<?xml version='1.0' encoding='utf-8'?>
<section article="ghg" article_name="Health - General" number="19-3B-01" title_number="19" title_name="Health Care Facilities" subtitle_number="3B" subtitle_name="Freestanding Ambulatory Care Facilities">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <level label="1">
      <text>“Ambulatory surgical facility” means any center, service, office facility, or other entity that:</text>
      <level label="i">
        <text>Operates exclusively for the purpose of providing surgical services to patients requiring a period of postoperative observation but not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following admission; and</text>
      </level>
      <level label="ii">
        <text>Seeks reimbursement from payors as an ambulatory surgery center.</text>
      </level>
    </level>
    <level label="2">
      <text>“Ambulatory surgical facility” does not include:</text>
      <level label="i">
        <text>The office of one or more health care practitioners seeking only professional reimbursement for the provisions of medical services, unless:</text>
        <level label="1">
          <text>The office operates under contract or other agreement with a payor as an ambulatory surgical facility regardless of whether it is paid a technical or facility fee; or</text>
        </level>
        <level label="2">
          <text>The office is designated to receive ambulatory surgical referrals in accordance with utilization review or other policies adopted by a payor;</text>
        </level>
      </level>
      <level label="ii">
        <text>Any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title;</text>
      </level>
      <level label="iii">
        <text>The office of a health care practitioner with not more than one operating room if:</text>
        <level label="1">
          <text>The office does not receive a technical or facility fee; and</text>
        </level>
        <level label="2">
          <text>The operating room is used exclusively by the health care practitioner for patients of the health care practitioner;</text>
        </level>
      </level>
      <level label="iv">
        <text>The office of a group of health care practitioners with not more than one operating room if:</text>
        <level label="1">
          <text>The office does not receive a technical or facility fee; and</text>
        </level>
        <level label="2">
          <text>The operating room is used exclusively by members of the group practice for patients of the group practice; or</text>
        </level>
      </level>
      <level label="v">
        <text>An office owned or operated by one or more dentists licensed under the Health Occupations Article.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>“Freestanding ambulatory care facility” means:</text>
    <level label="1">
      <text>An ambulatory surgical facility;</text>
    </level>
    <level label="2">
      <text>A freestanding endoscopy facility;</text>
    </level>
    <level label="3">
      <text>A freestanding facility utilizing major medical equipment;</text>
    </level>
    <level label="4">
      <text>A kidney dialysis center; or</text>
    </level>
    <level label="5">
      <text>A freestanding birthing center.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>“Freestanding birthing center” means a facility that provides nurse midwife services under Title 8, Subtitle 6 of the Health Occupations Article.</text>
    </level>
    <level label="2">
      <text>“Freestanding birthing center” does not include:</text>
      <level label="i">
        <text>A hospital regulated under Subtitle 2 of this title; or</text>
      </level>
      <level label="ii">
        <text>The private residence of the mother.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>“Freestanding endoscopy facility” means a facility:</text>
      <level label="i">
        <text>For the testing, diagnosis, or treatment of a medical disorder in conjunction with the use of microscopic, endoscopic, or laparoscopic equipment that is inserted in a naturally occurring orifice of the body; and</text>
      </level>
      <level label="ii">
        <text>That seeks reimbursement as a freestanding endoscopy facility from payors or Medicare.</text>
      </level>
    </level>
    <level label="2">
      <text>“Freestanding endoscopy facility” does not include:</text>
      <level label="i">
        <text>The office of one or more health care practitioners unless:</text>
        <level label="1">
          <text>The office operates under a contract or other agreement with a payor as a freestanding endoscopy facility regardless of whether it is paid a technical or facility fee; or</text>
        </level>
        <level label="2">
          <text>The office is designated to receive endoscopic referrals in accordance with utilization review or other policies adopted by a payor; or</text>
        </level>
      </level>
      <level label="ii">
        <text>Any facility or service operated by a hospital and regulated under Subtitle 2 of this title.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <level label="1">
      <text>“Freestanding facility operating major medical equipment” means a facility using major medical equipment.</text>
    </level>
    <level label="2">
      <text>“Freestanding facility operating major medical equipment” does not include any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title.</text>
    </level>
  </level>
  <level label="g">
    <text>“Health care practitioner” means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide medical services in the ordinary course of business or practice of a profession.</text>
  </level>
  <level label="h">
    <level label="1">
      <text>“Kidney dialysis center” means a facility that provides hemodialysis or chronic peritoneal dialysis.</text>
    </level>
    <level label="2">
      <text>“Kidney dialysis center” does not include any facility or service owned or operated by a hospital and regulated under Subtitle 2 of this title.</text>
    </level>
  </level>
  <level label="i">
    <text>“License” means a license issued by the Secretary under this subtitle.</text>
  </level>
  <level label="j">
    <text>“Major medical equipment” means:</text>
    <level label="1">
      <text>Cardiac catheterization equipment;</text>
    </level>
    <level label="2">
      <text>A computer tomography (CT) scanner;</text>
    </level>
    <level label="3">
      <text>A lithotripter;</text>
    </level>
    <level label="4">
      <text>Radiation therapy equipment, including a linear accelerator; or</text>
    </level>
    <level label="5">
      <text>A magnetic resonance imager (MRI).</text>
    </level>
  </level>
  <level label="k">
    <text>“Nonsterile procedure room” means a room:</text>
    <level label="1">
      <text>In which minor surgical procedures are performed, including endoscopy and endoscopic procedures requiring deep sedation;</text>
    </level>
    <level label="2">
      <text>That can only be accessed from a semi–restricted corridor or an unrestricted corridor;</text>
    </level>
    <level label="3">
      <text>That is not used for open surgical procedures that:</text>
      <level label="i">
        <text>Enter the thorax, abdomen, pelvis, cranium, or spine; or</text>
      </level>
      <level label="ii">
        <text>Routinely require induction of deep sedation or general anesthesia for the entirety of the surgical procedure; and</text>
      </level>
    </level>
    <level label="4">
      <text>In which deep sedation or general anesthesia may be induced if:</text>
      <level label="i">
        <text>Warranted by the clinical situation; and</text>
      </level>
      <level label="ii">
        <text>The room is equipped to safely conduct the required level of anesthesia.</text>
      </level>
    </level>
  </level>
  <level label="l">
    <text>“Payor” means:</text>
    <level label="1">
      <text>A health insurer, nonprofit health service plan, or health maintenance organization that holds a certificate of authority to offer health insurance policies or contracts in the State in accordance with this article or the Insurance Article;</text>
    </level>
    <level label="2">
      <text>A third party administrator or any other entity under contract with a Maryland business to administer health benefits; or</text>
    </level>
    <level label="3">
      <text>A self–insured group.</text>
    </level>
  </level>
  <level label="m">
    <text>“Sterile operating room” means a room in a surgical suite that meets the requirements of a restricted area and is designated and equipped for performing surgical operations or other invasive procedures that may require an aseptic field.</text>
  </level>
  <level label="n">
    <text>“Surgical services” has the meaning incorporated in the Centers for Medicare and Medicaid Services State Operations Manual – Guidance for Surveyors: Ambulatory Surgical Centers.</text>
  </level>
</section>
