ASC SPECIALTY HUB — PAGE 13 OF 13
Developed by GoHealthcare Practice Solutions
ASC State Regulatory Profiles — Volume Three
Midwest and Great Plains — Licensure, Facility Categories, Need Review, and Utilization Review Law in Twelve States
The third volume of the GoHealthcare ASC State Regulatory Profiles series, covering Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin — the region with the widest spread in the country between the most and least regulated ambulatory surgery environments.
Publication Information
Document Control
| Document Title | ASC State Regulatory Profiles — Volume Three — Midwest and Great Plains — Licensure, Facility Categories, Need Review, and Utilization Review Law in Twelve States |
|---|---|
| Series | GoHealthcare MSK Specialty Procedure Library™ — ASC Specialty Hub |
| Document Identifier | GH-MSK-HUB-ASC-P13 |
| Standard Applied | GoHealthcare Clinical Procedure Guide Standard v1.0 |
| Publication Date | August 3, 2026 |
| Document Version | Version 1.0 |
| Developed By | GoHealthcare Practice Solutions, under the leadership of Pinky Maniri, Founder and Chief Executive Officer |
ASC Specialty Hub
Purpose, Audience, and Sources
| Purpose | Provide ASC leaders, developers, counsel, and multi-state operators with a verified starting point for state regulatory research in the Midwest and Great Plains, using a consistent profile structure across the series. |
|---|---|
| Primary Audience | Physicians; ASC administrators, developers, and executives; healthcare counsel; prior authorization and utilization management teams; revenue cycle leaders; multi-state operators; compliance officers |
| Credentials | MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in Healthcare A.I. Governance |
| Primary Sources | State statutes and administrative codes as cited per jurisdiction; state licensing agency published materials; National Academy for State Health Policy 50-state certificate-of-need database updated December 12, 2025; CMS ASC Prior Authorization Demonstration and WISeR Model materials; 42 CFR Part 416, Subpart C; state enactments through mid-2026 |
| Scope Exclusions | This volume does not state legal conclusions, does not opine on the lawfulness of any structure or arrangement, and does not substitute for primary state legal research or advice from counsel licensed in the relevant jurisdiction. Statutory and regulatory citations are provided as verified research starting points and are subject to amendment, renumbering, and readoption. Where a profile states that a requirement was not located in the sources consulted, that means exactly that — not that no such requirement exists. |
| Website | https://www.gohealthcarellc.com |
ASC Specialty Hub
ASC Specialty Hub — Page Index
This page is one of thirteen in the GoHealthcare Ambulatory Surgery Center Specialty Hub. Each page is written to stand alone for the team that owns that domain, and to connect to the domains upstream and downstream of it.
| # | Knowledge Center page | # | Knowledge Center page |
|---|---|---|---|
| 01 | Specialty Overview | 08 | KPIs and Metrics |
| 02 | Practice Operations | 09 | AI Applications |
| 03 | Prior Authorization | 10 | Best Practices |
| 04 | Revenue Cycle | 11 | Procedure Links |
| 05 | Documentation | 12 | Frequently Asked Questions |
| 06 | Coding | 13 | State Regulatory Reference ◀ you are here |
| 07 | Compliance |
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ASC Specialty Hub
Scope and Method of This Volume
This volume is the third of four in the GoHealthcare ASC State Regulatory Profiles series. It covers twelve Midwest and Great Plains states: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin.
Verification Standard for This Volume
Each citation in this volume was located in a primary or official state source during preparation. Where a field reads that a requirement was not located in the sources consulted, that is an accurate statement of the research position and not an assertion that no such requirement exists. Those fields are marked explicitly rather than filled with plausible-sounding detail.
This volume is a research starting point and an orientation, not legal advice and not a substitute for primary state legal research. Confirm the current text of any cited provision with the state agency and obtain review by qualified healthcare counsel licensed in the relevant jurisdiction.
Why This Region Is Different
This region contains the widest spread in the country between the most and least regulated ASC environments. Wisconsin imposes no state licensure requirement on ambulatory surgery centers at all. Iowa imposed one for the first time in 2023 and made unlicensed operation a serious misdemeanor. Ohio and Michigan operate mature, detailed frameworks with certificate of need attached. A single operating model will not transfer cleanly across these twelve states.
