Social Security Act §1833

(v)taking into accountthe comments received during the public comment period, develops andmakes available to the public (through an Internet website and otherappropriate mechanisms) a list of final determinations of the paymentamounts for such tests under this subsection, together with the rationalefor each such determination, the data on which the determinationsare based, and responses to comments and suggestions received fromthe public.(C)Under theprocedures established pursuant to subparagraph (A), the Secretaryshall(i)set forth thecriteria for making determinations under subparagraph (A); and(ii)make availableto the public the data (other than proprietary data) considered inmaking such determinations.(D)The Secretarymay convene such further public meetings to receive public commentson payment amounts for new tests under this subsection as the Secretarydeems appropriate.(E)For purposesof this paragraph:(i)The term HCPCS refers to the Health Care Procedure Coding System.(ii)A code shallbe considered to be substantially revised if thereis a substantive change to the definition of the test or procedureto which the code applies (such as a new analyte or a new methodologyfor measuring an existing analyte-specific test).(9)Notwithstandingany other provision in this part, in the case of any diagnostic laboratorytest for HbA1c that is labeled by the Food and Drug Administrationfor home use and is furnished on or after April 1, 2008, the paymentrate for such test shall be the payment rate established under thispart for a glycated hemoglobin test (identified as of October 1, 2007,by HCPCS code 83036 (and any succeeding codes)).(i)(1)The Secretaryshall, in consultation with appropriate medical organizations(A)specify thosesurgical procedures which are appropriately (when considered in termsof the proper utilization of hospital inpatient facilities) performedon an inpatient basis in a hospital but which also can be performedsafely on an ambulatory basis in an ambulatory surgical center (meetingthe standards specified under section 1832(a)(2)(F)(i)), critical accesshospital, or hospital outpatient department, and(B)specify thosesurgical procedures which are appropriately (when considered in termsof the proper utilization of hospital inpatient facilities) performedon an inpatient basis in a hospital but which also can be performedsafely on an ambulatory basis in a physicians office.The lists of procedures established under subparagraphs (A)and (B) shall be reviewed and updated not less often than every 2years.(2)(A)For servicesfurnished prior to the implementation of the system described in subparagraph(D), subject to subparagraph (E), the amount of payment to be madefor facility services furnished in connection with a surgical procedurespecified pursuant to paragraph (1)(A) and furnished to an individualin an ambulatory surgical center described in such paragraph shallbe equal to 80 percent of a standard overhead amount established bythe Secretary (with respect to each such procedure) on the basis ofthe Secretarys estimate of a fair fee which(i)takes into accountthe costs incurred by such centers, or classes of centers, generallyin providing services furnished in connection with the performanceof such procedure as determined in accordance with a survey (basedupon a representative sample of procedures and facilities) of theactual audited costs incurred by such centers in providing such services,(ii)takes suchcosts into account in such a manner as will assure that the performanceof the procedure in such a center will result in substantially lessamounts paid under this title than would have been paid if the procedurehad been performed on an inpatient basis in a hospital, and(iii)in the caseof insertion of an intraocular lens during or subsequent to cataractsurgery includes payment which is reasonable and related to the costof acquiring the class of lens involved.Each amount so established shall be reviewed and updated notlater than July 1, 1987, and annually thereafter to take account ofvarying conditions in different areas.(B)The amountof payment to be made under this part for facility services furnished,in connection with a surgical procedure specified pursuant to paragraph(1)(B), in a physicians office shall be equal to 80 percentof a standard overhead amount established by the Secretary (with respectto each such procedure) on the basis of the Secretarys estimateof a fair fee which(i)takes into accountadditional costs, not usually included in the professional fee, incurredby physicians in securing, maintaining, and staffing the facilitiesand ancillary services appropriate for the performance of such procedurein the physicians office, and(ii)takes suchitems into account in such a manner which will assure that the performanceof such procedure in the physicians office will result in substantiallyless amounts paid under this title than would have been paid if theservices had been furnished on an inpatient basis in a hospital.Each amount so established shall be reviewed and updated notlater than July 1, 1987, and annually thereafter and may be adjustedby the Secretary, when appropriate, to take account of varying conditionsin different areas.