Relates to the registration of office-based surgery facilities and payments for the use thereof.
TITLE OF BILL: An act to amend the public health law, in relation to registration of office-based surgery facilities and payments for the use thereof
PURPOSE: To require accredited office-based surgery facilities to register and obtain a certificate of registration from a nationally recognized accrediting agency as designated by the Department of Health and to permit such facilities to seek reimbursement from health plans for a facility fee.
SUMMARY OF PROVISIONS: This bill amends Public Health Law § 230-d to require office-based surgery (OBS) facilities to register with a nationally-recognized accrediting agency as designated by the Department of Health to receive a certificate of registration. The bill provides grounds for the issuance of a certificate of registration, requires the facility to conspicuously post the certificate of registration and provides that the registration shall be valid for 3 years, or until the accredited status of the facility expires.
This legislation also authorizes accredited OBS facilities who have received a certificate of registration to seek reimbursement for a facility fee, provided the health plan currently reimburses for the use of the facility charged in connection with the same covered procedure performed at an ambulatory surgery center or hospital. When calculating the appropriate rate of OBS facility fees, the health plans may also take into consideration certain comparable and non-comparable costs and obligations of ambulatory surgery centers and hospitals.
EXISTING LAW: Current law requires OBS facilities to obtain and maintain full accredited status by a nationally-recognized accrediting agency approved by the Commissioner of Health. There are three accreditation entities which have been approved by the Commissioner: Accreditation Association for Ambulatory Health Care (AAAHC), American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and The Joint Commission.
JUSTIFICATION: In 2007, legislation was enacted to require that if certain procedures are not performed in a hospital or other Article 28 facility, they must be performed in an accredited OBS facility. Sections of this legislation became effective on January 14, 2008 and on July 14, 2009. This measure was the culmination of the work of the Department of Health's Committee on Quality Assurance in Office-Based Surgery.
The accreditation conferred upon these OBS facilities assures that these practices meet nationally recognized standards for patient safety and quality care and include: environment of care; emergency management; infection prevention and control; life safety; medication management; national patient safety goals; performance improvement; record of care,
treatment of services; rights and responsibilities of the individual; and transplant safety.
Accredited OBS facilities provide quality care at a lower cost than care provided in more costly Article 28 Ambulatory Surgery Centers (ASCs) and hospitals. In fact, for thousands of New Yorkers, these facilities represent critical access points for vital, affordable health care services. However, many health plans refuse to pay OBS facilities a facility fee; this despite the fact that accredited OBS facilities must shoulder the burden of significant costs not unlike those of the ASCs and hospitals. Unfortunately, there has been a lack of recognition of these costs on the part of third party payors. More importantly, insurance companies have also failed to recognize that the impact of non-payment of these fees has been to drive procedures from the low cost OBS locations into the much more expensive hospital and other Article 28 facilities. This inevitable shift will dramatically drive up the cost of medical care. Sadly, numerous accredited OBS facilities have already started to close and move procedures to more expensive Article 28 facilities and hospitals.
Inexplicably, since the enactment of the OBS accreditation process, third party payors have cited the fact that OBS facilities are not licensed as a basis for denial of claims. This bill addresses that by establishing a registration and certification process to provide OBS facilities with an added level of recognition to better enable them to seek reimbursement for facility fees from third party payors.
In addition, those few third party payors who have reimbursed OBS facilities have done so only for in-network facilities. To make matters worse, payors will often refuse to reimburse for out-of-network facilities, even in cases where the insureds have contracted and paid for out-of-network coverage. For the most part, OBS facilities have been denied access to the health plans' network further hindering their ability to seek reimbursement and negatively impacting their patients' choice and access and to low cost, quality care. This bill would correct such inequity by providing accredited office-based surgery facilities with a mechanism to obtain a formal recognition through a certificate of registration. Specifically, the bill would authorize accredited OBS facilities to seek reimbursement for a facility fee if the health plan currently reimburses for the use of the facility charged in connection with the same covered procedure performed at an ASC or hospital, provided however, that when calculating the appropriate rate of OBS facility fees, the health plans may take into consideration certain comparable and non-comparable costs and obligations of ASCs and hospitals. This recognition under the law and ability to seek certain reimbursements will assure the continued operation of these safe and cost-effective OBS practices thereby maintaining access to affordable, quality care for thousands of patients.
LEGISLATIVE HISTORY: 2012: S.4597-B died in Health 2011: S.4597-A passed Senate
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: Immediately; provided, subdivision 6 of section 230-d of the public health law shall be deemed to have been in full force and effect on and after January 18, 2009.