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ASC Specialty Hub
Illinois
| Licensing authority | Illinois Department of Public Health. Under Section 4 of the Act, no person may open, conduct, or maintain an ambulatory surgical treatment center without first obtaining a license from the Department. |
|---|---|
| Statutory basis | Ambulatory Surgical Treatment Center Act, 210 ILCS 5. |
| Licensure regulation | 77 Ill. Adm. Code Part 205, Ambulatory Surgical Treatment Center Licensing Requirements — including conditions of licensure (205.118), license fee (205.125), diagnostic and interventional cardiac catheterization procedures (205.135), infection control (205.550), and Subpart I covering building design, construction standards, and physical requirements (205.1310 et seq.; control station requirement at 205.1370). Rulemaking has expressly aligned portions of Part 205 with the federal ASC Conditions for Coverage at 42 CFR 416, creating a governing body, expanding organizational plan and professional work standards, and requiring a data-driven quality assessment program in the policies and procedures manual. |
| Title protection | A person or facility not licensed under the Act or the Hospital Licensing Act may not hold itself out to the public as a "surgery center" or a "center for surgery." Operating without a license is a business offense, and the Director may seek injunctive relief through the Attorney General or State's Attorney. |
| License scope and term | A license is issued only for the premises and persons named in the application and is not transferable or assignable. Only those facilities, services, programs, and procedures included in the application are licensed. The license is valid for one year, renewable annually on Department approval and payment of the fee, and must be posted conspicuously. |
| Reportable changes | A new application is required for changes including change in ownership. Notice is required for personnel changes involving administrative staff, medical director, or supervising nurse; for a corporation, any change in shareholder equity involving five percent or more interest; and any change in the registered agent or person authorized to receive service of process. |
|---|---|
| Medicare interaction | An ASTC that elects an agreement with CMS must also meet the Medicare conditions at 42 CFR 416 and maintain an active Medicare ASC provider agreement in Illinois. |
| Procedure disapproval | The Director may issue a Notice of Disapproval effective immediately — including where evidence becomes available from a national study or an FDA or other regulatory warning that a procedure cannot be safely performed in an ambulatory setting — with fifteen days to request a hearing. |
| Related program | 77 Ill. Adm. Code Part 210 governs a Postsurgical Recovery Care Center demonstration program, under which a model may be no larger than twenty beds and participation depends on an available allocated slot for the geographic area. |
| Need review | Certificate of need administered through the Illinois Health Facilities and Services Review Board. Confirm current thresholds and ambulatory surgery applicability. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Prior authorization reporting requirements enacted; prior authorization prohibited for inpatient psychiatric admission and outpatient mental health services as of January 1. Confirm current text. |
Operational Note
Illinois licenses the procedures, not just the facility. Only the facilities, services, programs, and procedures included in the application are licensed, and the Director holds an immediate-effect disapproval power tied to emerging safety evidence. For an MSK center adding higher-acuity spine or arthroplasty volume, the application content is the operating authority — confirm coverage before the first case, not after.
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ASC Specialty Hub
Indiana
| Licensing authority | Indiana Department of Health, Division of Acute Care. |
|---|---|
| Statutory basis | "Ambulatory outpatient surgical center" is defined at IC 16-18-2-14. |
| Licensure regulation | 410 IAC 15-1.1 (definitions and general provisions) and the Article 15 hospital licensure rules framework, within which ambulatory outpatient surgical centers are addressed. The rules classify patients by ASA physical status, defining ASA Class I as a normal, healthy patient. |
| Operating requirements | The center must admit the patient to the open staff of the ambulatory outpatient surgical center; require that, in all cases other than those requiring only local infiltrate anesthetics, a physician licensed under IC 25-22.5 with specialized training or experience in anesthetic administration supervise the administration and remain present in the facility during the procedure; provide at least one operating room and, where anesthetics other than local infiltration are administered, at least one post-anesthesia recovery room; be equipped to perform diagnostic x-ray and laboratory examinations required in connection with surgery; provide full-time registered and licensed nursing services; and maintain the equipment and trained personnel necessary to handle foreseeable emergencies. |
| Need review | Indiana maintains a certificate of need program of limited scope. Confirm current ambulatory surgery applicability with the Department. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Prior authorization decision timeline legislation enacted; AI in healthcare legislation enacted March 2026. Confirm current text and effective dates. |
|---|
Operational Note
Indiana's open staff requirement and its explicit anesthesia supervision-and-presence rule are both operational constraints that show up in physician contracting and anesthesia arrangements, not only in the license file.
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ASC Specialty Hub
Iowa
| Licensing authority | Department of Inspections, Appeals, and Licensing (DIAL), with quality data reporting administered in coordination with the Iowa Department of Health and Human Services. |
|---|---|
| Statutory basis | Iowa Code Chapter 135R, enacted by 2023 Iowa Acts, Senate File 75 — the statute that first established ambulatory surgical center licensure in Iowa. Definition at Iowa Code § 135R.1; confidentiality at § 135R.6; penalty at § 135R.9. |
| Licensure regulation | 481 IAC Chapter 49, adopted through rulemaking with a regulatory analysis published in the Iowa Administrative Bulletin on December 13, 2023 and a public hearing held January 3, 2024. The rules cover licensure, external quality data reporting, enforcement and penalties, waivers, and the public and confidential nature of records. |
| Penalty for unlicensed operation | Establishing, operating, or maintaining an ambulatory surgical center without a license is a serious misdemeanor under Iowa Code § 135R.9. |
| Public findings | The Department's final findings regarding a center's compliance with licensing requirements are made available to the public on the Department's website. Other information obtained by the Department that does not constitute final inspection findings, including complainant identifying information, is confidential under § 135R.6, subject to referral to other law enforcement or regulatory agencies under § 10A.105(5). |
| Waivers | Requests may be submitted under 481 IAC Chapter 6. The director may grant a waiver where good and sufficient reasons are established, no substantial risk to patient health, safety, or welfare is presented, and alternate means or compensating circumstances justify it. A waiver is limited to the specific project and sets no precedent. |
| Need review | Certificate of need applies to ambulatory surgical centers. An ASC operating before the licensure mandate took effect is granted an initial license and is not required to obtain a new certificate of need solely because licensure is now mandated by Chapter 135R. |
| Definitional divergence | The rulemaking record reflects public comment on the difference between the state and federal definitions of ambulatory surgical center, and on the risk of double reporting by federally certified centers. Confirm which definition governs for each obligation. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Iowa Code § 514F.8(2A), effective July 1, 2026 — a utilization review organization may use an AI-based algorithm or system to provide an initial review of a prior authorization request, but may not use AI to issue a medical necessity denial. Prior authorization decision timeline legislation also enacted. |
Operational Note
Iowa is the newest ASC licensure regime in the country and the rules are still settling. Two points deserve attention: the state and federal definitions of ambulatory surgical center are not identical, and inspection findings are published publicly. Both change how an Iowa center should manage survey response and public communications.
