Ambulatory Surgery Center Definition
“Ambulatory surgical center” means a facility, the primary purpose of which is to provide elective surgical care, in which the patient is admitted to and discharged from such facility within 24 hours, and which is not part of a hospital.
Excluded from the definition are:
- Facilities existing for the primary purpose of performing terminations of pregnancy
- An office maintained by a physician for the practice of medicine
- An office maintained for the practice of dentistry
License Requirements
It is unlawful for a person to use or advertise to the public, in any way or by any medium whatsoever, any facility as a "hospital" or "ambulatory surgical center" unless such facility has first secured a license.
Initial applicants for licensure must have a current project under review with the Agency of Health Care Administration's Office of Plans and Construction for compliance with appropriate building code before applying for licensure. Any application for licensure submitted prior to having a project review will be returned. The licensure application fee is $1,679.82 and the survey/inspection fee is $400. The renewal fee is $1,679.82, and the change of ownership application fee is $1,679.82.
It is unlawful for any person to own, operate or maintain an unlicensed provider. If after receiving notification from the agency, such person or entity fails to cease operation, the person or entity is subject to penalties. Each day of operation is a separate offense. Any person or entity that fails to cease operation after agency notification may be fined $1,000 for each day of noncompliance.
Certificate of Need
Florida's CON law does not apply to ASCs.
Length of Stay Restriction
For adults, patients must be admitted to and discharged from an ASC within 24 hours.
For minors, each ASC providing surgical services to minors requiring a length of stay past midnight must be staffed with the following professionals with specialized training and expertise in the treatment of pediatric patients:
- A surgeon who is board-certified or eligible in a pediatric surgical subspecialty or a board-certified or eligible surgeon with additional training and expertise with pediatric patients acceptable to the governing board
- An anesthesiologist or other physician or a certified registered nurse anesthetist under the on-site medical direction of a licensed physician or an anesthesiologist assistant under the direct supervision of an anesthesiologist shall be present in the room with the pediatric patient throughout all general anesthesia, regional anesthesia and monitored anesthesia care
- Nursing and other direct care staff must have specialized training and experience with pediatric patients. Nursing personnel must be PALS and/or Advanced Cardiac Life Support certified. There must be at least one registered professional nurse on duty at all times
Medical History and Physical Examination
Florida requires that the medical records service of an ASC shall ensure that each medical record shall contain past personal history and a physical examination report.
Transfer Agreement
Florida requires that ASC bylaws require all attending medical staff members who do not have admitting privileges at an acute care general hospital to document a written agreement with a physician who has staff privileges with one or more acute care general hospitals licensed by the state to accept any patient who requires continuing care; or ensure that there is a written center agreement, with one or more acute care general hospitals licensed by the state, which will admit any patient referred who requires continuing care.
Price Transparency
Florida imposes multiple price transparency requirements on ASCs.
Bundled Services and Procedures: ASCs are required to provide timely and accurate financial information and quality of service measures to patients and prospective patients of the facility, or to patients’ survivors or legal guardians, as appropriate. ASCs are required to make available to the public on their website information on payments made to the facility for defined bundles of services and procedures. At a minimum, the facility shall provide the estimated average payment received from all payors, excluding Medicaid and Medicare, for the descriptive service bundles available at that facility and the estimated payment range for such bundles. Using plain language, comprehensible to an ordinary layperson, the facility must disclose that the information on average payments and the payment ranges is an estimate of costs that may be incurred by the patient or prospective patient and that actual costs will be based on the services actually provided to the patient. The facility’s website must:
- Provide information to prospective patients on the facility’s financial assistance policy, including the application process, payment plans and discounts, and the facility’s charity care policy and collection procedures
- If applicable, notify patients and prospective patients that services may be provided in the health care facility by the facility as well as by other health care providers who may separately bill the patient and that such health care providers may or may not participate with the same health insurers or health maintenance organizations as the facility
- Inform patients and prospective patients that they may request from the facility and other health care providers a more personalized estimate of charges and other information, and inform patients that they should contact each health care practitioner who will provide services in the hospital to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider
- And provide the names, mailing addresses and telephone numbers of the health care practitioners and medical practice groups with which it contracts to provide services in the facility and instructions on how to contact the practitioners and groups to determine the health insurers and health maintenance organizations with which they participate as network providers or preferred providers.
Shoppable Services (Not Effective Until January 1, 2026): ASCs are required to post on their website a consumer-friendly list of standard charges for at least 300 shoppable health care services, or an Internet-based price estimator tool meeting federal standards. If a facility provides fewer than 300 distinct shoppable health care services, it shall make available on its website the standard charges for each service it provides.
