ASC Legislation

Ambulatory surgery centers (ASCs) have a strong track record of high-quality care and positive patient outcomes. With this high-quality care also comes savings to patients and healthcare payers, providing a value to patients and the healthcare delivery system that is unmatched.

ASCs save Medicare approximately $7 billion a year. Future savings, however, are threatened by problematic Medicare policies that limit Medicare beneficiaries’ access to outpatient surgical care.

ASCA’s primary focus for the 119th Congress is the introduction and passage of the Medicare Beneficiary Co-Pay Fairness Act (H.R. 3006/S. 1776) and the Outpatient Surgery Access Act of 2026 (H.R. 8091). By enacting these bills, Congress would ensure Medicare beneficiaries are not penalized for choosing the high-quality, lower-cost site of service that ASCs provide and allow ASC services to grow naturally. For more information about these bills, read about the provisions below or see ASCA’s one-page summaries.

Medicare Beneficiary Co-Pay Fairness Act

Issue: A beneficiary typically has a coinsurance responsibility of 20 percent of the procedure cost when that procedure is performed in an ASC. When a beneficiary receives the same procedure in an HOPD, the copay is capped at the inpatient deductible amount, which is $1,736 for 2026, and the hospital is made whole by the Medicare program. This copay penalty limits patients’ access to care in ASCs and ultimately increases costs to Medicare, its beneficiaries and taxpayers.

This issue primarily impacts those without supplemental coverage—an area where a racial disparity in access has been observed, with only 40 percent of black beneficiaries being covered by supplemental insurance in contrast to 72 percent of white beneficiaries.

Solution: This provision of the bill applies the same framework that applies to HOPD services, capping a beneficiary’s copay and making the facility whole for the difference.

Outpatient Surgery Access Act of 2026

Issue: Lagging annual payment updates and a policy that discourages procedure volume growth in ASCs have limited the savings that ASCs can generate for the Medicare program. Historically, CMS has updated ASC payments for inflation based on the Consumer Price Index for All Urban Consumers (CPI-U) as opposed to the hospital market basket (HMB), a more accurate measure of inflation for the healthcare sector that is used for hospital outpatient department (HOPD) payment updates. Due to the mismatch between what the CPI-U measures and the goods used when providing outpatient surgical services, ASC reimbursements have not accurately tracked inflation. CMS has indicated that the trial alignment of ASC and HOPD update factors will end after 2026, threatening access to ASCs over the long term. According to a 2026 claims analysis, ASCs have saved Medicare an average of $4.6 billion per year during this trial period so far. From 2014 to 2018, the five-year period immediately prior to the HMB trial policy, ASCs saved Medicare an average of $3.8 billion per year.

To control costs in the ASC payment system, CMS applies a budget-neutrality mechanism known as the secondary scalar, which counterintuitively increases program costs by limiting access to ASCs. Although Congress only authorized the secondary scalar for use in the first year of the ASC payment system, it is still being applied annually. The policy decreases reimbursements as procedure volume grows, creating an artificial obstacle to the natural migration of procedures from the higher-cost HOPD setting and preventing ASCs from generating even greater savings for Medicare.

Solution: Aligning the ASC and HOPD update factors and eliminating the secondary weight scalar would reduce Medicare costs by providing greater access to the lower-cost outpatient surgical care provided in ASCs.