By Chad Beebe, AIA, SASHE, ASHE Deputy Executive Director of Advocacy
Ambulatory surgical centers (ASCs) are often a source of confusion regarding occupancy types. Some architecture or engineering consultants will look to the Center for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs), specifically Part 416. The consultant may see that the CoPs say that for ambulatory surgical services, the facility must follow the provisions in NFPA 101: Life Safety Code® for the ambulatory health care occupancy. Reading the code in this way can cause an error, however. If the ASC is owned and operated by the hospital, it must comply with the CoPs for hospitals – found in Part 482 of the CoPs. Part 416 is for standalone ASCs that are distinct entities. A hospital cannot bill for services under Part 416—nor would it want to. There is an advantage of a being a hospital-based ASC under Part 482 of the CoPs. CMS recognizes the depth of expertise associated with an ASC backed by a hospital and its staff; since it costs more to run and operate a hospital-based ASC, the Medicare and Medicaid programs allow services to be billed at hospital provider status and can include a facility fee.
Hospital-based ASCs also have an advantage when complying with the Life Safety Code. Consider a building such as a medical office building (MOB) on a hospital campus that houses a small ambulatory surgery center that provides services or treatment simultaneously to 3 or fewer patients. If this ASC is associated with the hospital, it does not have to meet ambulatory health care occupancy standards under the ambulatory surgical services CoPs. Instead, the building could fall under the business occupancy standards of the Life Safety Code. It is important to look at the number of patients receiving services in the entire building. If four or more are: (1) rendered incapable of self preservation (2) receiving anesthesia or (3) emergency patients that due to the nature of their injury need assistance for self preservation in emergency conditions, then the facility falls into the ambulatory health care occupancy regardless of other factors. This is extremely important for many small services provided on an outpatient basis and could affect endoscopy departments, lithotripsy, some imaging procedures, and other services.
In conclusion: Just because the sign on the door says ambulatory surgical center, don’t jump to the conclusion that that it has to be an ambulatory health care occupancy.