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ASC Specialty Hub
Kansas
| Licensing authority | Kansas Department of Health and Environment, Health Facilities Program. |
|---|---|
| Statutory definition | K.S.A. 65-425(f) defines an ambulatory surgical center as an establishment with an organized medical staff of one or more physicians; permanent facilities equipped and operated primarily to perform surgical procedures; continuous physician services during surgical procedures and until the patient has recovered from the obvious effects of anesthetic, with physician services available at all other times whenever a patient is in the facility; continuous registered professional nursing services whenever a patient is in the facility; and which does not provide services or accommodations for a patient to stay more than 24 hours. An ASC is a "medical care facility" under § 65-425(h). |
| Physician discharge evaluation | Before discharge from an ambulatory surgical center, each patient shall be evaluated by a physician for proper anesthesia recovery. |
| Physician office exclusion | Nothing in K.S.A. 65-425 requires the office of a physician or physicians to be licensed under the act as an ambulatory surgical center. |
| Licensure regulation | Kansas Administrative Regulations promulgated by KDHE under Article 28-34 (medical care facilities). Confirm the specific ASC sections and current text with the Health Facilities Program. |
| Corporate practice of medicine | Kansas case law has held a physician employment contract with a licensed ambulatory surgical center void for violating the corporate practice of medicine doctrine. Physician employment and contracting structures in Kansas ASCs warrant counsel review. |
| Need review | Kansas is a non-CON jurisdiction under the certificate of need scan consulted. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | No AI-in-utilization-review enactment identified in the sources consulted. |
Operational Note
Kansas requires a physician — not a nurse applying protocol criteria — to evaluate every patient for proper anesthesia recovery before discharge. That is a staffing and workflow requirement stricter than many centers assume, and it should be reflected in the discharge documentation. The corporate practice of medicine exposure is a separate and serious structuring question.
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ASC Specialty Hub
Michigan
| Licensing authority | Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification / Bureau of Community and Health Systems. Michigan uses the term freestanding surgical outpatient facility (FSOF). |
|---|---|
| Statutory basis | Public Health Code, 1978 PA 368, Part 208, MCL 333.20101 et seq. Definition at MCL 333.20104(8); FSOF requirements at MCL 333.20821. |
| Facility definition | A facility, other than the office of a physician, dentist, podiatrist, or other private practice office, offering a surgical procedure and related care that in the opinion of the attending physician can be safely performed without requiring overnight inpatient hospital care. The definition excludes a surgical outpatient facility owned by and operated as part of a hospital, as specified in the statute. |
| Statutory operating requirements | Under MCL 333.20821 an FSOF must be organized, administered, staffed, and equipped to provide major and minor surgical procedures outside a hospital on a regular and scheduled basis; have the physician, nursing, technical, and supportive personnel, the technical, diagnostic, and treatment services, and the equipment necessary to assure safe performance; have a written agreement with a nearby licensed hospital for emergency admission of postsurgical patients; and establish a clinical record for each patient including history, physical examination, justification for treatment planned and rendered, tests and examinations, observations, and treatment provided. |
|---|---|
| Administrative rules | LARA administrative rules for licensing health facilities or agencies define FSOF by reference to MCL 333.20104 and describe its characteristics, including that the owner or operator may make the facility available to other physicians, dentists, podiatrists, or other providers who comprise its professional staff. |
| Need review | Certificate of need administered by the Michigan Department of Health and Human Services CON Program. Surgical services provided in a freestanding surgical outpatient facility, in a Medicare-certified ambulatory surgery center, or in a surgical department of a hospital licensed under Part 215 are covered clinical services under CON Review Standards for Surgical Services (CON-206), applying MCL 333.22225(1) and (2)(c). Only surgical services performed in an operating room in those settings are covered by the program. MCL 333.22209 addresses relocation of licensed beds from a hospital to a commonly controlled FSOF. |
| CON access conditions | The surgical services standards impose access conditions, including that the applicant not deny surgical services based on ability to pay or source of payment, provide services based on clinical indications of need, and maintain volume information by payer and non-paying source annually. Operation and referral must conform to MCL 333.16221. |
| Medicare certification | LARA has advised that Michigan is not performing initial Medicare surveys and that providers should obtain accreditation to achieve certification, with the deeming survey report and approval letter submitted to the Bureau of Survey and Certification before the packet is forwarded to the MAC. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Gold carding statute active. Confirm the qualifying threshold, look-back period, and exemption duration. |
Operational Note
Michigan's CON standards attach payer-blind access conditions to surgical services approval and require annual volume reporting by payer and non-paying source. That is a data obligation and a case-selection constraint, and it should be built into the center's reporting infrastructure at opening rather than reconstructed later.
