Bill Text: NY S02944 | 2013-2014 | General Assembly | Amended
Bill Title: Relates to the registration of office-based surgery facilities and payments for the use thereof.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2014-01-08 - REFERRED TO HEALTH [S02944 Detail]
Download: New_York-2013-S02944-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2944--A
2013-2014 Regular Sessions
I N S E N A T E
January 25, 2013
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Health -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law, in relation to registration of
office-based surgery facilities and payments for the use thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Legislative intent. The legislature hereby finds that New
2 York state is home to approximately 1,000 accredited physician-owned
3 ambulatory surgery facilities, referred to as Office-Based Surgery (OBS)
4 practices, currently providing patient access to virtually all types of
5 covered outpatient surgical procedures safely and at a lower cost
6 compared to other settings, including traditional ambulatory surgery
7 centers and hospitals.
8 The legislature further finds that advances in medicine, including
9 surgical techniques, equipment and improvements in anesthesia enable
10 procedures to be performed safely, conveniently and at a much lower cost
11 in an office-based setting. In fact, conservative estimates show physi-
12 cian-owned ambulatory surgery facilities can achieve cost savings of
13 30%-40% as compared with other settings. The enviable safety record of
14 the accredited OBS industry is also well established.
15 The legislature also finds that like many states, New York is experi-
16 encing a growing physician shortage. The problem is compounded for
17 accredited office-based surgery facilities and the patients they treat
18 by the recent refusal on the part of many third party payers to reim-
19 burse facility costs for covered procedures. These expenses are substan-
20 tial and include capital costs, equipment usage, supplies and overhead.
21 The motives behind these denials are inexplicable given that this venue
22 represents the lowest-cost provider. In fact, it was not long ago that
23 insurers were consistently reimbursing OBS practices for their facility
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02577-02-3
S. 2944--A 2
1 costs. Practitioners invested in their practices dependent on these
2 established reimbursement practices. Without the mechanism to negotiate
3 with the payers, these mostly small or solo practices lack the clout and
4 market power to negotiate and convince insurers to reinstate reimburse-
5 ment.
6 The legislature also finds that lack of reimbursement has driven many
7 physician owned ambulatory surgery practices out of the market. Many
8 more are likely to follow resulting in thousands of lost jobs, decreased
9 access to care and substantially higher costs to patients and the over-
10 all healthcare delivery system.
11 The legislature further finds that while office-based surgery prac-
12 tices are recognized in statute pursuant to the accreditation require-
13 ments in section 230-d of the public health law, there is nothing in
14 current law or regulations that specifically identifies accredited
15 office-based surgery entities as facilities entitled to seek reimburse-
16 ment for facility related costs.
17 Therefore, the legislature hereby declares that, due to the integral
18 role that accredited office-based surgery practices play in the safe,
19 efficient and low-cost delivery of surgical services, as well as the
20 need to protect and enhance patient safety and access to affordable care
21 for all New Yorkers, it is in the interest of the people of this state
22 to further enhance recognition of accredited office-based surgery prac-
23 tice and protect and encourage a robust and successful industry in this
24 state.
25 S 2. Clause (i) of subparagraph (A) of paragraph 1 of subsection (e)
26 and subsection (g) of section 4900 of the insurance law, as amended by
27 chapter 558 of the laws of 1999, are amended to read as follows:
28 (i) provided by a facility licensed, CERTIFIED OR ACCREDITED pursuant
29 to SECTION TWO HUNDRED THIRTY-D, article twenty-eight, thirty-six,
30 forty-four or forty-seven of the public health law or pursuant to arti-
31 cle nineteen, [twenty-three,] thirty-one or thirty-two of the mental
32 hygiene law; or
33 (g) "Health care provider" means a health care professional or a
34 facility licensed, CERTIFIED OR ACCREDITED pursuant to SECTION TWO
35 HUNDRED THIRTY-D, article twenty-eight, thirty-six, forty-four or
36 forty-seven of the public health law or a facility licensed OR CERTIFIED
37 pursuant to article nineteen, [twenty-three,] thirty-one or thirty-two
38 of the mental hygiene law.
39 S 3. Paragraph 2 of subsection (b) of section 4901 of the insurance
40 law, as added by chapter 705 of the laws of 1996, is amended to read as
41 follows:
42 (2) Those circumstances, if any, under which utilization review may be
43 delegated to a utilization review program conducted by a facility
44 licensed, CERTIFIED OR ACCREDITED pursuant to SECTION TWO HUNDRED THIR-
45 TY-D OR article twenty-eight of the public health law or pursuant to
46 article thirty-one of the mental hygiene law;
47 S 4. Subsection (b) of section 4906 of the insurance law, as added by
48 chapter 237 of the laws of 2009, is amended to read as follows:
49 (b) Notwithstanding subsection (a) of this section, in lieu of the
50 external appeal process as set forth in this article, a health care plan
51 and a facility licensed, CERTIFIED OR ACCREDITED pursuant to SECTION TWO
52 HUNDRED THIRTY-D OR article twenty-eight of the public health law may
53 agree to an alternative dispute resolution mechanism to resolve disputes
54 otherwise subject to this article.
55 S 5. This act shall take effect immediately and shall be deemed to
56 have been in full force and effect on and after January 18, 2009 with
S. 2944--A 3
1 respect to claims and appeals filed for health care services provided at
2 facilities subject to the provisions of section 230-d of the public
3 health law during the period of time which such facilities remain fully
4 licensed, certified or accredited pursuant to such section.
