The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 1370
INTRODUCER: Senator Trumbull
SUBJECT: Ambulatory Surgical Centers
DATE: March 17, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. AHS
3. RC
I. Summary:
SB 1370 creates and amends numerous sections of the Florida Statutes to remove regulation of
ambulatory surgical centers (ASC) from Part I of ch. 395, F.S., which currently houses
regulations for both ASCs and hospitals, and create a new ch. 396, F.S., specific to the regulation
of ASCs. The bill also specifies that it is the intent of the Legislature to bifurcate all fees and
public records exemptions related to ASCs established in ch. 395, F.S., and transfer those fees to,
and preserve such public records exemptions under, ch. 396, F.S.
The bill provides an effective date of July 1, 2025.
II. Present Situation:
Ambulatory Surgical Centers
An ASC is a licensed health care facility that is not part of a hospital and has the primary
purpose of providing elective surgical care. A patient is admitted to and discharged from the
facility within 24 hours.
1
ASCs are required to be licensed by the Agency for Health Care
Administration (AHCA) and may choose to be Medicare certified and/or accredited.
2
Licensure
ASCs are licensed and regulated under ch. 395, F.S., by the AHCA under the same regulatory
framework as hospitals.
3
Applicants for ASC licensure are required to submit certain information
to the AHCA prior to accepting patients for care or treatment, including:
1
Agency for Health Care Administration, Ambulatory Surgical Center, available at https://ahca.myflorida.com/health-
quality-assurance/bureau-of-health-facility-regulation/hospital-outpatient-services-unit/ambulatory-surgical-center, (last
visited Mar. 13, 2025).
2
Id.
3
Sections 395.001-395.1065, F.S., and part II, ch. 408, F.S.
REVISED: BILL: SB 1370 Page 2
• An affidavit of compliance with fictitious name;
• Registration of articles of incorporation; and
• The applicant’s zoning certificate or proof of compliance with zoning requirements.
4
Upon receipt of an initial ASC application, the AHCA is required to conduct a survey to
determine compliance with all laws and rules. Applicants are required to provide certain
information during the initial inspection, including:
• Governing body bylaws, rules, and regulations;
• Medical staff bylaws, rules, and regulations;
• A roster of medical staff members;
• A roster of registered nurses and licensed practical nurses with current license numbers;
• A nursing procedure manual;
• A fire plan; and
• A comprehensive emergency management plan.
5
The licensure fee is $1,679.82 and the survey/inspection fee is $400.
6
Currently there are 532
licensed ASCs in Florida.
7
In 2023, ASCs were visited by patients for outpatient services
3,205,371 times which equals 53.6 percent of all outpatient visits in Florida.
8
Accreditation
If an ASC chooses to become accredited by an organization recognized by the AHCA, including
the Accreditation Association for Ambulatory Health Care, the QUAD A, the Accreditation
Commission for Health Care, or the Joint Commission, the ASC may be deemed to be in
compliance with state licensure and certification requirements. Deemed ASCs are not scheduled
for routine on-site licensure or recertification surveys, although periodic Life Safety Code
inspections are still required. Facilities must provide a complete copy of the most recent survey
report indicating continuation as an accredited facility in lieu of inspections. The survey report
should include correspondence from the accrediting organization containing:
• The dates of the survey,
• Any citations to which the accreditation organization requires a response,
• A response to each citation,
• The effective date of accreditation,
• Any follow-up reports, and
• Verification of Medicare (CMS) deemed status, if applicable.
Facilities no longer accredited or granted accreditation status other than accredited, or fail to
submit the requested documentation, will be scheduled for annual licensure or recertification
surveys to be conducted by AHCA field office staff.
9
4
Rule 59A-5.003(4), F.A.C.
5
Rule 59A-5.003(5), F.A.C.
6
Supra note 1.
7
Florida Health Finder report, available at https://quality.healthfinder.fl.gov/Facility-Search/FacilityLocateSearch, (last
visited Mar. 13, 2025).
8
Ambulatory (outpatient) Surgery Query Results, Florida Health Finder, available at
https://quality.healthfinder.fl.gov/QueryTool/QTResults#, (last visited Mar. 13, 2025).
9
Supra note 1. BILL: SB 1370 Page 3
Licensure Requirements
Pursuant to s. 395.1055, F.S., the AHCA is authorized to adopt rules for hospitals and ASCs.
Separate standards may be provided for general and specialty hospitals, ASCs, mobile surgical
facilities, and statutory rural hospitals, but the rules for all hospitals and ASCs are required to
include minimum standards for ensuring that:
• A sufficient number of qualified types of personnel and occupational disciplines are on duty
and available at all times to provide necessary and adequate patient care;
• Infection control, housekeeping, sanitary conditions, and medical record procedures are
established and implemented to adequately protect patients;
• A comprehensive emergency management plan is prepared and updated annually;
• Licensed facilities are established, organized, and operated consistent with established
standards and rules; and
• Licensed facility beds conform to minimum space, equipment, and furnishing standards.
Rule 59A-5 of the Florida Administrative Code (F.A.C.) implements the minimum standards for
ASCs. Those rules require policies and procedures to ensure the protection of patient rights.
Staff and Personnel Rules
ASCs are required to have written policies and procedures for surgical services, anesthesia
services, nursing services, pharmaceutical services, laboratory services, and radiologic services.
In providing these services, ACSs are required to have certain professional staff available,
including:
• A qualified person responsible for the daily functioning and maintenance of the surgical
suite;
• An anesthesiologist or other physician, or a certified registered nurse anesthetist under the
on-site medical direction of a licensed physician, or an anesthesiologist assistant under the
direct supervision of an anesthesiologist, who must be in the center during the anesthesia and
post-anesthesia recovery period until all patients are cleared for discharge;
• A registered professional nurse who is responsible for coordinating and supervising all
nursing services;
• A registered professional circulating nurse for a patient during that patient’s surgical
procedure; and
• A registered professional nurse who must be in the recovery area at all times when a patient
is present.
