Outpatient Surgery Access Act of 2026
- Sponsor
- Rep. Van Duyne, Beth [R-TX-24]
- Committees
- Ways and Means Committee (primary)
- Last action
- Mar 25, 2026
Bottom line
This bill seeks to increase Medicare payments to ambulatory surgical centers by aligning their annual updates with hospital outpatient departments and integrating their budget neutrality calculations.
What it actually does
The bill, titled the "Outpatient Surgery Access Act of 2026," aims to modernize Medicare payments for ambulatory surgical centers (ASCs). It mandates that starting in 2027, ASCs will receive annual payment updates equal to those given to hospital outpatient departments (OPDs). Additionally, it prohibits ASC-specific budget neutrality adjustments and requires that ASC expenditures be included in the broader budget neutrality calculations for OPD services.
Proponents argue
Supporters argue that aligning ASC payment updates with hospital outpatient departments will ensure fair compensation for ASCs, which often provide services at a lower cost than hospitals. This modernization would help maintain patient access to high-quality, cost-effective outpatient surgical care, especially in rural or underserved areas, and encourage the shift of appropriate procedures to more efficient settings.
Opponents contend
Opponents might contend that this bill could lead to increased Medicare spending if the combined budget neutrality mechanism does not fully offset the higher ASC payments, potentially straining the Medicare trust fund. They might also argue that while ASCs are often cheaper, they may not handle the same complexity of cases as hospital outpatient departments, and a direct alignment of payment updates might not be entirely appropriate without further differentiation.
The bill is very short and can be read and understood quickly, allowing ample time for evaluation.
Section 2, amending Section 1833(i)(2)(D) of the Social Security Act.
Equalizing Annual Payment Updates for ASCs and OPDs
This provision mandates that starting in 2027, the annual payment update factor for services provided by Ambulatory Surgical Centers (ASCs) under Medicare will be the same as the update factor applied to hospital Outpatient Department (OPD) services. This means ASCs will no longer receive potentially lower, separate annual payment increases, aiming to create parity in how these two types of facilities are reimbursed for similar services.
Supporters argue
Supporters argue this provision corrects a long-standing disparity where ASCs often received lower payment updates than hospital outpatient departments for similar services, despite ASCs generally having lower overhead. They contend that this alignment will ensure fair compensation, encourage investment in ASCs, and maintain patient access to high-quality, lower-cost surgical settings.
Critics contend
Critics might argue that a direct alignment of payment updates without considering differences in patient acuity, facility costs, or regulatory burdens between ASCs and hospital OPDs could lead to overpayment for some ASC services. They may also raise concerns about the overall cost implications for the Medicare program.
Tradeoffs
The provision balances the desire to ensure fair compensation and viability for ASCs against potential increases in overall Medicare spending and the complexities of comparing service delivery across different facility types, which may have varying cost structures and patient populations.
Section 3, amending Section 1833(i)(2)(D)(ii) and Section 1833(t)(9)(B) of the Social Security Act.
Modifying Budget Neutrality Adjustments for Outpatient Surgical Procedures
This provision makes two key changes to budget neutrality calculations. First, it prohibits the Secretary from applying specific budget neutrality adjustments solely for ASC services starting in 2027. Second, it requires that when calculating budget neutrality adjustments for hospital outpatient department (OPD) services, the Secretary must also factor in expenditures made under the revised ASC payment system. This means any changes in ASC spending will now be considered within the broader OPD budget neutrality framework, effectively combining the pools for these calculations.