,i #aacth ,,congress #ast ,session ,h4 ,r4 #bejj ,,in ,,the ,,house ,,of ,,representatives ,june #be1 #bjac ,mr4 ,nunes 7for himself1 ,mr4 ,larson of ,connecticut1 ,mr4 ,buchanan1 ,mr4 ,bucshon1 ,mr4 ,burgess1 ,mr4 ,cole1 ,mr4 ,griffin of ,arkansas1 ,mr4 ,hall1 ,mr4 ,larsen of ,washington1 ,mr4 ,marchant1 ,mr4 ,michaud1 ,mr4 ,nugent1 ,mr4 ,pascrell1 ,mr4 ,roe of ,tennessee1 ,ms4 ,linda ,t4 ,snchez of ,california1 ,mr4 ,schweikert1 ,mr4 ,david ,scott of ,georgia1 ,mr4 ,sessions1 ,mr4 ,smith of ,washington1 ,mr4 ,veasey1 ,mr4 ,whitfield1 and ,mr4 ,stivers7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to modernize payments for ambulatory surgical centers under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ambulatory ,surgical ,center ,quality and ,access ,act of #bjac4 #b4 ,aligning updates for ambulatory surgical center services with updates for ,,opd services ,section #ahcc7;i77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77#b77;,d77 is amended-- 7#a7 by redesignating clause 7vi7 as clause 7vii72 7#b7 in the first sentence of clause 7v71 by inserting before the period the following3 and1 in the case of #bjad or a subsequent year1 by the adjustment described in subsection 7t77#c77;,g7 for the respective year2 and 7#c7 by inserting after clause 7v7 the following new clause3 7vi7 ,in implementing the system described in clause 7i7 for #bjad and each subsequent year1 there shall be an annual update under such system for the year equal to the ,,opd fee schedule increase factor specified under subsection 7t77#c77;,c77iv7 for such year1 adjusted in accordance with clauses 7iv7 and 7v74 4 #c4 ,transparency of quality reports and application of value-based purchasing to ,a,s,cs 7a7 ,quality measures ,paragraph 7#g7 of section #ahcc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77 is amended by adding at the end the following new subparagraphs3 7,c7 ,to the extent that quality measures implemented by the ,secretary under this paragraph for ambulatory surgical centers and under section #ahcc7t77#ag7 for hospital outpatient departments are applicable to the provision of surgical services in both ambulatory surgical centers and hospital outpatient departments1 the ,secretary shall make reported data on such centers and departments available on the website ,medicare4gov 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 area4 7,d7 ,for each procedure covered for payment in an ambulatory surgical center1 the ,secretary shall publish1 along with the quality reporting comparisons provided for in subparagraph 7,c71 comparisons of the ,medicare payment and beneficiary copayment amounts for the procedure when performed in ambulatory surgical centers and hospital outpatient departments in the same geographic area4 7,e7 ,the ,secretary shall ensure that an ambulatory surgery center and a hospital has the opportunity to review1 and submit any corrections for1 the data to be made public with respect to the ambulatory surgery center under subparagraph 7,c7 prior to such data being made public4 4 7b7 ,ambulatory surgical center value-,based purchasing program ,section #ahcc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77 is amended by adding at the end the following new paragraph3 7#h7 ,value-based purchasing program 7,a7 ,establishment ,the ,secretary shall establish an ambulatory surgical center value-based purchasing program 7in this subsection referred to as the ,program7 under which1 subject to subparagraph 7,i71 each ambulatory surgical center that the ,secretary determines meets 7or exceeds7 the performance standards under subparagraph 7,d7 for the performance period 7as established under subparagraph 7,e77 for a calendar year is eligible1 from the amounts made available in the total shared savings pool under subparagraph 7,i77iv71 for shared savings under subparagraph 7,i71 which shall be in the form1 after application of the adjustments under clauses 7iv71 7v71 and 7vi7 of paragraph 7#b77;,d71 of an increase in the amount of payment determined under the payment system under paragraph 7#b77;,d7 for surgical services furnished by such center during the subsequent year1 by the value-based percentage amount under subparagraph 7,h7 specified by the ,secretary for such center and year4 7,b7 ,program start date ,the ,program shall apply to payments for procedures occurring on or after ,january #a1 #bjae4 7,c7 ,measures 7i7 ,in general ,for purposes of the ,program1 the ,secretary shall select measures from the measures specified under paragraph 