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
Why it matters
Starting January 1, 2026, Medicare patients who get certain surgeries in ambulatory surgical centers could have their coinsurance capped at the annual inpatient hospital deductible instead of paying a higher amount.
The change is prospective, not retroactive. The amendment applies only to services furnished on or after January 1, 2026. That gives the Department of Health and Human Services and Medicare administrators time to implement the payment change, while signaling to beneficiaries and ASC operators that cost-sharing rules for surgical facility services may change beginning in calendar year 2026.
What does H.R. 3006 do?
Caps coinsurance at annual inpatient deductible
The bill says that if the coinsurance for ambulatory surgical center facility services tied to a surgical procedure is higher than the inpatient hospital deductible established under section 1813(b) for that year, the patient's coinsurance must be reduced to that deductible amount.
Applies to ASC facility services for surgeries
The new subsection (ee) applies specifically to 'facility services' described in section 1833(a)(1)(G) of the Social Security Act, 42 U.S.C. 1395l, when those services are furnished during a year with respect to a surgical procedure.
HHS must pay suppliers the difference
If a patient's coinsurance is cut because it exceeds the annual inpatient hospital deductible under section 1813(b), the Secretary of Health and Human Services must pay the supplier furnishing the services an amount equal to the reduction.
Amends Medicare payment law directly
Section 1(a)(1) inserts the phrase 'subject to subsection (ee)' into section 1833(a)(1)(G), and section 1(a)(2) adds the new subsection (ee), making the cap part of title XVIII of the Social Security Act.
Starts on January 1, 2026
The bill's effective date is explicit: the amendments apply to services furnished on or after January 1, 2026, meaning earlier services are not covered by the new coinsurance limit.
Who benefits from H.R. 3006?
Medicare beneficiaries using ambulatory surgical centers
They benefit because, for services furnished on or after January 1, 2026, their coinsurance for covered ASC facility services related to a surgical procedure cannot be higher than the inpatient hospital deductible set under section 1813(b) for that year.
Patients facing high-cost ASC procedures
Patients whose normal coinsurance would exceed the annual inpatient hospital deductible get the clearest protection, because the bill requires the Secretary of Health and Human Services to reduce their coinsurance down to the deductible cap.
ASC suppliers furnishing facility services
Suppliers benefit because when beneficiary coinsurance is reduced, the Secretary of Health and Human Services must pay the supplier an amount equal to that reduction rather than forcing the center to absorb the shortfall.
Families managing Medicare out-of-pocket costs
Families may get more predictable bills because the cap is tied to a known yearly benchmark — the inpatient hospital deductible established under section 1813(b) for that year — instead of an uncapped higher coinsurance amount for certain ASC services.
Who is affected by H.R. 3006?
Secretary of Health and Human Services
The Secretary is directly affected because the bill imposes a mandatory duty: reduce coinsurance amounts that exceed the section 1813(b) inpatient hospital deductible and pay suppliers the exact amount of the reduction.
Medicare program administrators
Administrators will need to implement the revised payment rule in section 1833(a)(1)(G) and the new subsection (ee) by January 1, 2026, including systems that compare ASC coinsurance to the yearly inpatient hospital deductible.
Ambulatory surgical center suppliers
ASC suppliers are affected operationally because beneficiary billing may change for covered surgical facility services, but they would receive a federal payment equal to any coinsurance reduction required under the bill.
Federal Medicare spending
Medicare spending could rise because whenever coinsurance for ASC facility services is reduced to the inpatient hospital deductible cap, the federal government must pay suppliers the amount of that reduction.
H.R. 3006 Common Questions
How much can Medicare ASC coinsurance be under HR 3006?
Under H.R. 3006 Section 1(a), coinsurance for ASC facility services tied to a surgical procedure cannot exceed that year’s inpatient hospital deductible under Social Security Act section 1813(b).
When does the Medicare ASC copay cap start?
According to H.R. 3006 Section 1(b), the new ASC coinsurance limit applies only to services furnished on or after January 1, 2026.
Can Medicare patients pay more than the inpatient hospital deductible for ambulatory surgery center services?
No. Under H.R. 3006 Section 1(a), if ASC facility-service coinsurance is higher than the annual inpatient hospital deductible, it must be reduced to that deductible amount.
Does HR 3006 apply to surgeries done before 2026?
No. Under H.R. 3006 Section 1(b), the amendment is prospective only and applies to services furnished on or after January 1, 2026.
Which Medicare services get the coinsurance cap under HR 3006?
Under H.R. 3006 Section 1(a), the cap applies to ASC “facility services” described in section 1833(a)(1)(G) when furnished for a surgical procedure.
Does HR 3006 cover doctor fees or only ambulatory surgery center facility charges?
It targets ASC facility services, not all charges. H.R. 3006 Section 1(a) amends section 1833(a)(1)(G) and adds subsection (ee) for facility services furnished in an ambulatory surgical center.
Who pays the difference if an ASC patient's coinsurance is reduced under HR 3006?
Under H.R. 3006 Section 1(a), the Secretary of Health and Human Services must pay the supplier an amount equal to the coinsurance reduction.
Is the new ASC coinsurance limit tied to the inpatient hospital deductible each year?
Yes. Under H.R. 3006 Section 1(a), the cap is pegged to the inpatient hospital deductible established under section 1813(b) for the same year.
Can ambulatory surgery centers still receive full payment if Medicare cuts the patient's copay?
Yes. According to H.R. 3006 Section 1(a), HHS must pay the supplier the amount by which the patient’s coinsurance was reduced.
Does HR 3006 change Medicare law directly or just require a study?
It changes Medicare law directly. Under H.R. 3006 Section 1(a), section 1833(a)(1)(G) is amended and a new subsection 1833(ee) is added to title XVIII.
Based on H.R. 3006 bill text
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.
GovInfo provides the official U.S. Code text for 42 U.S.C. 1395l, the codified Medicare section amended by H.R. 3006.
GovInfo provides the official U.S. Code text for 42 U.S.C. 1395e, the inpatient hospital deductible provision referenced by the bill.
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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