Ambulatory Surgery Center Definition
"Ambulatory surgical treatment center" means any institution, place or building devoted primarily to the performance of surgical procedures. Such facilities shall not provide beds or other accommodations for the stay of a patient to exceed 12 hours duration, provided that the length of stay may be extended for an additional twelve 12 hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for the observation or recovery, but in no event shall the length of stay exceed 24 hours.
Excluded from the definition are:
- Private physicians' offices
- Offices of dentists
License Requirements
The commission is empowered to license and regulate ASCs.
The annual license fee is $1,404.
The department is authorized to initiate proceedings seeking injunctive and any other form of relief available in law or equity against any person who owns, operates, or manages the operation of any facilities required to be licensed under this part without having the license required by this part.
Certificate of Need
Due to passage of HB 2269 during the 2024 legislative session, ASCs licensed on or after December 1, 2027 will no longer require a CON to operate.
Until that time, important forms and information can be found below:
Application
Filing Instructions
Applicant Self-check List
Standards and Criteria for Ambulatory Surgical Treatment Centers
Length of Stay Restriction
ASCs shall not provide beds or other accommodations for the stay of a patient to exceed 12 hours duration, provided that the length of stay may be extended for an additional 12 hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for observation or recovery, but in no event shall the length of stay exceed 24 hours.
Medical History and Physical Examination
There must be a complete history and physical work-up in the chart of every patient prior to surgery, except in emergencies. If the history has been dictated, but not yet recorded in the patient’s chart, there must be a statement to that effect and an admission note in the chart by the practitioner who admitted the patient.
Transfer Agreement
Each ASC must have a written transfer agreement with a local hospital.
Price Transparency
Tennessee does not impose state-level price transparency requirements on ASCs.
Workers' Compensation
The payment rate for each APC group is the basis for determining the maximum total payment to which an ASC is entitled. Under the Medical Fee Schedule rules, the OPPS reimbursement system shall be used for reimbursement for all outpatient services, wherever they are performed. The current, effective Medicare APC rates shall be used as the basis for facility fees charged for outpatient services and shall be reimbursed at a maximum of 150% of current value for such services. Procedures listed with CMS status indicator C shall be reimbursed, but with the maximum amount being usual and customary, which is 80% of the billed charges. For all other outpatient hospital care in all ASCs, facility fees shall be calculated in accordance with the most current Medicare rules and procedures applicable to such services and shall be reimbursed at a maximum rate of 150% of the current value of Medicare reimbursement for outpatient hospital care.
Medical Fee Schedule handbooks are available here.
Patient Safety Reporting Requirements
Tennessee previously required ASCs to report on "unusual events", unexpected occurrences or accidents resulting in death or life-threatening or serious injury to the patient not related to a natural course of the patient's illness or underlying condition. The requirement to report on unusual events was repealed in 2009, with all licensed health care facilities now required to report on abuse of patients, misappropriation of patient property and neglect of patients.
Charity Care
While rulemaking has yet to occur, Tennessee's repeal of its CON requirements for ASCs in 2024 (effective December 1, 2027) led to the creation of new charity care requirements. Non-hospital ambulatory surgical treatment centers licensed on or after December 1, 2027 shall:
- Participate in the TennCare medical assistance program and provide an amount of care to patients who are TennCare enrollees that is comparable to similarly situated hospital-based ambulatory surgical treatment centers, taking into account the types of outpatients surgeries, procedures and treatments being performed in the facility;
- And provide an amount of charity care that is comparable to similarly situated hospital-based ambulatory surgical treatment centers, taking into account the types of outpatient surgeries, procedures and treatments being performed in the facility.
Surgical Smoke
Tennessee does not impose surgical smoke evacuation requirements on ASCs.
Advance Directives
Tennessee's statutes are hosted on Lexis Nexis, and the Health Care Decisions Act can be found at § 68-11-1808.
Advance Directive Forms
State Regulator
Tennessee Department of Health
Office of Health Care Facilities
665 Mainstream Drive 2nd Floor
Nashville, TN 37243
Logan Grant, Executive Director, Office of Health Care Facilities
logan.grant@tn.gov
615.741.7532
Statutory & Regulatory References
Tennessee Code Annotated: § 68-11, Part 2
Tennessee Rules and Regulations: Chapter 1200-08-10