,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ghfc  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,m>* #i1 #bjbf,mr4    
,bilirakis 7= himself1 ,mr4 ,ruiz1 ,mr4 
,murphy1 & ,mr4 ,davis ( ,ill9ois7      
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 align paym5t  
"u ,m$ic>e = specifi$ surgical proc$ures
 ) high-co/ supplies furni%$ 9          
(fice-bas$ facilities1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,promot+ ,fairness = ,m$ic>e        
,provid]s ,act ( #bjbf4  #b4 ,align+    
paym5t "u m$ic>e = specifi$ high supply 
co/ surgical proc$ures furni%$ 9        
(fice-bas$ facilities  7a7 ,cov]age (   
facility s]vices ,section               
#ahcb7;a77#b77;,f7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,f77
 is am5d$--  7#a7 9 ! matt] prec$+      
clause 7i71 by /rik+ specifi$ by !      
,secret>y2  7#b7 9 clause 7i7--  7,a7 by
 ins]t+ specifi$ by ! ,secret>y be=e    
pursuant2 &  7,b7 at ! end1 by /rik+ or2
  7#c7 9 clause 7ii7-- 7,a7 by ins]t+   
specifi$ by ! ,secret>y be=e pursuant2 &
  7,b7 at ! end1 by /rik+ ! semicolon & 
ins]t+ 1 or2 &  7#d7 by add+ at ! end ! 
foll[+ new clause3  7iii7 t are specifi$
 high supply co/ surgical proc$ures 7z  
def9$ 9 section #ahcd7;bb77#d7 ) respect
 to a ye> 7beg9n+ ) #bjbg7 & furni%$    
dur+ su* ye> 9 an (fice-bas$ facility 7z
 def9$ 9 section #ahcd7;bb77#e772  4    
7b7 ,paym5t rules  7#a7 ,paym5t =       
facility s]vices ,section #ahcc7;a77#a7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciel7a77 is am5d$--  7,a7 by
 /rik+ & 7,,hh7 & ins]t+ 7,,hh72 &  7,b7
 by ins]t+ be=e ! semicolon at ! end !  
foll[+ 1 & 7,,ii7 ) respect to facility 
s]vices furni%$ 9 connection ) a        
specifi$ high supply co/ surgical       

proc$ure 7z def9$ 9 section             
#ahcd7;bb77#d77 ) respect to a ye>      
7beg9n+ ) #bjbg7 furni%$ to an          
individual 9 an (fice-bas$ facility 7z  
def9$ 9 section #ahcd7;bb77#e77 dur+ su*
 ye>1 ! am\nts paid %all be1 subject to 
section #ahcd7;bb77#c71 #hj p]c5t ( !   
paym5t am\nt det]m9$ "u section         
#ahcd7;bb7 = su* facility s]vices       
furni%$ 9 connection ) su* proc$ure at  
su* (fice-bas$ facility4  7#b7 ,paym5t  
det]m9ation = specifi$ high supply co/  
surgical proc$ures furni%$ 9 (fice-bas$ 
facilities ,section #ahcd ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciel7a77
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7bb7 ,paym5t = specifi$    
high supply co/ surgical proc$ures      
furni%$ 9 (fice-,bas$ facilities  7#a7  
,9 g5]al ,9 ! case ( a specifi$ high    
supply co/ surgical proc$ure furni%$ 9  
an (fice-bas$ facility dur+ #bjbg or a  
subsequ5t ye>1 subject to p>agraphs 7#b7
 & 7#c71 paym5t = su* proc$ure %all be  
det]m9$ "u ?is "p 9 ! same mann] z      

paym5t w\ld be det]m9$ "u ?is "p if su* 
proc$ure _h be5 furni%$ 9 an ambulatory 
surgical c5t] & n consid]$ (fice-bas$ "u
 section #ahcc7;i77#a77;,b71 except t   
paym5t = facility s]vices furni%$ 9     
connection ) su* proc$ure %all be equal 
to #ij p]c5t ( ! am\nt t w\ld be payable
 = facility s]vices furni%$ 9 connection
 ) su* proc$ure "u section #ahcc7;i7 =  
su* ye> if su* proc$ure _h be5 furni%$ 9
 an ambulatory surgical c5t] & treat$ z 
a s]vice commonly furni%$ 9 su* a c5t]4 
7#b7 ,application 9 case (              
device-int5sive proc$ures ,9 apply+     
p>agraph 7#a7 9 ! case ( a specifi$ high
 supply co/ surgical proc$ure t is a    
device-int5sive proc$ure 7z describ$ 9  
section #daf4aga7;b77#b7 ( title #db1   
,code ( ,f$]al ,regulations 7or any     
successor regulation771 in/ead ( !      
paym5t am\nt appli$ "u su* p>agraph1 !  
paym5t am\nt = ! facility s]vices )     
respect to su* proc$ure %all be ! am\nt 
t w\ld be calculat$ "u section          
#daf4agb7;h77#b77;ii7 ( title #db1 ,code

