{
  "legislationId": "119_HR_7863",
  "lastUpdate": "2026-03-26T12:30:00.873Z",
  "history": [
    {
      "timestamp": "2026-03-26T12:30:00.873Z",
      "source_url": "https://www.congress.gov/119/bills/hr7863/BILLS-119hr7863ih.htm",
      "model": "gemini-flash-lite-latest",
      "prompt_sent": "\nROLE: Fact Checker.\nZADANIE: Porównaj SOURCE (oryginał) i SUMMARY (streszczenie przygotowane przez inne AI).\n\nTwoim celem jest wykrycie \"ZMYŚLONYCH KONKRETÓW\" (Fabricated Entities) w SUMMARY.\n\nSOURCE:\n[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 7863 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 7863 To amend title XVIII of the Social Security Act to align payment under Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES March 9, 2026 Mr. Bilirakis (for himself, Mr. Ruiz, Mr. Murphy, and Mr. Davis of Illinois) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to align payment under Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Promoting Fairness for Medicare Providers Act of 2026''. SEC. 2. ALIGNING PAYMENT UNDER MEDICARE FOR SPECIFIED HIGH SUPPLY COST SURGICAL PROCEDURES FURNISHED IN OFFICE-BASED FACILITIES. (a) Coverage of Facility Services.--Section 1832(a)(2)(F) of the Social Security Act (42 U.S.C. 1395k(a)(2)(F)) is amended-- (1) in the matter preceding clause (i), by striking ``specified by the Secretary''; (2) in clause (i)-- (A) by inserting ``specified by the Secretary'' before ``pursuant''; and (B) at the end, by striking ``or''; (3) in clause (ii)-- (A) by inserting ``specified by the Secretary'' before ``pursuant''; and (B) at the end, by striking the semicolon and inserting ``, or''; and (4) by adding at the end the following new clause: ``(iii) that are specified high supply cost surgical procedures (as defined in section 1834(bb)(4) with respect to a year (beginning with 2027) and furnished during such year in an office-based facility (as defined in section 1834(bb)(5));''. (b) Payment Rules.-- (1) Payment for facility services.--Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)) is amended-- (A) by striking ``and (HH)'' and inserting ``(HH)''; and (B) by inserting before the semicolon at the end the following ``, and (II) with respect to facility services furnished in connection with a specified high supply cost surgical procedure (as defined in section 1834(bb)(4)) with respect to a year (beginning with 2027) furnished to an individual in an office-based facility (as defined in section 1834(bb)(5)) during such year, the amounts paid shall be, subject to section 1834(bb)(3), 80 percent of the payment amount determined under section 1834(bb) for such facility services furnished in connection with such procedure at such office-based facility''. (2) Payment determination for specified high supply cost surgical procedures furnished in office-based facilities.-- Section 1834 of the Social Security Act (42 U.S.C. 1395l(a)) is amended by adding at the end the following new subsection: ``(bb) Payment for Specified High Supply Cost Surgical Procedures Furnished in Office-Based Facilities.-- ``(1) In general.--In the case of a specified high supply cost surgical procedure furnished in an office-based facility during 2027 or a subsequent year, subject to paragraphs (2) and (3), payment for such procedure shall be determined under this part in the same manner as payment would be determined under this part if such procedure had been furnished in an ambulatory surgical center and not considered office-based under section 1833(i)(1)(B), except that payment for facility services furnished in connection with such procedure shall be equal to 90 percent of the amount that would be payable for facility services furnished in connection with such procedure under section 1833(i) for such year if such procedure had been furnished in an ambulatory surgical center and treated as a service commonly furnished in such a center. ``(2) Application in case of device-intensive procedures.-- In applying paragraph (1) in the case of a specified high supply cost surgical procedure that is a device-intensive procedure (as described in section 416.171(b)(2) of title 42, Code of Federal Regulations (or any successor regulation)), instead of the payment amount applied under such paragraph, the payment amount for the facility services with respect to such procedure shall be the amount that would be calculated under section 416.172(h)(2)(ii) of title 42, Code of Federal Regulations (or any successor regulation) with respect to a procedure that has been assigned device-intensive status, except that in applying such calculation the non-device portion described in paragraph (B) of such section shall be equal to 90 percent of the amount that would otherwise be calculated for such portion. ``(3) Limitation on copayment amount to inpatient hospital deductible amount.-- ``(A) In general.--In no case shall the amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year exceed the amount of the inpatient hospital deductible established under section 1813(b) for that year. ``(B) Maintaining payment to provider.