Bill Text: NY S06544 | 2017-2018 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Prohibits certain practices concerning or consideration for referrals by providers of substance use disorder services.
Spectrum: Moderate Partisan Bill (Republican 11-2)
Status: (Engrossed - Dead) 2018-06-18 - SUBSTITUTED BY A7689A [S06544 Detail]
Download: New_York-2017-S06544-Introduced.html
Bill Title: Prohibits certain practices concerning or consideration for referrals by providers of substance use disorder services.
Spectrum: Moderate Partisan Bill (Republican 11-2)
Status: (Engrossed - Dead) 2018-06-18 - SUBSTITUTED BY A7689A [S06544 Detail]
Download: New_York-2017-S06544-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 6544 2017-2018 Regular Sessions IN SENATE June 1, 2017 ___________ Introduced by Sen. AKSHAR -- (at request of the Office of Alcoholism and Substance Abuse Services) -- read twice and ordered printed, and when printed to be committed to the Committee on Alcoholism and Drug Abuse AN ACT to amend the mental hygiene law and the penal law, in relation to prohibiting deceptive acts and practices for substance use disorder treatment The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The mental hygiene law is amended by adding a new section 2 32.06 to read as follows: 3 § 32.06 Prohibition on deceptive acts and practices. 4 (a) Definitions. As used in this section, the following terms shall 5 have the following meanings, unless the context clearly requires other- 6 wise: 7 (1) "Addiction professional" shall mean a professional who, within the 8 scope of their license issued pursuant to title eight of the education 9 law or credential issued pursuant to section 19.07 of the mental hygiene 10 law, if working in an individual capacity, provides substance abuse and 11 prevention services. 12 (2) "Credentialed professional" shall include any person who is in the 13 process of applying for a credential issued by the commissioner pursuant 14 to section 19.07 of the mental hygiene law, or who has a valid creden- 15 tial, or who is eligible for credential renewal; 16 (3) "Health care provider" shall mean a practitioner in an individual 17 practice, group practice, partnership, professional corporation or other 18 authorized form of association, a hospital or other health care institu- 19 tion issued an operating certificate pursuant to article twenty-eight of 20 the public health law or article thirty-one or thirty-two of the mental 21 hygiene law, and any other purveyor of health or health related items or 22 services. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10119-01-7S. 6544 2 1 (4) "Potential service recipient" shall mean a person who is a 2 substance abuser, substance dependent, in need of services to avoid 3 becoming a substance abuser, or substance dependent. 4 (5) "Substance abuse program" shall mean any public or private person, 5 corporation, partnership, agency, either profit or non-profit, or state 6 or municipal government which provides, or holds itself out as provid- 7 ing, substance abuse services, in either a residential or ambulatory 8 setting, to persons who are substance abusers, substance dependent, in 9 need of services to avoid becoming substance abusers, substance depend- 10 ent or to significant others. 11 (6) "Substance abuse services" shall include services to inhibit the 12 onset of substance abuse or substance dependence; to address the social 13 dysfunction, medical problems and other disabilities associated with 14 substance abuse or substance dependence, and to rehabilitate persons 15 suffering from substance abuse or dependence. 16 (b) It is unlawful for any person, including any individual, addiction 17 professional, credentialed professional, health care provider, health 18 care facility or substance abuse program to: 19 (1) Promote, offer, give, solicit or pay any commission, bonus, 20 rebate, kickback, or bribe, directly or indirectly, in cash or in kind, 21 or engage in any split-fee arrangement, to induce the referral of a 22 potential service recipient or in connection with the performance of a 23 substance abuse service; 24 (2) Solicit, agree to receive or receive any commission, bonus, 25 rebate, kickback, or bribe, directly or indirectly, in cash or in kind, 26 or engage in any split-fee arrangement, in any form whatsoever, in 27 return for referring a potential service recipient or in connection with 28 the performance of a substance abuse service; or 29 (3) Aid, abet, advise, or otherwise participate in the conduct prohib- 30 ited under paragraph one or paragraph two of this subdivision. 31 (c) This section shall not apply to: 32 (1) Any discount, payment, waiver of payment, or payment practice not 33 prohibited by 42 U.S.C. § 1320a-7b(b) or regulations promulgated there- 34 under. 