,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bejj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #be1 #bjac ,mr4 
,nunes 7= himself1 ,mr4 ,l>son (        
,connecticut1 ,mr4 ,bu*anan1 ,mr4       
,buc%on1 ,mr4 ,burgess1 ,mr4 ,cole1 ,mr4
 ,griff9 ( ,arkansas1 ,mr4 ,hall1 ,mr4  
,l>s5 ( ,wa%+ton1 ,mr4 ,m>*ant1 ,mr4    
,mi*aud1 ,mr4 ,nug5t1 ,mr4 ,pascrell1   
,mr4 ,roe ( ,t5nessee1 ,ms4 ,l9da ,t4   
,sn*ez ( ,cali=nia1 ,mr4 ,s*weik]t1 ,mr4
 ,david ,scott ( ,georgia1 ,mr4         
,sessions1 ,mr4 ,smi? ( ,wa%+ton1 ,mr4  
,veasey1 ,mr4 ,:itfield1 & ,mr4 ,/iv]s7 
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to mod]nize      
paym5ts = ambulatory surgical c5t]s "u !
 ,m$ic>e program1 & = o!r purposes4  #a4

 ,%ort title ,?is ,act may be cit$ z !  
,ambulatory ,surgical ,c5t] ,quality &  
,access ,act ( #bjac4  #b4 ,align+      
updates = ambulatory surgical c5t]      
s]vices ) updates = ,,opd s]vices       
,section #ahcc7;i77#b77;,d7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciel7i77#b77;,d77 is am5d$--  7#a7 by 
r$esignat+ clause 7vi7 z clause 7vii72  
7#b7 9 ! fir/ s5t5ce ( clause 7v71 by   
ins]t+ be=e ! p]iod ! foll[+3 &1 9 !    
case ( #bjad or a subsequ5t ye>1 by !   
adju/m5t describ$ 9 subsection          
7t77#c77;,g7 = ! respective ye>2 &  7#c7
 by ins]t+ aft] clause 7v7 ! foll[+ new 
clause3  7vi7 ,9 implem5t+ ! sy/em      
describ$ 9 clause 7i7 = #bjad & ea*     
subsequ5t ye>1 !re %all be an annual    
update "u su* sy/em = ! ye> equal to !  
,,opd fee s*$ule increase factor        
specifi$ "u subsection 7t77#c77;,c77iv7 
= su* ye>1 adju/$ 9 accordance ) clauses
 7iv7 & 7v74  4  #c4 ,transp>5cy (      
quality reports & application (         
value-bas$ pur*as+ to ,a,s,cs  7a7      

,quality measures ,p>agraph 7#g7 (      
section #ahcc7;i7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7i77 is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraphs3  7,c7 ,to ! ext5t t       
quality measures implem5t$ by !         
,secret>y "u ?is p>agraph = ambulatory  
surgical c5t]s & "u section             
#ahcc7t77#ag7 = hospital outpati5t      
dep>tm5ts are applicable to ! provision 
( surgical s]vices 9 bo? ambulatory     
surgical c5t]s & hospital outpati5t     
dep>tm5ts1 ! ,secret>y %all make report$
 data on su* c5t]s & dep>tm5ts available
 on ! website ,m$ic>e4gov 9 a mann] t w 
p]mit side-by-side comp>isons on su*    
measures = ambulatory surgical c5t]s &  
hospital outpati5t dep>tm5ts 9 ! same   
geographic area4  7,d7 ,= ea* proc$ure  
cov]$ = paym5t 9 an ambulatory surgical 
c5t]1 ! ,secret>y %all publi%1 along ) !
 quality report+ comp>isons provid$ = 9 
subp>agraph 7,c71 comp>isons ( ! ,m$ic>e
 paym5t & b5efici>y copaym5t am\nts = ! 
proc$ure :5 p]=m$ 9 ambulatory surgical 

c5t]s & hospital outpati5t dep>tm5ts 9 !
 same geographic area4  7,e7 ,!         
,secret>y %all ensure t an ambulatory   
surg]y c5t] & a hospital has !          
opportunity to review1 & submit any     
corrections =1 ! data to be made public 
) respect to ! ambulatory surg]y c5t] "u
 subp>agraph 7,c7 prior to su* data be+ 
made public4  4  7b7 ,ambulatory        
surgical c5t] value-,bas$ pur*as+       
program ,section #ahcc7;i7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #aciel7i77
 is am5d$ by add+ at ! end ! foll[+ new 
p>agraph3  7#h7 ,value-bas$ pur*as+     
program  7,a7 ,e/abli%m5t ,! ,secret>y  
%all e/abli% an ambulatory surgical c5t]
 value-bas$ pur*as+ program 79 ?is      
subsection ref]r$ to z ! ,program7 "u   
:i*1 subject to subp>agraph 7,i71 ea*   
ambulatory surgical c5t] t ! ,secret>y  
det]m9es meets 7or exce$s7 ! p]=mance   
/&>ds "u subp>agraph 7,d7 = ! p]=mance  
p]iod 7z e/abli%$ "u subp>agraph 7,e77 =
 a cal5d> ye> is eligible1 f ! am\nts   
made available 9 ! total %>$ sav+s pool 

