Ambulatory Surgery
The Maryland Health Care Commission (MHCC) regulates ambulatory surgery centers and facilities across the state to support quality care, appropriate capacity, and oversight of outpatient surgical services. This page provides an overview of how ambulatory surgery services are regulated in Maryland, along with access to facility data, reports, and information on regulatory processes.
About Ambulatory Surgery in Maryland
An ambulatory surgery facility (ASF), and an ambulatory surgery center (ASC), are both licensed health care facilities that provides same-day surgical services to patients who do not require an overnight hospital stay. These facilities perform a wide range of procedures across multiple specialties in a controlled, outpatient setting.
In Maryland, the distinction between an ASC and an ASF is based on the number of operating rooms: an ASC has two or fewer operating rooms, while an ASF has three or more operating rooms. This distinction is important because facilities with three or more operating rooms are subject to Certificate of Need (CON) review requirements.
The Maryland Health Care Commission (MHCC) regulates ASFs through the CON program. MHCC reviews and approves the establishment, expansion, or modification of ASFs to ensure that proposed projects are consistent with State Health Plan standards, meet community need, and do not result in unnecessary duplication of health care services. MHCC also regulates ASCs for certain changes in services, capacity, or ownership through Determination of Coverage (DOC) reviews to assess whether a CON is required for the changes.
Quick Facts: ASC vs. ASF
Maryland distinguishes ambulatory surgery facilities by the number of operating rooms.
- Ambulatory Surgery Center (ASC): Two or fewer operating rooms subject to Determination of Coverage (DOC) review
- Ambulatory Surgery Facility (ASF): Three or more operating rooms subject to Certificate of Need (CON) review
Facility Data and Reports
Quality & Performance
Access information on the quality and performance of ambulatory surgery centers in Maryland.
Facility Data
Request public use files containing inventory and utilization information on licensed surgical facilities in Maryland
Reports
Browse staff reports and recommendations on ambulatory surgery facilities in Maryland, prepared by the Commission in accordance with the State Health Plan.
Regulatory Process
The CON process begins with the submission of a Letter of Intent (LOI), followed by a pre-application conference with MHCC staff. The applicant then files a formal CON application, which is reviewed by MHCC for completeness. Once deemed complete, the application enters a formal review period that includes opportunities for public comment and, if applicable, comparative review with competing applications. The CON review schedules are posted on the MHCC website at mhcc.maryland.gov.
MHCC staff evaluate the application in accordance with the State Health Plan and applicable review criteria, including project need, cost-effectiveness, impact on existing providers, financial feasibility, and health equity A staff report and recommendation are prepared and presented to the Commission. The Commission then issues a final decision to approve, approve with conditions, or deny the application.
Following approval, the applicant must meet applicable conditions and will be required to obtain first use approval from MHCC prior to initiating services.
The Commission administers an annual survey application, typically conducted by the Quality Center around June or July each year.
If an ambulatory surgery center (ASC) undergoes an acquisition or any change of ownership, the facility must submit a Determination of Coverage (DOC) request to the Maryland Health Care Commission (MHCC). The DOC review allows MHCC to evaluate the proposed transaction and determine whether a Certificate of Need (CON) is required.
Applicants are advised to submit Notice of Acquisition materials at least 45 days in advance of the anticipated transaction to allow sufficient time for review.
Freestanding Medical Facilities fall under Hospitals, fall under Ambulatory Surgery.