Regulation & Legislation

As legislative scrutiny of facility fees intensifies in North Carolina and elsewhere, ambulatory surgery center (ASC) leaders are working overtime to protect what some say is the bedrock of funding for outpatient care. Facility fees, often misunderstood and frequently politicized, are now at the center of proposed legislation in multiple states, including model language introduced in North Carolina’s budget bill. While lawmakers aim to crack down on billing practices that raise patient … [Read more...]

House Republicans on Sunday introduced a bill that includes significant cuts to Medicaid funding, including tighter eligibility requirements and reduced reimbursements to states. Some estimates show that the GOP-proposed changes would equate to about $715 billion in Medicaid cuts down the road. This comes amid a broader push to offset tax cuts introduced during the Trump administration. While the proposed cuts could deeply affect hospitals and other health care providers with a … [Read more...]

A bipartisan group of U.S. representatives recently introduced the Medicare Beneficiary Co-Pay Fairness Act of 2025, a bill that aims to address inequities in Medicare’s copay structure and help lower costs for patients receiving care at ambulatory surgery centers (ASCs).  Currently, patients who seek care at both ASCs and hospital outpatient departments (HOPDs) typically face a 20% co-pay. However, while HOPDs benefit from a copay cap, set at $1,676 for 2025, patients at ASCs often face … [Read more...]

Contractual disputes, compliance pitfalls and insurance denials driven by artificial intelligence are among the many legal issues that should be on ambulatory surgery center (ASC) operators' radar in 2025. Generally, legal experts expect litigation involving ASCs to rise this year, attorneys at ArentFox Schiff wrote in a recent JD Supra post, pointing to expanding case volume tied to operational, regulatory and transactional friction points. As more high-acuity procedures shift from … [Read more...]

The site-neutrality movement, aimed at standardizing payments across outpatient health care settings, has rapidly emerged as an important discussion among ambulatory surgery center (ASC) operators.  While potentially beneficial in driving procedures into lower-cost environments by eliminating hospital facility fees, industry leaders have mixed perspectives on its implementation. Michael McClain, managing partner at Left Coast Healthcare Advisors, told Ambulatory Surgery Center News his … [Read more...]

Certificate of need (CON) laws have long shaped the development of health care facilities across the United States, originally enacted to control costs, reduce duplication of services and make sure resources were distributed in line with community needs.  However, these regulations have increasingly come under scrutiny by ambulatory surgery center (ASC) operators who argue the laws restrict growth, limit physician autonomy and stifle free-market competition.  Several states, most recently … [Read more...]

The Senate confirmed Dr. Mehmet Oz as the new administrator of the Centers for Medicare & Medicaid Services (CMS), doing so by a 53-45 margin. Most senators voted along party lines. Oz’s confirmation will likely portend policy and regulatory shifts that may impact ambulatory surgery centers (ASCs).  Oz’s public statements during his confirmation hearings focused heavily on post-acute care and skilled nursing concerns, but he also hinted at broader reimbursement and regulatory … [Read more...]

In a sweeping move that could reshape health care administration across the country, the U.S. Department of Health and Human Services (HHS) has unveiled a major restructuring plan.  Under the plan, HHS will reduce its workforce from 82,000 to 62,000 employees and consolidate 28 divisions into 15, with the aim of streamlining administrative functions and centralizing processes such as human resources, information technology, procurement, external affairs and policy, according to a Trump … [Read more...]

The site-neutrality movement has rapidly become one of the most talked-about issues in health care. But what does it mean for ambulatory surgery center operators?  At its core, site neutrality is about leveling the playing field between different outpatient settings by eliminating the extra facility fees that hospital outpatient departments (HOPDs) often receive, Rachel Carey, counsel at Whiteford, Taylor & Preston LLP, told Ambulatory Surgery Center News. “It's a movement to … [Read more...]

Tenet Healthcare Corporation (NYSE: THC) is pivoting toward higher-acuity services to mitigate policy risks in the face of legislative uncertainties, including Medicaid cuts and site neutrality.  The company has already increased its higher-acuity procedures volume, but that trend will continue. “Our focus is on continuing to build and expand our high-margin service lines,” CEO Saum Sutaria said at the recent Barclays Global Healthcare Conference. To that tune, Tenet is investing in … [Read more...]