,i #aaith ,,congress #b;d ,session ,h4 ,r4 #ghfc ,,in ,,the ,,house ,,of ,,representatives ,march #i1 #bjbf,mr4 ,bilirakis 7for himself1 ,mr4 ,ruiz1 ,mr4 ,murphy1 and ,mr4 ,davis of ,illinois7 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 align payment under ,medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,promoting ,fairness for ,medicare ,providers ,act of #bjbf4 #b4 ,aligning payment under medicare for specified high supply cost surgical procedures furnished in office-based facilities 7a7 ,coverage of facility services ,section #ahcb7;a77#b77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,f77 is amended-- 7#a7 in the matter preceding clause 7i71 by striking specified by the ,secretary2 7#b7 in clause 7i7-- 7,a7 by inserting specified by the ,secretary before pursuant2 and 7,b7 at the end1 by striking or2 7#c7 in clause 7ii7-- 7,a7 by inserting specified by the ,secretary before pursuant2 and 7,b7 at the end1 by striking the semicolon and inserting 1 or2 and 7#d7 by adding at the end the following new clause3 7iii7 that are specified high supply cost surgical procedures 7as defined in section #ahcd7;bb77#d7 with respect to a year 7beginning with #bjbg7 and furnished during such year in an office-based facility 7as defined in section #ahcd7;bb77#e772 4 7b7 ,payment rules 7#a7 ,payment for facility services ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended-- 7,a7 by striking and 7,,hh7 and inserting 7,,hh72 and 7,b7 by inserting before the semicolon at the end the following 1 and 7,,ii7 with respect to facility services furnished in connection with a specified high supply cost surgical procedure 7as defined in section #ahcd7;bb77#d77 with respect to a year 7beginning with #bjbg7 furnished to an individual in an office-based facility 7as defined in section #ahcd7;bb77#e77 during such year1 the amounts paid shall be1 subject to section #ahcd7;bb77#c71 #hj percent of the payment amount determined under section #ahcd7;bb7 for such facility services furnished in connection with such procedure at such office-based facility4 7#b7 ,payment determination for specified high supply cost surgical procedures furnished in office-based facilities ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended by adding at the end the following new subsection3 7bb7 ,payment for specified high supply cost surgical procedures furnished in office-,based facilities 7#a7 ,in general ,in the case of a specified high supply cost surgical procedure furnished in an office-based facility during #bjbg or a subsequent year1 subject to paragraphs 7#b7 and 7#c71 payment for such procedure shall be determined under this part in the same manner as payment would be determined under this part if such procedure had been furnished in an ambulatory surgical center and not considered office-based under section #ahcc7;i77#a77;,b71 except that payment for facility services furnished in connection with such procedure shall be equal to #ij percent of the amount that would be payable for facility services furnished in connection with such procedure under section #ahcc7;i7 for such year if such procedure had been furnished in an ambulatory surgical center and treated as a service commonly furnished in such a center4 7#b7 ,application in case of device-intensive procedures ,in applying paragraph 7#a7 in the case of a specified high supply cost surgical procedure that is a device-intensive procedure 7as described in section #daf4aga7;b77#b7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation771 instead of the payment amount applied under such paragraph1 the payment amount for the facility services with respect to such procedure shall be the amount that would be calculated under section #daf4agb7;h77#b77;ii7 of title #db1 ,code of ,federal ,regulations 7or any successor regulation7 with respect to a procedure that has been assigned device-intensive status1 except that in applying such calculation the non-device portion described in paragraph 7,b7 of such section shall be equal to #ij percent of the amount that would otherwise be calculated for such portion4 7#c7 ,limitation on copayment amount to inpatient hospital deductible amount 7,a7 ,in general ,in no case shall the amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year exceed the amount of the inpatient hospital deductible established under section #ahac7;b7 for that year4 7,b7 ,maintaining payment to provider ,in the case that an individual enrolled under this part would1 without