ASC Daily Briefing — July 17, 2026
New Today
Ohio opts out of the Medicare physician-supervision requirement for CRNAs — effective now, and it directly reaches ASCs. Gov. Mike DeWine submitted the opt-out letter to CMS on July 10, 2026, making Ohio the 27th state to opt out. This is not payment policy — it changes how the Conditions for Coverage apply to Ohio ASCs. Under 42 CFR 416.42(c), an ASC is exempted from the physician-supervision requirement for CRNAs at 416.42(b)(2) once the governor submits the attestation letter, and the exemption is effective upon submission — there is no CMS approval step or waiting period. Ohio ASCs may therefore staff anesthesia with CRNAs without the federal supervision requirement as of July 10. The opt-out follows Ohio House Bill 52, effective June 8, 2026, which replaced “supervision” with “collaboration” with a physician, dentist, or podiatrist under state law. Source: AANA — Ohio Opts Out of Physician Supervision for CRNAs
Action for Ohio ASCs: the federal floor dropped, but nothing changes automatically at the center. Anesthesia staffing is still governed by state law (HB 52 collaboration), medical staff bylaws, governing-body policy, credentialing and privileging, and payer contracts — any of which may still require supervision independently. If you intend to rely on the opt-out, update anesthesia policy and bylaws deliberately and document the governing-body decision; surveyors will hold you to your own adopted policy, not to the opt-out. Centers that do not want to change practice need do nothing.
Note for multi-state operators: Ohio is also one of the 10 states in the CMS ASC prior-authorization demonstration. The two are unrelated, but both touch Ohio ASC operations this year.
All other items surfaced today were already captured on the Standing Compliance Reference or in recent briefings: the CY 2027 OPPS/ASC Proposed Rule (CMS-1850-P, comment deadline August 31, 2026), the CY 2026 OPPS/ASC Final Rule (CMS-1834-FC) in effect, the Conditions for Coverage at 42 CFR Part 416, the HHS Section 504 accessible MDE baseline (effective July 8, 2026), the 10-state ASC prior-authorization demonstration, AAAHC v44/v45, TJC 2026 standards, the five CMS-approved ASC accreditors, the CMS AO-oversight final rule, and the HHS-OIG 2026 Work Plan. No new enforcement actions, accreditation announcements, or additional Federal Register ASC notices appeared today.
Standing Items Changed
Added to the standing Page (new ongoing item): State opt-outs from the Medicare CRNA physician-supervision requirement under 42 CFR 416.42(c) — now 27 states, with Ohio added July 10, 2026. This is an evergreen structural item affecting ASC anesthesia staffing and belongs on the standing list rather than only in a daily post.
Reminder: the CY 2027 Proposed Rule comment deadline (August 31, 2026) remains the next actionable date — 45 days out.