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ASC Specialty Hub
Minnesota
| Licensing authority | Minnesota Department of Health, Health Regulation Division — Licensing and Certification Program. Minnesota uses the term freestanding outpatient surgical center. |
|---|---|
| Statutory basis | Minn. Stat. §§ 144.50 to 144.56, with rulemaking authority at §§ 144.12 and 144.55 to 144.56. |
| Licensure regulation | Minnesota Rules Chapter 4675, parts 4675.0100 to 4675.2800, governing construction, equipment, maintenance, operation, and licensure of outpatient surgical centers — including separation of treatment areas for patient preparation, surgery, and recovery at 4675.0700 and 4675.0800. |
| Facility definition | A freestanding facility organized for the specific purpose of providing elective outpatient surgery for preexamined, prediagnosed, low-risk patients. Admissions are limited to procedures using local or general anesthesia that do not require overnight inpatient care. The center is not organized to provide regular emergency medical services and does not include a physician's or dentist's office or clinic for the practice of medicine or delivery of primary care. "Surgery" means treatment of conditions by operative means involving incision or repair of human tissues. |
|---|---|
| Application requirements | Application must be made in writing by the person or persons who will be the licensee, operate the facility, and be responsible for its operation, with documentation providing full disclosure of ownership. A corporate applicant must furnish names and addresses of the governing body and names of current officers; an out-of-state corporation must furnish a copy of its certificate of authority to do business in Minnesota. Evidence of workers' compensation coverage is required. |
| License term and fee | Licenses are renewed annually on a calendar-year basis and are not transferable. Applications should be submitted at least 90 days prior to the anticipated opening date. Minn. Stat. § 144.55 sets the annual license fee for outpatient surgical centers at $1,512. |
| Nursing standard | As a condition of licensure, outpatient surgical centers must provide nursing care consistent with nationally accepted nursing clinical standards for perioperative nursing. |
| Medicare interaction | All federally certified ambulatory surgical centers operating in Minnesota must hold a Minnesota freestanding outpatient surgical center license. Minn. R. 9505.0240 defines an ambulatory surgical center for medical assistance purposes as a facility licensed under parts 4675.0100 to 4675.2800 and certified under 42 CFR Part 416. |
| Need review | Minnesota's certificate of need framework is limited in scope relative to most CON states. Confirm current ambulatory surgery applicability. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | No AI-in-utilization-review enactment identified in the sources consulted. |
Operational Note
The Minnesota definition is restrictive in a way that matters for MSK case selection: elective surgery on preexamined, prediagnosed, low-risk patients. As the covered procedures list expands toward higher-acuity arthroplasty and spine work, confirm that the intended case mix remains within the state's definitional boundary, and note the 90-day application lead time in any opening schedule.
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ASC Specialty Hub
Missouri
| Licensing authority | Department of Health and Senior Services, Section for Health Standards and Licensure, Bureau of Ambulatory Care. DHSS licenses ASCs, performs initial and periodic surveys, and conducts complaint investigations regarding patient care. |
|---|---|
| Statutory basis | §§ 197.154 and 197.225, RSMo. |
| Licensure regulation | 19 CSR 30-30 — including licensure provisions at 19 CSR 30-30.010/.060 and administration standards for ambulatory surgical centers at 19 CSR 30-30.020. The rules were originally filed December 2, 1975, previously codified at 13 CSR 50-30, and have been amended repeatedly. A subset of ASCs may instead be licensed as birthing centers under 19 CSR 30-30.090–.110. |
| Governing body and medical staff | Bylaws of the governing body must provide for selection and appointment of medical staff members based on defined criteria and in accordance with an established process. |
| Complaint process | Complaints are directed to the Bureau of Hospital Licensing and Certification; the complainant is to be contacted within five working days of receipt. |
| Need review | Certificate of need administered through the Missouri Health Facilities Review Committee. Confirm current thresholds and ambulatory surgery applicability. |
|---|---|
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Prior authorization reduction legislation proposed. Confirm current session status. |
Operational Note
Missouri's ASC rules date from 1975 and have been amended rather than rewritten. Read them alongside the federal Conditions for Coverage rather than assuming alignment; where the state rule is more specific, the state rule governs the license.
