The Massachusetts Department of Public Health updated its state medical regulations on Jan. 11, 2017, allowing existing freestanding ASCs to apply for a determination of need without an acute care hospital affiliation. The DPH will continue to mandate applicants submitting plans to build a new ASC to affiliate with either a Health Policy Commission-certified ACO or existing independent community hospital.
Here are four key notes:
1. In August 2016, the Public Health Council reviewed a revision of the state's determination of need law and held two public hearings in Boston and Northampton, Mass. The state's existing determination of need regulation stated surgery centers had to be affiliated with an acute care hospital to make changes such as:
• Any capital expenditure
• Substantial change in service
• An original license
• Transfer of ownership
• DON-required service
• Equipment
• Any combination of these listings
2. During the two hearings and 45-day comment period, the DPH received overall support regarding the revision, but the majority of comments featured concern over requiring surgery centers affiliate with an acute care hospital. The memo states, "While most commenters supported DPH's overall approach to the DON revision, they objected to this specific section of the proposed revisions, citing that the ASC provisions failed to take into account the significant savings and quality benefits provided by independent freestanding ASCs."
3. The DPH updated its DON regulations to allow existing freestanding ASCs to apply for a DON without such an affiliation. However, it does not apply to constructing a new freestanding ASC. Rather, the memo states that an applicant filing a DON to build an ASC must joint venture with a HPC-certified ACO or existing independent community hospital.
4. Additionally, the memo states if an HPC-certified ACO wants to build a new ASC in the same service location as one of the state's 10 remaining independent community hospitals, the applicant has to have a letter of support from the independent community hospital or enter into a joint venture or affiliation with the independent community hospital. Throughout the state, there are 10 independent community hospitals and more than 50 existing freestanding ASCs.
"We were extremely impressed with the level of support for ASCs in response to the initial regulations, and appreciate the Department of Public Health's willingness to work with the MAASC in redrafting the regulations," said Greg DeConciliis, president of Massachusetts Association of Ambulatory Surgery Centers. "Ultimately, they have responded to our many concerns in the final draft of the regulations. Patients will now have greater access to care, and providers will benefit from a level playing field for freestanding ambulatory surgery centers and be better able to meet the needs of patients."