--In the case that an individual enrolled under this part would, without application of subparagraph (A), be subject to an amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year that exceeds the amount of the inpatient hospital deductible established under section 1813(b) for that year, the Secretary shall increase the amount paid to the office-based facility as specified under section 1833(a)(1)(II) for such facility services by the amount by which-- ``(i) the coinsurance payable by the individual for such facility services without application of this paragraph; exceeds ``(ii) the coinsurance payable by the individual for such facility services with application of this paragraph. ``(4) Specified high supply cost surgical procedure defined.-- ``(A) In general.--For purposes of this part, subject to subparagraphs (B) and (C), the term `specified high supply cost surgical procedure' means a surgical procedure that as of 2023-- ``(i) when performed in an ambulatory surgical center, was payable under section 1833(i); and ``(ii) when performed in a physician's office-- ``(I) was payable under section 1848 at the practice expense relative value unit-based amount for non- facility sites of service; and ``(II) included a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, was greater than $500. ``(B) Review and revisions to specified services.-- ``(i) In general.--For each year (beginning with 2028), the Secretary shall review the procedures included in the definition of specified high supply cost surgical procedures under this paragraph and, based on such review and through rulemaking-- ``(I) shall add a surgical procedure (not described in subparagraph (A)) for inclusion in such definition if the procedure, with respect to such year, satisfies the criteria specified in clause (ii); and ``(II) may remove a surgical procedure from inclusion in such definition if the procedure, with respect to such year, satisfies the criteria specified in clause (iii). ``(ii) Criteria for required inclusion.-- For purposes of clause (i)(I), a surgical procedure satisfies the criteria specified in this clause, with respect to a year, if-- ``(I) when performed in an ambulatory surgical center, the procedure is payable under section 1833(i); and ``(II) when performed in a physician's office, the procedure-- ``(aa) would be, without application of this subsection or section 1833(a)(i)(II), payable under section 1848 at the practice expense relative value unit-based amount for non-facility sites of services; and ``(bb) includes a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, is greater than the threshold specified in clause (iv) for such year. ``(iii) Criteria for permissive removal.-- For purposes of clause (i)(II), a surgical procedure satisfies the criteria described in this clause, with respect to a year, if, when performed in a physician's office, the procedure includes a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, does not exceed the amount equal to 80 percent of the threshold specified in clause (iv) for such year. ``(iv) Dollar amount threshold specified.-- For purposes of clauses (ii) and (iii), the threshold specified in this clause is-- ``(I) with respect to 2028, the dollar amount specified in subparagraph (A)(ii), reduced by the percentage increase in the MEI (as defined in section 1842(i)(3)) over the 3-year period ending with 2028; or ``(II) with respect to a subsequent year, the amount specified in this clause for the preceding year reduced by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year. ``(C) Special rule for use of more than one of the same supply item in a procedure.--In the case of a surgical procedure that requires the use of more than one of the same supply item in such procedure-- ``(i) in applying subparagraph (A)(ii)(II), if as of 2023 the sum of the price inputs described in such subparagraph of all of such same supply items exceeds the dollar amount specified in such subparagraph, then the procedure shall be treated as satisfying the requirement of such subparagraph; and ``(ii) in applying subparagraph (B), with respect to 2028 or a subsequent year-- ``(I) if the sum of the price inputs described in clause (ii)(II)(bb) of such subparagraph of all of such same supply items exceeds the threshold specified in clause (iv) of such subparagraph for such year, then the procedure shall be treated as satisfying the criterion described in such clause (ii)(II)(bb) with respect to such year; and ``(II) if the sum of the price inputs described in clause (iii) of such subparagraph of all of such same supply items does not exceed the amount described in such clause for such year, then the procedure shall be treated as satisfying the criteria described in such clause with respect to such year. ``(5) Office-based facility defined.--For purposes of this part, the term `office-based facility' means a physician's office that, with respect to facility services furnished in connection with specified high supply cost surgical procedures-- ``(A) meets health, safety, and other standards specified by the Secretary in regulations; and ``(B) has entered into an agreement with the Secretary under which the physician's office-- ``(i) accepts the payment amount determined under this subsection as full payment for such facility services; ``(ii) accepts an assignment described in section 1842(b)(3)(B)(ii) with respect to payment for all such facility services furnished by the office to individuals enrolled under this part; and ``(iii) participates under this part and is paid as an office-based facility with respect to all such procedures.''