"u subp>agraph 7,i77iv71 = %>$ sav+s "u 
subp>agraph 7,i71 :i* %all be 9 ! =m1   
aft] application ( ! adju/m5ts "u       
clauses 7iv71 7v71 & 7vi7 ( p>agraph    
7#b77;,d71 ( an increase 9 ! am\nt (    
paym5t det]m9$ "u ! paym5t sy/em "u     
p>agraph 7#b77;,d7 = surgical s]vices   
furni%$ by su* c5t] dur+ ! subsequ5t    
ye>1 by ! value-bas$ p]c5tage am\nt "u  
subp>agraph 7,h7 specifi$ by ! ,secret>y
 = su* c5t] & ye>4  7,b7 ,program />t   
date ,! ,program %all apply to paym5ts =
 proc$ures occurr+ on or aft] ,janu>y   
#a1 #bjae4  7,c7 ,measures  7i7 ,9 g5]al
 ,= purposes ( ! ,program1 ! ,secret>y  
%all select measures f ! measures       
specifi$ "u p>agraph 7#g74  7ii7        
,availability ( measure & data ,!       
,secret>y may n select a measure "u ?is 
p>agraph = use "u ! ,program ) respect  
to a p]=mance p]iod = a cal5d> ye>      
unless su* measure has be5 includ$1 & ! 
report$ data available1 on ! website    
,m$ic>e4gov1 = at lea/ #a ye> prior to !
 beg9n+ ( su* p]=mance p]iod4  7iii7    

,measure n applicable unless ,,asc      
furni%es s]vices appropriate to measure 
,a measure select$ "u ?is p>agraph = use
 "u ! ,program %all n apply to an       
ambulatory surgical c5t] if su* c5t]    
does n furni% s]vices appropriate to su*
 measure4  7,d7 ,p]=mance /&>ds  7i7    
,e/abli%m5t ,! ,secret>y %all e/abli%   
p]=mance /&>ds ) respect to measures    
select$ "u subp>agraph 7,c77i7 = a      
p]=mance p]iod = a cal5d> ye>4  7ii7    
,a*ievem5t & improvem5t ,! p]=mance     
/&>ds e/abli%$ "u clause 7i7 %all       
include levels ( a*ievem5t & improvem5t4
  7iii7 ,tim+ ,! ,secret>y %all e/abli% 
& ann\nce ! p]=mance /&>ds "u clause 7i7
 n lat] ?an #fj days prior to ! beg9n+ (
 ! p]=mance p]iod = ! cal5d> ye>        
involv$4  7,e7 ,p]=mance p]iod ,=       
purposes ( ! ,program1 ! ,secret>y %all 
e/abli% ! p]=mance p]iod = a cal5d> ye>4
 ,su* p]=mance p]iod %all beg9 & end    
prior to ! beg9n+ ( su* cal5d> ye>4     
7,f7 ,,asc p]=mance score ,! ,secret>y  
%all develop a me?odology = assess+ !   

total p]=mance ( ea* ambulatory surg]y  
c5t] bas$ on p]=mance /&>ds ) respect to
 ! measures select$ "u subp>agraph 7,c7 
= a p]=mance p]iod 7z e/abli%$ "u       
subp>agraph 7,e774 ,us+ su* me?odology1 
! ,secret>y %all provide = an assessm5t 
79 ?is subsection ref]r$ to z ! ,,asc   
p]=mance score7 = ea* ambulatory        
surgical c5t] = ea* p]=mance p]iod4 ,!  
me?odology %all provide t ! ,,asc       
p]=mance score is det]m9$ us+ ! high] ( 
its a*ievem5t or improvem5t score = ea* 
measure4  7,g7 ,appeals ,! ,secret>y    
%all e/abli% a process by :i* ambulatory
 surg]y c5t]s may appeal ! calculation (
 ! ambulatory surg]y c5t]'s p]=mance )  
respect to ! p]=mance /&>ds e/abli%$ "u 
subp>agraph 7,d7 & ! ambulatory surg]y  
c5t] p]=mance score "u subp>agraph 7,e74
 ,! ,secret>y %all ensure t su* process 
provides = resolution ( appeals 9 a     
timely mann]4  7,h7 ,calculation (      
value-bas$ inc5tive paym5t  7i7         
,value-bas$ p]c5tage am\nt ,= purposes (
 subp>agraph 7,a71 ! ,secret>y %all     

