Ambulatory Surgery Center Definition
"Ambulatory surgical center" means a distinct entity that operates exclusively to provide surgical services to patients not requiring hospitalization and meets the requirements of the federal Health Care Financing Administration for participation in the Medicare program.
Excluded from the definition are:
- A medical office building
- One or more practitioners engaged in a solo or group practice, whether conducted for profit or not for profit, and however organized, so long as such practice is wholly owned and controlled by one or more of the practitioners associated
- A clinic conducted by a hospital or by the federal government or commonwealth
- Dental clinics operated by local schools and health departments for the sole purpose of providing education and dental hygiene services
License Requirements
The department shall issue for a term of two years, and shall renew for like terms, a license, subject to revocation by it for cause, to any person, city, town, or county it deems responsible and suitable to establish or maintain a hospital, an institution for the care of unwed mothers or a clinic.
License fees are based on the number of outpatient visits per year, with licenses renewed biennially:
- Less than 5,000: $255
- 5,000-25,000: $450
- 25,000-100,000: $705
- Over 100,000: $900
Any ASC who operates without a license shall, for a first offense, be punished by a fine of not more than $500, and for a subsequent offense by a fine of not more than $1,000 or by imprisonment for not more than two years.
Certificate of Need
CON Application
Length of Stay Restriction
ASCs serve patients who do not require hospitalization or overnight services upon completion of the procedure, but who require constant medical supervision for a limited amount of time following the conclusion of the procedure. A definition of overnight is not provided.
Medical History and Physical Examination
A physician shall perform a physical examination, review the patient's medical history, and review the results of pertinent pre-operative diagnostic studies prior to surgery.
Transfer Agreement
Each clinic (which are defined to include ASCs) shall have a written agreement with a nearby hospital providing emergency services for the transfer there of patients for emergency treatment beyond that provided by the clinic.
Price Transparency
Massachusetts requires ASCs to provide patients with an estimate of anticipated charges.
Upon scheduling an admission, procedure or service for a patient or prospective patient for a condition that is not an emergency medical condition or upon request by a patient or prospective patient, a health care provider (defined to include ASCs) shall disclose whether the health care provider is participating in the patient’s health benefit plan. If the health care provider’s status as participating in the patient’s health benefit plan changes during a continued course of treatment, the health care provider shall inform a patient of this change in status.
If the health care provider is participating in the patient’s or prospective patient’s health benefit plan, the health care provider shall, at the time of scheduling the admission, procedure or service:
- Inform such patient or prospective patient that they may request disclosure of the allowed amount (defined as the contractually agreed-upon maximum amount paid by a carrier to a health care provider for a health care service provided to an insured) and the amount of any facility fees for the admission, procedure or service
- And inform the patient or prospective patient that they may obtain additional information about any applicable out-of-pocket costs from their insurance carrier as required by state law. However, if a patient or prospective patient requests disclosure of the allowed amount and any facility fees, the health care provider shall make the disclosure not later than two days after receipt of the request.
If a health care provider is unable to quote a specific amount in advance due to the health care provider’s inability to predict the specific treatment or diagnostic code, the health care provider shall disclose the estimated maximum allowed amount for the admission, procedure or service and the amount of any anticipated facility fees.
If the health care provider is not participating in the patient’s or prospective patient’s health benefit plan, the health care provider shall, at the time of scheduling the admission, procedure or service:
- Provide the charge and the amount of any facility fees for the admission, procedure or service
- Inform the patient or prospective patient that they will be responsible for the amount of the charge and the amount of any facility fees for the admission, procedure or service not covered through their health benefit plan
- And inform the patient or prospective patient that they may be able to obtain the admission, procedure or service at a lower cost from a health care provider who participates in their health benefit plan.
Workers' Compensation
Payment rates are based upon Medicare rates for Massachusetts effective January 1, 2008.
Fee Schedule available here.
Patient Safety Reporting Requirements
ASCs are required to document and report information on specified Serious Reportable Events (SREs) and Healthcare Associated Infections (HAIs). Massachusetts makes this information available to the public. More information on requirements for SREs can be found here and information on HAIs can be found here.
Charity Care
Massachusetts does not impose charity care requirements on ASCs.
Surgical Smoke
Massachusetts does not impose surgical smoke evacuation requirements on ASCs.
Advance Directives
Health Care Proxies: Physicians Refusal to Honor Proxy
For Full Act: §§ 1 to 16
Advance Directive Form
State Regulator
Massachusetts Department of Public Health
Division of Health Care Facility Licensure and Certification
67 Forest Street
Marlborough, MA 01752
Sherman Lohnes, Director, Division of Health Care Facility Licensure and Certification
sherman.lohnes@state.ma.us
617.753.8160
Statutory & Regulatory References
General Laws of Massachusetts: Ch. 111 § 51 and § 53G
Code of Massachusetts Regulations: 105 CMR 140.000