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Medicare ASC Payment Reform Bill Introduced in US Senate

By admin | November 1, 2007

Senator Michael Crapo (R-ID) introduced legislation in the US Senate today to improve the ASC payment system and the mechanism that the Centers for Medicare and Medicaid Services (CMS) uses to determine what procedures Medicare reimburses ASCs for providing. The legislation was developed in concert with the ASC community.

The Ambulatory Surgical Center Medicare Payment Modernization Act of 2007 Senator Crapo introduced today:

* Requires CMS to pay ASCs 75% of the hospital outpatient department (HOPD) rate. This is in contrast to the Medicare ASC payment reform CMS released earlier this year that results in payments to ASCs of 65% of the HOPD rate.

* Links the ASC and HOPD payment system in an ongoing manner in contrast to CMS’s new system, which result in different annual updates to ASCs and HOPDs so that, over time, rates will continue to diverge.

* Authorizes ASCs to perform and receive Medicare facility payments for any surgical service, except for those procedures where (1) the US Department of Health and Human Services secretary identifies a specific risk concerning a certain procedure being performed in an ambulatory surgical setting or (2) an overnight stay is required. In contrast to the final Medicare reforms, the legislation does not use a number of arbitrary criteria to determine what procedures are excluded.

* Clarifies that any Medicare standards for ASCs that limit the provision of services to Medicare beneficiaries shall not be applicable to the provision of services to non-Medicare patients if the provision of those services is allowed under applicable state licensure laws.

Senator Crapo explained the introduction of the legislation saying, “This bill will allow ASCs to provide more services, encourage competition to improve quality of care and generate savings for Medicare and its beneficiaries.” Senator Crapo went on to say, “I look forward to working with ASC owners and employees across the country to enact this important piece of legislation.”

FASA President Kathy Bryant commended Senator Crapo for his leadership in ASC payment reform and supported the bill saying, “ASCs, physicians and other health care providers all are working to expand consumer choice and transparency and improve patient care. This legislation would enable patients to directly evaluate their options when deciding where to have surgery and save money on their outpatient surgery.”

Letters will be available shortly for ASCs to send directly from FASA’s web site to their senators asking them to cosponsor the legislation. Letters will also be available to send Senator Crapo to thank him for his leadership and support.

To vists the web site, CLICK HERE

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