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ASC Specialty Hub
Nebraska
| Licensing authority | Nebraska Department of Health and Human Services, Division of Public Health — health facility licensure. Confirm the specific licensure unit and contact with the Division. |
|---|---|
| Statutory and regulatory basis | Not located in the sources consulted during preparation. Confirm the governing chapter, current text, and licensing contact directly with the state agency before relying on any assumption about scope or process. |
| Facility category | Confirm the state's operative term for ambulatory surgical facilities and whether physician-office surgical settings are separately treated. |
| Need review | Nebraska maintains a certificate of need program under the certificate of need scan consulted. Confirm current ambulatory surgery applicability and thresholds directly with the State. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Prior authorization decision timeline legislation effective at the start of 2026. LB 77 requires disclosure of artificial intelligence use to providers and enrollees. |
Operational Note
This profile is deliberately incomplete rather than speculatively filled. Nebraska's AI disclosure requirement under LB 77 is verified and immediately usable; the licensure citation is not, and should be obtained from the Division of Public Health before it is relied upon.
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ASC Specialty Hub
North Dakota
| Licensing authority | North Dakota Department of Health and Human Services — health facility licensure. Confirm the specific licensure unit and contact with the Department. |
|---|---|
| Statutory and regulatory basis | Not located in the sources consulted during preparation. Confirm the governing chapter, current text, and licensing contact directly with the state agency before relying on any assumption about scope or process. |
| Need review | North Dakota is a non-CON jurisdiction under the certificate of need scan consulted. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | Prior authorization decision timeline legislation effective at the start of 2026. Confirm the operative timelines. |
|---|
Operational Note
As with Nebraska, the licensure citation was not located in the sources consulted and is left open rather than approximated. The non-CON status and the 2026 prior authorization timeline legislation are verified.
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ASC Specialty Hub
Ohio
| Licensing authority | Ohio Department of Health, Bureau of Regulatory Operations, which processes initial, renewal, and change of operator license applications. All ambulatory surgical facilities in Ohio must be licensed under Ohio Revised Code § 3702.30. |
|---|---|
| Statutory basis | R.C. § 3702.30 (health care facility licensure), with rules promulgated under §§ 3702.12 and 3702.30 and amplifying §§ 3702.12, 3702.13, and 3702.30. |
| Licensure regulation | Ohio Administrative Code Chapter 3701-83, Health Care Facilities — ambulatory surgical facility definitions at OAC 3701-83-15, with the ASF-specific rules running from 3701-83-15 to 3701-83-22. Chapter 3701-83 also governs freestanding dialysis centers, inpatient rehabilitation facilities, birthing centers, radiation therapy centers, and diagnostic imaging centers. |
| Facility definition | A facility in which surgical services are provided to patients who do not require hospitalization for inpatient care, where the duration of services for any patient does not extend beyond twenty-four hours after admission, and where either the surgical services are provided in a building separate from a building in which inpatient care is provided (regardless of common organizational ownership), or the surgical services are provided within a building in which inpatient care is provided but the operator of the surgical portion is not the operator of the remainder of the building. |
| Infection control | The statutory quality standards require an ASF to maintain an infection control program designed to minimize infections and communicable diseases and facilitate a functional and sanitary environment. Facility staff must create and administer a plan to prevent, identify, and manage infections; ensure the program is directed by a qualified professional trained in infection control; ensure it is an integral part of the facility's quality assessment and performance improvement program; and implement corrective and preventive measures expeditiously. |
| Informed consent | Every ASF must require each physician practicing at the facility to comply with all relevant Revised Code provisions relating to obtaining informed consent. |
| Hospital licensure boundary | Effective September 30, 2024, Ohio transitioned hospitals from registration to licensure under OAC Chapter 3701-22. An ambulatory surgical facility or other health care facility licensed under R.C. § 3702.30 is not subject to hospital licensure. |
| Need review | Ohio maintains a certificate of need program of limited scope; confirm current ambulatory surgery applicability with the Department. |
| Medicare prior authorization | WISeR Model state and ASC Prior Authorization Demonstration Phase 2 state. Demonstration requests accepted from February 2, 2026 for dates of service on or after February 16, 2026. Two distinct Medicare prior authorization regimes apply. |
| State utilization review law | No AI-in-utilization-review enactment identified in the sources consulted. |
Operational Note
Ohio is one of only three states subject to both Medicare prior authorization programs reaching ASCs. Ohio's ASF definition is also unusual in that it can capture surgical operations located inside a building providing inpatient care where the operators differ — a structure common in hospital joint ventures and worth confirming before assuming hospital outpatient department treatment.
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ASC Specialty Hub
South Dakota
| Licensing authority | South Dakota Department of Health — health facility licensure. Confirm the specific licensure unit and contact with the Department. |
|---|---|
| Statutory and regulatory basis | Not located in the sources consulted during preparation. Confirm the governing chapter, current text, and licensing contact directly with the state agency before relying on any assumption about scope or process. |
| Need review | South Dakota is a non-CON jurisdiction under the certificate of need scan consulted. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | No AI-in-utilization-review enactment identified in the sources consulted. |
Operational Note
Left open rather than approximated. The non-CON status is verified; the licensure framework must be confirmed with the Department of Health.