7#g74 7ii7 ,availability of measure and data ,the ,secretary may not select a measure under this paragraph for use under the ,program with respect to a performance period for a calendar year unless such measure has been included1 and the reported data available1 on the website ,medicare4gov1 for at least #a year prior to the beginning of such performance period4 7iii7 ,measure not applicable unless ,,asc furnishes services appropriate to measure ,a measure selected under this paragraph for use under the ,program shall not apply to an ambulatory surgical center if such center does not furnish services appropriate to such measure4 7,d7 ,performance standards 7i7 ,establishment ,the ,secretary shall establish performance standards with respect to measures selected under subparagraph 7,c77i7 for a performance period for a calendar year4 7ii7 ,achievement and improvement ,the performance standards established under clause 7i7 shall include levels of achievement and improvement4 7iii7 ,timing ,the ,secretary shall establish and announce the performance standards under clause 7i7 not later than #fj days prior to the beginning of the performance period for the calendar year involved4 7,e7 ,performance period ,for purposes of the ,program1 the ,secretary shall establish the performance period for a calendar year4 ,such performance period shall begin and end prior to the beginning of such calendar year4 7,f7 ,,asc performance score ,the ,secretary shall develop a methodology for assessing the total performance of each ambulatory surgery center based on performance standards with respect to the measures selected under subparagraph 7,c7 for a performance period 7as established under subparagraph 7,e774 ,using such methodology1 the ,secretary shall provide for an assessment 7in this subsection referred to as the ,,asc performance score7 for each ambulatory surgical center for each performance period4 ,the methodology shall provide that the ,,asc performance score is determined using the higher of its achievement or improvement score for each measure4 7,g7 ,appeals ,the ,secretary shall establish a process by which ambulatory surgery centers may appeal the calculation of the ambulatory surgery center's performance with respect to the performance standards established under subparagraph 7,d7 and the ambulatory surgery center performance score under subparagraph 7,e74 ,the ,secretary shall ensure that such process provides for resolution of appeals in a timely manner4 7,h7 ,calculation of value-based incentive payment 7i7 ,value-based percentage amount ,for purposes of subparagraph 7,a71 the ,secretary shall specify a value-based percentage amount for an ambulatory surgical center for a calendar year4 7ii7 ,requirements ,in specifying the value-based percentage amount for each ambulatory surgical center for a calendar year under clause 7i71 the ,secretary shall ensure that such percentage is based on-- 7,i7 the ,,asc performance score of the ambulatory surgery center under subparagraph 7,f72 and 7,,ii7 the amount of the total savings pool made available under subparagraph 7,i77iii77,i7 for such year4 7,i7 ,annual calculation of shared savings funding for value-based incentive payments 7i7 ,determining bonus pool ,in each year of the ,program1 ambulatory surgery centers shall be eligible to receive payment for shared savings under the ,program only if for such year the sum of-- 7,i7 the estimated amount of expenditures under this title for ,medicare fee-for-service beneficiaries 7as defined in section #ahii7;h77#c77 for surgical services for which payment is made under the payment system under paragraph 7#b71 adjusted for beneficiary characteristics1 and 7,,ii7 the estimated amount of expenditures under this title for ,medicare fee-for-service beneficiaries 7as so defined7 for the same surgical services for which payment is made under the prospective payment system under subsection 7t71 adjusted for beneficiary characteristics1 is at least the percent specified by the ,secretary below the applicable benchmark determined for such year under clause 7ii74 ,for purposes of this subparagraph1 such sum shall be referred to as estimated expenditures4 ,the ,secretary shall determine the appropriate percent described in the preceding sentence to account for normal variation in volume of services under this title and to account for changes in the coverage of services in ambulatory surgery centers and hospital outpatient departments during the performance period involved4 7ii7 ,establish