Ambulatory Surgical Centers: Regulation and Accreditation

Ambulatory surgical centers (ASC) are subject to an interlocking series of state, federal and voluntary regulation and accreditation standards.   They are designed to ensure that patients receive safe, quality services.    The following is a brief summary.

  • State licensure:  In 46 states, ASCs must be licensed under state law.   Each state sets forth its own licensure requirements, but typically they require initial and ongoing inspection and reporting.  The states without licensure requirements are Idaho, West Virginia, Wisconsin and Wyoming.

    • Third party accreditation required in 28 states:  In 28 of the 46 states, accreditation by a third party is required as part of licensure.  The three accreditation bodies recognized are Accreditation Association for Ambulatory Health Care (AAAHC), American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), and JCAHO. 

  • State certificate of need laws:  25 states have “certificate of need” laws that apply to ambulatory surgical centers.  Under these laws, any party seeking to open an ASCs must demonstrate a need for the new service and construction.   These laws are designed to control health care costs by avoiding overbuilding of facilities. 
     
  •  Federal accreditation for Medicare:  ASC must be certified under the Medicare program to participate in Medicare.  They must demonstrate compliance with state licensure law, and they must also demonstrate ongoing compliance with Medicare standards designed to ensure patient safety and the quality of services provided. They must demonstrate compliance on an ongoing basis. 

    • Note:  Medicare also limits the scope of surgical procedures reimbursed to elective procedures with short anesthesia and operating times.

  • Voluntary accreditation:  Many ASCs choose to become accredited by AAAHC, AAAAS or JCAHO voluntarily.  Accreditation can be a selling point to third-party payers, and if the ASC is in  one of the 18 states that do not currently require accreditation as part of licensure, they are well-positioned if that changes. 


To see the licensure requirements in your state, click here:  State requirements for Ambulatory Surgery Centers (35.9 KB PDF)

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