ASC Regulations by State - Reimbursement Principles

1 ASC Regulations BY State ASC Regulations by Statei State CON State ? State Regulator ASC Regulations licensing requirements ASC Definition Exclusions licensing Fees AL Yes Alabama Department of Public Health Health Care Facilities Box 303017 Montgomery, AL 36130-3017 Ray Sherer, licensing Director (Ph) Patricia Edwards, Asst to Director Alabama ASC Regulations All hospitals must obtain a license, and "ambulatory surgical treatment facilities for patients not requiring hospitalization" are included in the definition of hospital. Any health care facility with the primary purpose of providing medically necessary or elective surgical care. Offices of private physicians and dentists Health care facilities defined as hospitals $200 fee plus $5 per bed over 10 beds Renewed annually AK Yes Alaska Department of Health & Human Services Health Facilities licensing & Certification 619 E. Ship Creek Ave Ste 232 Anchorage, AK 99501 Shelby Larsen, Certification & licensing Consultant (Ph) Jeanne Anglin, Administrative Assistant for Health Facilities Certification & licensing (Ph) Alaska ASC Regulations No individual or entity may operate a facility that falls under AS (b) which includes ambulatory surgical centers, unless they first obtain a license from the department.

2 A facility which is not a part of a hospital, nor part of a physician 's general medical practice, and which operates primarily for the purpose of providing surgical services to patients who do not require hospitalization is an ambulatory surgical facility and must comply with 7 AAC AAC Facilities that are part of a hospital or part of a physician 's general medical practice. Set by the Department AZ No Arizona Department of Health Services Division of licensing Services 150 N. 18th Avenue 4th Floor Phoenix, AZ 85007 General Phone: General Fax: Kathy McCanna, Bureau Chief of Medical Facilities licensing (Ph) (F) Arizona ASC Regulations A person shall not establish, conduct or maintain in this State a health care institution or any class or subclass of health care institution unless that person holds a current and valid license issued by the department specifying the class or subclass of health care institution the person is establishing, conducting or maintaining.

3 No hospital, recuperation center, or related institution shall be established, An "outpatient surgical center" is a type of health care institution with facilities and limited hospital services for the diagnosis or treatment of patients by surgery whose recovery, in the concurring opinions of the surgeon and the anesthesiologist does not require inpatient care in a hospital. Private offices and clinics of health care providers licensed under title 32 that are not freestanding urgent care centers are exempt from the health care institution licensure requirement, unless: Patients are kept overnight as bed patients or treated otherwise under general anesthesia except when treatment by general anesthesia is regulated by title A $50 non-refundable application fee must accompany each of the following: Initial application Renewal ASC physician S OVERVIEW September 2013 P a g e | - 2 - State CON State ?

4 State Regulator ASC Regulations licensing requirements ASC Definition Exclusions licensing Fees conducted, or maintained in this State without obtaining a license. 32, chapter 11; or The office or clinic is an abortion clinic application Change of ownership AR No Arkansas Department of Health Health Facilities Services 5800 W 10th St, Suite 400 Little Rock, AR 72204-1704 Randal Pruett (Ph) (Fax) Arkansas ASC Regulations No hospital, recuperation center, or related institution shall be established, conducted, or maintained in this State without obtaining a license. "Outpatient surgery center" means a facility in which surgical services, other than minor dental surgery, are offered that require the use of general or intravenous anesthetics and where, in the opinion of the attending physician , hospitalization, as defined in the present licensure law, is not necessary. Minor dental surgery $1,000 CA No California Department of Public Health *Oversees CMS-certified ASCs (if an ASC is CMS-certified and accredited, the ASC would also fall under Medical Board of CA jurisdiction) 1615 Capitol Avenue Sacramento, CA 95814 General Phone: Medical Board of California *Oversees accredited ASCs 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815 Letitia Robinson, licensing Manager (Ph) CA Dept.

5 Of Public Health Regulations Medical Board of CA Regulations All facilities must be licensed, CMS-certified, and/or accredited. A "surgical clinic" means a clinic that is not part of a hospital and that provides ambulatory surgical care for patients who remain less than 24 hours. A surgical clinic does not include any place or establishment owned or leased and operated as a clinic or office by one or more physicians or dentists in individual or group practice, regardless of the name used publicly to identify the place or establishment, provided, however, that physicians or dentists may, at their option, apply for licensure. NOTE: Most ASCs in California are not surgical clinics. physician ownership is prohibited in surgical clinics. "Outpatient setting" means any facility, clinic, unlicensed clinic, center, office or other setting that is not part of a general acute care facility as defined in Section A surgical clinic does not include any place or establishment owned or leased and operated as a clinic or office by one or more physicians or dentists in individual or group practice, regardless of the name used publicly to identify the place or establishment, provided, however, that physicians or dentists may, at their option, apply for licensure.

