10 CMS, State Legislative Updates for ASCs

Here are 10 recent legislative and legal updates impacting the ambulatory surgery center industry on the national and state level.

1. January 1, 2014 marked the beginning of the 2014 Medicare N1 codes. There are 210 new procedures given N1 status by Medicare, most of which were separately paid in previous years. The new regulation applies to the ASC, not the physician, and only for Medicare covered patients. Learn more about the new N1 codes here.

2. In Illinois, a judge recently upheld a promissory estoppel counterclaim filed by Grand Avenue Surgical Center in Chicago regarding a legal conflict with Connecticut General Life Insurance Company over out-of-network reimbursement. The judge dismissed Connecticut General's motion to dismiss GASC's counterclaim as pre-empted by the Employee Retirement Income Security Act. Learn more about the case here.

3. The Idaho House is considering the bill HB 497, which would create a state pricing database accessible to online consumers that would include pricing information for the 50 most common procedures performed at hospitals and ASCs. The database is estimated to cost $1.7 million.

4. The Centers for Medicare and Medicaid Services proposed expanding emergency preparedness requirements at the end of last year. Providers, including ASCs, would be required to:

•    Develop an emergency plan using an all-hazards approach focusing on capacities and capabilities;
•    Develop and implement policies and procedures based on the risk assessment and emergency plan;
•    Develop and maintain a communication plan complying with federal and state law to coordinate across healthcare providers and with state, local and public health departments and emergency systems;
•    Develop and maintain training and testing programs.

5. The CMS Final Payment Rule includes new quality reporting requirements for cataract surgery. The new requirements include reporting improvement in the patient's visual function within 90 days following cataract surgery, which is a patient reported outcome measure. According to the report, several stakeholders have met with members of Congress to raise issue with the new measure and the potential for unfair penalization under the current rule.

6. In January, MedPAC made the final recommendation for pay rates in 2015, recommending ASCs get no pay raise next year. MedPAC recommended increasing hospital inpatient and outpatient prospective payment systems by 3.25 percent. However, MedPAC also suggested reducing or eliminating the differences between hospital outpatient departments and physician offices for some procedures.

7. It was announced earlier this year that CMS delayed data collection for three new quality measures that were finalized for inclusion in the Ambulatory Surgical Center Quality Reporting Program until April 1. ASCs still need to report data from this year, but instead of reporting for all 12 months only patient encounters from April 1 to Dec. 31 should be included.

8. The Oklahoma Health Care Cost Reduction and Transparency Act of 2014 (HB 2400) passed unanimously in the House Public Health Committee and is now on its way to the House Floor. The bill would require hospitals and surgery centers to disclose price for 100 most common diagnostic services, 100 most common surgical procedures and 50 most common imaging procedures. Information would be posted on the Oklahoma Department of Health website.

9. Massachusetts Ambulatory Surgery Center in Bethesda, Md., is preparing to add 23-hour capabilities to its ASC, which offers orthopedics among other procedures. The ASC would be among the first in the state to have patients stay 23 hours. The state follows CMS guidelines which state ASCs can keep patients for 23 hours and 59 minutes.

10. At the end of 2013, the Illinois Legislative Joint Commission on Administrative Rules once again ruled to support it's prohibition against certificate of need changes that would be detrimental to ASCs. The rule would have required ASCs to seek a CON approval before adding a new specialty, but the JCAR found the rules "will have undue economic impact on entities to whom service approvals have already been issued."

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