ASC SPECIALTY HUB — PAGE 13 OF 13

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ASC State Regulatory Profiles — Volume Four

West, Southwest, and Non-Contiguous — Licensure, Need Review, Medicare Program Exposure, and Utilization Review Law in Fifteen States

The fourth and final volume of the GoHealthcare ASC State Regulatory Profiles series, covering Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming — the region carrying the heaviest Medicare prior authorization exposure and the strongest state artificial intelligence utilization review statutes in the country.

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Important Notice — Read Before Use

This document is an educational and operational reference. It is not medical advice, legal advice, coding advice, or a substitute for physician clinical judgment, official CMS guidance, accreditation standards, state licensure requirements, or the applicable payer's own written policy.

Coverage rules, payment rates, quality reporting requirements, prior authorization criteria, state law, and coding conventions change frequently and often without broad notice. Every code, policy citation, effective date, and payment figure must be independently verified against the current primary source before it is relied upon for a clinical, billing, contracting, or compliance decision.

Publication Information

Document Control

Document Title	ASC State Regulatory Profiles — Volume Four — West, Southwest, and Non-Contiguous — Licensure, Need Review, Medicare Program Exposure, and Utilization Review Law in Fifteen 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 West, Southwest, and Non-Contiguous, 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

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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

ASC State Regulatory Series

• State Regulatory Reference
• Volume 1 - Northeast and Mid-Atlantic
• Volume Two - South and Southeast
• Volume Three - Midwest and Great Plains
• Volume Four - West, Southwest and Non-Contiguous

On This Page

Explore This Guide

Use the links below to move directly to each section.

Core Guidance

1. Scope and Method of This Volume
2. Alaska
3. Arizona
4. California
5. Colorado
6. Hawaii
7. Idaho
8. Montana
9. Nevada
10. New Mexico
11. Oklahoma
12. Oregon

References, Governance and Supporting Material

13. Texas
14. Utah
15. Washington
16. Wyoming
17. Volume 4 Comparative Summary
18. Regional Operating Observations
19. Key Takeaways
20. Series Completion and Maintenance
21. References
22. Related GoHealthcare Resources
23. Document History
24. Educational Disclaimer and Terms of Use

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ASC Specialty Hub

Scope and Method of This Volume

This volume is the fourth and final volume in the GoHealthcare ASC State Regulatory Profiles series. It covers fifteen Western, Southwestern, and non-contiguous states: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming.

Concentration of Medicare Prior Authorization Exposure

This volume carries the heaviest Medicare prior authorization exposure of the four. Arizona, Texas, and Washington are WISeR Model states. Arizona and Texas are also ASC Prior Authorization Demonstration Phase 2 states, and California is a Phase 1 state. Oklahoma is a WISeR state. Arizona and Texas are two of the only three states in the country subject to both Medicare programs.

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.

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Alaska

Licensing authority	Alaska Department of Health — health facility licensing and certification. 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 statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Alaska maintains a certificate of need program. Reporting in the sources consulted indicates that Alaska's CON law has been characterized as not applicable to ambulatory surgery centers. This is precisely the kind of distinction that must be confirmed with the State, because the certificate of need scan records program existence rather than ASC applicability.
Medicare prior authorization	Not a WISeR state. Not an ASC Prior Authorization Demonstration state.
State utilization review law	Prior authorization decision timelines effective 2026 — among the fastest enacted, requiring decisions within 72 hours for routine requests and 24 hours for expedited requests.

Operational Note

Alaska's 24-hour expedited and 72-hour routine decision requirement is materially faster than the federal CMS-0057-F baseline. For a center operating across state lines, the escalation cadence for Alaska plans should be set to the state clock, not the federal one.

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Arizona

Licensing authority	Arizona Department of Health Services — health care institution licensure. Confirm the specific licensure class and administrative code article with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Accreditation	Arizona has historically been reported as a state requiring accreditation for ambulatory surgical facilities. Confirm current status directly with the Department, as the source for that characterization is dated.
Need review	Arizona is a non-CON jurisdiction under the certificate of need scan consulted.
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; WISeR applies to the select items and services list from January 15, 2026. Two distinct Medicare prior authorization regimes apply, with different service lists, submission channels, and review entities.
State utilization review law	AI-in-utilization-review legislation enacted. Confirm the current text and effective date.