and update benchmark ,for purposes of clause 7i71 the ,secretary shall calculate a benchmark for each year described in such clause equal to the product of-- 7,i7 estimated expenditures described in clause 7i7 for such year1 and 7,,ii7 the average annual growth in estimated expenditures for the most recent three years4 ,such benchmark shall be reset at the start of each calendar year1 and adjusted for changes in enrollment under the ,medicare fee-for-service program4 7iii7 ,payments based on shared savings ,if the requirement under clause 7i7 is met for a year-- 7,i7 #ej percent of the total savings pool estimated under clause 7iv7 for such year shall be made available for shared savings to be paid to ambulatory surgical centers under this paragraph2 7,,ii7 a percent 7as determined appropriate by the ,secretary1 in accordance with subparagraph 7,h77 of such amount made available for such year shall be paid as shared savings to each ambulatory surgery center that is determined under the ,program to have met or exceeded performance scores for such year2 and 7,,iii7 all funds made available under subclause 7,i7 for such year shall be used and paid as sharing savings for such year in accordance with subclause 7,,ii74 7iv7 ,estimate of the total savings pool ,for purposes of clause 7iii71 the ,secretary shall estimate for each year of the ,program the total savings pool as the product of-- 7,i7 the conversion factor for such year determined by the ,secretary under the payment system under paragraph 7#b77;,d7 divided by the conversion factor calculated under subsection 7t77#c77;,c7 for such year for covered ,,opd services1 multiplied by #ajj1 and 7,,ii7 7aa7 the product of the estimated ,medicare expenditures for surgical services described in clause 7i77,i7 furnished during such year to ,medicare fee-for-service beneficiaries 7as defined in section #ahii7;h77#c77 for which payment is made under subsection 7t7 and the average annual growth in the estimated ,medicare expenditures for such services furnished to ,medicare fee-for-service beneficiaries 7as so defined7 for which payment is made under subsection 7t7 in the most recent available #c years1 less 7bb7 the estimated ,medicare expenditures for surgical services described in clause 7i77,i7 furnished to ,medicare fee-for-service beneficiaries for which payment was made under subsection 7t7 in the most recent year4 7,j7 ,no effect in subsequent calendar years ,the value-based percentage amount under subparagraph 7,h7 and the percent determined under subparagraph 7,i77iii77,i7 shall apply only with respect to the calendar year involved1 and the ,secretary shall not take into account such amount or percentage in making payments to an ambulatory surgery center under this section in a subsequent calendar year4 4 #d4 ,advisory ,panel on ,hospital ,outpatient ,payment ,representation 7a7 ,,asc representative ,the second sentence of section #ahcc7t77#i77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#i77;,a77 is amended by inserting and suppliers subject to the prospective payment system 7including at least one ambulatory surgical center representative7 after an appropriate selection of representatives of providers4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of the enactment of this ,act4 #e4 ,reasons for excluding additional procedures from ,,asc approved list 7a7 ,in general ,section #ahcc7;i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77#a77 is amended by adding at the end the following3 ,in updating such lists for application in years beginning after the date of the enactment of this sentence1 for each procedure that was requested to be included in such lists during the public comment period but which the ,secretary does not propose 7in the final rule updating such lists7 to so include in such lists1 ,secretary shall cite in such final rule the specific criteria in paragraph 7b7 or 7c7 of section #daf4aff of title #db1 ,code of ,federal ,regulations1 based on which the procedure was excluded4 ,if paragraph 7b7 of such section is cited for exclusion of a procedure1 the ,secretary shall identify the peer reviewed research or the evidence upon which such determination is based4 ,the ,secretary may not use or cite section #daf4aff7;c77#g7 of such title as criteria or a basis for exclusion of a procedure from such lists44 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to lists of ambulatory surgery procedures for application in years beginning after the date of the enactment of this ,act4