To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
This bill changes how Medicare pays for services provided at ambulatory surgical centers. It limits the coinsurance amount patients pay for certain services to the same amount as the inpatient hospital deductible. This means that if a surgical procedure’s coinsurance would be higher than the hospital deductible, Medicare will reduce the coinsurance amount to match the deductible and reimburse the surgical center for that difference. The changes will take effect on January 1, 2026.
Key provisions
- Limits Medicare coinsurance for services in ambulatory surgical centers.
- Sets the coinsurance amount equal to the inpatient hospital deductible.
- Reduces the coinsurance amount if it would exceed the deductible.
- Provides reimbursement to the surgical center for the difference between the original coinsurance and the deductible.
Who is affected
- Medicare beneficiaries
- Ambulatory surgical centers
- Medicare providers
Notable changes
- Changes the way Medicare reimburses for services at ambulatory surgical centers.
- Links the coinsurance amount to the inpatient hospital deductible.
Fiscal impact
The bill may result in reduced Medicare payments to ambulatory surgical centers and potentially lower out-of-pocket costs for Medicare beneficiaries.
Bill text
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