Operational Note

Arizona is one of three states subject to both Medicare prior authorization programs reaching ASCs. The single most valuable control an Arizona center can build is a scheduling-stage screen that checks every traditional Medicare case against both the WISeR select items and services list and the five ASC demonstration categories, and captures the unique tracking number from whichever program applies.

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California

Licensing authority	California Department of Public Health (CDPH), Center for Health Care Quality, Licensing and Certification Program — for licensed surgical clinics. The Medical Board of California approves accrediting agencies for outpatient settings.
Facility category	California licenses a surgical clinic (SURGC) as a specialty clinic, not an "ambulatory surgery center." Health and Safety Code § 1204(b)(1) defines a surgical clinic as a clinic that is not part of a hospital and that provides ambulatory surgical care for patients who remain less than 24 hours. The definition excludes any place or establishment owned or leased and operated as a clinic or office by one or more physicians or dentists in individual or group practice, regardless of the name used publicly — though such physicians or dentists may apply for licensure at their option.
The Capen decision	A 2007 California Court of Appeal decision ended state licensure of physician-owned ASCs. CDPH states that where a surgical clinic is owned by a physician or group of physicians in whole or in part, CDPH does not have authority to license the clinic per the Capen decision, and the clinic qualifies for exemption from licensure under HSC § 1206(a). To qualify as a license-exempt ASC under § 1206(a), the practitioner must be licensed by the Medical Board of California as a physician and surgeon under 22 CCR § 73085.
Accreditation for unlicensed centers	California requires unlicensed ASCs to be accredited where they administer general anesthesia, under HSC § 1248.1. Accrediting agencies are approved by the Medical Board of California under HSC §§ 1248.15 and 1248.4. For facilities using only local anesthesia or peripheral nerve blocks, accreditation has not been required.

Licensed clinic standards	Licensed surgical clinics comply with federal certification standards as the basis for state licensing under HSC § 1225(c)(2). Facilities intended to be licensed by CDPH require OSHPD-3 certification through the Department of Health Care Access and Information (HCAI, formerly OSHPD).
Medicare certification for exempt centers	Physician-owned centers exempt from state licensure may still obtain Medicare certification, processed through the CDPH Centralized Applications Branch in coordination with the local district office. CDPH must survey for compliance with NFPA 101 Life Safety Code at the Ambulatory Health Care Occupancy level, in addition to California Building Code, local permitting, and Title 24 requirements.
Application processing	All Facilities Letter 25-19 advised that, effective July 1, 2025, incomplete applications submitted to the Centralized Applications Branch will be denied.
Corporate practice of medicine	California's corporate practice of medicine doctrine, codified at Business and Professions Code § 2400, constrains ownership, governance, and operational control structures. A structural misstep can jeopardize licensing, Medicare enrollment, and the legal foundation of the enterprise.
Need review	California is a non-CON jurisdiction.
Medicare prior authorization	ASC Prior Authorization Demonstration Phase 1 state. Requests accepted from January 5, 2026 for dates of service on or after January 19, 2026. Not a WISeR state.
State utilization review law	SB 1120 governs AI in utilization review, requiring that decisions rest on the enrollee's individual clinical history rather than group data alone. SB 598 imposes decision timelines tighter than the federal baseline — reported as 72 hours for standard non-urgent and 24 hours for urgent requests. Confirm the operative text.

Operational Note

California is the most structurally distinctive ASC environment in the country. Whether a center is licensed at all turns on ownership, and whether it must be accredited turns on anesthesia level. The practical consequence is that ownership structure, anesthesia plan, and licensure status are one interlocking decision, not three sequential ones — and the corporate practice of medicine doctrine constrains the ownership variable. Resolve all three with California counsel before signing a lease.

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Colorado

Licensing authority	Colorado Department of Public Health and Environment — health facilities and emergency medical services licensure. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Colorado is a non-CON jurisdiction.
Medicare prior authorization	Not a WISeR state. Not an ASC Prior Authorization Demonstration state.
State utilization review law	HB 1139 governs AI in utilization review across insurers, pharmacy benefit managers, private utilization review organizations, behavioral health administrative services organizations, and managed care entities — requiring that AI used for utilization review base decisions on the patient's individual clinical history rather than group data alone, not be applied in a discriminatory way, and be periodically audited for accuracy. Gold carding legislation is also active.

Operational Note

Colorado's HB 1139 is one of the broadest AI utilization review statutes by covered entity type, reaching private utilization review organizations directly. That matters for MSK centers, because most commercial MSK denials are issued by a delegated vendor rather than the plan itself.

