Digital Debut

A Look Back at State Health Policy Trends in 2025

Facility fees, price transparency and site-neutral reimbursements gained consideration last year

BY STEPHEN ABRESCH | JANUARY 21, 2026

ASCA tracked more than 600 bills across the 50 states in 2025 for impacts to the ASC community. States used their legislative sessions to tackle both old bills, like price transparency, and new bills, with site-neutral reimbursements seeing consideration across several states.

Facility Fees

Facility fee restrictions continue to occupy state legislators, with 11 states—Arizona, California, Illinois, Massachusetts, Minnesota, Montana, New York, North Carolina, Ohio, Oregon, Texas—considering 27 bills last year, compared to 14 bills in nine states in 2024. Texas, one of the first states to give consideration to these proposals, considered six different measures related to facility fees, including two (HB 2075 and HB 3321) that would have prohibited ASCs from charging facility fees.

North Carolina took, which first considered the issue in 2023, took it up again in 2025, with new protections for ASCs. Three pieces of legislation—HB 434, SB 257 and SB 316—contained provisions that would prohibit charging facility fees outside of certain settings, with all three explicitly shielding ASCs from the prohibition. SB 257, which was the appropriations act, had the provisions stripped before enactment, though the other two measures remain active in 2026. Illinois considered four different measures—HB 1431, HB 1434, SB 232, SB 2182—largely focused on transparency for hospital facility fees, and even enacted HB 1431, which requires hospitals to provide disclosures to patients about facility fees.

Price Transparency

States have pursued burdensome and ill-fitting price transparency requirements for years, and 2025 was no different. In 2025 alone, 13 states considered 31 proposals, with Indiana and Texas enacting new requirements impacting ASCs.

Indiana, which first imposed good faith estimate requirements on ASCs in 2020, enacted HB 1003 in 2025, which shortens the time frame to deliver a good faith estimate from five to two days. Texas enacted three different measures—HB 216, HB 1314 and SB 331—impacting ASCs. HB 216 adds new requirements to how itemized bills, first required by legislation enacted in 2023, must be delivered to patients. HB 1314 amends the state’s written estimate charges, which have been imposed on ASCs since 2007, to require such estimates to be delivered within five days of receiving a request. It also requires facilities to include with the estimate the manner in which a patient can dispute final billed charges that exceed amount specified in the estimate by $400 or more. Finally, SB 331 subjects ASCs to the state’s hospital price transparency requirements. First enacted in 2021, this bill requires facilities to make publicly available a digital file in a machine-readable format containing a list of all standard charges for all facility items or services and a consumer-friendly list of standard charges for at least 300 shoppable services (including the 70 services identified as shoppable services by CMS), or at least for all the shoppable services provided by the facility if less than 300.

Site-Neutral Reimbursements

While facility fee and price transparency legislation has become a common occurrence, 2025 was the first year that states took up site-neutral reimbursement proposals for consideration. Arkansas, Idaho, Indiana, New York and Texas all considered site-neutral reimbursement proposals during their 2025 legislative sessions, with Idaho enacting its legislation (HB 345). The law did not impact ASCs.

New York’s legislation (A 2140/S 705) would prohibit healthcare providers—defined to include ASCs—from charging for any applicable service an amount that exceeds the lesser of 150 percent of the amount paid by Medicare or the negotiated rate between the provider and the insurance carrier. The bills additionally prohibit healthcare providers from charging facility fees for any “applicable services” defined as any outpatient or ambulatory items or services that can be safely provided across ambulatory settings. These measures remain active in 2026.

Indiana’s legislation would have been the most damaging to ASCs. At introduction, HB 1003 contained provisions mandating commercial insurers, HMOs and the state Medicaid program reimburse covered services provided in an outpatient setting at the same reimbursement rate as at a physician’s office for the same equivalent service. ASCA and the Indiana Federation of Ambulatory Surgical Centers (IFASC) interpreted the language to mean that all care provided at an ASC would be reimbursed at the physician office rate, effectively banning facility fees by another means. Thanks to sustained advocacy efforts, the provisions were removed from the bill before they were enacted.

The last noteworthy development was the release of the National Academy for State Health Policy’s (NASHP) state model legislation on site-neutral reimbursements in October of 2025. The model legislation, based on the bills introduced in New York, is designed for easy introduction across the states and has already been introduced in Virginia in 2026.

ASCA is monitoring these and other issues at the state level in 2026. If you have any questions or want to learn more, write Stephen Abresch at sabresch@ascassociation.org.