Ambulatory Surgical Center Medicare Payment Modernization Act of 2007
Summary of Legislation
Representatives Kendrick Meek (D-FL) and Wally Herger (R-CA) introduced on March 29, 2007, and Senator Crapo (R-ID) introduced on October 26, 2007, legislation to improve the ASC payment system and the mechanism that the Centers for Medicare and Medicaid Services (CMS) uses to determine what procedures Medicare reimburses ASCs for providing. The legislation was developed in concert with the ASC community. The modifications in this legislation would expand Medicare beneficiaries’ access to care in ASCs.
The legislation would modify the current ASC Medicare benefit by changing how CMS designates which procedures CMS will pay ASCs for performing and how the payment rate for each procedure is determined.
ASC List
Similar to the ASC payment reform finalized by CMS in August, under the legislation, CMS would develop a list of those procedures that ASCs would not be paid for rather than the current process of deter mining what procedures ASCs will be paid for. In contrast to the final Medicare reforms, the legislation does not use a number of arbitrary criteria to determine what procedures are excluded. The bill is patterned after the recommendation of MedPAC that ASCs should be authorized to perform and receive Medicare facility payments for any surgical service, except for those procedures where (1) the HHS Secretary identifies a specific risk concerning a certain procedure being performed in an ambulatory surgical setting, or (2) an overnight stay is required.
ASC Payments
The Ambulatory Surgical Center Medicare Payment Modernization Act of 2007 would require CMS to pay ASCs based on a flat percentage of the HOPD rate. Specifically, the payment would be 75% of the hospital outpatient department (HOPD) rate. The legislation includes a phase-in and special transition rules to avoid disruptions in access that could occur if sudden changes in ASC payments occurred. This is in contrast to the ASC payment reform finalized by Medicare, which would result in payments to ASCs of 65% of the HOPD rate and would not directly link the two payment systems. Over time, the rates would continue to diverge as the annual updates would continue to differ and patients would not be able to make direct cost comparisons between the two sites of care.
In contrast to final Medicare ASC payment reforms, under the provisions of this legislation
- ASCs would be paid 75% of the HOPD fee schedule amount for each covered service.
- ASCs would receive the same annual updates and other relevant adjustments as HOPDs.
- Includes a clarification that any Medicare standards for ASCs that limit the provision of services to Medicare beneficiaries shall not be applicable to the provision of services to non-Medicare patients if the provision of those services is allowed under applicable State licensure laws. (Senate version only)
- Excludes the use of arbitrary criteria by CMS when determining what procedures are excluded from ASC payment by Medicare.