. (3) Conforming amendments.-- (A) For services furnished in an ambulatory surgical center.--Section 1833(i)(2) of the Social Security Act (42 U.S.C. 1395l(i)(2)) is amended by adding at the end the following new subparagraph: ``(F) For purposes of determining payment under this subsection for a specified high supply cost surgical procedure (as defined in section 1834(bb)(4) with respect to a year (beginning with 2027)) furnished in an ambulatory surgical center during such year, such procedure shall be treated as a service commonly furnished in an ambulatory surgical center.''. (B) For services furnished in an off-campus outpatient department of a provider.--Section 1833(t)(21)(C) of the Social Security Act (42 U.S.C. 1395l(t)(21)(C)) is amended by adding at the end the following new sentence: ``In applying the previous sentence in the case of a specified high supply cost surgical procedure (as defined in section 1834(bb)(4) with respect to a year) furnished by an off-campus outpatient department of a provider, payment shall be determined under section 1834(bb).''. (C) For clarification on applicable payment for obf facility services.--Section 1833(a)(4) of the Social Security Act (42 U.S.C. 1395l(a)(4)) is amended by inserting ``(other than in clause (iii) of such section)'' after ``section 1832(a)(2)(F)''. (c) Provider Agreement and Medicare Enrollment.-- (1) In general.--Section 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is amended-- (A) in paragraph (2), by striking at the end ``and''; (B) in paragraph (3), at the end, by striking the period and adding ``; and''; and (C) by adding at the end the following new paragraph: ``(4) an office-based facility (as defined in paragraph (5) of section 1834(bb)), but only with respect to the furnishing during a year of specified high supply cost surgical procedures (as defined in paragraph (4) of such section with respect to such year).''. (2) Consultation with state agencies regarding conditions of participation.--Section 1863 of the Social Security Act (42 U.S.C. 1395z) is amended by striking ``or by ambulatory surgical centers under section 1832(a)(2)(F)(i)'' and inserting ``by ambulatory surgical centers under section 1832(a)(2)(F)(i), or by office-based facilities (as defined in section 1834(bb)(5)) with respect to furnishing specified high supply cost surgical procedures (as defined in section 1834(bb)(4))''. (3) Use of state agencies to determine compliance with conditions of participation.--Section 1864(a) of the Social Security Act (42 U.S.C. 1395aa(a)) is amended-- (A) in the first sentence, by inserting ``or whether a physician's office is an office-based facility (as defined in section 1834(bb)(5),'' after ``standards specified under section 1832(a)(2)(F)(i),''; and (B) in the fifth sentence, by inserting ``office- based facility (as defined in section 1834(bb)(5)) with respect to furnishing ambulatory high supply cost surgical procedures (as defined in section 1834(bb)(4)),'' after each occurrence of ``ambulatory surgical center,''. <all>\n\nSUMMARY TO EVALUATE:\nTitle: Promoting Fairness for Medicare Providers Act: Better Access to Office-Based Surgery\nSummary: This bill changes how Medicare pays for surgeries involving expensive supplies when performed in a doctor's office. It aims to make these procedures more accessible while capping the amount patients have to pay out of pocket.\nKey Points: Aligns Medicare payments for office-based surgeries with those performed in specialized surgical centers., Caps patient copayments at the level of the standard hospital inpatient deductible., Ensures doctor's offices meet strict safety and health standards to qualify for these new payment rules., Covers procedures where medical supplies cost more than $500, starting in 2027.\n\nZASADY OCENY:\n1. Sprawdź wszystkie LICZBY, DATY i KWOTY w SUMMARY. Jeśli którejś brakuje w SOURCE -> is_valid: false.\n2. Sprawdź wszystkie NAZWISKA, ORGANIZACJE i MIEJSCA w SUMMARY. Jeśli którejś brakuje w SOURCE -> is_valid: false.\n3. Sprawdź wszystkie konkretne DZIAŁANIA PRAWNE . Jeśli tego mechanizmu nie ma w SOURCE -> is_valid: false.\n\nWAŻNE: Abstrakcyjne pojęcia (np. \"transparentność\", \"zaufanie\") są dozwolone jako wnioski.\n\nOUTPUT (JSON):\n{\n  \"is_valid\": true/false,\n  \"issue\": \"fabricated_entity\" / \"contradiction\" / \"none\"\n}\n\nWYMAGANIA FORMATOWANIA:\n1. Odpowiedz WYŁĄCZNIE surowym obiektem JSON.\n2. NIE używaj bloków kodu Markdown.\n3. NIE dodawaj żadnych wstępów ani wyjaśnień przed ani po JSONie.\n4. JSON musi być poprawny i gotowy do parsowania.\n\n",
      "ai_response_raw": "{\n  \"is_valid\": true,\n  \"issue\": \"none\"\n}"
    },
    {
      "timestamp": "2026-03-26T12:19:07.380Z",
      "source_url": "https://www.congress.gov/119/bills/hr7863/BILLS-119hr7863ih.htm",
      "model": "gemini-flash-latest",
