Outpatient Surgery Access Act of 2026
- Sponsor
- Sen. Cassidy, Bill [R-LA]
- Committees
- Finance Committee (primary)
- Last action
- Jul 14, 2026
Bottom line
The bill aims to increase Medicare payments to Ambulatory Surgical Centers by aligning their payment updates and budget neutrality calculations with hospital outpatient departments, promoting site-neutrality but potentially increasing Medicare spending.
What it actually does
This bill amends the Social Security Act to modernize Medicare payments for ambulatory surgical centers (ASCs). Specifically, it mandates that starting in 2027, ASCs will receive annual payment updates equal to those for hospital outpatient department (OPD) services. It also prohibits ASC-specific budget neutrality adjustments and requires ASC expenditures to be included in the overall budget neutrality calculations for OPD services.
Proponents argue
Proponents argue that the bill promotes site-neutrality in Medicare payments, ensuring ASCs are fairly compensated for similar services as hospital outpatient departments. This could encourage more procedures to be performed in lower-cost ASC settings, improving access for beneficiaries and potentially reducing overall healthcare costs by leveraging more efficient care delivery.
Opponents contend
Opponents might contend that the bill could significantly increase Medicare spending by removing a key cost-control mechanism for ASCs and granting them higher payment updates. They may also raise concerns that shifting services to ASCs without corresponding regulatory oversight could compromise patient safety or that it could financially strain hospitals which provide a broader range of services.
The bill is very short and directly amends specific sections of the Social Security Act, making it accessible for a quick review by an informed reader.
Section 2, amending Section 1833(i)(2)(D) of the Social Security Act
Equalizing Annual Payment Updates for ASCs
This provision mandates that starting in 2027 and each subsequent year, the annual payment update for Ambulatory Surgical Centers (ASCs) under Medicare will be equal to the update factor applied to hospital Outpatient Department (OPD) services. Currently, ASCs often receive lower annual updates. This change aims to bring ASC payment growth in line with hospital outpatient settings, promoting payment parity for similar services.
Supporters argue
Supporters argue this provision promotes site-neutrality in Medicare payments, ensuring ASCs are fairly compensated for similar services as hospital outpatient departments. This could encourage more procedures to be performed in lower-cost ASC settings, benefiting beneficiaries and the Medicare program by fostering efficiency and competition.
Critics contend
Opponents might argue that this could lead to increased Medicare spending if the higher payment updates for ASCs are not offset elsewhere. They may also raise concerns about potential shifts of complex procedures to ASCs without adequate regulatory oversight compared to hospitals, potentially impacting patient safety.
Tradeoffs
The tension lies between promoting fair competition and potentially lower-cost care settings (ASCs) versus controlling overall Medicare spending and ensuring appropriate regulatory oversight for all sites of care, especially given the different cost structures of ASCs and hospitals.
Section 3(a), amending Section 1833(i)(2)(D)(ii) of the Social Security Act
Eliminating Separate Budget Neutrality for ASCs
This provision prevents the Secretary of Health and Human Services from applying a separate budget neutrality adjustment specifically for ASC services starting in 2027. Currently, the Secretary can adjust ASC payments to ensure that changes to the payment system do not increase or decrease aggregate expenditures for ASC services. Eliminating this separate adjustment means ASC payments will no longer be constrained by their own aggregate expenditure target, potentially allowing for higher overall payments.
Section 3(b), amending Section 1833(t)(9)(B) of the Social Security Act
Including ASC Volume in OPD Budget Neutrality
This provision directs the Secretary, starting in 2027, to include expenditures made under the revised ASC payment system when determining budget neutrality adjustments for hospital Outpatient Department (OPD) services. This means that if more services shift to ASCs due to the payment changes, the volume and associated costs will be considered in the broader OPD budget neutrality calculation, potentially impacting OPD payments.