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House Committee Passes ASC Bill

Provisions in this legislation will help surgery centers work with CMS on the ASC Payment System

BY JEFF EVANS |  JUNE 2018

On June 21, the US House of Representatives Committee on Ways and Means marked up the ASC Payment Transparency Act (H.R. 6138). This bill comprises half of the ASC Quality and Access Act (H.R. 1838)—ASCA’s mainstay legislation—and will do the following:

• Add an ASC representative to the Advisory Panel on Hospital Outpatient Payment. The Centers for Medicare & Medicaid Services’ (CMS) Advisory Panel on Hospital Outpatient Payment (HOP) is a 15-member panel that impacts payment policies for both hospital outpatient departments (HOPD) and ASCs. Currently, statute requires all HOP members be employed by a hospital or health system. Since decisions made by the HOP impact ASC facility fees and the list of procedures for which Medicare will reimburse, ASCs—like hospitals—should have an industry representative on the panel.

• Disclose criteria used to determine ASC procedure list. CMS can exclude a procedure from the ASC procedure list because of a general concern for seven specific criteria. The agency, however, is not required to disclose which of the criteria excludes a given procedure. This makes it difficult for ASCs to marshal the data needed to challenge these decisions. This provision will add clarity to the CMS review process by requiring CMS to disclose which criteria trigger a procedure’s exclusion and prohibits CMS from excluding procedures reported with unlisted codes from the ASC setting. Adding procedures that can be performed safely in an ASC to this list saves Medicare and its beneficiaries money.

These provisions will help ASCs, specialty societies and other health care stakeholders engage CMS as it considers changes to the ASC Payment System. Further, H.R. 6138 will support Medicare beneficiaries as they seek the high-quality, efficient and cost-effective community care that ASCs deliver.

ASCA has advocated for these provisions for several years and will continue monitoring the progress of this legislation.

For more information on the ASC Payment Transparency Act and other federal legislative activity, write Jeff Evans.