ASCs are navigating an unusually active regulatory moment in 2026 — from a resurgent federal push to repeal the ban on physician-owned hospitals to state-by-state fights over certificate-of-need laws and a widening gap in how ASCs get paid compared to hospitals. Here’s what’s actually moving.
1. CMS is testing whether physician-owned hospitals can re-enter Medicare. The agency’s proposed FY 2027 rule includes a request for information asking whether its Innovation Center authority can waive parts of ACA Section 6001 — the 2010 provision that froze new physician-owned hospitals — to let them participate in the Team bundled payment model.
2. A House hearing put healthcare consolidation and CON laws under a national spotlight. A House Judiciary subcommittee field hearing on healthcare fraud and competition, held Sept. 14, 2026, examined certificate-of-need laws, vertical integration and consolidation’s effect on access and cost.
3. Multiple competing bills aim to repeal or narrow the physician-owned hospital ban. HR 4002, the Patient Access to Higher Quality Health Care Act, would repeal Section 6001’s restrictions entirely; HR 2191, the Physician-Led and Rural Access to Quality Care Act, takes a narrower approach limited to facilities more than 35 miles from an existing hospital. Neither has reached a floor vote.
4. A new federal bill would ban corporate and private equity ownership of physician practices. The Stop Corporate Takeovers of Physicians Act, introduced Sept. 16, looks to close the “friendly physician” loophole that lets MSOs exert operational control over practices in states that already restrict corporate ownership.
5. Massachusetts significantly expanded oversight of private equity healthcare deals. A law signed in January 2025 increases state scrutiny of PE sponsors, equity investors, healthcare REITs and MSOs by changing the state’s determination-of-need review process.
6. Certificate-of-need reform is accelerating in several states. South Carolina eliminated CON requirements for ASCs this year, and North Carolina and Montana have seen notable movement toward CON revision. Hawaii is a live counterexample — a bill to exempt ASCs from the state’s CON process has drawn direct opposition from the governor’s senior healthcare advisor, who argued nonprofit hospitals rely on surgical revenue to subsidize unprofitable services.
7. New Jersey significantly expanded which ASCs face state assessments. Under a law that took effect July 1, one-room surgical practices — previously exempt — will be subject to New Jersey’s ambulatory care assessment starting in 2026, while the state also eliminated the $350,000 annual cap on the tax.
8. A bipartisan bill wants to close the ASC-hospital payment gap. The Outpatient Surgery Access Act of 2026, introduced in both the House and Senate, would permanently apply the same inflationary payment update used for hospitals to ASCs and eliminate an ASC-specific, budget-neutrality adjustment.
9. CMS significantly expanded which procedures ASCs can perform, while also proposing new cuts. The 2026 final rule added 573 procedures to the ASC covered procedures list and began phasing out the inpatient-only list; the 2027 proposed rule would add more procedures while also cutting several of the highest-volume pain management codes performed in ASCs.
10. AI-driven prior authorization is expanding into traditional Medicare. CMS’ Wasteful and Inappropriate Service Reduction model will add prior authorization to some fee-for-service procedures, including spine and orthopedic services, and is already reshaping how ASCs plan expansions and service-line investments.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
