Outpatient Surgery Quality and Access Act of 2021
Bill: H.R.5818 | Sponsor: Rep. Larson, John B. (D-CT)
Policy area: Health

Summary:
Outpatient Surgery Quality and Access Act of 2021
This bill establishes and modifies certain requirements relating to Medicare payments for ambulatory surgical center (ASC) services.
Specifically, the bill (1) requires the payment system for ASC services to feature certain positive annual adjustments equivalent to those made with respect to hospital outpatient department (OPD) services; (2) revises quality reporting requirements to permit publicly available, side-by-side comparisons of quality measures for ASCs and OPDs in the same geographic area; and (3) requires the Centers for Medicare & Medicaid Services (CMS), when excluding requested procedures from the list of those approved to be performed in ASCs, to cite specified reasons for doing so.
With respect to excluding procedures from the approved list for ASCs, the CMS may not cite as a basis for exclusion that a procedure can only be reported using an unlisted surgical procedure code. (Physicians sometimes use unlisted codes when performing new procedures or services if no existing code is adequately descriptive.)
The bill also limits the copayment amount for ASC services under Medicare to that of the inpatient hospital deductible.

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 Representatives 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''.

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 before the 
                period the following: ``and, in the case of 2022 or a 
                subsequent year, by the adjustment 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 subsection (t)(3)(C)(iv) for such year, adjusted in 
accordance with clauses (iv) and (v).''.

SEC. 3. TRANSPARENCY OF QUALITY REPORTING AND MEDICARE BENEFICIARY 
              INFORMATION.

    Paragraph (7) of section 1833(i) of the Social Security 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 implemented by the 
Secretary under this paragraph for ambulatory surgical centers and 
under section 1833(t)(17) for hospital outpatient departments are 
applicable to the provision of surgical services in both ambulatory 
surgical centers 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 departments in the same geographic area.
    ``(D) The Secretary shall ensure that an ambulatory surgery center 
and a hospital has the opportunity to review, 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 inform 
beneficiaries under this title of publicly available comparisons 
provided for in subparagraph (C).''.

SEC. 4. ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT 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 suppliers subject to the prospective payment 
system (including at least one ambulatory surgical center 
representative)'' 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 enactment of this Act.

SEC. 5. REASONS FOR EXCLUDING ADDITIONAL PROCEDURES 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 adding at the end the following: ``In 
updating such lists for application in years beginning after the date 
of the enactment of this sentence, for each procedure that was 
requested to be included in such lists during the public comment 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 procedure was excluded. If paragraph (b) of such section is 
cited for exclusion of a procedure, the Secretary shall identify 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 following before the comma 
at the end: ``, except that in no case shall the copayment amount for 
such services furnished in a year exceed the amount of the inpatient 
hospital deductible established under section 1813(b) for the year 
(and, notwithstanding any other provision of this section, the amount 
of payment for such services shall be increased 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 Action.--Section 
1833(i)(2)(D)(ii) of the Social Security Act (42 U.S.C. 
1395l(i)(2)(D)(ii)) is amended by adding 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 Security Act (42 U.S.C. 1395l(t)(9)(B)) is 
amended by inserting ``taking into account the volume of procedures 
paid under this subsection combined with the volume of procedures 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.
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