application of subparagraph 7,a71 be subject to an amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year that exceeds the amount of the inpatient hospital deductible established under section #ahac7;b7 for that year1 the ,secretary shall increase the amount paid to the office-based facility as specified under section #ahcc7;a77#a77;,,ii7 for such facility services by the amount by which-- 7i7 the coinsurance payable by the individual for such facility services without application of this paragraph2 exceeds 7ii7 the coinsurance payable by the individual for such facility services with application of this paragraph4 7#d7 ,specified high supply cost surgical procedure defined 7,a7 ,in general ,for purposes of this part1 subject to subparagraphs 7,b7 and 7,c71 the term specified high supply cost surgical procedure means a surgical procedure that as of #bjbc-- 7i7 when performed in an ambulatory surgical center1 was payable under section #ahcc7;i72 and 7ii7 when performed in a physician's office-- 7,i7 was payable under section #ahdh at the practice expense relative value unit-based amount for non-facility sites of service2 and 7,,ii7 included a ,,hcpcs code with a supply item for which the price input for such supply item1 used for determining the practice expense relative value units for such code1 was greater than #ejj4 7,b7 ,review and revisions to specified services 7i7 ,in general ,for each year 7beginning with #bjbh71 the ,secretary shall review the procedures included in the definition of specified high supply cost surgical procedures under this paragraph and1 based on such review and through rulemaking-- 7,i7 shall add a surgical procedure 7not described in subparagraph 7,a77 for inclusion in such definition if the procedure1 with respect to such year1 satisfies the criteria specified in clause 7ii72 and 7,,ii7 may remove a surgical procedure from inclusion in such definition if the procedure1 with respect to such year1 satisfies the criteria specified in clause 7iii74 7ii7 ,criteria for required inclusion ,for purposes of clause 7i77,i71 a surgical procedure satisfies the criteria specified in this clause1 with respect to a year1 if-- 7,i7 when performed in an ambulatory surgical center1 the procedure is payable under section #ahcc7;i72 and 7,,ii7 when performed in a physician's office1 the procedure-- 7aa7 would be1 without application of this subsection or section #ahcc7;a77i77,,ii71 payable under section #ahdh at the practice expense relative value unit-based amount for non-facility sites of services2 and 7bb7 includes a ,,hcpcs code with a supply item for which the price input for such supply item1 used for determining the practice expense relative value units for such code1 is greater than the threshold specified in clause 7iv7 for such year4 7iii7 ,criteria for permissive removal ,for purposes of clause 7i77,,ii71 a surgical procedure satisfies the criteria described in this clause1 with respect to a year1 if1 when performed in a physician's office1 the procedure includes a ,,hcpcs code with a supply item for which the price input for such supply item1 used for determining the practice expense relative value units for such code1 does not exceed the amount equal to #hj percent of the threshold specified in clause 7iv7 for such year4 7iv7 ,dollar amount threshold specified ,for purposes of clauses 7ii7 and 7iii71 the threshold specified in this clause is-- 7,i7 with respect to #bjbh1 the dollar amount specified in subparagraph 7,a77ii71 reduced by the percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c77 over the #c-year period ending with #bjbh2 or 7,,ii7 with respect to a subsequent year1 the amount specified in this clause for the preceding year reduced by the percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c77 for such subsequent year4 7,c7 ,special rule for use of more than one of the same supply item in a procedure ,in the case of a surgical procedure that requires the use of more than one of the same supply item in such procedure-- 7i7 in applying subparagraph 7,a77ii77,,ii71 if as of #bjbc the sum of the price inputs described in such subparagraph of all of such same supply items exceeds the dollar amount specified in such subparagraph1 then the procedure shall be treated as satisfying the requirement of such subparagraph2 and 7ii7 in applying subparagraph 7,b71 with respect to #bjbh or a subsequent year-- 7,i7 if the sum of the price inputs described in clause 7ii77,,ii77bb7 of such subparagraph