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Hawaii

Licensing authority	Hawaii Department of Health — Office of Health Care Assurance. Confirm the specific licensure chapter with the Office.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Hawaii maintains a certificate of need program administered through the State Health Planning and Development Agency. Legislation to exempt ambulatory surgery centers from the CON process has been actively debated, with the administration and the hospital association opposing exemption on the ground that nonprofit hospitals rely on surgical revenue to offset uncompensated care. Confirm the current status before assuming either outcome.
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

Hawaii is the clearest example of an active, contested CON debate specific to ambulatory surgery. Any Hawaii development analysis should be dated and re-verified each legislative session rather than carried forward.

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Idaho

Licensing authority	Idaho Department of Health and Welfare — facility licensing and certification. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Idaho is a non-CON jurisdiction.
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.

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Montana

Licensing authority	Montana Department of Public Health and Human Services — health facility licensure. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Montana appears in the certificate of need program scan as maintaining a program, but Montana substantially repealed its CON law in 2021, and reporting since indicates growth in ambulatory surgery centers, home health agencies, and treatment centers following repeal. This is a clear instance where program existence and ambulatory surgery applicability diverge. Confirm current ASC applicability directly with the State.
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

Montana is the reason this series does not report certificate of need as a simple yes or no. A national scan can record a state as having a CON program while that program no longer reaches ambulatory surgery. Always confirm applicability, not just existence.

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Nevada

Licensing authority	Nevada Department of Health and Human Services, Division of Public and Behavioral Health — Health Care Quality and Compliance. Confirm the specific licensure chapter with the Division.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Nevada maintains a certificate of need program. 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	No AI-in-utilization-review enactment identified in the sources consulted.

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New Mexico

Licensing authority	New Mexico Department of Health — Division of Health Improvement, health facility licensing and certification. Confirm the specific licensure chapter with the Division.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	New Mexico is a non-CON jurisdiction.

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.

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Oklahoma

Licensing authority	Oklahoma State Department of Health — Medical Facilities Service. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Oklahoma maintains a certificate of need program of limited scope. Confirm current ambulatory surgery applicability directly with the State.
Medicare prior authorization	WISeR Model state. The select items and services list applies to Original Medicare fee-for-service from January 15, 2026 through the model period. Not an ASC Prior Authorization Demonstration state.
State utilization review law	Prior authorization decision timeline legislation enacted. Confirm the operative timelines.

Operational Note

Oklahoma's WISeR participation is the operationally dominant fact for an MSK center in the state, because the select items and services list is weighted toward interventional pain and spine procedures. Build the screening step and the unique tracking number capture into scheduling before anything else.

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Oregon

Licensing authority	Oregon Health Authority — Health Facility Licensing and Certification Program. Confirm the specific licensure chapter with the Authority.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Oregon maintains a certificate of need program. 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	No AI-in-utilization-review enactment identified in the sources consulted.

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Texas

Licensing authority	Texas Health and Human Services Commission (HHSC), Regulatory Services Division. HHSC is responsible for licensing and regulating ambulatory surgical centers in Texas.
Statutory basis	Texas Ambulatory Surgical Center Licensing Act, Texas Health and Safety Code Chapter 243. Surgical technologist practice is defined at Health and Safety Code Chapter 259.
Licensure regulation	Note a recent renumbering. On January 31, 2025, HHSC administratively transferred the ASC rules from 25 TAC Chapter 135 to 26 TAC, Part 1, Chapter 508. HHSC publishes a crosswalk of the transferred rules. Legacy citations to 25 TAC Chapter 135 — including § 135.2 (definitions), § 135.20 (initial application and issuance of license), and Subchapter B (fire prevention and safety requirements) — remain useful for locating historical text but should be updated to the 26 TAC citation in current documents.
Administrator qualification	The rules define an administrator as a person who is a physician, is a registered nurse, holds a baccalaureate or postgraduate degree in administration or a health-related field, or has one year of administrative experience in a health care setting.
Initial licensing survey	During the initial licensing period the department conducts a survey to ascertain compliance with Chapter 243 and the rules. The ASC must request an on-site survey after providing services to a minimum of one patient and must be providing services at the time of the survey. Where the ASC has applied to participate in Medicare, the Medicare survey may be conducted in conjunction with the licensing survey. The initial licensing survey may be waived where the ASC provides documented evidence of accreditation by The Joint Commission, AAAHC, or AAAASF together with Medicare deemed status.
Annual reportable events	On license renewal, an ASC must submit an annual report listing the number of occurrences at the center or at an outpatient facility it owns or operates of specified events during the preceding year, including medication errors resulting in unanticipated death or major permanent loss of bodily function unrelated to the natural course of the condition, patient suicide, sexual assault of a patient during treatment or on the premises, and hemolytic transfusion reactions. The department accepts, in lieu of its own form, a copy of a report submitted to a patient safety organization. The department compiles and publishes a best practices summary that may not identify a specific center, individual, or event.
Need review	Texas is a non-CON jurisdiction.
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	HB 3459 gold card law waives prior authorization for providers meeting a 90 percent approval rate for a service over the prior look-back period; rollout across payers has been reported as uneven. SB 815 prohibits artificial intelligence as the sole basis for an adverse determination.

