H.R. 8091: Outpatient Surgery Access Act of 2026

The Outpatient Surgery Access Act of 2026 aims to make changes to the way Medicare pays for services provided by ambulatory surgical centers (ASCs). Here’s a summary of the main points of the bill:

Modernizing Payment Updates

The bill proposes to adjust how annual payment updates for ASCs are calculated. Specifically, it seeks to align these updates with those for outpatient hospital services, ensuring that ASCs receive a similar increase in payments based on the outpatient department (OPD) fee schedule. This alignment is intended to begin in the year 2027 and continue annually thereafter.

Changes to Budget Neutrality Adjustments

Another key aspect of the bill is related to budget neutrality in payments. Budget neutrality means that any changes in payment rates should not lead to an increase or decrease in total expenditures for the services overall. The bill would:

• Prohibit ASC-Specific Budget Neutrality Adjustments: It would prevent the Secretary of Health and Human Services from applying adjustments specifically designed to ensure that total spending remains unchanged, effectively eliminating certain restrictions on how funds are allocated to ASCs.
• Combine Volume for Budget Neutrality Calculation: The bill would require that when determining adjustments for budget neutrality, the Secretary must consider all expenditures made under the new payment system for ASCs, streamlining the calculations and possibly increasing payments to ASCs.

Implementation Timeline

The changes outlined in this bill are set to take effect starting from the year 2027, marking a significant shift in the way Medicare handles payments for surgical services provided in outpatient settings.

Outcome Goals

The intent behind these adjustments is to improve access to outpatient surgical procedures, potentially enhancing the quality of care and operational efficiencies at ASCs while ensuring that they are paid fairly compared to outpatient hospital services.

Relevant Companies

• SGRY (Surgery Partners, Inc.): A company operating outpatient surgical facilities that may benefit from higher Medicare reimbursements.
• AMSG (American Surgical Hospital Association): May be impacted by changes in reimbursement structures affecting their member organizations.