      "prompt_sent": "\nJesteś ekspertem od prawa Stanów Zjednoczonych, który ma za zadanie analizować dokumenty ustaw, uchwał oraz innych dokumentów legislacyjnych, a następnie przygotowywać z nich informacje w przystępny sposób dla obywateli. Twoim celem jest przedstawienie informacji tak, aby obywatele mogli sami ocenić wpływ legislacji na ich życie, nawet bez posiadania specjalistycznej wiedzy legislacyjnej. Skup się na faktach i obiektywnych skutkach wprowadzanych zmian, unikając wartościowania i osobistych opinii. Wszelki żargon prawny jest zabroniony. Prezentuj informacje w jasny, zwięzły i angażujący sposób, tak aby były zrozumiałe dla osoby bez wykształcenia prawniczego. Unikaj długich, złożonych zdań. Zamiast pisać \"projekt ma na celu nowelizację kodeksu podatkowego...\", napisz \"Zmiany w podatkach: nowe ulgi i obowiązki dla...\". Kontynuuj swoją pracę, dopóki nie rozwiążesz swojego zadania. Jeśli nie masz pewności co do generowanej treści, przeanalizuj dokument ponownie – nie zgaduj. Rozplanuj dobrze swoje zadanie przed przystąpieniem do niego. W podsumowaniu i kluczowych punktach, jeśli to możliwe i uzasadnione, podkreśl, jakie konkretne korzyści lub skutki (pozytywne lub negatywne) wprowadza ustawa dla życia codziennego obywateli, ich praw i obowiązków, finansów osobistych, bezpieczeństwa i innych ważnych kwestii (np. kategorycznych zakazów i nakazów czy najważniejszych konkretnych alokacji finansowych i terytorialnych).\n\nTwoja odpowiedź MUSI być w formacie JSON - i zawierać następujące klucze.\nZanim zwrócisz odpowiedź, dokładnie zweryfikuj, czy cała struktura JSON jest w 100% poprawna, włącznie ze wszystkimi przecinkami, nawiasami klamrowymi, kwadratowymi oraz cudzysłowami. Błędny JSON jest nieakceptowalny i uniemożliwi przetworzenie Twojej pracy.\n\nPrzeanalizuj dokładnie poniższy tekst dokumentu prawnego. To jest treść, na podstawie której masz wygenerować podsumowanie i kluczowe punkty:\n--- POCZĄTEK DOKUMENTU ---\n[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 7863 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 7863 To amend title XVIII of the Social Security Act to align payment under Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES March 9, 2026 Mr. Bilirakis (for himself, Mr. Ruiz, Mr. Murphy, and Mr. Davis of Illinois) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to align payment under Medicare for specified surgical procedures with high-cost supplies furnished in office-based facilities, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Promoting Fairness for Medicare Providers Act of 2026''. SEC. 2. ALIGNING PAYMENT UNDER MEDICARE FOR SPECIFIED HIGH SUPPLY COST SURGICAL PROCEDURES FURNISHED IN OFFICE-BASED FACILITIES. (a) Coverage of Facility Services.--Section 1832(a)(2)(F) of the Social Security Act (42 U.S.C. 1395k(a)(2)(F)) is amended-- (1) in the matter preceding clause (i), by striking ``specified by the Secretary''; (2) in clause (i)-- (A) by inserting ``specified by the Secretary'' before ``pursuant''; and (B) at the end, by striking ``or''; (3) in clause (ii)-- (A) by inserting ``specified by the Secretary'' before ``pursuant''; and (B) at the end, by striking the semicolon and inserting ``, or''; and (4) by adding at the end the following new clause: ``(iii) that are specified high supply cost surgical procedures (as defined in section 1834(bb)(4) with respect to a year (beginning with 2027) and furnished during such year in an office-based facility (as defined in section 1834(bb)(5));''. (b) Payment Rules.-- (1) Payment for facility services.--Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)) is amended-- (A) by striking ``and (HH)'' and inserting ``(HH)''; and (B) by inserting before the semicolon at the end the following ``, and (II) with respect to facility services furnished in connection with a specified high supply cost surgical procedure (as defined in section 1834(bb)(4)) with respect to a year (beginning with 2027) furnished to an individual in an office-based facility (as defined in section 1834(bb)(5)) during such year, the amounts paid shall be, subject to section 1834(bb)(3), 80 percent of the payment amount determined under section 1834(bb) for such facility services furnished in connection with such procedure at such office-based facility''. (2) Payment determination for specified high supply cost surgical procedures furnished in office-based facilities.-- Section 1834 of the Social Security Act (42 U.S.C. 1395l(a)) is amended by adding at the end the following new subsection: ``(bb) Payment for Specified High Supply Cost Surgical Procedures Furnished in Office-Based Facilities.-- ``(1) In general.--In the case of a specified high supply cost surgical procedure furnished in an office-based facility during 2027 or a subsequent year, subject to paragraphs (2) and (3), payment for such procedure shall be determined under this part in the same manner as payment would be determined under this part if such procedure had been furnished in an ambulatory surgical center and not considered office-based under section 1833(i)(1)(B), except that payment for facility services furnished in connection with such procedure shall be equal to 90 percent of the amount that would be payable for facility services furnished in connection with such procedure under section 1833(i) for such year if such procedure had been furnished in an ambulatory surgical center and treated as a service commonly furnished in such a center. ``(2) Application in case of device-intensive procedures.