Ambulatory Surgery Center Definition
Ambulatory surgical center is defined as a health care entity established for the primary purpose of providing medically necessary surgery, elective surgery, or preventive diagnostic procedures that do not require hospitalization but do require post surgical or post procedural observation and monitoring that generally will not exceed 24 hours from admission to discharge.
Excluded from the definition are:
- A practitioners private office or treatment rooms where the practitioner primarily consults with and treats patients including, but not limited to, practitioners organized as professional corporations, professional associations, professional limited liabilities companies, partnerships and sole proprietorships
- An outpatient surgery unit that is licensed as part of a hospital and located on a hospital campus
- An outpatient surgery center that is owned and operated by a hospital; licensed as an off campus location of the hospital; and has signage that clearly indicates the surgery center’s connection with the hospital
License Requirements
It is unlawful for any person, partnership, association or corporation to open, conduct, or maintain any ambulatory surgical center or other facility of a like nature, except those wholly owned and operated by any governmental unit or agency, without first having obtained a license from the Department of Public Health and Environment.
The fee for the initial licensure of an ASC is $6,897.34. The base fee for a license renewal is $1,504.88. ASCs accredited by an accrediting organization recognized by CMS as having deemed authority may be eligible for a 10% discount off the base renewal license fee, for a total of $1,354.39. The per room cost is $209.01. The total renewal fee shall not exceed $3,135.15.
Any person opening, conducting or maintaining any facility for the treatment and care of the sick or injured who does not have a provisional or regular license authorizing such person or entity to open, conduct, or maintain the facility is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than $50 nor more than $500.
Certificate of Need
Colorado does not have a CON program.
Length of Stay Restriction
Surgical procedures at ASCs are limited to those that do not exceed 23 hours combined operating and recovery and/or convalescent time.
Medical History and Physical Examination
Colorado requires patient medical records to include a medical history and physical examination completed prior to surgery.
Transfer Agreement
In the event emergency services are necessary, ASCs shall have a written transfer agreement with a local hospital or ensure that every physician performing surgery at the center has admitting privileges at a local hospital.
Price Transparency
Colorado imposes price transparency requirements on the codes most commonly used by health care facilities and mandates disclosures to self-pay patients.
Most Common Codes: A health care facility (defined to include ASCs) shall make available to the public, in a single document, either electronically or by posting conspicuously on its website if one exists, the health care prices for at least:
- The 50 most used, diagnosis-related group codes or other codes for in-patient health care services used by the health care facility for billing or, if those codes are not used, the codes under another coding system for in-patient health care services commonly used by the facility and accepted as a national standard for billing
- And the 25 most used outpatient CPT codes or health care services procedure codes used for billing or, if those codes are not used, the codes under another coding system for outpatient services commonly used by the facility and accepted as a national standard for billing.
If a health care facility did not use 25 codes for outpatient health care services at least 11 times in the previous 12 months, the health care facility shall make available the health care price for only those most common outpatient health care services or procedure codes that the health care facility used at least 11 times in the previous 12 months.
A health care facility shall include with the health care price provided a plain English description of the service for which the health care price is provided. The health care facility shall update the document as frequently as it deems appropriate, but at least annually.
The health care facility shall include:
- A disclosure specifying that the health care price for any given health care service is an estimate and that the actual charges for the health care service are dependent on the circumstances at the time the service is rendered
- And a statement encouraging patients covered by health insurance to consult with their insurer to determine accurate information regarding their financial responsibility for a particular health care service provided to them at the health care facility, and patients not covered by health insurance to discuss payment options with the facility prior to receiving a health care service from the facility since posted health care prices may not reflect the actual amount of their financial responsibility.
“Health care price” is defined as the price, before negotiating any discounts, that a health care provider or health care facility will charge a recipient for health care services that will be rendered. The “health care price” is the price charged for the standard service for the particular diagnosis and does not include any amount that may be charged for complications or exceptional treatment. The health care price for a specific health care service may be determined from any of the following:
- The price charged most frequently for the health care service during the previous 12 months
- The highest charge from the lowest half of all charges for the health care service during the previous 12 months
- Or a range that include the middle 50% of all charges for the health care service during the previous 12 months.
The “health care price” does not mean the amount charged if a public or private third party will be paying or reimbursing the health care facility for any portion of the cost of services rendered.
Disclosures to Self-Pay Recipients: Upon the request of a person seeking a health-care service who intends to self-pay for the service, designated billing or patient services personnel representing a health-care provider or a health-care facility shall provide, prior to the provision of the health-care service, a self-pay estimate of the total estimated cost to the recipient of the anticipated health-care service.
The self-pay estimate must:
- Be in writing or, if the health-care provider or health-care facility is unable to provide a written self-pay estimate, the self-pay estimate and the following information must be stated in a recorded telephone call:
- The date and time of the telephone call
- The telephone number of the consumer receiving the self-pay estimate
- The manner in which consent for the self-pay estimate amount must be provided by the intended recipient
- The name of the intended recipient of the health-care service
- The name of the health-care provider or health-care facility employee providing the self-pay estimate
- And any other information material to the determination of the self-pay estimate.
- Include the total estimated cost of the health-care service, including an itemization of all necessary components of the service, which components may include a facility fee and the cost of personnel, imaging, medical tools or devices, and medicine
- Be easy to understand by a person without knowledge of medical or technical jargon and with limited proficiency in math, science, and written and oral communication skills
- Be provided in English or Spanish, if requested by the consumer
- And be provided within the following time frames:
- Not later than one business day after the date the primary item or service is scheduled if a primary item or service is scheduled at least three days before the primary item or service is provided
- Not later than three business days after the date the primary item or service is scheduled if the primary item or service is scheduled at least ten business days before the primary item or service is provided
- Or not later than three days after a request for a self-pay estimate.
A provider or health-care facility that is in compliance with section 112 of Title I of division BB of the federal “No Surprises Act”, and rules promulgated and determined by the federal Centers for Medicare and Medicaid services under that act in 45 CFR 149.610, or any successor laws and regulations, is in compliance with these disclosure requirements for self-pay patients.
Workers' Compensation
ASCs are reimbursed at 153% of the Medicare OPPS/ASC fee schedule. Fee schedules are available at the Colorado Department of Labor and Employment's Medical Fee Schedule & Director's Interpretive Bulletins page.
Patient Safety Reporting Requirements
Colorado requires licensed healthcare facilities to report on any occurrence that results in the death of a patient, as well as any occurrence that results in:
- Brain or spinal cord injuries
- Life-threatening complications of anesthesia or life-threatening transfusion errors or reactions
- Second- or third-degree burns third-degree burns involving twenty percent or more of the body surface area of an adult patient or resident or fifteen percent or more of the body surface area of a child patient or resident.
Charity Care
Colorado does not impose charity care requirements on ASCs.
Surgical Smoke
Colorado requires ASCs to adopt and implement a policy that prevents human exposure to surgical smoke via the use of a surgical smoke evacuation system during any planned surgical procedure that is likely to generate surgical smoke.
Advance Directives
Colorado Medical Treatment Decision Act
§§ 15-18-101 to 15-18.5-105
Resources on Advance Directive Planning in Colorado
State Regulator
Colorado Department of Public Health & Environment
Health Facilities and Emergency Medical Services Division
4300 Cherry Creek Drive South
Denver, CO 80246
Elaine McManis, Director, Health Facilities and Emergency Medical Services Division
elaine.mcmanis@state.co.us
303.692.2886
Statutory & Regulatory References
Colorado Statutes: § 25-3-101(1)
Code of Colorado Regulations: 1011-1 Chapter XX