6 NOTE: Most ASCs in California are not surgical clinics. physician ownership is prohibited in surgical clinics. "Outpatient setting" does not include any setting where anxiolytics and analgesics are administered, when done so in compliance with the community standard of practice, in doses that do not have the probability of placing the patient at risk for The licensing fee for a surgical clinic is $2,487. ASC physician S OVERVIEW September 2013 P a g e | - 3 - State CON State ? State Regulator ASC Regulations licensing requirements ASC Definition Exclusions licensing Fees 1250, and where anesthesia, except local anesthesia or peripheral nerve blocks or both, is used in compliance with the community standard of practice, in doses that, when administered have the probability of placing a patient at risk for loss of the patient's life-preserving protective reflexes. "Outpatient setting" also means facilities that offer in vitro fertilization.

7 Loss of the patient's life-preserving protective reflexes. CO No Colorado Department of Public Health & Environment HF/CBON/1251583470236 Health Facilities Division 4300 Cherry Creek Drive South Denver, CO 80246-1530 Nancy McDonald, Director (Ph) (Fax) General Phone Number: or 303. Colorado ASC Regulations Health facilities, including ambulatory surgical centers, must obtain a license from the department of public health and environment before operating in the State . The complete list of health facilities regulated by the department is included in 25-3-101(1). A facility which operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization. Facilities licensed as part of a hospital, as well as facilities operated by government agencies, are not included in the ASC definition. In addition, a facility which is used as an office or clinic for the private practice of a physician (s), podiatrist(s), or dentist(s) is exempt except when: It holds itself out to the public or other health care providers as an ambulatory surgical center, surgical center, surgicenter or similar facility using a similar name or variation thereof; It is operated or used by a person or entity different than the physician (s), podiatrists(s), or dentist(s), or; Patients are charged a fee for use of the facility in addition to the physician (s), podiatrist(s), or dentist(s) professional services; unless such fees are an integrated part of the office-based surgery program Initial License $6,600 Renewal $1,440 plus $200 per room (max $3,000) ASC physician S OVERVIEW September 2013 P a g e | - 4 - State CON State ?

8 State Regulator ASC Regulations licensing requirements ASC Definition Exclusions licensing Fees incentive allowance of a licensed sickness and accident insurer, a non-profit hospital, medical-surgical and health service corporation, or a health maintenance organization and the program incentive occurs in a setting that does not require licensure. CT Yes State of Connecticut Department of Public Health Facility License & Investigations Section 410 Capitol Avenue - MS #12 HFL Box 340308 Hartford, CT 06134 General Phone Number: Barbara Cass, Section Chief (Ph) (Fax) Connecticut ASC Regulations No one, other than a hospital, shall establish or operate an outpatient surgical facility in Connecticut without obtaining a license from the Department of Public Health for such facility. A license shall be effective for a twelve month period and may be issued for that period only if the FSSC (Free Standing Surgery Center) is in full compliance with these Regulations .

9 An "outpatient surgical facility" is an entity, individual, firm, partnership, corporation, limited liability company or association, other than a hospital, engaged in providing surgical services or health conditions that include the use of moderate or deep sedation, moderate or deep analgesia or general anesthesia, as such levels of anesthesia are defined from time to time by the American Society of Anesthesiologists, or by such other professional or accrediting entity recognized by the Department of Public Health. Dentistry or dental medicine Biennial fee: $500 DE Yes Delaware Division of Public Health Office of Health Facilities licensing & Certification University Office Plaza 258 Chapman Road Chopin Building, Suite 101 Newark, DE 19702 General Phone Number: Mary Peterson, Office of Health Facilities licensing & Certification (Ph) (Fax) Delaware ASC Regulations All applications for renewal of licenses shall be filed with the Division at least thirty days prior to expiration.

10 "Free Standing Surgical Center" means a facility which operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization. A facility that is licensed as part of a hospital; A facility that provides services and/or accommodations for patients who stay overnight; A facility which is used as an office or clinic for the private practice of a physician , podiatrist or dentist except when: it holds itself out to the public or other health care providers as an FSSC, or it is operated or used by a person or entity different than the physician (s), No fee for endoscopy or pain management centers. ASC physician S OVERVIEW September 2013 P a g e | - 5 - State CON State ? State Regulator ASC Regulations licensing requirements ASC Definition Exclusions licensing Fees or patients are charged a fee for use of the facility in addition to the physician 's professional services.