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HR 8091

Outpatient Surgery Access Act of 2026

119th Congress Introduced by John Larson and 1 co-sponsor

H.R. 8091 would tie ASC payment updates to the same OPD update mechanism starting in 2027, prohibiting ASC-specific budget neutrality adjustments to ensure parity.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 8091

Overview

  • Bill: H.R. 8091
  • Session: 119th Congress
  • Title: Outpatient Surgery Access Act of 2026
  • Purpose: To amend title XVIII of the Social Security Act (Medicare) in order to modernize payments for ambulatory surgery centers (ASCs) and align their payment updates with updates for other outpatient department (OPD) services, while prohibiting certain budget neutrality adjustments specific to ASCs.

Main Purpose and Intent

  • Align and modernize Medicare payments for ambulatory surgical centers with the payment update framework used for OPD services.
  • Ensure ASC payment updates reflect the same annual update mechanism as OPD services beginning in 2027 and in subsequent years.
  • Limit or prevent ASC-specific budget neutrality adjustments that would artificially alter ASC expenditures relative to the revised payment system.
  • Require that budget neutrality calculations for ASC-related payments aggregate expenditures in a manner that accounts for the revised payment system.

Key Provisions and Changes

  1. Alignment of Updates with OPD Services (Section 2)

    • Amends Section 1833(i)(2)(D) of the Social Security Act.
    • Adds a new clause to specify that, for 2027 and each subsequent year, the Secretary must apply the annual update for ASC payments equal to the OPD fee schedule increase factor (as defined in subsection (t)(3)(C)(iv)) for that year, with adjustments per other applicable clauses (iv) and (v).
    • Overall effect: ASC payment updates would mirror the methodology and growth rate used for OPD services’ payment updates.

  2. Prohibition on ASC-Specific Budget Neutrality Adjustments (Section 3(a))

    • Prohibits, starting in 2027 and in subsequent years, the Secretary from applying any adjustment under the system that would result in the same aggregate expenditures for ASC services as would occur if this prohibition did not apply.
    • Purpose: Prevents ASC-specific budget neutrality adjustments from offsetting the intended updated payment rates, ensuring the revised system is budget-neutral across the broader OPD/ASC context only in a manner that does not blunt ASC payment increases.

  3. Combining Volume for Budget Neutrality (Section 3(b))

    • Amends Section 1833(t)(9)(B) to require the Secretary, when calculating budget neutrality adjustments for 2027 and later years, to consider expenditures under the revised ASC payment system.
    • Purpose: Ensures budget neutrality calculations reflect the revised payment structure, incorporating ASC-specific changes.

Who Would Be Affected

  • Ambulatory Surgical Centers (ASCs): Primary impact is on how their Medicare payments are updated annually, aligning more closely with OPD service updates and altering budget neutrality considerations.
  • Medicare program administration (Secretary of Health and Human Services): Responsible for implementing the updated update methodology and budget neutrality calculations.
  • Patients undergoing outpatient surgical procedures at ASCs: Indirect impact through potential changes in reimbursement levels reflected in ASC pricing and access.

Procedural and Timeline Aspects

  • Introduction: March 25, 2026, by Rep. Van Duyne (along with Rep. Larson of Connecticut as co-sponsor).
  • Referral: Committee on Energy and Commerce and Committee on Ways and Means, with further consideration to be determined by the Speaker.
  • Effective Timeline:
    • If enacted, the key changes take effect in 2027 and apply to 2027 and subsequent years for the updated payment system and associated budget neutrality considerations.
  • Status: As of introduction, awaiting committee action and potential floor consideration.

Summary

H.R. 8091 seeks to modernize Medicare ASC payments by tying their annual update to the same OPD update mechanism used for other outpatient services, starting in 2027. It also prohibits ASC-specific budget neutrality adjustments designed to offset expenditures and directs budget neutrality calculations to incorporate the revised ASC payment system. The intent is to create parity between ASC payments and OPD payments, with transparent budgeting effects for the Medicare program.

Compiled from official sources — confirm details with the bill’s official record.

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