ASC Standing Compliance Reference

This page lists ongoing ASC Medicare certification and accreditation items that remain in effect. It is updated only when an item changes. Last reviewed: September 18, 2026.

Standing Regulatory Items

  • CY 2026 OPPS/ASC Final Rule (CMS-1834-FC) — In effect since Jan 1, 2026. 2.6% ASC payment update for ASCQR-compliant centers; 560 procedures added to the ASC Covered Procedures List. Failure to meet ASCQR reporting = 2% payment reduction. CMS Fact Sheet
  • CY 2027 OPPS/ASC Proposed Rule (CMS-1850-P) — Published in the Federal Register July 7, 2026. Proposes a 2.4% ASC payment update, Year 2 of the inpatient-only (IPO) list phase-out (638 services), ASCQR measure changes, expanded prior authorization for botulinum toxin codes, and AO deeming for EMTALA administrative requirements. Also proposes removal of the Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure from the ASCQR Program. Comment period CLOSED August 31, 2026. The rule is now in the CMS drafting phase; based on prior-year cadence (CY 2026 final rule issued November 21, 2025), expect the CY 2027 final rule in mid-to-late November 2026, effective January 1, 2027. Federal Register
  • ASC annual update factor — hospital market basket trial expires after CY 2026 — Since 2019 CMS has updated ASC rates using the productivity-adjusted hospital market basket instead of CPI-U under a time-limited policy that ends with CY 2026. CMS-1850-P proposes to continue the market basket for CY 2027 (2.4% net); extension beyond CY 2027 requires further rulemaking or legislation. The Outpatient Surgery Access Act of 2026 (H.R. 8091, Van Duyne/Larson, introduced Mar 25, 2026; S. 4963, Cassidy/Blumenthal, introduced Jul 14, 2026) would make the market basket permanent and eliminate the ASC weight-scalar budget-neutrality adjustment. ASCA-supported; no committee action yet. ASCA press release.
  • Conditions for Coverage (42 CFR Part 416) — Ongoing ASC health and safety standards: governing body, surgical services, patient rights, infection control, admission/assessment/discharge. eCFR Part 416
  • ASCQR Program participation — Required annually to receive the full payment update. Finalized ASCQR measure removals (CY 2026 rule): COVID-19 Vaccination Coverage measure (effective CY 2024 reporting/CY 2026 payment), Facility Commitment to Health Equity/FCHE measure (effective CY 2025 reporting/CY 2027 payment), Screening for SDOH measure (effective CY 2025 reporting/CY 2027 payment), and Screen Positive Rate for SDOH measure (effective CY 2025 reporting/CY 2027 payment). OAS CAHPS quarterly submission deadlines (mandatory ASCQR measure; missed quarter = 2-point payment-update penalty): Q2 2026 due Oct 14, 2026; Q3 2026 due Jan 13, 2027; Q4 2026 due Apr 14, 2027; Q1 2027 due Jul 14, 2027. OAS CAHPS Preview Reports for ASCs now live in the Hospital Quality Reporting (HQR) system, not oascahps.org — the Q4 2024–Q3 2025 report (posted July 29, 2026) was the last one posted on the OAS CAHPS site; beginning with the Q1–Q4 2025 reporting period, ASC and HOPD preview reports are posted in HQR (hqr.cms.gov). Confirm each center has an active HARP account with the HQR OAS CAHPS role for its ASC CCN before the next quarterly refresh. OAS CAHPS announcements. OAS CAHPS deadlines.
  • ASC prior authorization demonstration (10 states) — Five-year CMS demonstration covering Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee, and Texas. Originally set to begin Dec 15, 2025; delayed and phased. Phase 1 (CA, FL, GA, MD, NY, PA, TN): dates of service on/after January 19, 2026. Phase 2 (AZ, OH, TX): dates of service on/after February 16, 2026. 41 codes across blepharoplasty/blepharoptosis/brow ptosis repair, botulinum toxin injection, panniculectomy and excess-skin excision, rhinoplasty, and vein ablation. ASCA
  • HHS Section 504 accessible medical equipment (MDE) rule — Effective July 8, 2026, ASCs receiving federal financial assistance (Medicare/Medicaid) must have at least one accessible exam table and one accessible weight scale (or 10% of each MDE type, whichever is greater), plus an ongoing new-acquisition obligation for MDE acquired after July 8, 2024. Related digital-accessibility (WCAG 2.1 AA) deadlines were extended to May 11, 2027 (15+ employees) and May 10, 2028 (fewer than 15). Enforced by HHS OCR. HHS MDE Requirements
  • CRNA physician-supervision state opt-outs (42 CFR 416.42(c)). A state may exempt its ASCs from the Medicare physician-supervision requirement for CRNAs at 42 CFR 416.42(b)(2) when the governor submits an attestation letter to CMS; the exemption is effective upon submission, with no CMS approval step. 27 states have opted out, most recently Ohio (letter submitted July 10, 2026), which followed Ohio HB 52 (effective June 8, 2026) replacing “supervision” with “collaboration” under state law. The opt-out lowers the federal floor only — state scope-of-practice law, medical staff bylaws, governing-body policy, credentialing/privileging, and payer contracts may still require supervision independently, and surveyors hold the ASC to its own adopted policy. Source: AANA — Ohio Opts Out of Physician Supervision for CRNAs
  • State surgical smoke evacuation requirements — 22 states now require ASCs to use surgical smoke plume evacuation systems. Newest: Michigan (HB 4779, signed July 21, 2026, effective immediately) for any surgical procedure involving heat-producing equipment likely to generate smoke; Delaware (HB 173, effective April 1, 2026), requiring an adopted written policy; and Maryland (HB 1087, signed May 26, 2026, effective January 1, 2028). North Carolina narrowed its existing requirement (in effect since January 1, 2026) via the 2026 appropriations act, S 257, signed July 2026 and effective on signature: the required smoke evacuation/filtering system is now defined as stand-alone, portable equipment (an assistant-held device qualifies), which excludes integrated or building-system approaches. Most statutes require both a written policy and equipment in active use — surveyors will look for both. ASC Focus

