Ambulatory Surgery Center Definition
"Ambulatory surgical center" means a facility that primarily provides surgical services to patients who do not require overnight hospitalization or extensive recovery, convalescent time or observation. The planned total length of stay for an ASC patient shall not exceed 23 hours. Patient stays of greater than 23 hours shall be the result of an unanticipated medical condition and shall occur infrequently. The 23-hour period begins with the induction of anesthesia.
Excluded from the definition are:
- An office or clinic of a licensed physician, dentist, or podiatrist
- A licensed nursing home
- A licensed hospital
License Requirements
A person may not establish or operate an ambulatory surgical center in this state without a license issued under this chapter. Each ASC must have a separate license. A license is not transferable or assignable.
The initial licensing fee is $5,200. An initial license lasts for one year. Renewal licenses must be accompanied by a fee of $5,200 and last two years.
A person commits a Class C misdemeanor by operating an unlicensed ASC. Each day of a continuing violation constitutes a separate offense. A person who violates the provisions of Texas Health and Safety Code Chapter 243, Ambulatory Surgical Centers or who fails to comply with a rule adopted under this chapter is liable for a civil penalty of not less than $100 or more than $500 for each violation if the Department determines the violation threatens the health and safety of a patient. Each day of a continuing violation constitutes a separate ground for recovery.
Certificate of Need
Texas does not have a CON program.
Length of Stay Restriction
The planned total length of stay for an ASC patient shall not exceed 23 hours.
Medical History and Physical Examination
Reports, histories and physicals shall be incorporated into the medical record in a timely manner.
Transfer Agreement
The ASC shall have a written transfer agreement with a hospital or all physicians performing surgery at the ASC shall have admitting privileges at a local hospital.
Price Transparency
Texas imposes multiple price transparency requirements on ASCs.
Estimated Charge: ASCs shall provide an estimate of the facility’s charges for any elective inpatient admission or nonemergency outpatient surgical procedure or other service on request and before the scheduling of the admission or procedure or service. The estimate must be provided not later than the 10th business day after the date on which the estimate is requested. The facility must advise the consumer that:
- The request for an estimate of charges may result in a delay in the scheduling and provision of the inpatient admission, outpatient surgical procedure or other service
- The actual charges for an inpatient admission, outpatient surgical procedure or other service will vary based on the persons’ medical condition and other factors associated with performance of the procedure or service
- The actual charges for an inpatient admission, outpatient surgical procedure or other service may differ from the amount to be paid by the consumer or the consumer’s third-party payor
- The consumer may be personally liable for payment for the inpatient admission, outpatient surgical procedure or other service depending on the consumer’s health benefit plan coverage
- And the consumer should contact their health benefit plan for accurate information regarding the plan structure, benefit coverage, deductibles, copayments, coinsurance and other plan provisions that may impact the consumer’s liability for payment for the inpatient admission, outpatient surgical procedure or other service.
Itemized Bill: A health care provider that requests payment from a patient after providing a health care service or related supply to the patient shall submit with the request a written, itemized bill of the alleged amount due for each service and supply provided to the patient during the patient's visit to the provider. The provider must submit the itemized bill not later than the 30th day after the provider receives a final payment on the provided service or supply from a third party. A health care provider may issue the itemized bill: electronically, including through a patient portal on the provider’s Internet website; through a hard copy delivered by mail or a common carrier; or through a hard copy the patient or the patient’s designee obtains at the provider’s place of business.
The itemized bill must include:
- A plain language description of each distinct health care service or supply the health care provider provided to the patient
- If the provider sought or is seeking reimbursement from a third party, any billing code submitted to the third party and the amounts billed to and paid by that third party
- And the amount the provider alleges is due from the patient for each service and supply provided to the patient.
A health care provider may issue the itemized bill electronically, including through a patient portal on the provider's Internet website. A patient is entitled to obtain from the health care provider an itemized bill on request at any time after the itemized bill is initially issued.
Standard Charges (Not Effective for ASCs Until August 31, 2029): A facility (defined to include ASCs) must make public a digital file in a machine-readable format that contains a list of all standard charges for all facility items or services. A facility shall: maintain a list of all standard charges for all facility items or services; and ensure the list is available at all times to the public, including by posting the list electronically.
The list of standard charges must include the following items, as applicable:
- A description of each facility item or service provided by the facility
- The following charges for each individual facility item or service when provided in either an inpatient setting or outpatient department setting, as applicable:
- The gross charge
- The de-identified minimum negotiated charge
- The de-identified maximum negotiated charge
- The discounted cash price
- And the payor-specific negotiated charge, listed by the name of the third-party payor and plan associated with the charge and displayed in a manner that clearly associates the charge with each third-party payor and plan
- And any code used by the facility for purposes of accounting or billing for the facility item or service, including the CPT code, HCPCS code, the DRG code, the National Drug Code (NDC), or other common identifier.