STATE OF NEW YORK ________________________________________________________________________ 2944 2013-2014 Regular Sessions IN SENATE January 25, 2013 ___________Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health 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: Section 1. Subdivision 1 of section 230-d of the public health law is amended by adding two new paragraphs (j) and (k) to read as follows: (J) "LICENSEE PRACTICE" SHALL MEAN AN OFFICE-BASED SURGERY FACILITY, WHICH HAS ACCREDITED STATUS. SUCH A FACILITY MAY OPERATE UNDER THE LICENSE OF THE LICENSEE. (K) "HEALTH PLAN" SHALL MEAN AN INSURER LICENSED PURSUANT TO THE INSURANCE LAW TO WRITE ACCIDENT AND HEALTH INSURANCE, OR A NON-PROFIT MEDICAL AND DENTAL INDEMNITY, OR HEALTH AND HOSPITAL SERVICE CORPORATION LICENSED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR A HEALTH MAINTENANCE ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THIS CHAPTER. S 2. Section 230-d of the public health law is amended by adding two new subdivisions 3-a and 6 to read as follows: 3-A. (A) EVERY FACILITY OPERATED AS AN OFFICE-BASED SURGERY PRACTICE OR SETTING SHALL, NOT LATER THAN JANUARY FIRST, TWO THOUSAND FOURTEEN, IN ADDITION TO OBTAINING AND MAINTAINING FULL ACCREDITED STATUS, HOLD A CERTIFICATE OF REGISTRATION ISSUED BY THE ACCREDITING AGENCY, IN CONSUL- TATION WITH THE DEPARTMENT. THE ACCREDITING AGENCY SHALL ISSUE A CERTIF- ICATE TO AN APPLICANT LICENSEE PRACTICE WHICH: (I) FILES AN APPLICATION FOR REGISTRATION IN SUCH FORM AND HAVING SUCH CONTENT AS SHALL BE DETERMINED BY THE ACCREDITING AGENCY, IN CONSULTA- TION WITH THE DEPARTMENT; (II) HAS SUCCESSFULLY COMPLETED AN ON-SITE INSPECTION OF THE FACILITY CONDUCTED BY A NATIONALLY-RECOGNIZED ACCREDITING AGENCY AS DESIGNATED BY THE COMMISSIONER;EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02577-01-3 S. 2944 2
(III) SUBMITS PROOF OF ITS FULL ACCREDITED STATUS; AND (IV) THE INITIAL CERTIFICATION OF WHICH HAS AN INITIATION DATE OF THE FIRST DATE OF ACCREDITATION AS LONG AS THE FACILITY REMAINS FULLY ACCREDITED PURSUANT TO THIS SECTION. (B) NO FACILITY OPERATED AS AN OFFICE-BASED SURGERY PRACTICE OR SETTING SHALL HOLD ITSELF OUT AS OR REPRESENT THAT IT IS REGISTERED, UNLESS IT HOLDS A VALID CERTIFICATE OF REGISTRATION ISSUED PURSUANT TO THIS SUBDIVISION. (C) THE CERTIFICATE OF REGISTRATION ISSUED TO A FACILITY PURSUANT TO THIS SUBDIVISION SHALL BE CONSPICUOUSLY POSTED AT THE PRINCIPAL ADMINIS- TRATIVE OFFICE OF SUCH FACILITY. (D) IN THE EVENT THE ACCREDITING AGENCY FINDS THAT AN APPLICATION SUBMITTED PURSUANT TO PARAGRAPH (A) OF THIS SUBDIVISION CONTAINS OR EVINCES ANY DEFICIENCY IN THE APPLICANT'S ACCREDITED STATUS, THE ACCRED- ITING AGENCY MAY ISSUE A PROVISIONAL CERTIFICATE OF REGISTRATION FOR SUCH PERIOD OF TIME AS MAY BE NECESSARY TO CURE SUCH DEFICIENCY. NO SUCH PROVISIONAL CERTIFICATE SHALL BE ISSUED UNTIL THE APPLICANT AGREES IN WRITING TO FULLY COMPLY WITH THE PROVISION OF THIS SECTION. (E) EACH CERTIFICATE OF REGISTRATION SHALL BE VALID FOR A PERIOD OF THREE YEARS, OR UNTIL THE ACCREDITED STATUS OF THE FACILITY EXPIRES, WHICHEVER SHALL OCCUR FIRST. 6. EVERY FACILITY OPERATED AS AN OFFICE-BASED SURGERY PRACTICE OR SETTING WITH FULL ACCREDITED STATUS, INCLUDING A CURRENT CERTIFICATE OF REGISTRATION, SHALL BE ELIGIBLE TO SEEK PAYMENT FROM A HEALTH PLAN FOR THE USE OF SUCH FACILITY. SUCH PAYMENT SHALL BE IN ADDITION TO THE FEE CHARGED BY THE LICENSEE FOR THE PERFORMANCE OF THE COVERED OFFICE-BASED SURGERY INVOLVING AN INSURED OR A HEALTH PLAN ENROLLEE; PROVIDED THAT THE HEALTH PLAN ALSO REIMBURSES FOR THE USE OF A FACILITY CHARGED IN CONNECTION WITH THE SAME COVERED PROCEDURE PERFORMED AT A HOSPITAL OR AMBULATORY SURGERY CENTER ORGANIZED PURSUANT TO ARTICLE TWENTY-EIGHT OF THIS CHAPTER. WHEN CALCULATING THE APPROPRIATE RATE OF OFFICE-BASED SURGERY FACILITY FEES, A HEALTH PLAN MAY ALSO TAKE INTO CONSIDERATION CERTAIN COMPARABLE AND NON-COMPARABLE COSTS AND OBLIGATIONS OF AMBULATO- RY SURGERY CENTERS AND HOSPITALS. S 3. This act shall take effect immediately; provided, however, that subdivision 6 of section 230-d of the public health law, as added by section two of this act, shall be deemed to have been in full force and effect on and after January 18, 2009, and shall only apply to facilities during the period of time which they remain fully accredited pursuant to section 230-d of the public health law.