care revenue are exempt from this tax. To better understand ASCs and how they save money, lawmakers included language that created a pilot program to increase Medicaid utilization in ASCs. In conjunction with the commissioner of the Department of Social Services, CAASC will help implement the pro- gram, including establishing a list of medical procedures to be considered and appropriate reimbursement rates for those procedures.

Pennsylvania Working together, the Pennsylva- nia Ambulatory Surgery Associa- tion (PASA) and ASCA were able to thwart a separate proposal for a pro- vider assessment in that state. During the 2018 legislative session, Gover- nor Tom Wolf (D) floated the idea of imposing a provider tax on ASCs to help boost revenue for the state. After many hours of deliberation with mem- bers of the legislature and executive branch, it was ultimately decided the state would not tax ASCs. Pennsylva- nia ASCs welcomed the reprieve from an additional tax burden that could have threatened their ability to con- tinue to provide high-quality, cost- effective care to patients in the state.

Massachusetts Working with the Massachusetts Asso- ciation of Ambulatory Surgery Cen- ters (MAASC), ASCA fought a pro- vider tax situation in Massachusetts that would have added an 8.75 percent tax on “assessed charges for commercial pay- ers” in ASCs. This small provision was part of a large health care bill (160 pages) titled The Honorable Peter V. Kocot Act (H.4639). Fortunately, the Massachu- setts Conference Committee could not come to an agreement on this piece of legislation and decided not to move for- ward. This decision came after immense pressure from MAASC, ASCA and doz- ens of other organizations. While ASCA fully supports the decision not to act on this proposal, the Massachusetts General

In 2018, the most prominent challenges ASCs encountered involved the regulation and licensing of facilities, length of stay, provider taxes and/or fee schedule reductions.”

—Michael Scheerhorn, ASCA

Court will undoubtedly revisit all these issues in its next session, which con- venes in January.

Fee Schedule Reductions Louisiana In May, working closely with the Loui- siana Ambulatory Surgery Center Asso- ciation (LASCA), ASCA submitted a comment letter on behalf of the ASC community to oppose an emergency rule proposal that would have elimi- nated ASC reimbursements from the Medicaid fee schedule. Currently, Lou- isiana is facing an estimated budget def- icit of more than $600 million, which prompted this decision. In the comment letter, ASCA provided evidence of the cost-effectiveness of ASCs by compar- ing reimbursement rates for three com- mon pediatric Medicaid procedures at ASCs versus HOPDs. The letter served its purpose—Medicaid reimbursements to ASCs were restored. More challenges await Louisiana ASCs as there are still


Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs. GovtAffairsUpdate

few viable solutions for the state’s bud- get crisis. This battle will undoubtedly continue in 2019.

A Look Ahead: 2019 Many states have massive budget defi- cits, meaning they will have to cut spend- ing or raise revenue to balance them. The urgency of addressing health care costs combined with a limited understanding of the benefits and services ASCs pro- vide only adds to the challenges ahead. ASCA

uses many tools and

resources to monitor and act on these challenges. From speaking with leg- islators to submitting comments on regulations and running sophisticated advocacy campaigns, ASCA is at the forefront of these emergent issues. Among the issues already mentioned, ASCs will face Medicaid expansion bal- lot initiatives in Idaho, Utah, Nebraska and Montana. If all these states vote in favor of expansion, access to coverage would expand to approximately 400,000 more people. By expanding the Medic- aid population, ASCA and other state associations would then have to worry about how states will react to the added costs. Many states will likely add addi- tional assessments on ASCs or reduce their fee schedule to accommodate the added costs. This is especially true if any of these states run into budgetary issues in FY 2019. For more information on State

Affairs, please write Ali Legros-Mur- phy at or Michael Scheerhorn at mscheerhorn@

Michael Scheerhorn is ASCA’s state affairs coordinator. Write him at mscheerhorn@


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