Policy
Tracking federal and state legislation, CMS rulemaking, and the regulatory rhythm that reshapes ambulatory surgery economics.
- DOJ's proposed OhioHealth judgment voids the contract clauses that block steering to ASCs
A proposed final judgment filed in the Southern District of Ohio would wipe out OhioHealth's anti-steering and transparency restrictions and install a five-year monitor; the government's competitive impact statement names the ambulatory surgery center as the lower-cost site payers were kept from steering to.
Why it matters: The clauses that stop a payer from pointing members at a cheaper site are now antitrust exposure rather than a negotiating position — and the filing is a public map of the contract language the Justice Department considers illegal. - Connecticut rewrites its CON program: OHS's review power moves to DPH, with a new 3-member panel
Public Act 26-68, signed May 26, makes the Department of Public Health the successor to the Office of Health Strategy for certificate-of-need review, stands up a three-member CON panel, and adds a relocation carve-out and a two-to-three-OR expedited path.
Why it matters: An independent CT surgery center can now relocate within its town or 10 miles without a CON, and ask for an expedited two-to-three-OR add — while a hospital's satellite outpatient surgery site is pulled squarely under CON as a health care facility. - Mississippi doubles its Certificate-of-Need dollar thresholds
HB 3, approved by Gov. Tate Reeves on February 4, raises the major-medical-equipment CON trigger from $1.5M to $3M and the capital-expenditure trigger from $5M to $10M.
Why it matters: An equipment buy up to $3M — or a clinical build-out under $10M — now clears below the new caps without a CON application, removing a months-long review from expansion and equipment timelines (a brand-new ASC still needs a CON for the service line itself). - CMS turns on prior authorization for ASC services in 10 states
A five-year Medicare demonstration now requires prior authorization for five service categories — including vein ablation and blepharoplasty — with claims subject to prepayment review if centers opt out.
Why it matters: Traditional Medicare has been the no-prior-auth refuge; this demonstration is the template for ending that, and affected centers need a request workflow now.