Ambulatory Surgery Center Definition
"Free Standing Surgical Center" means a facility other than a hospital or the office of a physician, dentist or podiatrist, or professional association thereof, which is maintained and operated for the purpose of providing surgical services and in which the expected duration of services would not exceed 23 hours 59 minutes following an admission.
Excluded from the definition of an FSSC are hospitals and the offices of physicians, dentists and podiatrists. Additionally a FSSC that is directly adjacent to and licensed as part of a hospital is not required to obtain an FSSC license.
License Requirements
An annual license shall be granted for a period of 12 months to all ASCs which are in compliance with state rules and regulations. Licenses shall be effective for a 12 month period following date of issuance and shall expire one year following such date, unless it is modified to a provisional, suspended, revoked or surrendered prior to the expiration date. ASCs must reapply for licensure at least 30 days prior to the expiration date of the license.
The fee for the initial licensure of an ASC is $250. The annual licensure fee is $150.
No penalties are provided for operating an unlicensed ASC.
Certificate of Need
Information regarding Delaware's CON program can be found here, and important links, including the CON application, can be found here.
Length of Stay Restriction
ASCs are defined to have an expected duration of services not exceeding 23 hours 59 minutes following an admission.
Medical History and Physical Examination
Not more than 30 calendar days before the date of the scheduled surgery, each patient must have a comprehensive medical history and physical assessment, completed by a physician or licensed independent practitioner, to determine whether there is anything in the patient's overall condition that would affect the planned surgery that requires additional interventions to reduce risk to the patient or may indicate that the ASC is not the appropriate setting for the surgery. The medical history and physical assessment must be comprehensive in order to determine the patient's readiness for surgery and specifically indicate that the patient is cleared for surgery in the ASC.
Transfer Agreement
Delaware does not require ASCs to maintain a written transfer agreement with a local hospital. There must be healthcare professionals with specialized training or experience in emergency care, including current Advance Cardiac Life Support certification, available in the ASC to provide emergency treatment at all times when patients are present.
Price Transparency
Delaware does not impose state-level price transparency requirements on ASCs.
Workers' Compensation
The maximum allowable payment for health care related payments shall be the lesser of the health care provider's actual charges or the fee set by the payment system. By January 31, 2017, no individual procedure in Delaware paid for through the workers' compensation system (as identified by HCPCS level 1 or level 2 code) shall be reimbursed at a rate greater than 200% of that reimbursed by the federal Medicare system, provided that radiology services may be reimbursed at up to 250% of the federal Medicare reimbursement and surgery services may be reimbursed at up to 300% of the federal Medicare reimbursement.
The maximum allowable reimbursement for ASC services shall be based on the CMS relative weight for each APC group multiplied by an appropriately calculated conversion factor for ASCs as published by the Department of Labor web site and relative weight listed in Addendum B – Final OPPS Payment by HCPCS Code for CY January 1, 2015.
CPT and HCPCS medical codes for treatment in an ASC not covered in this schedule shall be reimbursed at 64.02% for geozip 197 and 66.5% for geozip 199.
Patient Safety Reporting Requirements
Delaware does not impose reporting requirements on ASCs for adverse events.
Charity Care
As a condition of receiving a Certificate of Public Review (CPR, Delaware's version of a Certification of Need), an applicant must develop a formal written charity care plan and file a copy of it with the Delaware Health Resources Board at the time of application. If CPR approval is granted, the applicant will annually submit to the Health Resources Board a report from an independent, Delaware-licensed, certified public accountant that documents the amount of charity care they have provided during the previous fiscal year
In addition to directly providing medical services at reduced or no cost to the medically indigent, facilities can meet their charity care requirement by facilitating the development and operation of primary medical services to indigent persons. Examples include providing a new health service (e.g., a free clinic) or making a donation to a pre-approved safety net provider approved by the HRB whose mission is to care for the medically indigent.
Freestanding health care facilities can also count toward their charity care contribution enabling services that make it possible for medically indigent patients to receive services at their facility whom otherwise would not be able to do so. Examples include free or reduced cost laboratory services, free or reduced cost transportation to and from the facility, and free or reduced cost home care following a surgical procedure for medically indigent patients.
Charity care is defined as non-reimbursed charges for services to uninsured or underinsured Delawareans. Charity care may be determined prospectively or retrospectively. It does not include Medicaid or Medicare payment shortfalls or contractual allowances with third-party payers. It may include patient out-of-pocket expenses (e.g., deductibles, co-pays) for income tested patients who are uninsured or underinsured. Charity care discounts may include the provision of free care or care provided in accordance with an income-based sliding fee scale.
Surgical Smoke
On or before July 1, 2026, health care employers (defined to include ASCs) must adopt and implement policies that require the use of a surgical smoke evacuation system during any surgical procedure that is likely to generate surgical smoke.
Advance Directives
Health-Care Decisions: Obligations of Health Care Provider
For Full Act: §§ 2501 to 2518
Advance Directive Form
State Regulator
Delaware Division of Public Health
Office of Health Facilities Licensing & Certification
University Office Plaza
263 Chapman Road
Cambridge Building, Suite 200
Newark, DE 19702
Nancy Lizzi, Director, Office of Health Facilities Licensing & Certification
nancy.lizzi@delaware.gov
302.283.7220
Statutory & Regulatory References
Delaware Administrative Code: 16 § 3355