I 
113TH CONGRESS 
1ST SESSION H. R. 2500 
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 
JUNE 25, 2013 
Mr. NUNES (for himself, Mr. LARSON of Connecticut, Mr. BUCHANAN, Mr. 
BUCSHON, Mr. BURGESS, Mr. COLE, Mr. GRIFFIN of Arkansas, Mr. 
HALL, Mr. LARSEN of Washington, Mr. MARCHANT, Mr. MICHAUD, Mr. 
NUGENT, Mr. PASCRELL, Mr. ROE of Tennessee, Ms. LINDA T. SA´NCHEZ 
of California, Mr. SCHWEIKERT, Mr. DAVID SCOTT of Georgia, Mr. SES-
SIONS, Mr. SMITH of Washington, Mr. VEASEY, Mr. WHITFIELD, and Mr. 
STIVERS) introduced the following bill; which was referred to the Com-
mittee 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, 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 ‘‘Ambulatory Surgical 
Center Quality and Access Act of 2013’’. 
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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) 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 2014 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 2014 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).’’. 
SEC. 3. TRANSPARENCY OF QUALITY REPORTS AND APPLI-
CATION OF 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)) 
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is amended by adding at the end the following new sub-
paragraphs: 
‘‘(C) To the extent that quality measures 
implemented by the Secretary under this para-
graph for ambulatory surgical centers and 
under section 1833(t)(17) for hospital out-
patient departments are applicable to the provi-
sion of surgical services in both ambulatory sur-
gical centers and hospital outpatient depart-
ments, 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 meas-
ures for ambulatory surgical centers and hos-
pital outpatient departments in the same geo-
graphic area. 
‘‘(D) For each procedure covered for pay-
ment in an ambulatory surgical center, the Sec-
retary shall publish, along with the quality re-
porting comparisons provided for in subpara-
graph (C), comparisons of the Medicare pay-
ment and beneficiary copayment amounts for 
the procedure when performed in ambulatory 
surgical centers and hospital outpatient depart-
ments in the same geographic area. 
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‘‘(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) prior to such data being 
made public.’’. 
(b) AMBULATORY SURGICAL CENTER VALUE-BASED 
PURCHASING PROGRAM.—Section 1833(i) of the Social 
Security Act (42 U.S.C. 1395l(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 
shared savings under subparagraph (I), which 
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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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‘‘(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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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. 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-
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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. 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, Secretary shall cite in such final rule the specific cri-
teria 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 
cited for exclusion of a procedure, the Secretary shall iden-
tify the peer reviewed research or the evidence upon which 
such determination is based. The Secretary may not use 
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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. 
Æ 
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