Page:United States Statutes at Large Volume 100 Part 3.djvu/233

 PUBLIC LAW 99-509—OCT. 21, 1986

100 STAT. 2041

"(d) Each contract under this part shall require that the utiliza- Contracts. tion and quality control peer review organization's review responsibility pursuant to subsection (a)(1) will include review of all ambulatory surgical procedures specified pursuant to section 1833(i)(l)(A) which are performed in the area, or, at the discretion of 42 USC 1395/. the Secretary (and except as provided in section 1164(b)(4)) a sample 42 USC 1320C-13. of such procedures.". (e) COINSURANCE AND DEDUCTIBLE TO APPLY WITHOUT REGARD TO SETTING OF AMBULATORY SURGERY.—

(1) Clauses (i) and (ii) of section 1832(a)(2)(F) of the Social Security Act (42 U.S.C. 1395k(a)(2)(F)) are each amended by inserting "standard overhead" before "amount". (2)(A) Section 1833(b) of such Act (42 U.S.C. 13951(b)) is amended by striking paragraph (3) and redesignating paragraphs (4) and (5) as paragraphs (3) and (4). (B) Subparagraphs (A) and (B) of section 1833(i)(2) of such Act are each amended by inserting "80 percent o f before "a standard overhead amount". (f) DEVELOPMENT OF PROSPECTIVE PAYMENT METHODOLOGY FOR OUTPATIENT HOSPITAL SERVICES.—Section 1135 of the Social Security

Act (42 U.S.C. 1320b-5) is amended by adding at the end the following new subsection: "(d)(1) The Secretary shall develop a fully prospective payment system for ambulatory surgical procedures performed on patients in hospitals on an outpatient basis. "(2) The system shall, to the extent practicable, provide for an allinclusive payment rate for ambulatory surgical procedures performed on patients in hospitals on an outpatient basis, which rate encompasses payment for facility services and all medical and other health services, other than physicians' services, commonly furnished in connection with such procedures. "(3) The system shall provide for appropriate payment rates with respect to such procedures. "(4) Such rates shall take into account at least the following considerations: "(A) The costs of hospitals providing ambulatory surgical procedures. "(B) The costs under this title of payment for such procedures performed in ambulatory surgical centers. "(C) The extent to which any differences in such costs are justifiable. "(5) The Secretary shall submit to Congress— "(A) an interim report on the development of the system by April 1, 1988, and "(B) a final report on such system by April 1, 1989. The report under subparagraph (B) shall include recommendations concerning the implementation of the payment system for ambulatory surgical procedures performed on or after October 1, 1989. (6)(A) The Secretary shall develop a model system for the payment for outpatient hospital services other than ambulatory surgery. "(B) The Secretary shall submit to Congress a report on the model payment system under subparagraph (A) by January 1, 1991.". (g) REPORTING OF O P D SERVICES USING H C P C S. — Not later than July 1, 1987, each fiscal intermediary which processes claims under part B of title XVIII of the Social Security Act shall require hospitals, as a condition of payment for outpatient hospital services

Reports.

Reports.

Claims. 42 USC 1395U note. 42 USC 1395J.

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