35 (2) Payments to an addiction professional, health care provider, 36 health care facility or substance abuse program for professional consul- 37 tation services. 38 (3) Commissions, fees, or other remuneration lawfully paid to insur- 39 ance agents as provided under the insurance law. 40 (4) Payments by a health insurer who reimburses, provides, offers to 41 provide, or administers health, mental health, or substance abuse 42 services under a health benefit plan. 43 (5) Payments to or by an addiction professional, health care provider, 44 health care facility, a health care provider network entity, or a 45 substance abuse program, that has contracted with a health insurer, a 46 health care purchasing group, or the Medicare or Medicaid program to 47 provide health, mental health, or substance abuse services under a 48 health benefit plan when such payments are for services under the plan. 49 (6) Payments by an addiction professional, health care provider, 50 health care facility or substance abuse program to a health, mental 51 health, or substance abuse information service that provides information 52 upon request and without charge to consumers about providers of 53 substance abuse services to enable consumers to select appropriate 54 substance abuse programs, provided that such information service: 55 i. Does not attempt through its standard questions for solicitation of 56 consumer criteria or through any other means to steer or lead a consumerS. 6544 3 1 to select or consider selection of a particular addiction professional, 2 substance abuse services or substance abuse program; 3 ii. Does not provide or represent itself as providing diagnostic or 4 counseling services or assessments of an individual's need for substance 5 abuse services and does not make any promises of cure or guarantees of 6 treatment; 7 iii. Does not provide or arrange for transportation of a consumer to 8 or from the location of a substance abuse service or program; and 9 iv. Charges and collects fees from an addiction professional, health 10 care provider, health care facility or substance abuse program partic- 11 ipating in its services that are set in advance, are consistent with the 12 fair market value for those information services, and are not based on 13 the potential value of a potential service recipient or recipients to a 14 substance abuse program or of the goods or services provided by the 15 substance abuse program. 16 (d) Any individual, including an officer, partner, agent, attorney, or 17 other representative of a partnership, association, corporation, limited 18 liability company or partnership, public or private agency or any part 19 thereof who knowingly fails to comply with the provisions of this 20 section shall be guilty of a misdemeanor as defined in the penal law, 21 punishable in accordance with section 177.05 of the penal law. 22 (e) If the commissioner has reason to believe that there is an indi- 23 vidual, partnership, association, corporation, limited liability company 24 or partnership, public or private agency or any part thereof violating 25 subdivision (b) of this section, he or she shall proceed pursuant to 26 applicable sections of this chapter including but not limited to 27 sections 32.3, 32.15, 32.19 and 32.27 of this article. 28 (f) The party bringing an action under this section may recover 29 reasonable expenses in obtaining injunctive relief, including, but not 30 limited to, investigative costs, court costs, reasonable attorney's 31 fees, witness costs, and deposition expenses. 32 (g) The provisions of this section are in addition to any other civil, 33 administrative, or criminal actions provided by law and may be imposed 34 against both corporate and individual defendants. 35 § 2. Section 177.05 of the penal law, as added by chapter 442 of the 36 laws of 2006, is amended to read as follows: 37 § 177.05 Health care fraud in the fifth degree. 38 A person is guilty of health care fraud in the fifth degree when[,]: 39 1. with intent to defraud a health plan, he or she knowingly and will- 40 fully provides materially false information or omits material informa- 41 tion for the purpose of requesting payment from a health plan for a 42 health care item or service and, as a result of such information or 43 omission, he or she or another person receives payment in an amount that 44 he, she or such other person is not entitled to under the circumstances; 45 or 46 2. he or she knowingly and willfully directly or indirectly promotes, 47 offers, gives, solicits or receives, or agrees to receive, any fee, or 48 other consideration to or from a third party for the referral of a 49 potential service recipient in connection with the performance of 50 substance abuse services in violation of section 32.06 of the mental 51 hygiene law. 52 Health care fraud in the fifth degree is a class A misdemeanor. 53 § 3. This act shall take effect immediately.
