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.
Sponsor
Mike Kelly
Republican · PA-16
Bill Progress
Latest Action · Apr 24, 2025
Referred to 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. for review
Medicare patients shouldn't overpay at surgery centers
Why it matters
Medicare already caps what you owe for outpatient surgery at a hospital — pegged to the inpatient hospital deductible, roughly $1,700 in 2026. Get the exact same procedure at a freestanding ambulatory surgical center and that ceiling doesn't apply, so your share of the facility fee can run higher. H.R. 3006 extends the same cap to surgical centers, with Medicare covering the difference so the center isn't shorted.
Right now, Medicare treats two settings differently. At a hospital outpatient department, the law caps a patient's coinsurance for the facility fee at the inpatient hospital deductible for the year. At an ambulatory surgical center, no such cap exists — so the patient's share of the bill can be higher for the same surgical procedure.
H.R. 3006 applies that hospital-style ceiling to surgical centers. If your coinsurance for the facility services tied to a surgery would come in above the year's inpatient hospital deductible, Medicare reduces it down to that amount.
The surgery center doesn't eat the loss. The bill requires the Secretary of Health and Human Services to pay the center an amount equal to whatever the patient's coinsurance was reduced by. The change isn't retroactive — it applies to procedures done on or after January 1, 2026.
H.R. 3006 Bill Summary
What H.R. 3006 actually does.
Your surgery-center coinsurance gets a ceiling
When the coinsurance for a surgery center's facility services tied to a surgical procedure would exceed the year's inpatient hospital deductible, the bill reduces the patient's coinsurance down to that deductible amount.
Matches the cap hospitals already have
Hospital outpatient departments already cap a patient's facility-fee coinsurance at the inpatient hospital deductible. The bill extends the same benchmark to ambulatory surgical centers, which had been left out.
Medicare pays the surgery center the difference
When a patient's coinsurance is cut to the cap, the Secretary of Health and Human Services must pay the center an amount equal to the reduction, so the facility receives the same total payment.
Applies only to a surgery center's facility fee
The cap covers the facility services a surgical center bills for a procedure — not separate charges like the surgeon's professional fee.
Starts January 1, 2026
The cap applies to services furnished on or after January 1, 2026. Procedures done before that date are billed under the old rules.
Who benefits from H.R. 3006?
Medicare patients having outpatient surgery
Anyone on Medicare who gets a covered surgical procedure at an ambulatory surgical center on or after January 1, 2026. Their share of the facility fee can no longer climb above the year's inpatient hospital deductible — the same protection hospital outpatient patients already have.
People facing the most expensive procedures
The cap matters most when a procedure's facility coinsurance would otherwise run high. Those patients see the biggest cut, since their coinsurance gets pulled all the way down to the deductible ceiling.
Ambulatory surgical centers
Centers don't lose revenue from the reduced patient bills — Medicare reimburses them for the exact amount each patient's coinsurance was cut.
Families budgeting for a fixed-income relative's care
Tying the cap to a single published yearly figure makes the worst-case surgery-center bill more predictable, instead of an open-ended coinsurance amount that varies by procedure.
Who is affected by H.R. 3006?
Health and Human Services
The bill creates a mandatory duty: reduce any qualifying coinsurance that exceeds the inpatient hospital deductible, then pay the surgery center an amount equal to the reduction.
Medicare's payment systems
Program administrators have to build the new comparison into ASC billing — checking each procedure's coinsurance against the year's inpatient hospital deductible — before the January 1, 2026 start date.
Ambulatory surgical centers
Centers will bill patients a smaller coinsurance amount on affected procedures and instead receive that portion as a federal payment, which changes how the charge is split but not the total.
Federal Medicare spending
Costs could rise, since Medicare absorbs every dollar of coinsurance shifted off patients. How much depends on how often ASC coinsurance currently exceeds the inpatient hospital deductible.
HR3006 Legislative Journey
House: Committee Action
Apr 24, 2025
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.
