As the healthcare industry grapples with financial pressures, the demand for cost-effective and high-quality outpatient care means ambulatory surgery centers (ASCs) are poised for growth. But for ASCs, opportunity is not without complexity. The regulatory environment is changing rapidly, and ASCs need be nimble, vigilant, and adaptive.
Below are six key regulatory changes that ASC organizations must be mindful of in the coming year.
1. CMS-Proposed ASC Payment Rate Increase
For CY 2026, CMS has proposed a 2.4% payment rate increase for both HOPDs and ASCs that meet quality reporting requirements, which CMS estimates will result in approximately $480 million more in payments to ASCs compared to 2025. This increase is intended to align ASC payments with rising operational costs, but it may not be enough to offset the dramatic rise in expenses the past few years, particularly staffing.
How to Prepare: ASCs should ensure that they remain compliant with reporting requirements under the ASC Quality Reporting (ASCQR) program to benefit from the rate increase. Even with this rate increase, ASCs will need to continue to optimize efficiencies to reduce cost as well as maintain updated payer contracts to maximize profitability.
2. ASC Covered Procedures List (CPL) Expansion and Inpatient-Only (IPO) List Removal
For CY 2026, CMS has proposed removing 271 codes from the IPO list, with a plan to phase out the IPO list over three years. Additionally, CMS is proposing adding 276 CPT codes to the ASC CPL. This rule change will further enable continued case migration into ASCs as payers and providers look to introduce more complex procedures from hospitals to ASCs.
How to Prepare: ASCs must assess their ability to meet the increased demand for services as more cases can be performed outside of the hospital. Hospitals will benefit from assessing potential case out-migration and solutions for replacing those cases that transition to lower-cost-of-care settings.
3. Certificate of Need (CON) Law Changes
The CON landscape is continually evolving, with states frequently evaluating and adjusting their regulations, which has a major impact on ASC growth. Because CON laws vary significantly by state, ASC growth strategies must be tailored to their regulatory environment. Organizations in relaxed CON states such as Florida and California will have a lower barrier for entry but may face high competition, as evidenced by those two states having the largest number of ASCs in the country. Conversely, in states with larger regulatory hurdles, such as New York, existing ASCs may benefit from the limited competition from lack of new entrants but may have difficulty expanding.
How to Prepare: ASC organizations should continue to survey the CON landscape in their local markets to understand potential changes and refine their strategy accordingly.
4. One Big Beautiful Bill Act (OBBBA) Impacts
OBBBA was passed in July 2025 and includes sweeping changes to the Affordable Care Act (ACA) and Medicaid policy. Changes include coverage losses from OBBBA-related Medicaid restrictions pertaining to loss of federal funding and state budget decisions, ACA subsidy reductions, and rule codifications. New work and reporting requirements for Medicaid enrollees will reduce eligibility and increase churn, especially in nonexpansion states. Expiration of enhanced premium tax credits and codified rule changes will raise out-of-pocket costs, driving millions off ACA plans.
One potential outcome of OBBBA is an increase in uninsured and underinsured patients, resulting in declining revenue for ASCs in areas with a high Medicaid population or that perform cases that typically include a higher Medicaid volume, such as ENT and dental cases.
On the other hand, changes to insurance coverage may boost volume growth because of increased demand from patients seeking lower-cost sites of service, as ASCs can offer a more cost-effective option for many patients who are facing higher out-of-pocket costs.
How to Prepare: ASCs should review and prepare for potential changes in their payer mix based on market conditions and trends and evaluate how changes may impact their revenue projections.
5. Site-Neutral Payments
Momentum is building to expand site-neutral payments, whereby payers pay the same amount for the same medical service regardless of where it is performed. If reimbursement differentials shrink between HOPDs and ASCs, the demand for ASCs will grow, as patients and payers will be incentivized to have cases performed in a lower-cost setting.
How to Prepare: While there is likely to be significant industry pushback for these legislative changes, ASC organizations should still evaluate their ability to meet this future demand and craft a strategy to accommodate the potential case volume increase.
6. Medicare Wasteful and Inappropriate Service Reduction (WISeR) 2026 Rollout
The WISeR model is a new pilot program that CMS is launching on January 1, 2026, and running through 2031, to test an AI-enabled expedited preauthorization process for certain procedures that the government considers prone to waste and overuse. This program will apply in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington with an intended goal of lowering Medicare spending by reducing medically unnecessary care.
How to Prepare: ASCs in the model states should be aware of the WISeR model preauthorization process and prepare to modify policies to follow the regulations and minimize denials for their patients.
Further reading: Facing Intensifying Pressures, ASCs Focus on Sustainability
