Ambulatory Surgery Center Definition
“Ambulatory surgical center” means a public or private institution that is:
- Hospital-based or freestanding
- Operated under the supervision of an organized medical staff
- Established, equipped and operated primarily for the purpose of providing surgical services to patients not requiring hospitalization and whose recovery under normal circumstances is not expected to require inpatient care
Excluded from the definition are the private offices of physicians where in-office outpatient surgical procedures are performed as long as the physician office does not seek licensure, certification, reimbursement, or recognition as an ambulatory surgical center from a federal, state, or third-party insurer.
License Requirements
No person shall operate any health facility in this Commonwealth without first obtaining a license issued by the cabinet, which license shall specify the kind or kinds of health services the facility is authorized to provide. A license shall not be transferable and shall be issued for a specific location and, if specified, a designated geographical area.
The licensing fee for ASCs is $750.
Any person who operates a health facility or abortion facility without first obtaining a license or continues to operate a health facility or abortion facility after a final decision suspending or revoking a license shall be fined between $500 and $10,000 for each violation.
Certificate of Need
ASCs that were licensed as of July 12, 2012 are not required to obtain a CON to continue operations.
CON applications and information about the CON program can be found here.
Length of Stay Restriction
A center shall not retain a patient longer than 24 hours from the time of admission to discharge.
Medical History and Physical Examination
Adequate and complete medical records shall be prepared for all patients admitted to the surgical center. Notes shall be legibly written or typed and signed. A medical record shall include a medical history and physical evaluation that was performed and entered into the medical record no more than thirty (30) days prior to surgery.
Transfer Agreement
Kentucky's CON program requires ASC applicants to have a transfer agreement for the proposed ASC in place with at least one acute care hospital that is located within 30 minutes normal driving time of the center. ASCs must also have a physician on the medical staff with admitting privileges in a nearby hospital who is responsible for admitting patients in need of inpatient care.
Price Transparency
Kentucky imposes itemized billing price transparency requirements on ASCs.
When a copy of an itemized statement is requested by any paying patient, each health facility (including ASCs) shall furnish to the patient within 30 days of the patient’s discharge or within 15 days of the patient’s request, which is later, one copy free of charge of the itemized statement of services rendered and charges incurred by the patient.
A summary statement of serviced rendered and charged incurred by the patient shall be included with the invoice sent by a health facility to the patient. Each invoice shall indicate that an itemized statement may be obtained upon request.
The itemized statement rendered shall be the record maintained by the health facility that details the charges made for services rendered to patients and shall indicate whether an assignment of benefits has been obtained.
Workers' Compensation
ASC reimbursement is determined by multiplying the ASCs charges by its assigned cost-to-charge ratio after removing any duplicative charges, billing errors, charges for services or supplies not confirmed by ASC records, and charges for surgical implants and surgical hardware.
An ASC shall be assigned a cost-to-charge ration equal to:
- 120% of the average adjusted cost-to-charge ratio of all acute care hospitals located in the same county as the ASC
- 120% of the average adjusted cost-to-charge ratio of all acute care hospitals located in counties contiguous to the county in which the ASC is located, if an acute care hospital is not located in the county of the ASC
- Or the adjusted cost-to-charge ratio of the base hospital if the ASC is hospital based, it is licensed by the state and it is a Medicare provider based entity
Except as provided in the last bullet point above, an ASCs adjusted cost-to-charge ratio shall not exceed 50%.
More information regarding current ASC cost-to-charge ratios can be found on the Workers' Compensation Medical Services webpage.
Patient Safety Reporting Requirements
Health facilities participating in CMS reporting programs shall authorize the CDC to allow the Kentucky Department for Public Health to access health care-associated infection data reported to NHSN. More information about the state's HAI program can be found here.
Charity Care
Kentucky does not impose charity care requirements on ASCs.
Surgical Smoke
Kentucky requires ASCs that utilize an energy generating device to make use of a surgical smoke evacuation system: that effectively captures and neutralizes surgical smoke at the site of origin and before the smoke can make ocular contact or contact with the respiratory tract of the occupants of the room; and during any surgical procedure that is likely to produce surgical smoke.
Advance Directives
Kentucky Living Will Directive Act: Effect of Refusal to Comply
For Full Act: §§ 311.621 to 311.644
Living Will Packet
State Regulator
Kentucky Cabinet for Health & Family Services
Division of Health Care Office of Inspector General
275 E. Main Street, 5E-A
Frankfort, KY 40621
Belinda Beard, Director, Division of Health Care
belinda.beard@ky.gov
502.564.7963
Statutory & Regulatory References
Kentucky Statutes: § 216B.105
Kentucky Administrative Regulations: 902 KAR 20:101 and 902 KAR 20:106