These 12 states have CON laws that don't restrict ASCs

Marcus Robertson - Updated Friday, October 29th, 2021

Becker's ASC Review recently compiled data ranking all 50 states by ASC per capita, explored reasons why the bottom 15 have so few ASCs, and identified three states primed for new ASC growth based on key metrics.

What became clear is that of all the metrics we observed, the presence of certificate of need laws was the strongest correlation to how well-served a state is for ambulatory surgery.

New information presented here only strengthens that correlation.

CON laws are present in 35 states, though specifics vary. Some states —12, in fact — have laws that don't regulate ASCs, which means that only 23 states, plus the District of Columbia, require ASCs to apply for a CON, while 27 states do not.

Of the 35 states with CON requirements, the 12 that don't regulate ASCs tend to have more ASCs per capita. Mean per-capita ASC rates underscore the disparity.

States that require ASCs to apply for a CON have, on average, 1.57 ASCs per 100,000 residents. States with CON laws that don't regulate ASCs have an average of 1.86 per 100,000 residents, while those with no CON law have an average of 1.96 ASCs per 100,000 residents.

Below are all 50 states, plus the District of Columbia, ranked by per-capita ASC rate.

Note: Blue highlight denotes that a state has no CON law. Green denotes states with CON laws that do not regulate ASCs, according to the National Conference of State Legislatures.

Rank	State	No. of ASCs	Population	People per ASC	ASCs per (100k) capita
1	Maryland	342	6,177,224	18,062	5.54
2	Georgia	368	10,711,908	29,108	3.44
3	Wyoming	18	576,851	32,047	3.12
4	Idaho	55	1,839,106	33,438	2.99
5	New Jersey	259	9,288,994	35,865	2.79
6	Arizona	191	7,151,502	37,442	2.67
7	Mississippi	77	2,961,279	38,458	2.60
8	Nebraska	51	1,961,504	38,461	2.60
9	Nevada	80	3,104,614	38,808	2.58
10	Alaska	18	733,391	40,744	2.45
11	Washington	187	7,705,281	41,205	2.43
12	Colorado	134	5,773,714	43,087	2.32
13	Arkansas	69	3,011,524	43,645	2.29
14	Kansas	67	2,937,880	43,849	2.28
15	Delaware	22	989,948	44,998	2.22
16	Oregon	90	4,237,256	47,081	2.12
17	Florida	457	21,538,187	47,130	2.12
18	California	817	39,538,223	48,394	2.07
19	Tennessee	138	6,910,840	50,079	2.00
20	New Hampshire	27	1,377,529	51,020	1.96
21	Pennsylvania	248	13,002,700	52,430	1.91
22	Indiana	129	6,785,528	52,601	1.90
23	Louisiana	86	4,657,757	54,160	1.85
24	Montana	19	1,084,225	57,064	1.75
25	South Dakota	15	886,667	59,111	1.69
26	North Dakota	13	779,094	59,930	1.67
27	Missouri	102	6,154,913	60,342	1.66
28	Ohio	195	11,799,448	60,510	1.65
29	Texas	442	29,145,505	65,940	1.52
30	Hawaii	22	1,455,271	66,149	1.51
31	Connecticut	53	3,605,944	68,037	1.47
32	Wisconsin	85	5,893,718	69,338	1.44
33	Minnesota	81	5,706,494	70,451	1.42
34	Utah	45	3,271,616	72,703	1.38
35	South Carolina	70	5,118,425	73,120	1.37
36	North Carolina	129	10,439,388	80,925	1.24
37	Rhode Island	13	1,097,379	84,414	1.18
38	Maine	15	1,362,359	90,824	1.10
39	Michigan	106	10,077,331	95,069	1.05
40	Illinois	131	12,812,508	97,805	1.02
41	Oklahoma	40	3,959,353	98,984	1.01
42	New Mexico	20	2,117,522	105,876	0.94
43	Iowa	29	3,190,369	110,013	0.91
44	Alabama	41	5,024,279	122,543	0.82
45	Kentucky	35	4,505,836	128,738	0.78
46	Massachusetts	54	7,029,917	130,184	0.77
47	New York	147	20,201,249	137,423	0.73
48	Virginia	61	8,631,393	141,498	0.71
49	West Virginia	8	1,793,716	224,215	0.45
50	District of Columbia	3	689,545	229,848	0.44
51	Vermont	2	643,077	321,539	0.31

These 12 states have CON laws that don't restrict ASCs

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