Bill Text: NY A07374 | 2015-2016 | General Assembly | Introduced
Bill Title: Relates to referrals of patients for health related items or services that are prohibited under law.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Engrossed - Dead) 2016-03-28 - REFERRED TO HEALTH [A07374 Detail]
Download: New_York-2015-A07374-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 7374 2015-2016 Regular Sessions I N A S S E M B L Y May 6, 2015 ___________ Introduced by M. of A. PICHARDO -- read once and referred to the Commit- tee on Health AN ACT to amend the public health law, in relation to referrals of patients for health or health related items or services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph (g) of subdivision 2 of section 238-a of the 2 public health law, as added by chapter 803 of the laws of 1992, is 3 amended to read as follows: 4 (g) [in the case of any other financial relationship which the public 5 health council determines and specifies in regulations, subject to 6 approval by the commissioner, does not pose a substantial risk of payor 7 or patient abuse in relation to patient benefits consistent, to the 8 extent practicable, with financial relationships specified in regu- 9 lations adopted pursuant to federal law applicable to reimbursement 10 pursuant to title XVIII of the federal social security act (medicare) 11 for clinical laboratory services provided to beneficiaries of title 12 XVIII of the federal social security act (medicare)] ANY ARRANGEMENT 13 THAT, UNDER THE FEDERAL STATUTORY PROHIBITION ON CERTAIN REFERRALS CODI- 14 FIED AT 42 U.S.C. 1395NN AND REGULATIONS PROMULGATED THEREUNDER, WOULD 15 BE AN ARRANGEMENT BETWEEN A PRACTITIONER (OR IMMEDIATE FAMILY MEMBER) 16 AND A HEALTH CARE PROVIDER THAT: 17 (I) WOULD NOT BE A FINANCIAL RELATIONSHIP IF EXISTING BETWEEN A PHYSI- 18 CIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED UNDER SUCH FEDERAL LAW OR 19 REGULATIONS; OR 20 (II) WOULD SATISFY THE REQUIREMENTS OF AN EXCEPTION RELATING TO FINAN- 21 CIAL RELATIONSHIPS PROVIDED UNDER SUCH FEDERAL LAW OR REGULATIONS IF 22 EXISTING BETWEEN A PHYSICIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED 23 UNDER SUCH FEDERAL LAW OR REGULATIONS. 24 AN ARRANGEMENT SHALL NOT BE EXCEPTED UNDER THIS PARAGRAPH IF IT IS A 25 PARTICULAR TYPE OF FINANCIAL RELATIONSHIP THAT WOULD POSE A SUBSTANTIAL EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02698-01-5 A. 7374 2 1 RISK OF PAYOR OR PATIENT ABUSE, AS DETERMINED AND SPECIFIED BY THE 2 PUBLIC HEALTH AND HEALTH PLANNING COUNCIL IN REGULATIONS, SUBJECT TO 3 APPROVAL BY THE COMMISSIONER. 4 S 2. Paragraph (c) of subdivision 6 of section 238-a of the public 5 health law, as added by chapter 803 of the laws of 1992, is amended to 6 read as follows: 7 (c) provided further, however, that the following shall not constitute 8 a referral by a referring practitioner: 9 (i) a request by a practitioner for practitioners' services consisting 10 solely of professional services to be furnished personally by that prac- 11 titioner, or under that practitioner's supervision; 12 (ii) a request by a pathologist for clinical diagnostic laboratory 13 tests and pathological examination services, if such services are 14 furnished by or under the supervision of such pathologist pursuant to a 15 consultation requested by another practitioner; [and] 16 (iii) a request by a radiologist for diagnostic x-ray or imaging 17 services, if such services are furnished by or under the supervision of 18 such radiologist pursuant to a consultation requested by another practi- 19 tioner[.]; AND 20 (IV) A REFERRAL FOR ANY SERVICES EXCEPTED UNDER 42 U.S.C. S 1395NN AND 21 REGULATIONS PROMULGATED THEREUNDER, UNLESS THE PUBLIC HEALTH AND HEALTH 22 PLANNING COUNCIL DETERMINES AND SPECIFIES IN REGULATIONS, SUBJECT TO 23 APPROVAL BY THE COMMISSIONER, THAT A PARTICULAR TYPE OF REFERRAL WOULD 24 POSE A SUBSTANTIAL RISK OF PAYOR OR PATIENT ABUSE IN RELATION TO PATIENT 25 BENEFITS. 26 S 3. This act shall take effect immediately.