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Infection Control Program
ASCs are required to establish an infection control program involving members of the medical,
nursing, and administrative staff. The program must include written policies and procedures
reflecting the scope of the infection control program. The written policies and procedures must
be reviewed at least every two years by the infection control program members. The infection
control program must include:
• Surveillance, prevention, and control of infection among patients and personnel;
10
Rule 59A-5.0085, F.A.C. BILL: SB 1370 Page 4
• A system for identifying, reporting, evaluating, and maintaining records of infections;
• Ongoing review and evaluation of aseptic, isolation, and sanitation techniques employed by
the ASC; and
• Development and coordination of training programs in infection control for all personnel.
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Emergency Management Plan
ASCs are required to develop and adopt a written comprehensive emergency management plan
for emergency care during an internal or external disaster or emergency. The ASC must review
the plan and update it annually.
12
Medicare Requirements
ASCs are required to have an agreement with the federal Centers for Medicare & Medicaid
Services (CMS) to participate in Medicare. ASCs are also required to comply with specific
conditions for coverage. The CMS defines “ASC” as any distinct entity that operates exclusively
for the purpose of providing surgical services to patients not requiring hospitalization and for
whom the expected duration of services would not exceed 24 hours following an admission.
13
The CMS may deem an ASC to be in compliance with all of the conditions for coverage if the
ASC is accredited by a national accrediting body or licensed by a state agency and if the CMS
determines that such accreditation or licensure provides reasonable assurance that the conditions
for coverage are met.
14
All CMS conditions for coverage requirements are specifically required
in Rule 59A-5, F.A.C., and apply to all ASCs in Florida. The conditions for coverage require
ASCs to have a:
• Governing body that assumes full legal responsibility for determining, implementing, and
monitoring policies governing the ASC’s total operation;
• Quality assessment and performance improvement program;
• Transfer agreement with one or more acute care general hospitals, which will admit any
patient referred who requires continuing care;
• Disaster preparedness plan;
• Organized medical staff;
• Fire control plan;
• Sanitary environment;
• Infection control program; and
• Procedure for patient admission, assessment and discharge.
III. Effect of Proposed Changes:
SB 1370 creates ch. 396, F.S., consisting of ss. 396.201-396.225, F.S., entitled “Ambulatory
Surgical Centers.” The bill duplicates provisions from Part I of ch. 395, F.S., as necessary to
create substantively identical requirements for ASCs in the newly created ch. 396, F.S. The bill
also amends provisions in part I of ch. 395, F.S., as well as multiple other sections of the Florida
11
Rule 59A-5.011, F.A.C.
12
Rule 59A-5.018, F.A.C.
13
42 C.F.R. s. 416.2
14
42 C.F.R. s. 416.26(a)(1) BILL: SB 1370 Page 5
Statutes, to remove the regulation of ASCs from Part I of ch. 395, F.S., and make conforming
changes.
The bill also specifies that it is the intent of the Legislature to bifurcate all fees applicable to
ASCs authorized and imposed under ch. 395, F.S., and transfer them to ch. 396, F.S. The AHCA
is authorized to maintain its current fees for ASCs and may adopt rules to codify such fees in rule
to conform to changes made by the bill. Additionally, the bill specifies that it is the intent of the
Legislature to bifurcate any exemptions from public records and public meetings requirements
applicable to ASCs under ch. 395, F.S., and preserve such exemptions under ch. 396, F.S.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
None. BILL: SB 1370 Page 6
VI. Technical Deficiencies:
SB 1370 creates a new chapter of the Florida Statutes specific to the regulation of ASCs and
removes ASC regulation from ch. 395, F.S., where it is currently housed. As such, many other
statutes are required to be amended to make conforming changes to refer to ch. 396, F.S., rather
than ch. 395, F.S. As drafted, the bill includes some of the necessary conforming changes but
does not amend numerous other statutes that reference ch. 395, F.S., and include both ASCs and
hospitals. Such additional statutes should be amended to conform to the changes made by the
bill.
Additionally, the AHCA has raised several technical issues with SB 1370 including citing
multiple incorrect cross-references and several places in which not cross-referencing
ch. 396, F.S., may inadvertently leave out ASCs from exemptions or regulations that are
necessary for ASCs.
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VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 383.145, 383.50,
385.211, 390.011, 394.4787, 395.001, 395.002, 395.003, 395.1055, 395.10973, 395.3025,
395.607, 395.701, 400.518, 400.93, 400.9935, 401.272, 408.051, 408.07, 408.802, 408.820,
409.905, 409.906, 409.975, 456.041, 456.053, 456.056, 458.3145, 458.320, 458.351, 459.0085,
459.026, 465.0125, 468.505, 627.351, 627.357, 627.6056, 627.6405, 627.64194, 627.6616,
627.736, 627.912, 765.101, 766.101, 766.110, 766.1115, 766.118, 766.202, 766.316, 812.014,
945.6041, and 985.6441.
This bill creates the following sections of the Florida Statutes: 396.201, 396.225, 396.202,
396.203, 396.204, 396.205, 396.206, 396.207, 396.208, 396.209, 396.211, 396.212, 396.213,
396.214, 396.215, 396.216, 396.217, 396.218, 396.219, 396.221, 396.222, 396.223, and 396.224.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
15
Email from Jim Browne, AHCA Legislative Affairs Director, on March 14, 2025. On file with Senate Health Policy
Committee staff.