SCORE.—The 
Secretary shall develop a methodology for as-
sessing the total performance of each ambula-
tory surgery center based on performance 
standards with respect to the measures selected 
under subparagraph (C) for a performance pe-
riod (as established under subparagraph (E)). 
Using such methodology, the Secretary shall 
provide for an assessment (in this subsection 
referred to as the ‘ASC performance score’) for 
each ambulatory surgical center for each per-
formance period. The methodology shall provide 
that the ASC performance score is determined 
using the higher of its achievement or improve-
ment score for each measure. 
‘‘(G) APPEALS.—The Secretary shall es-
tablish a process by which ambulatory surgery 
centers may appeal the calculation of the ambu-
latory surgery center’s performance with re-
spect to the performance standards established 
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under subparagraph (D) and the ambulatory 
surgery center performance score under sub-
paragraph (E). The Secretary shall ensure that 
such process provides for resolution of appeals 
in a timely manner. 
‘‘(H) CALCULATION OF VALUE-BASED IN-
CENTIVE PAYMENT.— 
‘‘(i) 
VALUE-BASED
PERCENTAGE 
AMOUNT.—For purposes of subparagraph 
(A), the Secretary shall specify a value- 
based percentage amount for an ambula-
tory surgical center for a calendar year. 
‘‘(ii) REQUIREMENTS.—In specifying 
the value-based percentage amount for 
each ambulatory surgical center for a cal-
endar year under clause (i), the Secretary 
shall ensure that such percentage is based 
on— 
‘‘(I) the ASC performance score 
of the ambulatory surgery center 
under subparagraph (F); and 
‘‘(II) the amount of the total sav-
ings pool made available under sub-
paragraph (I)(iii)(I) for such year. 
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‘‘(I) ANNUAL
CALCULATION
OF
SHARED 
SAVINGS
FUNDING
FOR
VALUE-BASED
INCEN-
TIVE PAYMENTS.— 
‘‘(i) DETERMINING BONUS POOL.—In 
each year of the Program, ambulatory sur-
gery centers shall be eligible to receive pay-
ment for shared savings under the Pro-
gram only if for such year the sum of— 
‘‘(I) the estimated amount of ex-
penditures under this title for Medi-
care fee-for-service beneficiaries (as 
defined in section 1899(h)(3)) for sur-
gical services for which payment is 
made under the payment system 
under paragraph (2), adjusted for 
beneficiary characteristics, and 
‘‘(II) the estimated amount of ex-
penditures under this title for Medi-
care fee-for-service beneficiaries (as so 
defined) for the same surgical services 
for which payment is made under the 
prospective payment system under 
subsection (t), adjusted for beneficiary 
characteristics, 
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Such benchmark shall be reset at the start 
of each calendar year, and adjusted for 
changes in enrollment under the Medicare 
fee-for-service program. 
‘‘(iii) PAYMENTS BASED ON SHARED 
SAVINGS.—If the requirement under clause 
(i) is met for a year— 
‘‘(I) 50 percent of the total sav-
ings pool estimated under clause (iv) 
for such year shall be made available 
for shared savings to be paid to am-
bulatory surgical centers under this 
paragraph; 
‘‘(II) a percent (as determined 
appropriate by the Secretary, in ac-
cordance with subparagraph (H)) of 
such amount made available for such 
year shall be paid as shared savings to 
each ambulatory surgery center that 
is determined under the Program to 
have met or exceeded performance 
scores for such year; and 
‘‘(III) all funds made available 
under subclause (I) for such year 
shall be used and paid as sharing sav-
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ings for such year in accordance with 
subclause (II). 
‘‘(iv) ESTIMATE OF THE TOTAL SAV-
INGS POOL.—For purposes of clause (iii), 
the Secretary shall estimate for each year 
of the Program the total savings pool as 
the product of— 
‘‘(I) the conversion factor for 
such year determined by the Secretary 
under the payment system under 
paragraph (2)(D) divided by the con-
version factor calculated under sub-
section (t)(3)(C) for such year for 
covered OPD services, multiplied by 
100, and 
‘‘(II)(aa) the product of the esti-
mated Medicare expenditures for sur-
gical services described in clause (i)(I) 
furnished during such year to Medi-
care fee-for-service beneficiaries (as 
defined in section 1899(h)(3)) for 
which payment is made under sub-
section (t) and the average annual 
growth in the estimated Medicare ex-
penditures for such services furnished 
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to 
Medicare 
fee-for-service 
bene-
ficiaries (as so defined) for which pay-
ment is made under subsection (t) in 
the most recent available 3 years, less 
‘‘(bb) the estimated Medicare ex-
penditures for surgical services de-
scribed in clause (i)(I) furnished to 
Medicare fee-for-service beneficiaries 
for which payment was made under 
subsection (t) in the most recent year. 
‘‘(J) NO
EFFECT
IN
SUBSEQUENT
CAL-
ENDAR
YEARS.—The value-based percentage 
amount under subparagraph (H) and the per-
cent determined under subparagraph (I)(iii)(I) 
shall apply only with respect to the calendar 
year involved, and the Secretary shall not take 
into account such amount or percentage in 
making payments to an ambulatory surgery 
center under this section in a subsequent cal-
endar year.’’. 
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-
pliers subject to the prospective payment system (includ-
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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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