This information must be published in a single digital file that is in a machine-readable format. The list must be displayed in a prominent location on the home page of the facility’s publicly accessible Internet website or accessible by selecting a dedicated link that is prominently displayed on the home page of the facility’s website.
These provisions only apply to facilities with total gross revenue of $10 million or more.
Shoppable Services (Not Effective for ASCs Until August 31, 2029): A facility shall maintain and make publicly available a list of standard charges as described by Section 327.003 for each of at least 300 shoppable services provided by the facility. The facility may select the shoppable services to be included in the list, except that the list must include: the 70 services specified as shoppable services by CMS; or if the facility does not provide all of the shoppable services specified by CMS, as many of those shoppable services the facility does provide.
In selecting a shoppable service for inclusion in the list, a facility must: consider how frequently the facility provides the service and the facility's billing rate for that service; and prioritize the selection of services that are among the services most frequently provided by the facility. If a facility does not provide 300 shoppable services, the facility must maintain a list of the total number of shoppable services that the facility provides.
The list must:
- Include:
- A plain-language description of each shoppable service included on the list
- The payor-specific negotiated charge that applies to each shoppable service included on the list and any ancillary service, listed by the name of the third party payor and plan associated with the charge and displayed in a manner that clearly associates the charge with the third party payor and plan
- The discounted cash price that applies to each shoppable service included on the list and any ancillary service or, if the facility does not offer a discounted cash price for one or more of the shoppable or ancillary services on the list, the gross charge for the shoppable service or ancillary service, as applicable
- The de-identified minimum negotiated charge that applies to each shoppable service included on the list and any ancillary service
- The de-identified maximum negotiated charge that applies to each shoppable service included on the list and any ancillary service
- And any code used by the facility for purposes of accounting or billing for the facility item or service, including the CPT code, HCPCS code, the DRG code, the National Drug Code (NDC), or other common identifier.
- And, if applicable:
- State each location at which the facility provides the shoppable service and whether the standard charges included in the list apply at that location to the provision of that shoppable service in an inpatient setting, an outpatient department setting, or in both of those settings, as applicable
- And indicate if one or more of the shoppable services specified by the Centers for Medicare and Medicaid Services is not provided by the facility.
A facility is considered to meet these requirements if the facility maintains an Internet-based price estimator tool that:
- Provides a cost estimate for each shoppable service and any ancillary service included on the list maintained by the facility
- Allows a person to obtain an estimate of the amount the person will be obligated to pay the facility if the person elects to use the facility to provide the service
- And is:
- Prominently displayed on the facility's publicly accessible Internet website
- And accessible to the public without charge and without having to register or establish a user account or password.
These provisions only apply to facilities with total gross revenue of $10 million or more.
Workers' Compensation
Regardless of billed amount, reimbursement shall be:
- The amount for the service that is included in a specific fee schedule set in a contract that complies with the requirements of Labor Code §413.011
- Or if no contracted fee schedule exists that complies with Labor Code §413.011, the maximum allowable reimbursement (MAR) amount under subsection (f) of this section, including any reimbursement for implantables
The reimbursement calculation used for establishing the MAR shall be the Medicare ASC reimbursement amount determined by applying the most recently adopted and effective Medicare Payment System Policies for Services Furnished in Ambulatory Surgical Centers and Outpatient Prospective Payment System reimbursement formula and factors as published annually in the Federal Register. Reimbursement shall be based on the fully implemented payment amount as in ADDENDUM AA, ASC COVERED SURGICAL PROCEDURES FOR CY 2008, published in the November 27, 2007 publication of the Federal Register, or its successor.
Information regarding ASC fee guidelines can be found here.
Patient Safety Reporting Requirements
ASCs are required to document and report information on specified Preventable Adverse Events. Texas makes this information available to the public. More information on criteria and reporting requirements can be found here.
Charity Care
Texas does not impose charity care requirements on ASCs.
Surgical Smoke
Texas does not impose surgical smoke evacuation requirements on ASCs.
Advance Directives
Advanced Directives: Statement Relating to Advance Directives
For Full Act: §§ 166.031 to 166.053
Advance Directive Forms
State Regulator
Texas Department of State Health Services
Regulatory Licensing Unit - Facility Licensing Group
Delivery Code 2835
PO Box 149347, MC 2003
Austin, TX 78714
Beth McCay, Director of Health Facility Compliance Health Care Regulation, Regulatory Services Division
beth.mccay@hhs.texas.gov
737.218.7073
Statutory & Regulatory References
Texas Health & Safety Code: § 243
Texas Administrative Code: 26 TAC § 508