CMS Proposes New ASC Conditions

CMS proposed sweeping changes to the Ambulatory Surgical Center Medicare Conditions for Coverage on Aug. 31, 2007. For the most part, the changes bring the ASC Conditions in line with requirements for other Medicare-certified facilities, reflecting a patient-centered approach. The proposed conditions also reflect CMS' changing attitude toward what types of procedures are suitable for an ASC, and include updates consistent with the proposed ASC Fee Schedule, which significantly broadened the scope of services reimbursed by Medicare in an ASC setting.

• Overnight Stay: A new definition defines "overnight stay" as a stay exceeding 11:59 p.m. on the day of surgery. ASCs are defined as providing services to patients "not requiring an overnight stay" (instead of "not requiring hospitalization" as indicated in the current Condition). This seemingly minor change has the potential to derail operations of ASCs in some states who have been providing stays of up to 23 hours for non-Medicare patients, with CMS surveyors in effect looking the other way. It remains to be seen whether CMS will revise survey guidance to penalize ASCs at which non-Medicare patients stay past midnight, but if the Conditions are finalized as proposed, all bets should be off.
• Quality Assessment and Performance Improvement: While these areas were generally addressed in the current Conditions, they now include significantly more detail regarding the QA and PI programs that each ASC must implement and maintain, and clarify that the programs and their effectiveness are the responsibility of the governing body.
• Radiologic Services: This Condition will be expanded to reflect that radiologic services medically necessary and integral to the surgical procedure must be provided either directly (if the ASC meets the Conditions applicable to portable x-ray suppliers) or under arrangements (by an entity certified by Medicare as a portable x-ray supplier).
• Patients' Rights: A new patients' rights Condition is introduced, consistent with CMS' Conditions for other providers and suppliers. One twist for ASCs is a new requirement for disclosure of physician financial interests in the ASC prior to the first visit of the patient to the ASC.
• Infection Control: Consistent with CMS's view that infection control is key to the health and safety of patients, requirements for infection control are more detailed and are raised to Condition level.
• Patient Admission, Assessment and Discharge: This is another new Condition reflecting CMS's view of the needs of patients in healthcare facilities and consistent with CMS's Conditions for other providers.
• Disaster Planning: As a result of lessons learned following Hurricane Katrina, CMS introduces a new standard requiring ASCs to put written plans in place addressing disaster situations, and to perform annual drills.

While the new Conditions are only proposed, ASCs should expect that these requirements or similar standards will be implemented. ASCs should begin considering the areas in which they may need to implement more rigorous policies.CMS will accept comments on the proposed conditions until Oct. 30, 2007.

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