Operational Note

Two Texas items to act on immediately. First, update every internal citation from 25 TAC Chapter 135 to 26 TAC Chapter 508 — policies and manuals still citing the old chapter will read as out of date to a surveyor. Second, Texas is one of three states subject to both Medicare prior authorization programs, and it also operates the country's best-known gold card statute. Track physician-level approval rates against the 90 percent threshold deliberately; in Texas that tracking has statutory consequence, not just administrative benefit.

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Utah

Licensing authority	Utah Department of Health and Human Services — health facility licensing. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Need review	Utah is a non-CON jurisdiction.
Medicare prior authorization	Not a WISeR state. Not an ASC Prior Authorization Demonstration state.
State utilization review law	Prior authorization reform enacted — shortening response timelines to 72 hours for urgent requests and seven calendar days for non-urgent requests, and providing that prior authorizations for chronic conditions remain valid for 12 months. Utah also imposes AI disclosure requirements on entities conducting utilization review, including disclosure to the public, the department of insurance, network providers, and each enrollee, and operates a regulatory sandbox program for AI innovation.

Operational Note

Utah's twelve-month authorization validity for chronic conditions is unusual and directly useful in MSK. Where a patient's condition qualifies, it can eliminate repeat authorization cycles across a treatment course. Confirm which conditions the statute reaches before relying on it.

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Washington

Licensing authority	Washington State Department of Health. The Legislature enacted ASC licensure in 2007; licensure is required to operate an ambulatory surgical facility in the state.
Statutory basis	Chapter 70.230 RCW.
Licensure regulation	Chapter 246-330 WAC, adopted by the Department of Health on April 7, 2009 to implement the statute.
Inspection cycle	Effective July 1, 2009, the law provided for on-site inspections of licensed ASCs at least every eighteen months.
Need review	Certificate of need applies. The definition of ambulatory surgical facility for CON purposes appears at WAC 246-310-010(5), and the Department has issued an interpretive statement addressing that definition (CN 01-18). Confirm the current interpretation and thresholds directly with the Department.
Medicare prior authorization	WISeR Model state. The select items and services list applies to Original Medicare fee-for-service from January 15, 2026. Not an ASC Prior Authorization Demonstration state.

State utilization review law

SB 5395, effective June 11, 2026 — among the most comprehensive state limits on AI in prior authorization, governing health carriers, health care benefit managers, and public employee health plans. Only a licensed physician or licensed health professional acting within scope may deny a prior authorization request based on medical necessity, and insurers may not rely solely on AI to make such denial decisions. A human reviewer must evaluate the specific clinical issues by reviewing the requesting provider's recommendation, the enrollee's medical or clinical history, and the enrollee's individual clinical circumstances. Where a carrier uses AI in prior authorization involving medical necessity, the AI review criteria must include the enrollee's individual medical history and clinical circumstances and not solely group data. Washington is also banning nearly all non-compete agreements beginning June 30, 2027, which affects physician and staff employment structures.

Operational Note

Washington pairs the country's most comprehensive AI utilization review statute with WISeR participation. That combination creates an unusually strong documentation posture for a Washington MSK center: capture reviewer name, credential, and decision timestamp on every commercial adverse determination, because SB 5395 gives you a procedural argument that most states do not — and note that the federal WISeR review sits outside state insurance law entirely.