 ( ,f$]al ,regulations 7or any successor
 regulation7 ) respect to a proc$ure t  
has be5 assign$ device-int5sive /atus1  
except t 9 apply+ su* calculation !     
non-device portion describ$ 9 p>agraph  
7,b7 ( su* section %all be equal to #ij 
p]c5t ( ! am\nt t w\ld o!rwise be       
calculat$ = su* portion4  7#c7          
,limitation on copaym5t am\nt to        
inpati5t hospital d$uctible am\nt  7,a7 
,9 g5]al ,9 no case %all ! am\nt (      
co9surance = facility s]vices furni%$ 9 
connection ) a specifi$ high supply co/ 
surgical proc$ure 9 an (fice-bas$       
facility dur+ a ye> exce$ ! am\nt ( !   
inpati5t hospital d$uctible e/abli%$ "u 
section #ahac7;b7 = t ye>4  7,b7        
,ma9ta9+ paym5t to provid] ,9 ! case t  
an individual enroll$ "u ?is "p w\ld1   
)\t application ( subp>agraph 7,a71 be  
subject to an am\nt ( co9surance =      
facility s]vices furni%$ 9 connection ) 
a specifi$ high supply co/ surgical     
proc$ure 9 an (fice-bas$ facility dur+ a
 ye> t exce$s ! am\nt ( ! inpati5t      

hospital d$uctible e/abli%$ "u section  
#ahac7;b7 = t ye>1 ! ,secret>y %all     
increase ! am\nt paid to ! (fice-bas$   
facility z specifi$ "u section          
#ahcc7;a77#a77;,,ii7 = su* facility     
s]vices by ! am\nt by :i*-- 7i7 !       
co9surance payable by ! individual = su*
 facility s]vices )\t application ( ?is 
p>agraph2 exce$s  7ii7 ! co9surance     
payable by ! individual = su* facility  
s]vices ) application ( ?is p>agraph4   
7#d7 ,specifi$ high supply co/ surgical 
proc$ure def9$  7,a7 ,9 g5]al ,=        
purposes ( ?is "p1 subject to           
subp>agraphs 7,b7 & 7,c71 ! t]m specifi$
 high supply co/ surgical proc$ure means
 a surgical proc$ure t z ( #bjbc--  7i7 
:5 p]=m$ 9 an ambulatory surgical c5t]1 
0 payable "u section #ahcc7;i72 &  7ii7 
:5 p]=m$ 9 a physician's (fice--  7,i7 0
 payable "u section #ahdh at ! practice 
exp5se relative value unit-bas$ am\nt = 
non-facility sites ( s]vice2 &  7,,ii7  
includ$ a ,,hcpcs code ) a supply item =
 :i* ! price input = su* supply item1   

us$ = det]m9+ ! practice exp5se relative
 value units = su* code1 0 great] ?an   
#ejj4  7,b7 ,review & revisions to      
specifi$ s]vices  7i7 ,9 g5]al ,= ea*   
ye> 7beg9n+ ) #bjbh71 ! ,secret>y %all  
review ! proc$ures includ$ 9 ! def9ition
 ( specifi$ high supply co/ surgical    
proc$ures "u ?is p>agraph &1 bas$ on su*
 review & ?r\gh rulemak+-- 7,i7 %all add
 a surgical proc$ure 7n describ$ 9      
subp>agraph 7,a77 = inclusion 9 su*     
def9ition if ! proc$ure1 ) respect to   
su* ye>1 satisfies ! crit]ia specifi$ 9 
clause 7ii72 &  7,,ii7 may remove a     
surgical proc$ure f inclusion 9 su*     
def9ition if ! proc$ure1 ) respect to   
su* ye>1 satisfies ! crit]ia specifi$ 9 
clause 7iii74  7ii7 ,crit]ia = requir$  
inclusion ,= purposes ( clause 7i77,i71 
a surgical proc$ure satisfies ! crit]ia 
specifi$ 9 ?is clause1 ) respect to a   
ye>1 if--  7,i7 :5 p]=m$ 9 an ambulatory
 surgical c5t]1 ! proc$ure is payable "u
 section #ahcc7;i72 &  7,,ii7 :5 p]=m$ 9
 a physician's (fice1 ! proc$ure--  7aa7

