Impact on ASCs

The changes in the final rule are almost exclusively directed at the accrediting bodies, said Barbara Sylvester, RN, director of regulatory affairs and quality at the Accreditation Commission for Health Care. “The biggest potential impact on ASCs is tied to limitations on education during the period prior to survey,” she said. “In the 300-plus-page document, there are inconsistencies in terminology related to education — specifically focused on limitations during the period immediately prior to survey. If the intent is a blanket prohibition on education by the surveying AO, then ASCs may need to use a second AO or consultant for education on the CfCs [conditions for coverage] in the 12 months before an initial or renewal survey.”

ASCs should not expect a fundamentally different accreditation experience because of this rule, said Noel Adachi, president and CEO of the Accreditation Association for Ambulatory Health Care. “Many of the concepts reflected in the final rule — including continuous readiness, peer expertise and quality improvement — have long been part of AAAHC’s 1095 Strong approach,” she said. “AAAHC Medicare deemed status surveys are already unannounced, reinforcing readiness every day rather than preparation for a scheduled event.”

What changed

According to CMS, the final rule is designed to:

• Ensure accrediting organizations’ accreditation standards continue to meet or exceed those of the Medicare program.
• Align accreditation and survey processes with CMS requirements.
• Confirm accrediting organizations’ enforcement of CMS requirements.
• Reinforce that all accredited entities must deliver safe, effective care.
• Prevent accrediting organizations’ conflicts of interest that may arise from related consulting services.

Additionally, the rule creates a new process for monitoring accrediting organization performance; establishes consistent standards, processes and definitions; updates validation and performance systems; requires accrediting organization surveyors to take the same CMS training as state agency surveyors; and reduces burden on state agencies, accrediting organizations and providers by streamlining the CMS-accrediting-organization validation process, CMS states.

Certified facilities, whether surveyed by state agencies or accrediting organizations, must meet the same health and safety standards. The rule requires accreditation surveys be conducted without advance notice, ensuring consistency with previously established CMS policy.

The rule addresses longstanding concerns by prohibiting accrediting organizations from conducting mock surveys for providers they accredit before initial surveys and within 12 months of reaccreditation, according to CMS. This prohibition helps ensure consulting activities do not compromise the objectivity and integrity of the accreditation process. Additionally, variability in accreditation standards has led to inconsistent survey findings and enforcement across Medicare-certified facilities, CMS stated. This rule establishes clear, uniform requirements to eliminate ambiguity. By applying Medicare conditions and requirements as the baseline standards, CMS ensures the application of consistent safety requirements across facilities.

What the accrediting agencies plan to do

“The final rule reinforces the important partnership between CMS and accrediting organizations in advancing patient safety and quality while raising expectations for accrediting organizations in several key areas: strengthening alignment between accreditation standards and Medicare requirements; enhancing surveyor training and competency oversight; expanding quality monitoring and validation activities; increasing transparency and accountability in organizational governance, including strengthened conflict-of-interest disclosures; and demonstrating the integrity of accrediting organizations’ oversight processes,” Adachi said. While implementation will require operational changes, the rule does not alter AAAHC’s fundamental purpose, she said. “Instead, it reinforces the value of an accreditation model designed specifically for ambulatory care — one that helps organizations strengthen quality and patient safety every day of the 1,095-day accreditation cycle.”

For AAAHC, many of these changes build upon practices already established, Adachi explained. “AAAHC is well positioned for this next chapter,” she said. “Our focus remains unchanged. We partner with CMS and the organizations we accredit to advance high-quality ambulatory care and build sustainable cultures of quality, safety, and readiness.”

Sylvester believes the same. “Most of the regulatory changes have been previously implemented for some, if not all, deemed programs,” she said. “For an AO with deeming authority for multiple settings, like ACHC, full compliance will be a matter of expanding changes made over the past couple of years to include all deemed programs.”

Joint Commission is ready as well. “The proposed rule has been out for quite a while and, as a result, there was nothing new or unexpected — no surprises — in the final rule; we are fully prepared to meet the requirements by the implementation date,” the organization stated in an email.

DNV launched its accreditation program for ASCs in the U.S. in December 2025. “DNV has always aligned closely with CMS standards and procedures, while emphasizing quality management, safe care, and continual improvement,” said Troy D. McCann, executive director of regulatory affairs. “This is especially true of our ASC accreditation program. We are reviewing the final rule to assess effects on our operations and potential impacts on our accredited and certified facilities. We intend to submit formal comments.”

View the final rule on the Federal Register. View the fact sheet.