,,ii  #aah? ,,congress  #a/ ,session    
,s4 #cab  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #i1 #bjbc,mr4 
,blum5?al 7= himself & ,mr4 ,cassidy7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,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 ! ,outpati5t ,surg]y ,quality
 & ,access ,act ( #bjbc4  #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$-- 7#a7 9   
clause 7v7-- 7,a7 9 ! fir/ s5t5ce1 by   
ins]t+ be=e ! p]iod ! foll[+3 &1 9 !    
case ( #bjbd or a subsequ5t ye>1 by !   
adju/m5t describ$ 9 subsection          
7t77#c77;,g7 = ! respective ye>2 &  7,b7
 by mov+ ! m>g9 #f ems to ! left2  7#b7 
by r$esignat+ clause 7vi7 z clause      

7vii72 &  7#c7 by ins]t+ aft] clause 7v7
 ! foll[+ new clause3  7vi7 ,9 implem5t+
 ! sy/em describ$ 9 clause 7i7 = #bjbd &
 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 report+ & ,m$ic>e b5efici>y     
in=mation ,p>agraph 7#g7 ( section      
#ahcc7;i7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciel7i77 is am5d$ 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 ,! ,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  7,e7 ,! ,secret>y
 %all develop mat]ials & in=m           
b5efici>ies "u ?is title ( publicly     
available comp>isons provid$ = 9        
subp>agraph 7,c74  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$44  7b7 ,effective   
date ,! am5dm5t made by subsection 7a7  
%all apply to li/s ( ambulatory surg]y  

proc$ures = application 9 ye>s beg9n+   
aft] ! date ( ! enactm5t ( ?is ,act4    
#f4 ,limitation on ambulatory surg]y    
c5t] copaym5t = a proc$ure to ! hospital
 d$uctible am\nt ,section               
#ahcc7;a77#a77;,g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciel7a77#a77;,g77
 is am5d$ by ins]t+ ! foll[+ be=e !     
comma at ! end3 1 except t 9 no case    
%all ! copaym5t am\nt = su* s]vices     
furni%$ 9 a ye> exce$ ! am\nt ( !       
inpati5t hospital d$uctible e/abli%$ "u 
section #ahac7;b7 = ! ye> 7&1 not)/&+   
any o!r provision ( ?is section1 ! am\nt
 ( paym5t = su* s]vices %all be increas$
 by ! am\nt ( any r$uction 9 ! copaym5t 
am\nt = su* s]vices pursuant to ?is     
subp>agraph74  #g4 ,alignm5t ( budget   
neutrality adju/m5t = outpati5t surgical
 proc$ures  7a7 ,prohibit+ unau?oriz$   
ag5cy action ,section                   
#ahcc7;i77#b77;,d77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7i77#b77;,d77ii77 is am5d$ by add+
 at ! end ! foll[+3 ,! prec$+ s5t5ce    

%all only apply to ! fir/ ye> ! sy/em   
describ$ 9 clause 7i7 0 implem5t$ & %all
 n apply to any ye> aft] #bjbc44  7b7   
,comb9+ volume = budget neutrality      
calculation ,section #ahcc7t77#i77;,b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciel7t77#i77;,b77 is am5d$ by ins]t+ 
tak+ into acc\nt ! volume ( proc$ures   
paid "u ?is subsection comb9$ ) ! volume
 ( proc$ures paid "u subsection 7i71    
aft] subp>agraph 7,a714  7c7 ,effective 
,date ,! am5dm5ts made by subsections   
7a7 & 7b7 %all apply 9 ye>s beg9n+ aft] 
! date ( ! enactm5t ( ?is ,act4