Legislation Overview

Given the continued fiscal challenges posed by administering healthcare programs, policymakers and regulators should continue to focus on fostering innovative methods of healthcare delivery that offer safe, high-quality care so that progressive changes in the nation’s healthcare system can be implemented.

Support should be reserved for those policies that foster competition and promote the use of sites of service providing more affordable care, while always maintaining high quality and stringent safety standards. In light of the many benefits ASCs have brought to the nation’s healthcare system, policymakers should develop and implement payment and coverage policies that increase access to, and use of, ASCs.

Ambulatory Surgical Center Quality and Access Act of 2019 (H.R. 4350/S. 3085)

  • The Ambulatory Surgical Center Quality and Access Act of 2019 would make permanent the use of the hospital market basket as the inflationary update factor for ASC reimbursement, which better measures the cost of practicing medicine.

  • This legislation would also require the Centers for Medicare & Medicaid Services (CMS) to post similar quality metrics of ASCs and HOPDs online in a “side-by-side comparison.” The publicly available data would include quality measures for both sites of service in the same geographical areas.

  • The Advisory Panel on Hospital Outpatient Payment makes recommendations on various aspects of the outpatient prospective payment system and ASC rule. In the past, this panel was composed solely of individuals from the hospital community. This legislation would add an ASC industry leader to that panel so that the ASC perspective can be represented.

  • The bill would also add transparency to the healthcare industry by requiring CMS to disclose which criteria they use to deny certain procedures from being performed in an ASC and by requiring them to make publicly available the results of quality reporting measures that apply to both ASCs and HOPDs.

Removing Barriers to Colorectal Cancer Screening Act of 2019 (H.R. 1570/S. 668)

  • Under current law, Medicare waives coinsurance and deductibles for colonoscopies. When a polyp is discovered and removed, the procedure is reclassified as therapeutic for Medicare billing purposes and patients are required to pay the coinsurance. The Removing Barriers to Colorectal Screening Act of 2019 would eliminate unexpected costs for Medicare beneficiaries when a polyp is discovered and removed, ensuring that unexpected copays do not deter a patient from having the screening performed.

  • By eliminating financial barriers, this legislation would attain higher screening rates and reduce the incidence of colorectal cancer.