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Wyoming

Licensing authority	Wyoming Department of Health — Healthcare Licensing and Surveys. Confirm the specific licensure chapter with the Department.
Statutory and regulatory basis	Not located in the sources consulted during preparation. Confirm the governing statute and administrative code chapter, the current text, and the licensing contact directly with the state agency before relying on any assumption about scope or process.
Accreditation	Wyoming has historically been reported as a state where accreditation is required and state licensure is not required for ambulatory surgical facilities. The source for that characterization is dated and must be confirmed with the Department before it is relied upon.
Need review	Wyoming is a non-CON jurisdiction.
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.

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Volume 4 Comparative Summary

State	Licensure citation	Need review	Medicare PA
Alaska	Not located — confirm with DOH	CON program exists; ASC applicability reported as excluded — confirm	--
Arizona	Not located — confirm with ADHS	Non-CON	WISeR + ASC Demo Phase 2
California	HSC §§ 1204(b)(1), 1206(a), 1248.1, 1225(c)(2); CDPH; MBC accreditation	Non-CON	ASC Demo Phase 1
Colorado	Not located — confirm with CDPHE	Non-CON	--

State	Licensure citation	Need review	Medicare PA
Hawaii	Not located — confirm with DOH	CON — SHPDA; ASC exemption actively debated	--
Idaho	Not located — confirm with DHW	Non-CON	--
Montana	Not located — confirm with DPHHS	CON substantially repealed 2021 — confirm ASC applicability	--
Nevada	Not located — confirm with DPBH	CON — confirm applicability	--
New Mexico	Not located — confirm with DOH	Non-CON	--
Oklahoma	Not located — confirm with OSDH	CON of limited scope	WISeR
Oregon	Not located — confirm with OHA	CON — confirm applicability	--
Texas	HSC ch. 243; 26 TAC Pt. 1 ch. 508 (formerly 25 TAC ch. 135); HHSC	Non-CON	WISeR + ASC Demo Phase 2
Utah	Not located — confirm with DHHS	Non-CON	--
Washington	Ch. 70.230 RCW; ch. 246-330 WAC; DOH	CON — WAC 246-310-010(5)	WISeR
Wyoming	Not located — confirm with DOH	Non-CON	--

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Regional Operating Observations

• This is the Medicare prior authorization region. Four of the six WISeR states are here — Arizona, Oklahoma, Texas, and Washington — along with two of the three ASC Demonstration Phase 2 states and one Phase 1 state. An MSK center in Arizona or Texas operates under two federal prior authorization regimes simultaneously.
• California's licensure question is an ownership question. Under the Capen decision and HSC § 1206(a), a physician-owned surgical clinic is exempt from CDPH licensure; accreditation is then required only where general anesthesia is administered. Ownership structure, anesthesia plan, and licensure status are one interlocking decision.
• Texas renumbered its ASC rules on January 31, 2025, moving from 25 TAC Chapter 135 to 26 TAC Chapter 508. Internal citations should be updated.
• Certificate of need existence and applicability diverge most visibly here. Montana substantially repealed its CON law in 2021 while still appearing in national program scans; Alaska's program has been reported as not reaching ASCs; Hawaii's ASC exemption is actively contested. Confirm applicability, never just existence.
• Three of the strongest state utilization review statutes in the country sit in this region. Washington SB 5395 requires a licensed human decision-maker and individualized clinical review for medical necessity denials; California SB 1120 requires individual clinical history; Colorado HB 1139 reaches private utilization review organizations directly and requires periodic accuracy audits.
• Utah and Alaska have the most favorable authorization timing provisions — Utah's twelve-month validity for chronic conditions and Alaska's 24-hour expedited and 72-hour routine decision requirement.
• Texas operates the country's best-known gold card statute (HB 3459, 90 percent approval threshold), with reported uneven payer rollout. Physician-level approval rate tracking has statutory consequence in Texas.
• Nine of the fifteen profiles in this volume carry an unverified licensure citation. That is stated plainly. These are predominantly smaller ASC markets where a single verification call to the state agency will close the gap, and the operationally decisive facts — CON status and Medicare program participation — are verified for every state in the volume.

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Key Takeaways

• Arizona and Texas are subject to both Medicare prior authorization programs reaching ASCs; Oklahoma and Washington are WISeR states; California is an ASC Demonstration Phase 1 state.
• California licenses surgical clinics, not ASCs, and physician-owned centers are exempt from licensure under the Capen decision — with accreditation required where general anesthesia is used.
• Texas moved its ASC rules to 26 TAC Chapter 508 effective January 31, 2025 and can waive the initial licensing survey for accredited, Medicare-deemed centers.
• Washington inspects licensed ASCs at least every eighteen months and has enacted the most comprehensive state AI utilization review statute.
• Montana, Alaska, and Hawaii illustrate why certificate of need applicability must be confirmed rather than inferred from a national program list.
• Where a licensure citation was not verified, this volume says so. A stated gap is more useful than an unverifiable citation.

