Alaska, Delaware, Illinois and Ohio have now finalized changes to regulations governing ASCs, aligning them with changes made by the Centers for Medicare & Medicaid Services (CMS) in 2019. All four states amended their medical history and physical examination (H&P) requirements in the last 12 months, while Alaska and Illinois also changed their written transfer agreement requirements. These represent the first states to update these requirements for ASCs following the 2019 CMS rulemaking.