 w\ld be1 )\t application ( ?is         
subsection or section                   
#ahcc7;a77i77,,ii71 payable "u section  
#ahdh at ! practice exp5se relative     
value unit-bas$ am\nt = non-facility    
sites ( s]vices2 &  7bb7 includes a     
,,hcpcs code ) a supply item = :i* !    
price input = su* supply item1 us$ =    
det]m9+ ! practice exp5se relative value
 units = su* code1 is great] ?an !      
?re%old specifi$ 9 clause 7iv7 = su*    
ye>4  7iii7 ,crit]ia = p]missive removal
 ,= purposes ( clause 7i77,,ii71 a      
surgical proc$ure satisfies ! crit]ia   
describ$ 9 ?is clause1 ) respect to a   
ye>1 if1 :5 p]=m$ 9 a physician's (fice1
 ! proc$ure includes a ,,hcpcs code ) a 
supply item = :i* ! price input = su*   
supply item1 us$ = det]m9+ ! practice   
exp5se relative value units = su* code1 
does n exce$ ! am\nt equal to #hj p]c5t 
( ! ?re%old specifi$ 9 clause 7iv7 = su*
 ye>4  7iv7 ,doll> am\nt ?re%old        
specifi$ ,= purposes ( clauses 7ii7 &   
7iii71 ! ?re%old specifi$ 9 ?is clause  

is--  7,i7 ) respect to #bjbh1 ! doll>  
am\nt specifi$ 9 subp>agraph 7,a77ii71  
r$uc$ by ! p]c5tage increase 9 ! ,,mei  
7z def9$ 9 section #ahdb7;i77#c77 ov] ! 
#c-ye> p]iod end+ ) #bjbh2 or  7,,ii7 ) 
respect to a subsequ5t ye>1 ! am\nt     
specifi$ 9 ?is clause = ! prec$+ ye>    
r$uc$ by ! p]c5tage increase 9 ! ,,mei  
7z def9$ 9 section #ahdb7;i77#c77 = su* 
subsequ5t ye>4  7,c7 ,special rule = use
 ( m ?an "o ( ! same supply item 9 a    
proc$ure ,9 ! case ( a surgical proc$ure
 t requires ! use ( m ?an "o ( ! same   
supply item 9 su* proc$ure-- 7i7 9      
apply+ subp>agraph 7,a77ii77,,ii71 if z 
( #bjbc ! sum ( ! price inputs describ$ 
9 su* subp>agraph ( all ( su* same      
supply items exce$s ! doll> am\nt       
specifi$ 9 su* subp>agraph1 !n !        
proc$ure %all be treat$ z satisfy+ !    
requirem5t ( su* subp>agraph2 &  7ii7 9 
apply+ subp>agraph 7,b71 ) respect to   
#bjbh or a subsequ5t ye>-- 7,i7 if ! sum
 ( ! price inputs describ$ 9 clause     
7ii77,,ii77bb7 ( su* subp>agraph ( all (

 su* same supply items exce$s ! ?re%old 
specifi$ 9 clause 7iv7 ( su* subp>agraph
 = su* ye>1 !n ! proc$ure %all be treat$
 z satisfy+ ! crit]ion describ$ 9 su*   
clause 7ii77,,ii77bb7 ) respect to su*  
ye>2 &  7,,ii7 if ! sum ( ! price inputs
 describ$ 9 clause 7iii7 ( su*          
subp>agraph ( all ( su* same supply     
items does n exce$ ! am\nt describ$ 9   
su* clause = su* ye>1 !n ! proc$ure %all
 be treat$ z satisfy+ ! crit]ia describ$
 9 su* clause ) respect to su* ye>4     
7#e7 ,(fice-bas$ facility def9$ ,=      
purposes ( ?is "p1 ! t]m (fice-bas$     
facility means a physician's (fice t1 ) 
respect to facility s]vices furni%$ 9   
connection ) specifi$ high supply co/   
surgical proc$ures--  7,a7 meets heal?1 
safety1 & o!r /&>ds specifi$ by !       
,secret>y 9 regulations2 &  7,b7 has    
ent]$ into an agreem5t ) ! ,secret>y "u 
:i* ! physician's (fice--  7i7 accepts !
 paym5t am\nt det]m9$ "u ?is subsection 
z full paym5t = su* facility s]vices2   
7ii7 accepts an assignm5t describ$ 9    