-- In applying paragraph (1) in the case of a specified high supply cost surgical procedure that is a device-intensive procedure (as described in section 416.171(b)(2) of title 42, Code of Federal Regulations (or any successor regulation)), instead of the payment amount applied under such paragraph, the payment amount for the facility services with respect to such procedure shall be the amount that would be calculated under section 416.172(h)(2)(ii) of title 42, Code of Federal Regulations (or any successor regulation) with respect to a procedure that has been assigned device-intensive status, except that in applying such calculation the non-device portion described in paragraph (B) of such section shall be equal to 90 percent of the amount that would otherwise be calculated for such portion. ``(3) Limitation on copayment amount to inpatient hospital deductible amount.-- ``(A) In general.--In no case shall the amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year exceed the amount of the inpatient hospital deductible established under section 1813(b) for that year. ``(B) Maintaining payment to provider.--In the case that an individual enrolled under this part would, without application of subparagraph (A), be subject to an amount of coinsurance for facility services furnished in connection with a specified high supply cost surgical procedure in an office-based facility during a year that exceeds the amount of the inpatient hospital deductible established under section 1813(b) for that year, the Secretary shall increase the amount paid to the office-based facility as specified under section 1833(a)(1)(II) for such facility services by the amount by which-- ``(i) the coinsurance payable by the individual for such facility services without application of this paragraph; exceeds ``(ii) the coinsurance payable by the individual for such facility services with application of this paragraph. ``(4) Specified high supply cost surgical procedure defined.-- ``(A) In general.--For purposes of this part, subject to subparagraphs (B) and (C), the term `specified high supply cost surgical procedure' means a surgical procedure that as of 2023-- ``(i) when performed in an ambulatory surgical center, was payable under section 1833(i); and ``(ii) when performed in a physician's office-- ``(I) was payable under section 1848 at the practice expense relative value unit-based amount for non- facility sites of service; and ``(II) included a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, was greater than $500. ``(B) Review and revisions to specified services.-- ``(i) In general.--For each year (beginning with 2028), the Secretary shall review the procedures included in the definition of specified high supply cost surgical procedures under this paragraph and, based on such review and through rulemaking-- ``(I) shall add a surgical procedure (not described in subparagraph (A)) for inclusion in such definition if the procedure, with respect to such year, satisfies the criteria specified in clause (ii); and ``(II) may remove a surgical procedure from inclusion in such definition if the procedure, with respect to such year, satisfies the criteria specified in clause (iii). ``(ii) Criteria for required inclusion.-- For purposes of clause (i)(I), a surgical procedure satisfies the criteria specified in this clause, with respect to a year, if-- ``(I) when performed in an ambulatory surgical center, the procedure is payable under section 1833(i); and ``(II) when performed in a physician's office, the procedure-- ``(aa) would be, without application of this subsection or section 1833(a)(i)(II), payable under section 1848 at the practice expense relative value unit-based amount for non-facility sites of services; and ``(bb) includes a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, is greater than the threshold specified in clause (iv) for such year. ``(iii) Criteria for permissive removal.-- For purposes of clause (i)(II), a surgical procedure satisfies the criteria described in this clause, with respect to a year, if, when performed in a physician's office, the procedure includes a HCPCS code with a supply item for which the price input for such supply item, used for determining the practice expense relative value units for such code, does not exceed the amount equal to 80 percent of the threshold specified in clause (iv) for such year. ``(iv) Dollar amount threshold specified.-- For purposes of clauses (ii) and (iii), the threshold specified in this clause is-- ``(I) with respect to 2028, the dollar amount specified in subparagraph (A)(ii), reduced by the percentage increase in the MEI (as defined in section 1842(i)(3)) over the 3-year period ending with 2028; or ``(II) with respect to a subsequent year, the amount specified in this clause for the preceding year reduced by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year. ``(C) Special rule for use of more than one of the same supply item in a procedure.--In the case of a surgical procedure that requires the use of more than one of the same supply item in such procedure-- ``(i) in applying subparagraph (A)(ii)(II), if as of 2023 the sum of the price inputs described in such subparagraph of all of such same supply items exceeds the dollar amount specified in such subparagraph, then the procedure shall be treated as satisfying the requirement of such subparagraph; and ``(ii) in applying subparagraph (B), with respect to 2028 or a subsequent year-- ``(I) if the sum of the price inputs described in clause (ii)(II)(bb) of such subparagraph of all of such same supply items exceeds the threshold specified in clause (iv) of such subparagraph for such year, then the procedure shall be treated as satisfying the criterion described in such clause (ii)(II)(bb) with respect to such year; and ``(II) if the sum of the price inputs described in clause (iii) of such subparagraph of all of such same supply items does not exceed the amount described in such clause for such year, then the procedure shall be treated as satisfying the criteria described in such clause with respect to such year. ``(5) Office-based facility defined.