CMS Revises Ambulatory Surgical Center (ASC) Advance Directive Notification Guidance; Interpretive Guidelines Updated 
CMS has released revised interpretive guidelines  to CMS state survey agencies and CMS regional offices. The new guidelines require ASC compliance with advance directives. While ASCs are still allowed to refuse to honor advance directives, the latest interpretive guidelines state:
“A blanket statement of refusal by the ASC to comply with any patient advance directives is not permissible. However, if and to the extent permitted under State law, the ASC may decline to implement elements of an advance directive on the basis of conscience or any other reason permitted under State law if it includes in the information concerning its advance directive policies a clear and precise statement of limitation.”
CMS specifically states that an ASC’s notice of limitation could, if permitted by State law, indicate that it would always attempt to resuscitate a patient and transfer that patient to a hospital in the event of deterioration. The guidelines also include guidance that incorporates information related to emergency equipment requirements and day-of-surgery notification of patient rights:
- The regulation no longer prescribes a specific list of emergency equipment that must be available in every ASC operating room. Instead, the ASC’s governing body and medical staff are required to specify the types of emergency equipment required that are appropriate to the ASC’s patient population, to make it available immediately during emergencies, and to ensure it is maintained by appropriate personnel (interpretive guidelines for this section begin on page 177).
- An ASC is no longer required to provide notice of patient rights in advance of the date of the procedure. Provision of both verbal and written notice on the same day as, but prior to the start of, the surgical procedure is acceptable (interpretive guidelines for this section begin on page 187).