(C)(i)Notwithstandingthe second sentence of each of subparagraphs (A) and (B), except asotherwise specified in clauses (ii), (iii), and (iv), if the Secretaryhas not updated amounts established under such subparagraphs or undersubparagraph (D), with respect to facility services furnished duringa fiscal year (beginning with fiscal year 1986 or a calendar year(beginning with 2006)), such amounts shall be increased by the percentageincrease in the Consumer Price Index for all urban consumers (U.S.city average) as estimated by the Secretary for the 12-month periodending with the midpoint of the year involved.(ii)In each ofthe fiscal years 1998 through 2002, the increase under this subparagraphshall be reduced (but not below zero) by 2.0 percentage points.(iii)In fiscalyear 2004, beginning with April 1, 2004, the increase under this subparagraphshall be the Consumer Price Index for all urban consumers (U.S. cityaverage) as estimated by the Secretary for the 12-month period endingwith March 31, 2003, minus 3.0 percentage points.(iv)In fiscal year2005, the last quarter of calendar year 2005, and each of calendaryears 2006 through 2009, the increase under this subparagraph shallbe 0 percent.(D)(i)Taking into accountthe recommendations in the report under section 626(d) of MedicarePrescription Drug, Improvement, and Modernization Act of 2003, theSecretary shall implement a revised payment system for payment ofsurgical services furnished in ambulatory surgical centers.(ii)In the yearthe system described in clause (i) is implemented, such system shallbe designed to result in the same aggregate amount of expendituresfor such services as would be made if this subparagraph did not apply,as estimated by the Secretary and taking into account reduced expendituresthat would apply if subparagraph (E) were to continue to apply, asestimated by the Secretary.(iii)The Secretaryshall implement the system described in clause (i) for periods ina manner so that it is first effective beginning on or after January1, 2006, and not later than January 1, 2008.(iv)The Secretarymay implement such system in a manner so as to provide for a reductionin any annual update for failure to report on quality measures inaccordance with paragraph (7).(v)In implementingthe system described in clause (i) for 2011 and each subsequent year,any annual update under such system for the year, after applicationof clause (iv), shall be reduced by the productivity adjustment describedin section 1886(b)(3)(B)(xi)(II). The application of the preceding sentence may result in such updatebeing less than 0.0 for a year, and may result in payment rates underthe system described in clause (i) for a year being less than suchpayment rates for the preceding year.(vi)There shallbe no administrative or judicial review under section 1869, 1878, or otherwise, of the classification system, the relative weights,payment amounts, and the geographic adjustment factor, if any, underthis subparagraph.(E)With respectto surgical procedures furnished on or after January 1, 2007, andbefore the effective date of the implementation of a revised paymentsystem under subparagraph (D), if(i)the standardoverhead amount under subparagraph (A) for a facility service forsuch procedure, without the application of any geographic adjustment,exceeds(ii)the MedicareOPD fee schedule amount established under the prospective paymentsystem for hospital outpatient department services under paragraph(3)(D) of section 1833(t) for such service for such year, determined without regard to geographicadjustment under paragraph (2)(D) of such section,the Secretary shall substitute under subparagraph (A) the amountdescribed in clause (ii) for the standard overhead amount for suchservice referred to in clause (i).(iii)The Secretaryshall implement the system described in clause (i) for periods ina manner so that it is first effective beginning on or after January1, 2006, and not later than January 1, 2008.(iv)The Secretarymay implement such system in a manner so as to provide for a reductionin any annual update for failure to report on quality measures inaccordance with paragraph (7).(v)There shall beno administrative or judicial review under section 1869, 1878, or otherwise, of the classificationsystem, the relative weights, payment amounts, and the geographicadjustment factor, if any, under this subparagraph.(3)(A)The aggregateamount of the payments to be made under this part for outpatient hospitalfacility services or critical access hospital services furnished beforeJanuary 1, 1999, in connection with surgical procedures specifiedunder paragraph (1)(A) shall be equal to the lesser of(i)the amount determinedwith respect to such services under subsection (a)(2)(B); or(ii)the blend amount(described in subparagraph (B)).(B)