5 Legislative & Regulatory Changes Impacting Ambulatory Surgery Centers

1. Montana killed tougher CON legislation. The Montana House Human Services Committee has voted to kill House Bill 306, which would have required a stricter review process for organizations to build ambulatory surgery centers in the state.

HB 306 specifically would have required an organization to apply for a certificate of need and conduct an impact study to find the ramifications of the proposed ASC on existing healthcare facilities, such as critical access hospitals, in a county with 50,000 people or less. Currently, a CON is required in counties with 20,000 people or less.

2. Maine looks to roll back CON program. Republican lawmakers in Maine are seeking to roll back the state's certificate of need program that requires state officials to review proposals for major provider expansions and construction of new facilities.

The repeal is sponsored by Richard Malaby (R-Hancock) who said in the report, "I feel philosophically that hospitals [and] ambulatory surgical centers should be competing and improving their product and maybe, through competition, bring down cost for consumers." The Maine Hospital Association opposes the repeal.

3. Republicans work to repeal IPAB. Republican senators have reintroduced a bill to repeal the Independent Payment Advisory Board — a structure the lawmakers say will result in healthcare rationing. The IPAB, part of President Barack Obama's Patient Protection and Affordable Care Act, is a panel of 15 healthcare experts who must make targeted cuts in Medicare payments to physicians if the program's overall spending exceeds a certain amount.

The panel was designed to cease Congress' involvement in Medicare cuts. President Obama has not yet nominated any experts to the panel, even though it is supposed to be active next year, according to the report. The bill reintroduced yesterday would repeal the IPAB. Sen. Orrin Hatch (R-Utah), one of 30 sponsors of the bill, said "the IPAB empowers government and leaves the tough medical choices up to unelected Washington bureaucrats."

4. South Dakota bill would let providers treat patients, regardless of health plan.  A South Dakota bill would allow physicians to treat patients enrolled in any insurance plan in the state, as long as the providers are willing to meet the plans' terms and conditions. Healthcare providers in the state are divided by the legislation, according to the report. Chiropractors, optometrists and specialty providers like Black Hills Surgical Hospital in Rapid City support the bill, while Gov. Dennis Daugaard (R) and systems operated by Sioux Falls-based Sanford Health and Avera Health, among others, do not.

5. HHS released final rule on PPACA essential health benefits. The Department of Health and Human Services issued a final rule on essential health benefits that must be covered when health insurance is expanded in 2014. Starting Jan. 1, 2014, under the Patient Protection and Affordable Care Act, health insurers will have to cover essential health benefits in the individual and small group plans sold on the health insurance marketplaces. Benefits will also apply to people who qualify for Medicaid under the health law's Medicaid expansion.

EHB include items and services in 10 specific categories, including ambulatory patient services, emergency services, prescription drugs, rehabilitative services, lab services and more. However, states will have flexibility in determining how much coverage of EHB will be required. States can choose benchmark plans from options in their markets that are equal in scope to a typical employer plan.

More Articles on Legislation:
GOP Legislator Seeks to Repeal Maine's CON Program
Montana Bill Would Establish Stricter CON Process for ASCs
Outlook for De Novo ASCs in 2013 and Beyond: Q&A With Luke Lambert of ASCOA

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