December 1999

Health Care E-lert - All Freestanding Ambulatory Care Facilities in Maryland Must Now Be Licensed - 12/09/99

2 min

In recent years, freestanding ambulatory care facilities have not required a license to operate in Maryland. However, the Health Care Reform Act of 1995 mandated that freestanding ambulatory care facilities, including ambulatory surgical facilities, freestanding endoscopy facilities, freestanding facilities utilizing major medical equipment, kidney dialysis centers, and freestanding birthing centers become licensed by the Department of Health and Mental Hygiene.

Nearly four years later, DHMH proposed regulations to implement the statutory licensure requirement. Those regulations became final in July of this year, and took effect on August 23, 1999. As of that date, it became unlawful for anyone to establish or to operate a freestanding ambulatory care facility without a license.

The regulations contain general licensing requirements that apply to all freestanding ambulatory care facilities, as well as additional requirements applicable to each type of freestanding ambulatory care facility. The general licensing requirements outline minimum policies and procedures that each facility must develop and implement, including policies and procedures that describe "the provision of complete and partial charity care for indigent and Medicaid patients to promote access to all services regardless of an individual's ability to pay." Kidney dialysis centers and freestanding ambulatory surgical facilities are required to obtain Medicare certification as a condition of licensure.

In another example of delayed rulemaking, HCFA recently adopted new Safe Harbors for business practices that would be protected against Anti-Kickback penalties, including a Safe Harbor for ambulatory surgical centers owned by physicians or jointly owned by physicians and a hospital.

For further information about licensure requirements or Safe Harbors for freestanding ambulatory care facilities, contact Peter Parvis (410-244-7644,