H.R. 3006: To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.

H.R. 3006 is a proposed bill that seeks to amend the Social Security Act, specifically concerning the costs associated with certain medical services performed in ambulatory surgical centers (ASCs). Below are the key points of the bill:

Limitation on Coinsurance Amount

The bill introduces a limitation on the coinsurance amount that patients would have to pay for facility services provided during surgical procedures in ASCs. Here are the main components:

• Coinsurance Reduction: If the coinsurance amount calculated for the facility services exceeds the inpatient hospital deductible amount established for the year, the coinsurance will be reduced. This means patients will pay no more than the deductible amount for these services.
• Payment to Suppliers: The government will compensate the suppliers (ambulatory surgical centers) by paying them an equivalent amount to the reduction in coinsurance. This ensures that while patients pay less, the facilities do not face a financial loss on the services they provide.

Effective Date

The amendments proposed in this bill would take effect for services provided on or after January 1, 2026. This allows time for the necessary adjustments and preparations to be made by health care providers and insurers.

Implications

This legislation aims to alleviate some of the financial burden on patients receiving care in ASCs by capping how much they can be charged in coinsurance relative to higher inpatient deductible amounts. This may encourage more patients to seek outpatient surgical care, as the cost may be more predictable and manageable.

Relevant Companies

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