CMS Proposes New Rules for ASCs That Serve Medicare Patients

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that will revise the requirements that ambulatory surgical centers (ASCs) must meet in order to bill Medicare for services furnished to beneficiaries.

This proposed rule would update the existing ASC Conditions for Coverage (CFC) to reflect contemporary standards of practice in the ASC community, as well as recommendations from the HHS inspector seneral. The new requirements will promote and protect patient access to quality services in ASCs.

ASCs are typically free-standing facilities that perform outpatient surgery. To participate in the Medicare program, they must meet Medicare’s conditions for coverage. The most commonly performed ASC procedures currently include cataract removal and lens replacement, other eye procedures, and colonoscopy. However, the specific types of procedures that will be covered when performed in an ASC, and the payment rates that will apply, have been dramatically changed as a result of a final ASC payment methodology rule that was issued by CMS on July 16, 2007.

That final rule is intended, among other things, to provide ASC payment for additional surgical procedures and create a rational relationship between payments for services furnished in ASCs and the same services when performed in either a hospital outpatient department or a physician’s office. As a result of the added procedures to be paid in ASCs and the revised ASC payment rates for existing ASC services, there may be a significant change in the mix of services performed in ASCs and in the alternate settings.

CMS expects that some of the new ASC procedures currently performed in the hospital outpatient department and the physician’s office will move to the ASC setting, and that there will also be migration of existing ASC procedures both into and out of ASCs as a result of the revised ASC payment system.

On July 16, 2007, CMS also issued a proposed rule setting payment rates, and adding procedures to the ASC-covered list, effective for ASC services performed on or after January 1, 2008.  The comment period on the proposed payment rates rule closes on Sept. 14, and a final rule will be issued on or before Nov. 1, 2007.

The proposed rule changes include:

-- A more comprehensive quality assessment and performance improvement condition (QAPI) that enables ASCs to take tailored proactive steps to ensure quality care;

-- Requiring the ASC’s governing body to be responsible for the oversight and accountability for the updated QAPI program;

-- Adding a new disaster preparedness plan standard to address emergency preparedness within the facility and interaction with local and state officials;

-- Adding requirements for radiologic services provided in an ASC to ensure they are parallel to the requirements for furnishing laboratory services;

-- Adding a new patient rights condition to address disclosure of physician financial interests in the ASC, advance directives, the grievance process and confidentiality of clinical records;

-- Expanding the infection control requirement to the condition level; and

-- Adding a comprehensive patient assessment requirement to ensure that accurate and thorough assessments are conducted to assure appropriate and safe surgery, and that patients would be able to tolerate a scheduled surgical procedure.

The proposed rule is posted on the CMS Web site at: http://www.cms.hhs.gov/center/asc.asp.  Information about the final payment methodology rule and the proposed payment rule for calendar year 2008 can be found at the same link.  Public comments will be accepted until Oct. 30, 2007 and a final rule will be issued later this year.

“AAASC is delighted that CMS has proposed improvements in the Medicare Conditions for Coverage that reflect standards of practice that most ambulatory surgery centers already address,” said Craig Jeffries, executive director of the American Association of Ambulatory Surgery Centers (AAASC). “Establishing these new requirements in regulatory rules should eliminate many of the regulatory oversight concerns raised by those who opposed further expansion of the list of procedures that Medicare allows to be performed in an ASC. These standards of practice, together with the outstanding experience of ASC measured by core outcomes that will begin to be collected by CMS in 2009, address the quality elements that underscore the value of ASC for Medicare beneficiaries looking for expanded access to high-quality, lower-cost and patient centered procedures.”