The Outpatient Surgery Access Act of 2026 aligns Medicare payment updates and budget neutrality adjustments for ambulatory surgical centers with those of hospital outpatient departments to ensure consistent reimbursement standards.
Beth Van Duyne
Representative
TX-24
The Outpatient Surgery Access Act of 2026 aims to modernize Medicare reimbursement by aligning annual payment updates for ambulatory surgical centers (ASCs) with those of hospital outpatient departments. Additionally, the bill eliminates separate budget neutrality adjustments for ASCs to ensure a more consistent and integrated payment structure across outpatient settings.
Outpatient Surgery Access Act of 2026 Sets New Medicare Payment Rules for Surgery Centers Starting in 2027
Starting in 2027, the Outpatient Surgery Access Act of 2026 changes the math on how Medicare pays for procedures at Ambulatory Surgical Centers (ASCs)—those standalone clinics where you might go for a colonoscopy or knee surgery instead of a massive hospital. Under Section 2, the bill ditches the old way of calculating annual raises for these centers and instead hitches their pay increases to the same 'inflation' factor used by big hospital outpatient departments. This essentially levels the playing field, ensuring that the local surgery center down the street gets the same percentage update for their services as the giant medical center across town.
Syncing the Books
Currently, hospitals and standalone surgery centers often operate under different financial rules, even when they’re doing the exact same job. This bill aims to fix that by requiring the Secretary of Health and Human Services to use the Outpatient Prospective Department (OPD) fee schedule as the baseline for ASCs. For a patient, this might not change your co-pay overnight, but it creates a more stable environment for these smaller clinics to stay in business. By ensuring their payments keep pace with hospital rates, the bill makes it more likely that these convenient, often cheaper alternatives to hospitals remain available in your community.
The Budget Neutrality Shift
Section 3 of the bill gets into the weeds of 'budget neutrality'—the government’s way of making sure total spending doesn't accidentally skyrocket when rules change. Starting in 2027, the bill bans the government from applying a separate budget adjustment just for surgery centers. Instead, it forces the government to lump the costs of surgery centers and hospital outpatient departments into one big bucket when calculating these adjustments. By combining the volume of services from both types of facilities, the bill ensures that the financial math reflects the reality of where people are actually getting their surgeries, rather than treating standalone centers as a separate, smaller line item.