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Q: Do you know if the ambulatory health care facilities are required to do an annual Test and Balance of the HVAC system?
A: No… I am not aware of that requirement. As far as I know, there is no standard for ambulatory healthcare occupancies (ASC) and healthcare occupancies (hospitals) to conduct annual TAB for their HVAC systems.
Now, having said that, the accreditation organizations and the CMS certification agencies do require you to demonstrate compliance with certain ASHRAE ventilation requirements in critical areas, such as operating rooms. But there is no actual standard that says you have to conduct annual TAB on the HVAC systems.
I suspect your accreditation organization and state agency who surveys on behalf of CMS will expect you to have documentation that your HVAC systems in your critical areas of the ambulatory healthcare occupancy is in compliance. An annual TAB report should be sufficient for that purpose.