--For purposes of this part, the term `office-based facility' means a physician's office that, with respect to facility services furnished in connection with specified high supply cost surgical procedures-- ``(A) meets health, safety, and other standards specified by the Secretary in regulations; and ``(B) has entered into an agreement with the Secretary under which the physician's office-- ``(i) accepts the payment amount determined under this subsection as full payment for such facility services; ``(ii) accepts an assignment described in section 1842(b)(3)(B)(ii) with respect to payment for all such facility services furnished by the office to individuals enrolled under this part; and ``(iii) participates under this part and is paid as an office-based facility with respect to all such procedures.''. (3) Conforming amendments.-- (A) For services furnished in an ambulatory surgical center.--Section 1833(i)(2) of the Social Security Act (42 U.S.C. 1395l(i)(2)) is amended by adding at the end the following new subparagraph: ``(F) For purposes of determining payment under this subsection for a specified high supply cost surgical procedure (as defined in section 1834(bb)(4) with respect to a year (beginning with 2027)) furnished in an ambulatory surgical center during such year, such procedure shall be treated as a service commonly furnished in an ambulatory surgical center.''. (B) For services furnished in an off-campus outpatient department of a provider.--Section 1833(t)(21)(C) of the Social Security Act (42 U.S.C. 1395l(t)(21)(C)) is amended by adding at the end the following new sentence: ``In applying the previous sentence in the case of a specified high supply cost surgical procedure (as defined in section 1834(bb)(4) with respect to a year) furnished by an off-campus outpatient department of a provider, payment shall be determined under section 1834(bb).''. (C) For clarification on applicable payment for obf facility services.--Section 1833(a)(4) of the Social Security Act (42 U.S.C. 1395l(a)(4)) is amended by inserting ``(other than in clause (iii) of such section)'' after ``section 1832(a)(2)(F)''. (c) Provider Agreement and Medicare Enrollment.-- (1) In general.--Section 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) is amended-- (A) in paragraph (2), by striking at the end ``and''; (B) in paragraph (3), at the end, by striking the period and adding ``; and''; and (C) by adding at the end the following new paragraph: ``(4) an office-based facility (as defined in paragraph (5) of section 1834(bb)), but only with respect to the furnishing during a year of specified high supply cost surgical procedures (as defined in paragraph (4) of such section with respect to such year).''. (2) Consultation with state agencies regarding conditions of participation.--Section 1863 of the Social Security Act (42 U.S.C. 1395z) is amended by striking ``or by ambulatory surgical centers under section 1832(a)(2)(F)(i)'' and inserting ``by ambulatory surgical centers under section 1832(a)(2)(F)(i), or by office-based facilities (as defined in section 1834(bb)(5)) with respect to furnishing specified high supply cost surgical procedures (as defined in section 1834(bb)(4))''. (3) Use of state agencies to determine compliance with conditions of participation.--Section 1864(a) of the Social Security Act (42 U.S.C. 1395aa(a)) is amended-- (A) in the first sentence, by inserting ``or whether a physician's office is an office-based facility (as defined in section 1834(bb)(5),'' after ``standards specified under section 1832(a)(2)(F)(i),''; and (B) in the fifth sentence, by inserting ``office- based facility (as defined in section 1834(bb)(5)) with respect to furnishing ambulatory high supply cost surgical procedures (as defined in section 1834(bb)(4)),'' after each occurrence of ``ambulatory surgical center,''. <all>\n--- KONIEC DOKUMENTU ---\n\nPAMIĘTAJ: Twoja odpowiedź MUSI być wyłącznie poprawnym obiektem JSON. Nie dodawaj żadnych dodatkowych znaków, komentarzy ani tekstu przed znacznikiem '{' ani po znaczniku '}'. Cała odpowiedź musi być parsowalna jako JSON.\nNa podstawie POWYŻSZEGO dokumentu, wypełnij poniższą strukturę JSON:\nOto struktura JSON, której oczekuję (wypełnij ją treścią):\n{\n  \"pl_ai_title\": \"Nowy, krótki tytuł dla aktu prawnego po polsku, oddający sedno wprowadzanych zmian (np. maksymalnie 10-12 słów).\",\n  \"pl_summary\": \"2-3 zdania zwięzłego podsumowania treści aktu prawnego po polsku, napisane z perspektywy wpływu na życie codzienne obywateli.\",\n  \"pl_key_points\": [\n    \"Pierwszy krótki punkt po polsku dotyczący najważniejszych wprowadzanych rozwiązań lub zmian.\",\n    \"Drugi krótki punkt po polsku...\"\n  ],\n  \"eng_ai_title\": \"A new, short title for the legal act in English, capturing the essence of the changes (e.g., max 10-12 words).