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ASC Specialty Hub
Wisconsin
| Licensing authority | None for ambulatory surgery centers. The Wisconsin Department of Health Services states that there are no state licensure or certificate requirements for ASCs in Wisconsin. |
|---|---|
| Medicare certification pathway | An ASC seeking Medicare certification contacts its Medicare Administrative Contractor to begin enrollment using CMS Form 855B, then arranges an initial Medicare certification deemed status survey with a CMS-approved accrediting organization such as AAAHC. |
| Plan review | Engineers in the Division of Quality Assurance Office of Plan Review and Inspection may provide advisory plan reviews of Life Safety Code requirements for ASC providers at no charge, where the ASC submits construction plans. |
| Need review | Wisconsin is a non-CON jurisdiction under the certificate of need scan consulted. |
| Practical implication | In the absence of a state license, the operative compliance framework for a Wisconsin ASC is the federal Conditions for Coverage at 42 CFR Part 416, the accrediting organization's standards, applicable building and life safety codes, and payer contract requirements. There is no state survey to fall back on and no state licensure record for payers or partners to rely on — accreditation carries correspondingly more weight. |
| Medicare prior authorization | Not a WISeR state. Not an ASC Prior Authorization Demonstration state. |
| State utilization review law | No AI-in-utilization-review enactment identified in the sources consulted. |
Operational Note
Wisconsin is the clearest example in the country of federal requirements operating without a state licensure overlay. That lowers the barrier to entry and raises the stakes on accreditation and on internal QAPI discipline, because there is no state survey process providing a second look.
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ASC Specialty Hub
Volume 3 Comparative Summary
| State | Licensure citation | Need review | Medicare PA |
|---|---|---|---|
| Illinois | 210 ILCS 5; 77 Ill. Adm. Code 205; IDPH | CON — Health Facilities and Services Review Board | -- |
| Indiana | IC 16-18-2-14; 410 IAC 15-1.1; IDOH Division of Acute Care | CON of limited scope — confirm applicability | -- |
| Iowa | Iowa Code ch. 135R (2023 SF 75); 481 IAC ch. 49; DIAL | CON applies to ASCs | -- |
| Kansas | K.S.A. 65-425; K.A.R. art. 28-34; KDHE | Non-CON | -- |
| Michigan | MCL 333.20104, 333.20821 (Part 208); LARA | CON — MDHHS; CON-206 surgical services standards | -- |
| Minnesota | Minn. Stat. §§ 144.50–144.56; Minn. R. ch. 4675; MDH | CON limited in scope | -- |
| Missouri | §§ 197.154, 197.225 RSMo; 19 CSR 30-30; DHSS | CON — Health Facilities Review Committee | -- |
| Nebraska | Not located in sources consulted — confirm with DHHS | CON — confirm applicability | -- |
| North Dakota | Not located in sources consulted — confirm with DHHS | Non-CON | -- |
| Ohio | R.C. § 3702.30; OAC ch. 3701-83 (3701-83-15 et seq.); ODH | CON of limited scope — confirm applicability | WISeR + ASC Demo Phase 2 |
| South Dakota | Not located in sources consulted — confirm with DOH | Non-CON | -- |
| Wisconsin | No state ASC licensure requirement | Non-CON | -- |
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Regional Operating Observations
- The regulatory range is the widest in the country. Wisconsin has no state ASC license; Iowa created one in 2023 with a criminal penalty for unlicensed operation; Illinois licenses the specific procedures listed in the application. A multi-state operator cannot use a single onboarding checklist here.
- Ohio carries both Medicare prior authorization programs. It is one of only three states — with Arizona and Texas — subject to both WISeR and the ASC Prior Authorization Demonstration.
- Two states embed patient-selection limits in the definition. Minnesota limits admissions to elective surgery on preexamined, prediagnosed, low-risk patients; Indiana classifies by ASA physical status. As MSK acuity rises, these definitions are the binding constraint, not the payer covered list.
- Open staff obligations appear in Indiana and in Michigan's rule characteristics. Physician ownership and exclusivity arrangements should be tested against them.
physician employment by an ASC.
• Michigan attaches payer-blind access conditions and annual payer-mix reporting to CON approval for surgical services.
- Four states in this volume have verified 2026 prior authorization or AI enactments — Iowa, Indiana, Nebraska, and North Dakota — while their licensure frameworks vary enormously. The payer layer and the facility layer move independently.
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Key Takeaways
- Wisconsin imposes no state ASC licensure requirement; federal Conditions for Coverage and accreditation carry the entire compliance load.
- Iowa's licensure regime is new as of 2023, publishes inspection findings, and makes unlicensed operation a serious misdemeanor.
- Illinois licenses procedures and services as listed in the application, and holds an immediate-effect disapproval power tied to emerging safety evidence.
- Ohio's ASF definition can reach surgical operations inside a building that also provides inpatient care where the operators differ.
- Minnesota's low-risk patient definition and 90-day application lead time are both planning constraints.
- Kansas requires physician evaluation for anesthesia recovery before discharge and presents corporate practice of medicine exposure on physician employment.
