Post-Surgical Injections as an Opioid Alternative Act

Post-Surgical Injections as an Opioid Alternative Act

This bill temporarily freezes Medicare payment at 2016 levels for specified spinal surgery outpatient procedures that are conducted in ambulatory surgical centers.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5804 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5804

    To amend title XVIII of the Social Security Act to provide for 
   modifications in payment for certain outpatient surgical services.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2018

     Mr. Shimkus (for himself, Mr. Krishnamoorthi, and Mr. Roskam) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to provide for 
   modifications in payment for certain outpatient surgical services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Post-Surgical Injections as an 
Opioid Alternative Act''.

SEC. 2. MODIFICATION OF PAYMENT FOR CERTAIN OUTPATIENT SURGICAL 
              SERVICES.

    (a) Freeze of Payment for Certain Services Furnished in Ambulatory 
Surgical Centers.--Section 1833(i)(2) of the Social Security Act (42 
U.S.C. 1395l(i)(2)) is amended by adding at the end the following new 
subparagraph:
            ``(F)(i) With respect to a targeted procedure (as defined 
        in clause (ii)) furnished during 2020 or a subsequent year 
        (before 2025) to an individual in an ambulatory surgical 
        center, the payment amount for such procedure that would 
        otherwise be determined under the revised payment system under 
        subparagraph (D), without application of this subparagraph, 
        shall be equal to the payment amount for such procedure 
        furnished in 2016.
            ``(ii) For purposes of clause (i), the term `targeted 
        procedure' means a procedure to which Healthcare Common 
        Procedure Coding System 62310 (or, for years beginning after 
        2016, 62321), 62311 (or, for years beginning after 2016, 
        62323), 62264, 64490, 64493, or G0260 (or any successor code) 
        applies.
            ``(iii) This subparagraph shall not be applied in a budget-
        neutral manner.''.
    (b) Data Collection.--
            (1) In general.--The Comptroller General shall collect data 
        relating to the cost differential between targeted procedures 
        (as defined in section 1833(i)(2)(F)(ii) of the Social Security 
        Act, as added by subsection (a)) that are performed in a 
        hospital operating room and such procedures that are performed 
        in an office setting within a hospital in order to determine 
        whether such procedures are being properly coded for claims, 
        based on setting, for payment under section 1833(i)(2)(D) of 
        the Social Security Act (42 U.S.C. 1395l(i)(2)(D)) and to 
        determine if further changes are needed in the classification 
        system for covered outpatient department services (as described 
        in section 1833(t)(2)(A) of the Social Security Act (42 U.S.C. 
        1395l(t)(2)(A)).
            (2) Report.--Not later than 4 years after the date of the 
        enactment of this Act, the Comptroller General shall submit a 
        report to the Committee on Energy and Commerce and the 
        Committee on Ways and Means of the House of Representatives and 
        the Committee on Finance of the Senate containing--
                    (A) a determination of whether procedures described 
                in paragraph (1) are being properly coded for claims, 
                based on setting, for payment under section 
                1833(i)(2)(D) of the Social Security Act (42 U.S.C. 
                1395l(i)(2)(D)); and
                    (B) recommendations on any changes the Comptroller 
                General determines are needed in the classification 
                system for covered outpatient department services (as 
                described in section 1833(t)(2)(A) of the Social 
                Security Act (42 U.S.C. 1395l(t)(2)(A)).
    (c) Study.--Not later than 3 years after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall conduct a 
study and submit to Congress a report on the extent to which procedures 
described in section 1833(i)(2)(F)(ii) of the Social Security Act, as 
added by subsection (a), are effective at preventing the need for 
opioids for individuals furnished such procedures.
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