\",\n  \"eng_summary\": \"2-3 sentences summarizing the legal act in English, from the perspective of its impact on citizens' daily lives.\",\n  \"eng_key_points\": [\n    \"First short bullet point in English regarding the most important solutions or changes being introduced.\",\n    \"Second short bullet point in English...\"\n  ],\n  \"de_ai_title\": \"Ein neuer, kurzer Titel für das Rechtsdokument auf Deutsch, der den Kern der Änderungen erfasst (z.B. max. 10-12 Wörter).\",\n  \"de_summary\": \"2-3 Sätze Zusammenfassung des Rechtsdokuments auf Deutsch, aus der Perspektive seiner Auswirkungen auf das tägliche Leben der Bürger.\",\n  \"de_key_points\": [\n    \"Erster kurzer Stichpunkt auf Deutsch zu den wichtigsten eingeführten Lösungen oder Änderungen.\",\n    \"Zweiter kurzer Stichpunkt auf Deutsch...\"\n  ],\n  \"fr_ai_title\": \"Un nouveau titre court pour l'acte juridique en français, saisissant l'essence des changements (par exemple, 10-12 mots maximum).\",\n  \"fr_summary\": \"Résumé de 2-3 phrases de l'acte juridique en français, du point de vue de son impact sur la vie quotidienne des citoyens.\",\n  \"fr_key_points\": [\n    \"Premier court point en français concernant les solutions ou changements les plus importants introduits.\",\n    \"Deuxième court point en français...\"\n  ],\n  \"es_ai_title\": \"Un nuevo título breve para el acto jurídico en español, que recoja la esencia de los cambios (por ejemplo, máximo 10-12 palabras).\",\n  \"es_summary\": \"Resumen de 2-3 frases del acto jurídico en español, desde la perspectiva de su impacto en la vida cotidiana de los ciudadanos.\",\n  \"es_key_points\": [\n    \"Primer punto breve en español sobre las soluciones o cambios más importantes que se introducen.\",\n    \"Segundo punto breve en español...\"\n  ],\n  \"it_ai_title\": \"Un nuovo titolo breve per l'atto giuridico in italiano, che colga l'essenza delle modifiche (ad es. massimo 10-12 parole).\",\n  \"it_summary\": \"Riepilogo di 2-3 frasi dell'atto giuridico in italiano, dal punto di vista del suo impatto sulla vita quotidiana dei cittadini.\",\n  \"it_key_points\": [\n    \"Primo breve punto in italiano riguardante le soluzioni o le modifiche più importanti introdotte.\",\n    \"Secondo breve punto in italiano...\"\n  ],\n  \"nl_ai_title\": \"Een nieuwe, korte titel voor de rechtshandeling in het Nederlands, die de essentie van de wijzigingen weergeeft (bijv. max. 10-12 woorden).\",\n  \"nl_summary\": \"Samenvatting van 2-3 zinnen van de rechtshandeling in het Nederlands, vanuit het perspectief van de impact op het dagelijks leven van burgers.\",\n  \"nl_key_points\": [\n    \"Eerste korte punt in het Nederlands betreffende de belangrijkste geïntroduceerde oplossingen of wijzigingen.\",\n    \"Tweede korte punt in het Nederlands...\"\n  ],\n  \"pt_ai_title\": \"Um novo título curto para o ato jurídico em português, capturando a essência das mudanças (por exemplo, máx. 10-12 palavras).\",\n  \"pt_summary\": \"Resumo de 2-3 frases do ato jurídico em português, na perspetiva do seu impacto na vida quotidiana dos cidadãos.\",\n  \"pt_key_points\": [\n    \"Primeiro ponto curto em português sobre as soluções ou alterações mais importantes introduzidas.\",\n    \"Segundo ponto curto em português...\"\n  ],\n  \"category\": [\"Categorize the document into one category by default, based on the field it primarily concerns. Choose up to 3 if the document also touches upon SIGNIFICANT issues from other categories. You MUST select categories ONLY from the following list: Health, Education, Family, Taxes, Labor, Security, Environment, Courts and Law, Transport, Benefits, Real Estate, Media and Culture, Local Government, Migration, Agriculture, Public Investments, Informatization, Economy. If the document does not definitively fit any of these, you MUST use \"Other\". If you use \"Other\", it should be the ONLY category selected. Do NOT invent new categories. The response must be an array of strings, e.g., [\"Taxes\", \"Family\"].\"]\n}\n\n",
      "ai_response_raw": "{\n  \"pl_ai_title\": \"Zmiany w Medicare: łatwiejszy dostęp do zabiegów chirurgicznych w gabinetach lekarskich\",\n  \"pl_summary\": \"Ustawa wprowadza nowe zasady płatności Medicare za skomplikowane zabiegi wykonywane bezpośrednio w gabinetach lekarskich zamiast w szpitalach. Dzięki temu pacjenci zyskają łatwiejszy dostęp do procedur medycznych przy jednoczesnym ograniczeniu ich kosztów własnych.\",\n  \"pl_key_points\": [\n    \"Wprowadzenie zwrotu kosztów za drogie materiały medyczne używane podczas zabiegów w gabinetach lekarskich.\",\n    \"Ograniczenie maksymalnej dopłaty pacjenta do wysokości standardowego wkładu własnego za pobyt w szpitalu.\",\n    \"Zwiększenie dostępności zabiegów chirurgicznych poza dużymi placówkami medycznymi i szpitalami.\",\n    \"Wymóg przestrzegania przez gabinety lekarskie rygorystycznych standardów bezpieczeństwa i zdrowia, aby otrzymać płatności.\"\n  ],\n  \"eng_ai_title\": \"Promoting Fairness for Medicare Providers Act: Better Access to Office-Based Surgery\",\n  \"eng_summary\": \"This bill changes how Medicare pays for surgeries involving expensive supplies when performed in a doctor's office. It aims to make these procedures more accessible while capping the amount patients have to pay out of pocket.