- Three profiles in this volume are deliberately incomplete. Incompleteness stated plainly is more useful than detail that cannot be verified.
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References
All references are primary or authoritative secondary sources. Blogs, AI-generated content, marketing websites, and non-authoritative sources are excluded by standard. Complete website addresses are provided.
- National Academy for State Health Policy. 50-State Scan of State Certificate-of-Need Programs, database updated December 12, 2025. Website: https://nashp.org/state-tracker/50-state-scan-of-state-certificate-of-need-programs/
- Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services. Website: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-pre-claim-review-initiatives/prior-authorization-demonstration-certain-ambulatory-surgical-center-services
- Centers for Medicare & Medicaid Services. Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services — Frequently Asked Questions, December 23, 2025. Website: https://www.cms.gov/files/document/asc-demonstration-faqs.pdf
- Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. WISeR Model Provider and Supplier Operational Guide. Website: https://www.cms.gov/priorities/innovation/files/wiser-provider-supplier-guide.pdf
- Electronic Code of Federal Regulations. 42 CFR Part 416, Subpart C — Specific Conditions for Coverage for Ambulatory Surgical Services. Website: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416/subpart-C
- Holland & Knight. States Continue Efforts to Regulate AI in Healthcare: A Review of Legislation Passed in 2026. Website: https://www.hklaw.com/en/insights/publications/2026/05/states-continue-efforts-to-regulate-ai-in-healthcare
- KFF. Regulation of AI in Prior Authorization and Claims Review: A Look at Federal and State Consumer Protections. Website: https://www.kff.org/patient-consumer-protections/regulation-of-ai-in-prior-authorization-and-claims-review-a-look-at-federal-and-state-consumer-protections/
- Georgetown University Center on Health Insurance Reforms. Prior Authorization Reform Heats Up. Website: https://chir.georgetown.edu/prior-authorization-reform-heats-up/
- GoHealthcare Practice Solutions Knowledge Center. Website: https://www.gohealthcarellc.com
- Illinois General Assembly. 77 Ill. Adm. Code Part 205, Ambulatory Surgical Treatment Center Licensing Requirements. Website: https://www.ilga.gov/Commission/jcar/admincode/JCARTitlePart.asp?Title=077&Part=0205
- Illinois Department of Public Health. Ambulatory Surgical Treatment Center Licensure. Website: https://dph.illinois.gov/topics-services/health-care-regulation/life-safety-construction/astc-licensure.html
- Indiana Department of Health. Article 15 Hospital Licensure Rules, 410 IAC 15-1.1. Website: https://www.in.gov/health/files/Article-15-Hospital-Licensure-Rules.PDF
- Indiana Department of Health. 410 IAC 15-1. Website: https://www.in.gov/health/files/410_IAC_15-1.pdf
- Iowa Administrative Rules. ARC 7886C — 481 IAC Chapter 49, ambulatory surgical centers, implementing Iowa Code Chapter 135R. Website: https://rules.iowa.gov/Notice/Details/7886C
- Iowa Department of Health and Human Services. Rulemaking record for ambulatory surgical center licensure under Iowa Code Chapter 135R. Website: https://hhs.iowa.gov/media/12153/download
- Kansas Revisor of Statutes. K.S.A. 65-425, Definitions. Website: https://www.ksrevisor.gov/statutes/chapters/ch65/065_004_0025.html
- Kansas Department of Health and Environment. Health Facilities Program — State Statutes and Regulations. Website: https://www.kdhe.ks.gov/601/Health-Facilities-Program-State-Statutes
- Michigan Legislature. MCL 333.20821 — Freestanding surgical outpatient facility requirements. Website: https://legislature.mi.gov/Laws/MCL?objectName=MCL-333-20821
- Michigan Department of Health and Human Services. CON Review Standards for Surgical Services (CON-206). Website: https://www.michigan.gov/-/media/Project/Websites/mdhhs/Doing-Business-with-MDHHS/Health-Care-Providers/Certificate-of-Need/CON-Review-Standards/SS_Standards.pdf
- Michigan Department of Licensing and Regulatory Affairs. Freestanding Surgical Outpatient Facilities (FSOF/ASC). Website: https://www.michigan.gov/lara/bureau-list/bsc/accs-division/asc
- Minnesota Department of Health. Freestanding Outpatient Surgical Center Licensing. Website: https://www.health.state.mn.us/facilities/regulation/surgical/index.html
- Minnesota Revisor of Statutes. Minnesota Rules Chapter 4675, Outpatient Surgical Centers. Website: https://www.revisor.mn.gov/rules/4675/full
- Minnesota Revisor of Statutes. Minn. Stat. § 144.55. Website: https://www.revisor.mn.gov/statutes/cite/144.55
- Missouri Department of Health and Senior Services. Ambulatory Surgery Centers. Website: https://health.mo.gov/safety/asc/index.php
- Missouri Secretary of State. 19 CSR 30-30, Ambulatory Surgical Centers. Website: https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-30.pdf
- Ohio Department of Health. Ambulatory Surgical Facilities. Website: https://odh.ohio.gov/know-our-programs/ambulatory-surgical-facilities/ambulatorysurgicalfacilities
- Ohio Laws. Ohio Revised Code § 3702.30. Website: https://codes.ohio.gov/ohio-revised-code/section-3702.30
- Ohio Laws. Ohio Administrative Code Chapter 3701-83. Website: https://codes.ohio.gov/ohio-administrative-code/chapter-3701-83
- Wisconsin Department of Health Services. Ambulatory Surgery Centers: Medicare Certification. Website: https://www.dhs.wisconsin.gov/regulations/asc/certification.htm
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ASC Specialty Hub
Related GoHealthcare Resources
- ASC Specialty Hub — the other twelve pages listed in the Page Index at the front of this document, available in the GoHealthcare Knowledge Center at https://www.gohealthcarellc.com
- GoHealthcare MSK Specialty Procedure Library™ — procedure-specific operational guides across interventional pain, spine surgery, neuromodulation, orthopedic surgery, and peripheral nerve procedures.