specify a value-bas$ p]c5tage am\nt = an
 ambulatory surgical c5t] = a cal5d>    
ye>4  7ii7 ,requirem5ts ,9 specify+ !   
value-bas$ p]c5tage am\nt = ea*         
ambulatory surgical c5t] = a cal5d> ye> 
"u clause 7i71 ! ,secret>y %all ensure t
 su* p]c5tage is bas$ on--  7,i7 ! ,,asc
 p]=mance score ( ! ambulatory surg]y   
c5t] "u subp>agraph 7,f72 &  7,,ii7 !   
am\nt ( ! total sav+s pool made         
available "u subp>agraph 7,i77iii77,i7 =
 su* ye>4  7,i7 ,annual calculation (   
%>$ sav+s fund+ = value-bas$ inc5tive   
paym5ts  7i7 ,det]m9+ bonus pool ,9 ea* 
ye> ( ! ,program1 ambulatory surg]y     
c5t]s %all be eligible to receive paym5t
 = %>$ sav+s "u ! ,program only if = su*
 ye> ! sum (--  7,i7 ! e/imat$ am\nt (  
exp5ditures "u ?is title = ,m$ic>e      
fee-=-s]vice b5efici>ies 7z def9$ 9     
section #ahii7;h77#c77 = surgical       
s]vices = :i* paym5t is made "u ! paym5t
 sy/em "u p>agraph 7#b71 adju/$ =       
b5efici>y *>act]i/ics1 &  7,,ii7 !      
e/imat$ am\nt ( exp5ditures "u ?is title

 = ,m$ic>e fee-=-s]vice b5efici>ies 7z s
 def9$7 = ! same surgical s]vices = :i* 
paym5t is made "u ! prospective paym5t  
sy/em "u subsection 7t71 adju/$ =       
b5efici>y *>act]i/ics1  is at lea/ !    
p]c5t specifi$ by ! ,secret>y bel[ !    
applicable b5*m>k det]m9$ = su* ye> "u  
clause 7ii74 ,= purposes ( ?is          
subp>agraph1 su* sum %all be ref]r$ to z
 e/imat$ exp5ditures4 ,! ,secret>y %all 
det]m9e ! appropriate p]c5t describ$ 9 !
 prec$+ s5t5ce to acc\nt = normal       
v>iation 9 volume ( s]vices "u ?is title
 & to acc\nt = *anges 9 ! cov]age (     
s]vices 9 ambulatory surg]y c5t]s &     
hospital outpati5t dep>tm5ts dur+ !     
p]=mance p]iod involv$4  7ii7 ,e/abli% &
 update b5*m>k ,= purposes ( clause 7i71
 ! ,secret>y %all calculate a b5*m>k =  
ea* ye> describ$ 9 su* clause equal to !
 product (--  7,i7 e/imat$ exp5ditures  
describ$ 9 clause 7i7 = su* ye>1 &      
7,,ii7 ! av]age annual gr[? 9 e/imat$   
exp5ditures = ! mo/ rec5t ?ree ye>s4    
,su* b5*m>k %all be reset at ! />t ( ea*

 cal5d> ye>1 & adju/$ = *anges 9        
enrollm5t "u ! ,m$ic>e fee-=-s]vice     
program4  7iii7 ,paym5ts bas$ on %>$    
sav+s ,if ! requirem5t "u clause 7i7 is 
met = a ye>--  7,i7 #ej p]c5t ( ! total 
sav+s pool e/imat$ "u clause 7iv7 = su* 
ye> %all be made available = %>$ sav+s  
to be paid to ambulatory surgical c5t]s 
"u ?is p>agraph2  7,,ii7 a p]c5t 7z     
det]m9$ appropriate by ! ,secret>y1 9   
accordance ) subp>agraph 7,h77 ( su*    
am\nt made available = su* ye> %all be  
paid z %>$ sav+s to ea* ambulatory      
surg]y c5t] t is det]m9$ "u ! ,program  
to h met or exce$$ p]=mance scores = su*
 ye>2 &  7,,iii7 all funds made         
available "u subclause 7,i7 = su* ye>   
%all be us$ & paid z %>+ sav+s = su* ye>
 9 accordance ) subclause 7,,ii74  7iv7 
,e/imate ( ! total sav+s pool ,=        
purposes ( clause 7iii71 ! ,secret>y    
%all e/imate = ea* ye> ( ! ,program !   
total sav+s pool z ! product (--  7,i7 !
 conv]sion factor = su* ye> det]m9$ by !
 ,secret>y "u ! paym5t sy/em "u p>agraph