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Series Completion and Maintenance

This volume completes the four-volume ASC State Regulatory Profiles series covering all fifty states and the District of Columbia. The series should be maintained as a living reference: state legislatures act annually, health agencies reorganize, and administrative codes are renumbered. Three maintenance disciplines keep it usable.

1. Annual verification for every jurisdiction in which the organization operates. Confirm the licensure citation, the need-review posture, and the renewal and reporting calendar with the state agency, and record the verification date and verifier.
2. Legislative-session monitoring for prior authorization and AI enactments. This is the fastest-moving layer. More than a hundred healthcare AI bills have been introduced across a majority of states, and decision-timeline and gold card statutes continue to be enacted and amended.
3. Program-version monitoring for the two Medicare prior authorization programs. WISeR select items and services and participant assignments change by operational guide version; the ASC Demonstration phase dates and code list are published and updated by CMS. Neither should be maintained inside a durable document.

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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.

1. 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/
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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/
8. Georgetown University Center on Health Insurance Reforms. Prior Authorization Reform Heats Up. Website: https://chir.georgetown.edu/prior-authorization-reform-heats-up/
9. GoHealthcare Practice Solutions Knowledge Center. Website: https://www.gohealthcarellc.com
10. California Department of Public Health. Ambulatory Surgery Center FAQs. Website: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/Ambulatory-Surgery-Center-FAQs.aspx
11. California Legislative Information. Health and Safety Code § 1204. Website: https://law.justia.com/codes/california/code-hsc/division-2/chapter-1/article-1/section-1204/
12. California Department of Industrial Relations. 8 CCR § 9789.30 — Hospital Outpatient Departments and Ambulatory Surgical Centers, Definitions. Website: https://www.dir.ca.gov/t8/9789_30.html
13. Texas Health and Human Services. Ambulatory Surgical Centers — licensing, Health and Safety Code Chapter 243, and the January 31, 2025 transfer of rules from 25 TAC Chapter 135 to 26 TAC Chapter 508. Website: https://www.hhs.texas.gov/providers/health-care-facilities-regulation/ambulatory-surgical-centers
14. Texas Administrative Code. 25 TAC § 135.20, Initial Application and Issuance of License (historical citation; transferred to 26 TAC Chapter 508). Website: http://txrules.elaws.us/rule/title25_chapter135_sec.135.20
15. Texas Health and Safety Code Chapter 243, Ambulatory Surgical Centers. Website: https://statutes.capitol.texas.gov/GetStatute.aspx?Code=HS&Value=243
16. Washington Ambulatory Surgery Center Association. State Regulations — chapter 70.230 RCW and chapter 246-330 WAC. Website: https://wasca.net/resources/state-regulations/
17. Healthcare Financial Management Association. Certificate of need legislation — 2026 state activity, including Hawaii ambulatory surgery center exemption debate. Website: https://www.hfma.org/fast-finance/certificate-of-need-legislation-2026-states/
18. Becker's ASC Review. The certificate-of-need shakeup: 7 states updating policies. Website: https://www.beckersasc.com/new-asc-development/the-certificate-of-need-shakeup-7-states-updating-policies/
19. Sheppard Mullin. Additional States Continue Legislative Trend with New Laws Limiting Use of Artificial Intelligence in Health Insurance Determinations. Website: https://www.sheppard.com/insights/blogs/additional-states-continue-legislative-trend-with-new-laws-limiting-use-of-artificial-intelligence-in-health-insurance-determinations

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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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ASC Specialty Hub

Document History

Version	Date	Summary of changes	Prepared by
1.0	August 3, 2026	Initial publication. Volume 4 of the four-volume ASC State Regulatory Profiles series, completing coverage of all fifty states and the District of Columbia. Citation-level profiles for fifteen Western, Southwestern, and non-contiguous states, including California's Capen-decision licensure exemption for physician-owned surgical clinics and its anesthesia-triggered accreditation requirement; Texas's January 31, 2025 transfer of ASC rules from 25 TAC Chapter 135 to 26 TAC Chapter 508, its initial survey waiver, and its annual reportable events obligation; Washington's eighteen-month inspection cycle and SB 5395 AI utilization review statute; the concentration of WISeR and ASC Prior Authorization Demonstration participation across Arizona, Oklahoma, Texas, Washington, and California; and the divergence between certificate of need program existence and ambulatory surgery applicability in Montana, Alaska, and Hawaii. Nine profiles carry explicitly unverified licensure citations. Includes series completion and maintenance guidance.	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.

