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MEDICARE REVISES LIST OF AMBULATORY SURGICAL CENTER PROCEDURES

MEDICARE REVISES LIST OF AMBULATORY SURGICAL CENTER PROCEDURES

The Centers for Medicare & Medicaid Services (CMS) today took steps to increase access to quality health care for Medicare beneficiaries by expanding the number of procedures covered when furnished in an ambulatory surgical center (ASC). 

“Many Medicare beneficiaries rely on the care they are getting in ambulatory surgical facilities and we want to continue efforts to improve their access to quality care in the most clinically appropriate setting,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. 

The interim final rule being issued today differs significantly from the proposed rule that was published November 26, 2004, largely in response to comments CMS received.  At that time, CMS proposed to add 25 procedures to the list. Today’s interim final rule, with an opportunity to comment, includes 65.  CMS also proposed to delete 100 procedures based on claims data showing the procedures were performed in physician offices more than half of the time.  CMS decided not to finalize that proposal and instead to delete only five procedures from the list after public input showed that deleting most of these services could jeopardize patient safety and access to care.

"The comments we received provided clear, clinical evidence that deleting the procedures, as we had proposed, could have led to reduced access, or riskier care for patients with more complicated medical conditions if performed in a physician's office rather than an ASC," Dr. McClellan said.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires CMS to develop a new payment system for ASCs and implement that system by January 2008.  CMS anticipates publishing a proposal for the new payment methodology in a separate rule by 2006.

CMS is required to update the ASC list every two years.  The new list will be published in the May 4 Federal Register, and will become effective July 5, 2005.  Comments will be accepted until July 5, and, if necessary, a final rule responding to any comments will be published at a later time.

Note: For more information, please see: http://www.cms.hhs.gov/suppliers/asc/