 7#b77;,d7 divid$ by ! conv]sion factor 
calculat$ "u subsection 7t77#c77;,c7 =  
su* ye> = cov]$ ,,opd s]vices1 multipli$
 by #ajj1 &  7,,ii7  7aa7 ! product ( ! 
e/imat$ ,m$ic>e exp5ditures = surgical  
s]vices describ$ 9 clause 7i77,i7       
furni%$ dur+ su* ye> to ,m$ic>e         
fee-=-s]vice b5efici>ies 7z def9$ 9     
section #ahii7;h77#c77 = :i* paym5t is  
made "u subsection 7t7 & ! av]age annual
 gr[? 9 ! e/imat$ ,m$ic>e exp5ditures = 
su* s]vices furni%$ to ,m$ic>e          
fee-=-s]vice b5efici>ies 7z s def9$7 =  
:i* paym5t is made "u subsection 7t7 9 !
 mo/ rec5t available #c ye>s1 less  7bb7
 ! e/imat$ ,m$ic>e exp5ditures =        
surgical s]vices describ$ 9 clause      
7i77,i7 furni%$ to ,m$ic>e fee-=-s]vice 
b5efici>ies = :i* paym5t 0 made "u      
subsection 7t7 9 ! mo/ rec5t ye>4  7,j7 
,no effect 9 subsequ5t cal5d> ye>s ,!   
value-bas$ p]c5tage am\nt "u subp>agraph
 7,h7 & ! p]c5t det]m9$ "u subp>agraph  
7,i77iii77,i7 %all apply only ) respect 
to ! cal5d> ye> involv$1 & ! ,secret>y  

%all n take into acc\nt su* am\nt or    
p]c5tage 9 mak+ paym5ts to an ambulatory
 surg]y c5t] "u ?is section 9 a         
subsequ5t cal5d> ye>4  4  #d4 ,advisory 
,panel on ,hospital ,outpati5t ,paym5t  
,repres5tation  7a7 ,,asc repres5tative 
,! second s5t5ce ( section              
#ahcc7t77#i77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7t77#i77;,a77 
is am5d$ by ins]t+ & suppli]s subject to
 ! prospective paym5t sy/em 7includ+ at 
lea/ "o ambulatory surgical c5t]        
repres5tative7 aft] an appropriate      
selection ( repres5tatives ( provid]s4  
7b7 ,effective date ,! am5dm5t made by  
subsection 7a7 %all take effect on !    
date ( ! enactm5t ( ?is ,act4  #e4      
,reasons = exclud+ additional proc$ures 
f ,,asc approv$ li/  7a7 ,9 g5]al       
,section #ahcc7;i77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7i77#a77 is am5d$ by add+ at ! end
 ! foll[+3 ,9 updat+ su* li/s =         
application 9 ye>s beg9n+ aft] ! date ( 
! enactm5t ( ?is s5t5ce1 = ea* proc$ure 

t 0 reque/$ to be includ$ 9 su* li/s    
dur+ ! public comm5t p]iod b :i* !      
,secret>y does n propose 79 ! f9al rule 
updat+ su* li/s7 to s include 9 su*     
li/s1 ,secret>y %all cite 9 su* f9al    
rule ! specific crit]ia 9 p>agraph 7b7  
or 7c7 ( section #daf4aff ( title #db1  
,code ( ,f$]al ,regulations1 bas$ on :i*
 ! proc$ure 0 exclud$4 ,if p>agraph 7b7 
( su* section is cit$ = exclusion ( a   
proc$ure1 ! ,secret>y %all id5tify ! pe]
 review$ rese>* or ! evid5ce ^u :i* su* 
det]m9ation is bas$4 ,! ,secret>y may n 
use or cite section #daf4aff7;c77#g7 (  
su* title z crit]ia or a basis =        
exclusion ( a proc$ure f su* li/s44  7b7
 ,effective date ,! am5dm5t made by     
subsection 7a7 %all apply to li/s (     
ambulatory surg]y proc$ures =           
application 9 ye>s beg9n+ aft] ! date ( 
! enactm5t ( ?is ,act4