“Shoppable health care service” is defined as a service that can be scheduled by a healthcare consumer in advance. The term includes, but is not limited to, the services described in s. 627.6387(2)(e) and any services defined in regulations or guidance issued by the United States Department of Health and Human Services.
“Standard charge” is defined as the term is defined in regulations or guidance issued by the United States Department of Health and Human Services for purposes of hospital price transparency.
Good Faith Estimate: Before providing any nonemergency medical services, ASCs shall provide in writing or by electronic means a good faith estimate of reasonably anticipated charges by the facility for the treatment of the patient’s or prospective patient’s specific condition. The facility is not required to adjust the estimate for any potential insurance coverage. The facility must provide the estimate to the patient’s health insurer, and the patient at least three business days before the date such service is to be provided, but no later than one business day after the date such service is scheduled, or, in the case of a service scheduled at least 10 business days in advance, no later than three business days after the date the service is scheduled. The facility must provide the estimate to the patient no later than three business days after the date the patient requests an estimate. The estimate may be based on the descriptive service bundles developed by the agency unless the patient or prospective patient requests a more personalized and specific estimate that accounts for the specific condition and characteristics of the patient or prospective patient. The facility shall inform the patient or prospective patient that he or she may contact his or her health insurer for additional information concerning cost-sharing responsibilities.
In the estimate, the facility shall provide to the patient or prospective patient information on the facility’s financial assistance policy, including the application process, payment plans and discounts and the facility’s charity care policy and collection procedures.
The estimate shall clearly identify any facility fees and, if applicable, include a statement notifying the patient or prospective patient that a facility fee is included in the estimate, the purpose of the fee, and that the patient may pay less for the procedure or service at another facility or in another health care setting.
The facility shall notify the patient or prospective patient of any revision to the estimate. In the estimate, the facility must notify the patient or prospective patient that service may be provided in the health care facility by the facility as well as by other health care providers that may separately bill the patient, if applicable.
Itemized Bill: Upon request, and after a patient’s discharge or release from an ASC, the facility must provide to the patient or to the patient’s survivor or legal guardian, as appropriate, an itemized statement or a bill detailing in plain language, comprehensible to an ordinary layperson, the specific nature of charges or expenses incurred by the patient. The initial statement or bill shall be provided within seven days after the patient’s discharge or release or after a request for such statement or bill, whichever is later. The initial statement or bill must contain a statement of specific services received and expenses incurred by date and provider for such items of service, enumerating in detail as prescribed by the agency the constituent components of the services received within each department of the licensed facility and including unit price data on rates charged by the licensed facility. The statement or bill must also clearly identify any facility fee and explain the purpose of the fee. The statement or bill must identify each item as paid, pending payment by a third party, or pending payment by the patient, and must include the amount due, if applicable. If an amount is due from the patient, a due date must be included. The initial statement or bill must direct the patient or the patient’s survivor or legal guardian, as appropriate, to contact the patient’s insurer or health maintenance organization regarding the patient’s cost sharing responsibilities. Any subsequent statement or bill relating to the episode of care must include all of the above information, with any revisions clearly delineated.
Each itemized statement or bill provided:
- Must include notice of hospital-based physicians and other health care providers who bill separately
- May not include any generalized category of expenses such as “other” or “miscellaneous” or similar categories
- Must list drugs by brand or generic name and not refer to drug code numbers when referring to drugs of any sort
- Must specifically identify physical, occupational or speech therapy treatment by date, type and length of treatment when such treatment is a part of the statement or bill.
Workers' Compensation
For each billed CPT code the ASC must be reimbursed either:
- According to an agreed upon contract price
- The Maximum Reimbursement Allowances (MRAs) listed in Appendix A
- Or if the billed CPT code is not listed in Appendix A, the MRA listed in Appendix B
The current Reimbursement Manual for Ambulatory Surgical Centers can be found here.
Patient Safety Reporting Requirements
ASCs are required to document and report information on specified Adverse Incidents. Florida makes this information available to the public. More information on criteria and reporting requirements can be found here.
Charity Care
Florida does not impose charity care requirements on ASCs.
Surgical Smoke
Florida does not impose surgical smoke evacuation requirements on ASCs.
Advance Directives
Healthcare Advance Directives: Transfer of a Patient
For Full Act: §§ 765.101 to 765.547
Advance Directive Forms
State Regulator
Florida Agency for Healthcare Administration
Hospital & Outpatient Services Unit, Bureau of Health Facility Regulation
2727 Mahan Drive, Mail Stop #31
Tallahassee, Florida 32308
Jack Plagge, Manager, Hospital & Outpatient Services Unit
jack.plagge@ahca.myflorida.com
850.412.4549
Statutory & Regulatory References
Florida Statutes: § 395.002
Florida Administrative Code:59A-5