\",\n  \"eng_key_points\": [\n    \"Aligns Medicare payments for office-based surgeries with those performed in specialized surgical centers.\",\n    \"Caps patient copayments at the level of the standard hospital inpatient deductible.\",\n    \"Ensures doctor's offices meet strict safety and health standards to qualify for these new payment rules.\",\n    \"Covers procedures where medical supplies cost more than $500, starting in 2027.\"\n  ],\n  \"de_ai_title\": \"Medicare-Reform: Angleichung der Zahlungen für chirurgische Eingriffe in Arztpraxen\",\n  \"de_summary\": \"Dieses Gesetz passt die Medicare-Zahlungen für bestimmte chirurgische Eingriffe an, die in Arztpraxen mit teuren Materialien durchgeführt werden. Bürger profitieren von einem besseren Zugang zu Behandlungen und gedeckelten Zuzahlungen.\",\n  \"de_key_points\": [\n    \"Angleichung der Vergütung für Eingriffe in Arztpraxen an die Sätze von ambulanten OP-Zentren.\",\n    \"Begrenzung der Zuzahlung für Patienten auf den Betrag der stationären Krankenhaus-Selbstbeteiligung.\",\n    \"Strenge Sicherheits- und Gesundheitsstandards für teilnehmende Arztpraxen zur Gewährleistung der Patientensicherheit.\",\n    \"Gilt für Verfahren mit Materialkosten über 500 US-Dollar ab dem Jahr 2027.\"\n  ],\n  \"fr_ai_title\": \"Réforme Medicare : alignement des paiements pour la chirurgie en cabinet médical\",\n  \"fr_summary\": \"Cette loi modifie le remboursement par Medicare des interventions chirurgicales utilisant des fournitures coûteuses effectuées en cabinet. Elle vise à faciliter l'accès aux soins tout en limitant les frais restants à la charge des patients.\",\n  \"fr_key_points\": [\n    \"Remboursement des frais de matériel coûteux pour les interventions chirurgicales pratiquées en cabinet médical.\",\n    \"Plafonnement du ticket modérateur pour les patients au niveau de la franchise hospitalière standard.\",\n    \"Exigence de normes de sécurité et de santé strictes pour les cabinets médicaux participants.\",\n    \"Application de ces nouvelles règles aux procédures dont les fournitures coûtent plus de 500 $ dès 2027.\"\n  ],\n  \"es_ai_title\": \"Ley de Equidad en Medicare: pagos por cirugías en consultorios médicos\",\n  \"es_summary\": \"Esta ley ajusta los pagos de Medicare para cirugías con suministros costosos realizadas en consultorios médicos. Busca mejorar el acceso a estos procedimientos y limitar los costos directos para los ciudadanos.\",\n  \"es_key_points\": [\n    \"Alineación de los pagos por cirugías en consultorios con las tarifas de los centros quirúrgicos ambulatorios.\",\n    \"Límite máximo al copago del paciente, que no superará el deducible hospitalario estándar.\",\n    \"Nuevos estándares obligatorios de seguridad y salud para los consultorios médicos autorizados.\",\n    \"Inclusión de procedimientos con costos de suministros superiores a 500 dólares a partir de 2027.\"\n  ],\n  \"it_ai_title\": \"Riforma Medicare: allineamento dei pagamenti per interventi chirurgici in studio\",\n  \"it_summary\": \"Questa legge modifica il modo in cui Medicare paga per gli interventi chirurgici con materiali costosi eseguiti negli studi medici. L'obiettivo è aumentare l'accesso alle cure limitando i costi a carico dei cittadini.\",\n  \"it_key_points\": [\n    \"Pagamenti Medicare per interventi in studio allineati a quelli dei centri chirurgici specializzati.\",\n    \"Tetto massimo ai costi a carico del paziente pari alla franchigia ospedaliera per i ricoveri.\",\n    \"Obbligo di rispettare rigorosi standard di sicurezza e salute per gli studi medici partecipanti.\",\n    \"Copertura per procedure con costi di materiali superiori a 500 dollari a partire dal 2027.\"\n  ],\n  \"nl_ai_title\": \"Medicare-wijziging: gelijke betaling voor chirurgische ingrepen in de huisartsenpraktijk\",\n  \"nl_summary\": \"Deze wet past de Medicare-betalingen aan voor operaties met dure materialen die in een dokterspraktijk worden uitgevoerd. Het verbetert de toegang tot zorg en beperkt de eigen bijdrage van de patiënt.\",\n  \"nl_key_points\": [\n    \"Vergoeding voor ingrepen in de praktijk wordt gelijkgetrokken met die van gespecialiseerde chirurgische centra.\",\n    \"Maximale eigen bijdrage voor de patiënt wordt beperkt tot het standaard eigen risico voor ziekenhuisopname.\",\n    \"Strenge veiligheids- en gezondheidsnormen voor deelnemende artsenpraktijken om kwaliteit te waarborgen.\",\n    \"Betreft procedures waarbij de medische hulpmiddelen meer dan 500 dollar kosten vanaf 2027.\"\n  ],\n  \"pt_ai_title\": \"Lei de Equidade no Medicare: pagamentos para cirurgias em consultórios médicos\",\n  \"pt_summary\": \"Esta lei altera a forma como o Medicare paga por cirurgias com materiais caros realizadas em consultórios. O objetivo é facilitar o acesso a tratamentos e limitar os custos diretos para os pacientes.\",\n  \"pt_key_points\": [\n    \"Alinhamento dos pagamentos em consultórios com as taxas dos centros cirúrgicos ambulatoriais.\",\n    \"Limite máximo para o copagamento do paciente baseado no valor da franquia hospitalar padrão.\",\n    \"Exigência de normas rigorosas de segurança e saúde para os consultórios médicos qualificados.\",\n    \"Abrange procedimentos com custos de materiais superiores a 500 dólares a partir de 2027.\"\n  ],\n  \"category\": [\"Health\"]\n}"
    }
  ]
}