About the Sponsor
Mike Kelly
Republican, Pennsylvania's 16th congressional district · 15 years in Congress
Committees: Ways and Means
View full profile →
Cosponsors (21)
This bill has 21 cosponsors: 11 Democrats, 10 Republicans, reflecting bipartisan support. Cosponsors represent 19 states: Alabama, California, Colorado, and 16 more.
Robert Menendez
Democrat · NJ
Troy Balderson
Republican · OH
John Larson
Democrat · CT
Mike Bost
Republican · IL
Tracey Mann
Republican · KS
Deborah Ross
Democrat · NC
Josh Gottheimer
Democrat · NJ
Ted Lieu
Democrat · CA
John Joyce
Republican · PA
Rashida Tlaib
Democrat · MI
Adrian Smith
Republican · NE
John Rutherford
Republican · FL
Committee Sponsors
Ways and Means Committee
5 of 45 committee members cosponsored
Energy and Commerce Committee
5 of 54 committee members cosponsored
50 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 3006 Quick Facts
- Committee
- Ways and Means
- Chamber
- House
- Policy
- Health
- Introduced
- Apr 24, 2025
Referred to 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. for review
Apr 24, 2025
Official Sources
Official congressional bill page with text, actions, sponsors, and status for H.R. 3006.
This is the Medicare payment provision the bill directly amends, including the ambulatory surgical center payment language in section 1833.
This section defines the inpatient hospital deductible that H.R. 3006 uses as the cap on ASC coinsurance.
CMS's official ambulatory surgical center payment page provides background on the Medicare ASC payment system affected by the bill.
Official CMS manual chapter covering ambulatory surgical center services and Medicare coverage rules relevant to what services the bill applies to.
Medicare's official consumer page explains deductibles and cost-sharing, including the inpatient hospital deductible referenced in the bill.
The official U.S. Code text for 42 U.S.C. 1395l, the codified Medicare payment section (Social Security Act §1833) that H.R. 3006 amends.
The official U.S. Code text for 42 U.S.C. 1395e, which sets the inpatient hospital deductible (Social Security Act §1813) that H.R. 3006 uses as the coinsurance cap.
H.R. 3006 Common Questions
What does H.R. 3006 actually cap?
Your coinsurance for a surgery center's facility fee. If your share of that fee would run above the year's Medicare inpatient hospital deductible — roughly $1,700 in 2026 — H.R. 3006 brings it back down to that amount.
Why do surgery-center patients pay more than hospital patients now?
Medicare already caps facility-fee coinsurance at a hospital outpatient department at the inpatient hospital deductible. Ambulatory surgical centers were left out of that cap, so the same procedure can cost a patient more there. H.R. 3006 closes the gap.
When does the cap start?
It applies to procedures done on or after January 1, 2026. The change isn't retroactive, so surgeries before that date are billed under the old rules.
Does it cover my surgeon's fee or just the surgery center's charge?
Just the surgery center's facility fee — the charge for using the center and its staff. Separate charges, like your surgeon's professional fee, aren't covered by this cap.
Does the surgery center lose money if my copay is cut?
No. When your coinsurance is reduced to the cap, the bill requires Health and Human Services to pay the center an amount equal to the reduction, so the center receives the same total.
How is the cap amount set each year?
It's pegged to Medicare's inpatient hospital deductible, which CMS sets annually — around $1,700 for 2026. Whatever that figure is for the year your surgery happens becomes the ceiling on your coinsurance.
Has H.R. 3006 become law yet?
Not yet. It was introduced in April 2025 and referred to the Energy and Commerce and Ways and Means committees, where it's awaiting action. It has bipartisan backing — sponsor Mike Kelly (R-PA) and 21 cosponsors from both parties.
Based on H.R. 3006 bill text
H.R. 3006 Bill Text
“To amend title XVIII of the Social Security Act to limit the coinsurance amount for certain services furnished in an ambulatory surgical center.”
Source: U.S. Government Publishing Office
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