Ambulatory Surgery Center Definition
"Ambulatory surgical facility" means any distinct entity that operates for the primary purpose of providing specialty or multispecialty outpatient surgical services in which patients are admitted to and discharged from the facility within 24 hours and do not require inpatient hospitalization, whether or not the facility is certified under Title XVIII of the federal social security act. An ASC includes one or more surgical suites that are adjacent to and within the same building as, but not in, the office of a practitioner in an individual or group practice, if the primary purpose of the one or more surgical suites is to provide specialty or multi-specialty outpatient surgical services, irrespective of the type of anesthesia administered in the one or more surgical suites. An ASC that is adjacent to and within the same building as the office of a practitioner in an individual or group practice may include a surgical suite that shares a reception area, restroom, waiting room, or wall with the office of the practitioner in an individual or group practice.
Excluded from the definition are:
- An ASC owned by a hospital
- A dentist's office
- Outpatient specialty or multispecialty surgical services routinely and customarily performed in the office of a practitioner in an individual or group practice
License Requirements
No person or governmental unit of the state of Washington shall establish, maintain, or conduct an ASC in this state or advertise by using the term "ambulatory surgical facility," "day surgery center," "licensed surgical center," or other words conveying similar meaning without a license issued by the department.
The fees for initial licensure and license renewal for ASCs are based on accreditation/certification status and procedure volume, and are as follows:
- Performs 1,000 or fewer surgical procedures on an annual basis:
- Accredited or Medicare certified: $12,900
- State licensed only: $17,550
- Performs 1,001-5,000 surgical procedures on an annual basis:
- Accredited or Medicare certified: $16,000
- State licensed only: $22,000
- Performs more than 5,000 surgical procedures on an annual basis:
- Accredited or Medicare certified: $19,650
- State licensed only: $27,200
Pursuant to chapter 34.05 RCW, the secretary may assess monetary penalties of a civil nature not to exceed $1,000 per violation.
Certificate of Need
Application forms and information regarding the CON program, including fees, can be found here.
Length of Stay Restriction
Patients must be admitted to and discharged from an ASC within 24 hours.
Medical History and Physical Examination
An ASC must complete and document an initial assessment of each patients physical condition, emotional and social needs in the medical record. Initial assessment includes dependent upon the procedure and the risk of harm or injury, a patient history and physical examination, if within thirty days prior to admission, and updated as needed if patient status has changed.
Transfer Agreement
An ASC shall have a facility safety and emergency training program. The program shall include…written transfer agreements with local hospitals licensed under chapter 70.41 RCW, approved by the ambulatory surgical facility's medical staff.
Price Transparency
Washington does not impose price transparency requirements on ASCs.
Workers' Compensation
Rates for procedures performed in ASCs are based on a modified version of the current system developed by CMS for ASC services. Washington state has expanded the CMS list by adding some procedures CMS identified as excluded procedures. Fee Schedules and payment policies can be found here.
Patient Safety Reporting Requirements
ASCs are required to document and report information on specified Adverse Events. Washington makes this information available to the public. More information on criteria and reporting requirements can be found here.
Charity Care
ASCs shall document and provide assurances of implementation of policies to provide access to individuals unable to pay consistent with charity care levels provided by hospitals affected by the proposed ASC. The amount of an ASC’s annual revenue utilized to finance charity care shall be at least equal to or greater than the average percentage of total patient revenue, other than Medicare or Medicaid, that affected hospitals in the planning area utilized to provide charity care in the last available reporting year.
Surgical Smoke
Health care employers (defined to include ASCs) shall adopt policies that require the use of a smoke evacuation system during any planned surgical procedure that is likely to generate surgical smoke which would otherwise make contact with the eyes or respiratory tract of the occupants of the room. Healthcare employers may select any smoke evacuation system that accounts for surgical techniques and procedures vital to patient safety and that takes into account employee safety.
Advance Directives
Natural Death Act: Procedures by Physician — Health Care Facility or Personnel May Refuse to Participate
For Full Act: §§ 70.122.010 to 70.122.905
Advance Directive Help & Forms
State Regulator
Washington Department of Health
Health Systems Quality Assurance
111 Israel Rd SE
Tumwater, WA 98501
Sasha De Leon, Assistant Secretary, Health Systems Quality Assurance
sasha.deleon@doh.wa.gov
360.236.4844
Statutory & Regulatory References
Revised Code of Washington: RCW 70.230
Washington Administrative Code: WAC 246-310-270