- GoHealthcare Revenue Cycle Knowledge Center — detailed reimbursement methodology, fee schedule analysis, payment rate modeling, edit tables, and revenue cycle analytics, which are intentionally outside the scope of the Procedure Library.
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Document History
| Version | Date | Summary of changes | Prepared by |
|---|---|---|---|
| 1.0 | August 3, 2026 | Initial publication. Volume 3 of the four-volume ASC State Regulatory Profiles series. Citation-level profiles for twelve Midwest and Great Plains states, including Wisconsin's absence of any state ASC licensure requirement; Iowa's new licensure regime under Iowa Code Chapter 135R with a serious misdemeanor penalty and published inspection findings; Illinois's procedure-specific licensure and immediate-effect disapproval power; Ohio's dual Medicare prior authorization exposure and its ASF definition reaching operations inside inpatient buildings under separate operators; Michigan's CON access conditions and payer-mix reporting; Minnesota's low-risk patient definition; and Kansas's physician discharge evaluation requirement. Three profiles carry explicitly unverified licensure citations. | GoHealthcare Practice Solutions, under the leadership of Pinky Maniri, Founder and Chief Executive Officer |
On Document Currency
This page carries a Publication Date and a Document Version rather than a scheduled review date. GoHealthcare's editorial standard is that a published review date becomes a public commitment the moment it lapses. Currency is communicated through version releases and through the verification standards stated throughout this document.
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ASC Specialty Hub
Educational Disclaimer and Terms of Use
This document is published by GoHealthcare Practice Solutions, under the leadership of Pinky Maniri, Founder and Chief Executive Officer. The following terms govern its use.
- Purpose and limitation of purpose. This document is provided solely for educational and operational reference purposes. It is intended to help healthcare professionals understand the operational, documentation, payer, coding, compliance, and reimbursement environment surrounding ambulatory surgical center services. It is not a clinical practice guideline, a procedural technique manual, a physician training resource, an accreditation manual, or a substitute for the specialty society guidance, clinical textbooks, and procedural training on which clinical practice properly depends.
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- Not medical advice. Nothing in this document constitutes medical advice or a recommendation regarding the care of any individual patient. All clinical decisions, including patient selection, site-of-service determination, procedure selection, and discharge, remain the exclusive responsibility of the treating physician exercising independent clinical judgment in the context of the individual patient's circumstances.
- Not legal advice. Nothing in this document constitutes legal advice or an opinion on the lawfulness of any arrangement, structure, policy, billing practice, or course of conduct. Matters involving the Anti-Kickback Statute, the Physician Self-Referral Law (Stark), the False Claims Act, the Civil Monetary Penalties Law, state fraud and abuse law, state licensure and certificate of need requirements, corporate practice of medicine, ownership and investment structures, contracting, employment, and privacy should be reviewed by qualified healthcare counsel before implementation.
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- Corrections and contact. GoHealthcare Practice Solutions welcomes correction. If you identify an error, an outdated citation, or a coverage position that has changed, please contact GoHealthcare Practice Solutions through https://www.gohealthcarellc.com so that it can be evaluated and, where warranted, corrected in a subsequent version and reflected in the Document History.
Educational Disclaimer — Summary
This document was developed by GoHealthcare Practice Solutions, under the leadership of Pinky Maniri, Founder and Chief Executive Officer — MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in Healthcare A.I. Governance.
It is educational and operational reference material only. It does not replace physician clinical judgment, payer policy review, legal advice, accreditation standards, or official CMS guidance. Coverage policies, coding guidance, and reimbursement requirements must always be verified with the applicable payer and current regulatory sources.
GoHealthcare Practice Solutions — a national Musculoskeletal Specialty Management Services Organization. Website: https://www.gohealthcarellc.com
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GoHealthcare Practice Solutions supports ambulatory surgery centers and musculoskeletal organizations across patient access, prior authorization, clinical documentation, coding alignment, denial prevention, revenue cycle management, compliance, performance analytics, and healthcare AI governance.
Developed by
Pinky Maniri
MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in Healthcare A.I. Governance
Founder and Chief Executive Officer, GoHealthcare Practice Solutions