Legislation

Representatives Kendrick Meek (D-FL) and Wally Herger (R-CA) introduced on March 29, 2007, legislation to establish a new ASC payment system and to reform the mechanism that the Centers for Medicare and Medicaid Services (CMS) uses to determine what procedures Medicare reimburses ASCs for providing. Similar legislation is expected to be introduced in the Senate. The legislation was developed in concert with the ASC community.

The Meek and Herger legislation would require CMS to pay ASCs based on a flat percentage of the HOPD rate. Specifically, the payment would be 75% of the HOPD rate. The proposal would include a phase-in and special transition rules to avoid disruptions in access that could occur if sudden changes in ASC payments occurred.

The legislation also replaces the criteria for determining which procedures will be reimbursed in ASCs. Under the bill, CMS would develop a list of those procedures that ASCs would not be paid for rather than the current process of determining what procedures ASCs will be paid for. 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. These two changes should significantly expand Medicare beneficiaries' access to ASCs.

MASA needs your help since the legislation has become even more critical since CMS issued a proposed rule to implement a new Medicare payment system that does not adequately meet the needs of ASCs. Unlike the legislation, the proposed rule would result in two separate payment systems for ASCs and HOPDs, with different schedules, updates and policies. This legislation will allow ASCs to continue to provide Medicare and its beneficiaries with high-quality, cost-effective care. More information on the CMS proposed rule is available here. By writing your Members of Congress asking for support, we can let Congress and CMS know how strongly the ASC community feels about having a fair and equitable payment system in place for ASCs.

• Write Your Members of Congress & Ask Them to Support ASC Legislation
• MASA Advocacy Page