Wrapping Up 2018 A look at ASCA’s work with the state associations this year BY MICHAEL SCHEERHORN

On behalf of ASCs across the country, and in col- laboration with the state ASC associations, ASCA monitors policymaking

in every state to ensure centers are not burdened with ill-conceived regulatory policies that could jeopardize the ASC model. During legislative sessions this year, ASCA engaged with members throughout the country, provided advo- cacy assistance to several state associa- tions and testified in front of state leg- islatures. 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.

Length of Stay Oregon

In 2018, Oregon passed HB 4020 to become one of only a few states to adopt extended stay recovery licen- sure. This bill establishes the regula- tory framework to define an “extended stay center” (ESC) and how these facilities are to be used by ASCs. This bill allows patients to be discharged to affiliated ESCs that are physically con- tiguous with the ASCs in which they receive surgery. Once discharged to an ESC, patients then have a 48-hour win- dow to be monitored, creating an over- all 72-hour window from admission into an ASC to recovery. This impor- tant development will provide patients with more comfort and flexibility dur- ing recovery after surgery in an ASC.

Florida HB 23 would have permitted ASCs to hold patients for up to 24 hours and allow the establishment of recov- ery care centers that would be able to provide recovery services for up to 72 hours. Current Florida law requires that

a patient is “… discharged from such facility (ASC) within the same working day and is not permitted to stay over- night.” This current language severely limits the services ASCs in Florida can provide. This bill will likely be intro- duced again next session, and ASCA will work with its members and the Florida Society of Ambulatory Surgi- cal Centers to help pass this legislation.

Facility Regulation and Licensing Vermont ASCA Regulatory Counsel Kara New- bury and Associate Director of Gov- ernment Affairs Ali Legros-Murphy testified before the Vermont Senate on S.278, a bill that would establish the regulatory framework for ASCs in the state. S.278 had several concerning provisions that ASCA outlined before the committee. The bill sought to reg- ulate and tax ASCs in new ways. In addition to imposing licensing require- ments and care board oversight, S.278 also imposed several taxes and fees


including a 6 percent provider tax lev- ied on net patient revenues. Upon rec- ommendation from the committee, key stakeholders and ASCA, the Senate Committee on Health and Welfare did not move S.278 out of committee.


The Illinois Ambulatory Surgery Cen- ter Association (IASCA) and ASCA also worked on regulations relating to facilities, such as section 205.320 of the Joint Committee on Administrative Rules, which reads, “A qualified physi- cian shall be present at the facility until all patients are medically discharged.” Regulation like this extends working hours of physicians for late-day pro- cedures and comes at a large cost to centers. IASCA’s proposal states phy- sician presence is unnecessary if a recovering patient “… is awake, phys- iologically stable, has experienced no intraoperative or postoperative com- plication, does not require the admin- istration of blood, and met any other level of care criteria established by the qualified consulting committee.” The IASCA proposal also includes language that requires the presence of a minimum of two nurses—one of whom must be an RN—and that a phy- sician remains on call.

Provider Tax Connecticut

ASCA and the Connecticut Associa- tion of Ambulatory Surgery Centers (CAASC) took a step forward in ensur- ing Medicaid and Medicare beneficia- ries’ access to the high-quality care ASCs provide with the passage of HB 5155. Prior law placed a 6 percent gross receipts tax on ASCs after the first mil- lion dollars of revenue earned. Under new legislation, a center’s first million dollars and both Medicaid and Medi-

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