Standing Accreditation Items

  • Accrediting organizations (deemed status) — There are five CMS-approved national ASC accreditors: AAAHC, ACHC (Accreditation Commission for Health Care, formerly HFAP), DNV Healthcare (initial ASC approval effective Dec 8, 2025 – Dec 10, 2029), The Joint Commission, and QUAD A (formerly AAAASF). ASCA — Accrediting Organizations
  • AAAHC v44 Standards — Governs AAAHC surveys conducted through December 14, 2026. Expanded focus on data collection/outcomes, alignment with state scope-of-practice rules, integration with Quality Roadmap reports. OR Today
  • AAAHC v45 Standards — effective for surveys conducted on or after December 15, 2026. CMS approval of v45 for Medicare deemed status confirmed — AAAHC stated in its August 28, 2026 comment letter to CMS on CMS-1850-P that “CMS recently approved AAAHC’s v45 Accreditation Standards.” Released August 18, 2026 across all handbooks (Ambulatory, Medicare Deemed Status, Advanced Orthopaedic Certification, Health Plans, Health Plans FEHB, Patient-Centered Medical Home). Introduces a comprehensive AI governance framework covering leadership accountability, risk assessment, cybersecurity, human oversight, transparency, and continuous readiness, plus refinements across all programs. Surveys before December 15, 2026 remain under v44. Scoring: most new AI Standards are designated Level 0 — no Plan of Correction required if cited, and not factored into the accreditation decision — but some AI requirements were added as Elements of Compliance within existing Standards, which follow normal POC rules and do count toward the accreditation decision. Standard identifiers are renumbered between v44 and v45, so internal policies and audit tools citing v44 numbers must be recrosswalked. Cybersecurity Standards are integrated across all accreditation programs. Policy changes effective with v45: Plan of Correction must be submitted within 10 calendar days of notification (30 calendar days remain to complete corrections); a Permitted Use Notice governs reproduction of survey materials; a new records retention and data protection section was added; the Good Faith Participation policy was expanded; and a Managing Business Unit (MBU) layer was added to the Business Unit structure. The Medicare Deemed Status Physical Environment Checklist has no substantive changes — applicable NFPA Life Safety Code editions did not change. AAAHC
  • AAAHC 1095 Advance AI Governance Guide — Complimentary implementation resource released August 17, 2026 to help organizations build the policy and committee structure the v45 AI standards expect. AAAHC
  • Oregon: AAAHC Medicare Deemed Status accepted for ASC relicensure — Under an agreement announced August 11, 2026, eligible Oregon ASCs may use their AAAHC deemed-status survey to satisfy Oregon Health Authority state relicensure survey requirements, eliminating a duplicate state survey. Verify eligibility and filing mechanics with OHA before cancelling a scheduled state survey. AAAHC
  • Accreditation does not dictate clinical service lines — AAAHC statement of August 13, 2026 clarifies that surveyor educational observations are not directives, and that decisions to offer, modify, expand, or discontinue clinical services rest with the organization. AAAHC asks accredited organizations not to attribute service-line changes to accreditation requirements in public communications. AAAHC
  • Joint Commission 2026 standards — Environment of Care and Life Safety consolidated into a single Physical Environment chapter; greater focus on performance outcomes and equipment condition during tracers. OR Today

Standing Oversight Items

  • CMS AO oversight final rule (42 CFR Part 488) — Strengthening Oversight of Accrediting Organizations and Preventing AO Conflicts of Interest, finalized June 12, 2026. Signals more rigorous, standardized, and independent accreditation surveys. Summary
  • HHS-OIG 2026 Work Plan — Heightened healthcare enforcement environment in 2026. No ASC-specific audit currently flagged; keep billing, medical-necessity, and certification documentation audit-ready. Saul Ewing
  • HHS-OIG Advisory Opinions 26-03 and 26-04 (Mar 9, 2026) — Both ASC-specific and favorable. AO 26-04: sole physician owner’s transfer of ASC ownership to a non-physician spouse (gift), physician children (FMV options), and outside physician investors (FMV) under a documented estate/retirement plan — no sanctions despite incomplete ASC safe-harbor fit, based on FMV pricing, pro-rata distributions, no referral linkage, and the retiring physician’s exit from governance and referrals. Current best roadmap for physician-owner succession. AO 26-03: manufacturer discount on IOLs/cataract supplies to ASCs contingent on affiliated practices buying its software — favorable. Advisory opinions bind only the requestor.
  • MedPAC ASC cost-data recommendation (March 2026 Report to Congress, Ch. 11) — MedPAC again recommends the Secretary require ASCs to submit cost data; ASCs remain the only major Medicare facility type without cost reporting. Repeated annually since 2010, not adopted; watch for CMS rulemaking or legislation. MedPAC Ch. 11.