1. 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.
2. No professional relationship. Use of this document does not create a physician-patient relationship, an attorney-client relationship, a consulting engagement, or any other professional relationship between the reader and GoHealthcare Practice Solutions or any of its personnel. No confidential relationship is formed by reading, downloading, distributing, or relying upon this document.
3. 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.
4. 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.
5. Coding limitations and compliance responsibility. Coding content in this document is a general operational orientation only. It does not constitute coding advice, certification, or a guarantee of payment. Code selection, modifier application, and claim submission are the responsibility of the submitting entity. Inaccurate or unsupported claim

1. submission may carry consequences under the False Claims Act, the Civil Monetary Penalties Law, the Anti-Kickback Statute, and the Physician Self-Referral Law, among other authorities. All coding must be supported by the medical record and verified against current official code descriptors and the applicable payer's current policy.
2. No guarantee of coverage, payment, or authorization outcome. Nothing in this document guarantees that any payer will authorize any service, cover any procedure, or pay any claim. Coverage determinations, authorization decisions, and payment outcomes rest with the applicable payer under its own policies and the governing contract.
3. Currency limitations. Coverage policies, national and local coverage determinations, payment rates, conversion factors, covered procedures lists, quality reporting requirements, correct coding edits, utilization management criteria, demonstration and model parameters, state statutes and regulations, and applicable law change frequently and often without broad notice. Information in this document reflects sources available as of the Publication Date and may become inaccurate at any time thereafter. Every material fact should be independently verified against the current primary source before reliance.
4. Payer content and artificial intelligence processing. Summaries of payer coverage policies and utilization management criteria in this document are original synthesis prepared for educational purposes and are not reproductions of payer manuals or proprietary criteria sets. Payer clinical policy content may be subject to use restrictions, including restrictions on reproduction, redistribution, and ingestion into artificial intelligence systems. Readers who intend to process payer-derived content through artificial intelligence systems should confirm the applicable license terms and obtain legal review before doing so.
5. Artificial intelligence-assisted authorship disclosure. Research synthesis, drafting, and production of this document were assisted by artificial intelligence tools under human editorial direction. All substantive content was reviewed by GoHealthcare Practice Solutions. Codes, coverage citations, regulatory references, effective dates, and payment figures were verified against primary sources during preparation. Notwithstanding that verification, readers must independently confirm all information before operational, billing, contracting, clinical, or compliance reliance.
6. Prohibition on use for artificial intelligence model training. This document may not be used, in whole or in part, to train, fine-tune, evaluate, or otherwise develop any artificial intelligence or machine learning model, nor incorporated into any dataset, corpus, retrieval index, or embedding store used for such purposes, without the express prior written permission of GoHealthcare Practice Solutions.
7. Intellectual property and permitted use. This document and the GoHealthcare MSK Specialty Procedure Library™ are the property of GoHealthcare Practice Solutions. It may be read, printed, and shared internally within a healthcare organization for educational purposes with attribution intact. It may not be modified, resold, republished, incorporated into a commercial product, or presented as the work of another party.
8. Third-party trademarks. CPT® is a registered trademark of the American Medical Association. All other product names, brand names, company names, and trademarks referenced are the property of their respective owners. Reference to any organization, payer, utilization management entity, device manufacturer, accreditation body, or product is for identification and educational purposes only and does not imply endorsement, affiliation, sponsorship, or any relationship between that party and GoHealthcare Practice Solutions.
9. External websites. Website addresses are provided for reader convenience. GoHealthcare Practice Solutions does not control third-party websites and is not responsible for their content, availability, accuracy, or continued existence. Inclusion of a website address does not constitute endorsement.
10. Limitation of liability. To the fullest extent permitted by law, GoHealthcare Practice Solutions and its personnel disclaim all liability for any loss, damage, claim, penalty, denial, recoupment, or adverse outcome arising from use of, or reliance upon, this document. Use is entirely at the reader's own risk and professional discretion.
11. 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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Founder and Chief Executive Officer, GoHealthcare Practice Solutions

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