,,ii  #aai? ,,congress  #a/ ,session    
,s4 #afbi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #f1 #bjbe ,mr4    
,k5n$y introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
align ,m$ic>e fee-=-s]vice paym5t rates 
across ambulatory sett+s4  #a4  ,%ort   
title  ,?is ,act may be cit$ z ! ,same  
,c>e1 ,l[] ,co/ ,act4  #b4  ,align+     
,m$ic>e fee-=-s]vice paym5t rates across
 ambulatory sett+s  7a7  ,9 g5]al       
,section #ahcd ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7aa7  ,site neutral paym5ts = c]ta9     
s]vices furni%$ 9 ambulatory sett+s     
7#a7  ,9 g5]al  ,= items & s]vices      
furni%$ 9 a specifi$ ambulatory sett+   
dur+ #bjbg or a subsequ5t ye> & includ$ 
9 an ambulatory paym5t classifications  
id5tifi$ pursuant to p>agraph 7#b7 = su*
 ye>1 paym5t "u ?is "p %all be made at !
 applicable site neutral paym5t rate "u 

?is "p 7z det]m9$ by ! ,secret>y7 if !  
requirem5ts = su* paym5t are o!rwise    
met4  7#b7  ,id5tification ( s]vices to 
:i* site neutral paym5ts apply  ,= #bjbg
 & subsequ5t ye>s3  7,a7  ,id5tification
  7i7  ,9 g5]al  ,! ,secret>y %all      
id5tify n few] ?an #ff ambulatory paym5t
 classifications = site neutral paym5ts 
:i* are appropriately furni%$ 9 ei!r a  
hospital outpati5t dep>tm5t1 ambulatory 
surgical c5t]1 or o!r sett+ det]m9$     
appropriate by ! ,secret>y4  7ii7       
,additional ,a,p,cs  ,! ,secret>y may   
add additional ambulatory paym5t        
classifications to ^? id5tifi$ "u clause
 7i7 z ! ,secret>y det]m9es cl9ically   
appropriate  7,b7  ,exception  ,!       
,secret>y %all reclassify ! ambulatory  
paym5t classifications = em]g5cy        
dep>tm5t visits1 critical c>e visits1 & 
trauma c>e visits at a hospital         
outpati5t dep>tm5t z ,compreh5sive      
,a,p,cs1 9 :i* all ! items & s]vices on 
! same claim are packag$ into a s+le    
paym5t unit4 ,any item or s]vice t is   

provid$ ) su* a visit s reclassifi$ %all
 n be treat$ z an item or s]vice        
id5tifi$ "u subp>agraph 7,a71 & %all n  
be subject to ! provisions ( p>agraph   
7#a74 ,! ,secret>y may1 pursuant to     
rulemak+1 specify exceptions to any     
reclassification "u ! fir/ s5t5ce ( ?is 
subp>agraph4  7#c7  ,consid]ation (     
,med,p,a,c recomm5dations  ,9 c>ry+ out 
?is subsection 7includ+ ! id5tification 
( s]vices "u p>agraph 7#b771 ! ,secret>y
 %all take into consid]ation !          
recomm5dations ( ! ,m$ic>e ,paym5t      
,advisory ,commission 9 ,*apt] #h       
7entitl$ ,align+ fee-=-s]vice paym5t    
rates across ambulatory sett+s7 ( its   
,m$ic>e & ! ,heal? ,c>e ,deliv]y ,sy/em 
report submitt$ to ,congress 9 ,june    
#bjbc4  7#d7  ,def9ition ( specifi$     
ambulatory sett+  ,9 ?is subsection1 !  
t]m specifi$ ambulatory sett+ means a   
hospital outpati5t dep>tm5t1 ambulatory 
surgical c5t]1 or o!r sett+ det]m9$     
appropriate by ! ,secret>y4  4  7b7     
,con=m+ am5dm5ts  7#a7  ,paym5t sy/em = 

ambulatory surgical c5t] s]vices        
,section #ahcc7;i77#b77;,d77i7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7i77#b77;,d77i77 is am5d$ by /rik+
 = paym5t & ins]t+ =1 subject to section
 #ahcd7;aa71 paym5t4  7#b7  ,,hopd fee  
s*$ule  ,section #ahcc7t7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciel7t77
 is am5d$--  7,a7 9 p>agraph 7#a77;,a71 
by /rik+ ! am\nt ( paym5t & ins]t+      
subject to section #ahcd7;aa71 ! am\nt (
 paym5t2 &  7,b7 9 p>agraph 7#i77;,b71  
by add+ at ! end ! foll[+3 ,9 det]m9+   
adju/m5ts "u ?is subp>agraph = #bjbg or 
a subsequ5t ye>1 ! ,secret>y %all n take
 into acc\nt "u ?is subp>agraph or      
p>agraph 7#b77;,e7 any *anges 9         
exp5ditures z a result ( ! application (
 section #ahcd7;aa74  7#c7  ,physician  
fee s*$ule  ,section #ahdh7;a77#a77;,b7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#d7;a77#a77;,b77 is    
am5d$ by ins]t+ & section #ahcd7;aa7    
aft] succe$+ provisions ( ?is           
subsection4