capital equipment to the hand gels to the post-op snacks for recover-
ing patients. There can be no mixing of supplies. "Any tangible good
that you can charge a patient for can't be comingled between the host
center and the leasing ASC," says Ms. Kirchner. "Each entity can
access supplies only on the days they operate. The other center's sup-
plies must be behind lock and key."
Each center involved in a dual-licensed agreement is required to
have its own policies and procedures, and must clearly post signage
stating their hours of operation. Multiple Medicare-certified ASCs that
share the same space can be cited for the code violations of a single
entity. Multiple entities may share clinical and business staffs, as long
as each center meets staffing requirements, such as orientation and
measuring core competencies.
Visits from outside consultants must also be done separately for
each ASC. Both physicians involved in the dual-licensed ASC Ms.
Montgomery brokered work with the same pharmacy consultant, who
had to make separate trips to review crash carts on the days the 2
entities were open. "She wanted to do it on the same day, but could-
n't," says Ms. Montgomery. "I've had state inspectors tell me that they
would enforce the rules of dual-licensure to the letter."
More to come?
CMS rules strictly prohibit 2 or more Medicare-certified ASCs from
sharing space, including the same ORs and common area, "but this pro-
hibition only applies if the use of the space is concurrent," says attorney
Jerry Sokol, a partner at McDermott, Will and Emery in Miami, Fla.
"Medicare rules have for some time specifically allowed multiple ASC
entities to use a single facility, as long as there are no overlapping hours
of operation." Medicare requirements are met as long as the 2 entities
commit to using a single facility during distinct periods of time, but
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