section #ahdb7;b77#c77;,b77ii7 ) respect
 to paym5t = all su* facility s]vices   
furni%$ by ! (fice to individuals       
enroll$ "u ?is "p2 &  7iii7 p>ticipates 
"u ?is "p & is paid z an (fice-bas$     
facility ) respect to all su* proc$ures4
  4  7#c7 ,con=m+ am5dm5ts  7,a7 ,=     
s]vices furni%$ 9 an ambulatory surgical
 c5t] ,section #ahcc7;i77#b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciel7i77#b77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3  7,f7 ,=     
purposes ( det]m9+ paym5t "u ?is        
subsection = a specifi$ high supply co/ 
surgical proc$ure 7z def9$ 9 section    
#ahcd7;bb77#d7 ) respect to a ye>       
7beg9n+ ) #bjbg77 furni%$ 9 an          
ambulatory surgical c5t] dur+ su* ye>1  
su* proc$ure %all be treat$ z a s]vice  
commonly furni%$ 9 an ambulatory        
surgical c5t]4  4  7,b7 ,= s]vices      
furni%$ 9 an (f-campus outpati5t        
dep>tm5t ( a provid] ,section           
#ahcc7t77#ba77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    

#aciel7t77#ba77;,c77 is am5d$ by add+ at
 ! end ! foll[+ new s5t5ce3 ,9 apply+ ! 
previ\s s5t5ce 9 ! case ( a specifi$    
high supply co/ surgical proc$ure 7z    
def9$ 9 section #ahcd7;bb77#d7 ) respect
 to a ye>7 furni%$ by an (f-campus      
outpati5t dep>tm5t ( a provid]1 paym5t  
%all be det]m9$ "u section #ahcd7;bb744 
7,c7 ,= cl>ification on applicable      
paym5t = obf facility s]vices ,section  
#ahcc7;a77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7a77#d77 is am5d$ 
by ins]t+ 7o!r ?an 9 clause 7iii7 ( su* 
section7 aft] section                   
#ahcb7;a77#b77;,f74  7c7 ,provid]       
agreem5t & m$ic>e enrollm5t  7#a7 ,9    
g5]al ,section #ahff7;e7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;cc7e77 is am5d$--  7,a7 9 p>agraph
 7#b71 by /rik+ at ! end &2  7,b7 9     
p>agraph 7#c71 at ! end1 by /rik+ !     
p]iod & add+ 2 &2 &  7,c7 by add+ at !  
end ! foll[+ new p>agraph3  7#d7 an     
(fice-bas$ facility 7z def9$ 9 p>agraph 
7#e7 ( section #ahcd7;bb771 b only )    

respect to ! furni%+ dur+ a ye> (       
specifi$ high supply co/ surgical       
proc$ures 7z def9$ 9 p>agraph 7#d7 ( su*
 section ) respect to su* ye>74  4  7#b7
 ,consultation ) /ate ag5cies reg>d+    
conditions ( p>ticipation ,section #ahfc
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciez7 is am5d$ by /rik+ or  
by ambulatory surgical c5t]s "u section 
#ahcb7;a77#b77;,f77i7 & ins]t+ by       
ambulatory surgical c5t]s "u section    
#ahcb7;a77#b77;,f77i71 or by (fice-bas$ 
facilities 7z def9$ 9 section           
#ahcd7;bb77#e77 ) respect to furni%+    
specifi$ high supply co/ surgical       
proc$ures 7z def9$ 9 section            
#ahcd7;bb77#d774  7#c7 ,use ( /ate      
ag5cies to det]m9e compliance )         
conditions ( p>ticipation ,section      
#ahfd7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;aa7a77 is am5d$--  
7,a7 9 ! fir/ s5t5ce1 by ins]t+ or :e!r 
a physician's (fice is an (fice-bas$    
facility 7z def9$ 9 section             
#ahcd7;bb77#e71 aft] /&>ds specifi$ "u  

section #ahcb7;a77#b77;,f77i712 &  7,b7 
9 ! fif? s5t5ce1 by ins]t+ (fice-bas$   
facility 7z def9$ 9 section             
#ahcd7;bb77#e77 ) respect to furni%+    
ambulatory high supply co/ surgical     
proc$ures 7z def9$ 9 section            
#ahcd7;bb77#d771 aft] ea* occurr5ce (   
ambulatory surgical c5t]14