of all of such same supply items exceeds the threshold specified in clause 7iv7 of such subparagraph for such year1 then the procedure shall be treated as satisfying the criterion described in such clause 7ii77,,ii77bb7 with respect to such year2 and 7,,ii7 if the sum of the price inputs described in clause 7iii7 of such subparagraph of all of such same supply items does not exceed the amount described in such clause for such year1 then the procedure shall be treated as satisfying the criteria described in such clause with respect to such year4 7#e7 ,office-based facility defined ,for purposes of this part1 the term office-based facility means a physician's office that1 with respect to facility services furnished in connection with specified high supply cost surgical procedures-- 7,a7 meets health1 safety1 and other standards specified by the ,secretary in regulations2 and 7,b7 has entered into an agreement with the ,secretary under which the physician's office-- 7i7 accepts the payment amount determined under this subsection as full payment for such facility services2 7ii7 accepts an assignment described in section #ahdb7;b77#c77;,b77ii7 with respect to payment for all such facility services furnished by the office to individuals enrolled under this part2 and 7iii7 participates under this part and is paid as an office-based facility with respect to all such procedures4 4 7#c7 ,conforming amendments 7,a7 ,for services furnished in an ambulatory surgical center ,section #ahcc7;i77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7i77#b77 is amended by adding at the end the following new subparagraph3 7,f7 ,for purposes of determining payment under this subsection for a specified high supply cost surgical procedure 7as defined in section #ahcd7;bb77#d7 with respect to a year 7beginning with #bjbg77 furnished in an ambulatory surgical center during such year1 such procedure shall be treated as a service commonly furnished in an ambulatory surgical center4 4 7,b7 ,for services furnished in an off-campus outpatient department of a provider ,section #ahcc7t77#ba77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77;,c77 is amended by adding at the end the following new sentence3 ,in applying the previous sentence in the case of a specified high supply cost surgical procedure 7as defined in section #ahcd7;bb77#d7 with respect to a year7 furnished by an off-campus outpatient department of a provider1 payment shall be determined under section #ahcd7;bb744 7,c7 ,for clarification on applicable payment for obf facility services ,section #ahcc7;a77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#d77 is amended by inserting 7other than in clause 7iii7 of such section7 after section #ahcb7;a77#b77;,f74 7c7 ,provider agreement and medicare enrollment 7#a7 ,in general ,section #ahff7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7e77 is amended-- 7,a7 in paragraph 7#b71 by striking at the end and2 7,b7 in paragraph 7#c71 at the end1 by striking the period and adding 2 and2 and 7,c7 by adding at the end the following new paragraph3 7#d7 an office-based facility 7as defined in paragraph 7#e7 of section #ahcd7;bb771 but only with respect to the furnishing during a year of specified high supply cost surgical procedures 7as defined in paragraph 7#d7 of such section with respect to such year74 4 7#b7 ,consultation with state agencies regarding conditions of participation ,section #ahfc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciez7 is amended by striking or by ambulatory surgical centers under section #ahcb7;a77#b77;,f77i7 and inserting by ambulatory surgical centers under section #ahcb7;a77#b77;,f77i71 or by office-based facilities 7as defined in section #ahcd7;bb77#e77 with respect to furnishing specified high supply cost surgical procedures 7as defined in section #ahcd7;bb77#d774 7#c7 ,use of state agencies to determine compliance with conditions of participation ,section #ahfd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aa7a77 is amended-- 7,a7 in the first sentence1 by inserting or whether a physician's office is an office-based facility 7as defined in section #ahcd7;bb77#e71 after standards specified under section #ahcb7;a77#b77;,f77i712 and 7,b7 in the fifth sentence1 by inserting office-based facility 7as defined in section #ahcd7;bb77#e77 with respect to furnishing ambulatory high supply cost surgical procedures 7as defined in section #ahcd7;bb77#d771 after each occurrence of ambulatory surgical center14