Licensing a New Ambulatory Surgery Center (ASC) in Missouri
Opening a new Ambulatory Surgery Center in Missouri involves a multi‑step approval and licensing process through the Department of Health and Senior Services (DHSS). The Bureau of Ambulatory Care (BAC) oversees ASC licensing, while the Physical Environment and Emergency Preparedness (PEEPS) Unit reviews facility design and construction.
Below is a streamlined guide to help you understand each step.
Step 1: Review Missouri ASC Regulations
Before beginning the process, review Missouri’s ASC licensure regulations:
Your facility must meet the design and construction standards outlined in:
- 19 CSR 30‑30.030
- 19 CSR 30‑30.040
Step 2: Contact the PEEPS Unit
Email the Health Standards and Licensure (HSL) Physical Environment and Emergency Preparedness (PEEPS) Unit at PEEPS@health.mo.gov.
Provide:
- Contact names and email addresses for your project team
PEEPS will send you the Construction and Renovation Project Tracking Form (PDF).
Complete the form and attach your Life Safety Code (LSC) Plan, then email both to:
(No drawings are needed at this stage.)
Once received, PEEPS assigns a project number (e.g., ASC ###).
Include this number in all future communications.
Step 3: Submit Construction Drawings
After your project number is issued, provide:
- One full‑size printed, signed, and sealed set of drawings
- One electronic PDF set on CD or USB (also signed and sealed)
- Your assigned project number on all materials
Important: Drawings are not accepted by email.
Submission options:
Mail:
Department of Health and Senior Services
c/o Physical Environment and Emergency Preparedness Unit (PEEPS)
920 Wildwood Drive
Jefferson City, MO 65109
Email communication: PEEPS@health.mo.gov
After sending drawings, contact PEEPS.
Step 4: Construction Phase Check‑Ins
During construction, contact PEEPS periodically to keep them informed of the construction process.
Step 5: Licensure Application (At 80% Completion)
At approximately 80% construction completion, BAC will send your designated contact(s):
- The ASC License Application
- An Organizational Chart Template
- Initial Licensure Preparedness Checklists
Submit all completed documents to BAC@health.mo.gov.
Application Timing
Submit your application 30–60 days before the initial licensure survey.
Applications remain active for 12 months.
Licensing Fee: $200
Payment options:
Check payable to:
Missouri Department of Health and Senior Services
Mail to:
Bureau of Ambulatory Care
P.O. Box 570
Jefferson City, MO 65102‑0570
Your application must include:
a. Proof your business is legally authorized to operate in Missouri
b. Organizational chart & key staff list (including administrator contact)
c. Governing board minutes approving establishment of the ASC
d. Surgical specialties list and estimated procedure/recovery times
Step 6: Preparedness Call
After BAC receives your complete application, a preparedness call will be scheduled with:
- Your facility staff
- BAC
- The Life Safety Code (LSC) Unit
Topics reviewed on the call include:
- Required policies and procedures
- Equipment and supply readiness (excluding controlled substances)
- Staff training and staffing levels
If your team is prepared, a tentative date will be set for the initial licensure survey.
Step 7: Initial Licensure Survey
A successful onsite survey is required before any patient care can begin.
Your facility must have:
- Required supplies and medications (non‑controlled substances)
- Completed policies and procedures
- Fully tested and operational equipment
- Trained and oriented staff
An ASC license is issued only after full compliance is verified.
Additional Requirements (If Applicable)
Controlled Substances
If your ASC will store or administer controlled substances, registrations must be obtained after you receive your ASC license:
BNDD
Phone: 573‑751‑6321
Email: bndd@health.mo.gov
Find more information at BNDD.
DEA
Phone: 800‑882‑9539
Email: DEA.Registration.Help@dea.gov
Find more information at the DEA website.
Laboratory Testing
Facilities performing lab testing need a Clinical Lab Improvement Act (CLIA) certificate (19 CSR 30‑30.020(1)(4)).
CLIA Program
Phone: 573‑751‑6318
Email: CLIA@health.mo.gov
Find more information at outpatient healthcare.
Medicare ASC Certification
You must be state‑licensed before pursuing Medicare certification.
Please note: CMS prioritizes initial Medicare ASC surveys at a low level, and the state may not be able to conduct these surveys promptly.
Facilities are encouraged to contact a CMS‑approved Accreditation Organization (AO)
Ongoing Communication
To support a smooth opening, please provide:
- Construction start date
- Expected completion date
- Regular progress updates
- Notice of any timeline changes
Send updates via email to the BAC and CARP teams.
Questions?
Bureau of Ambulatory Care (BAC)
Phone: 573‑751‑1588
Email: BAC@health.mo.gov