S3154-2013 Actions

• Jan 30, 2013: REFERRED TO HEALTH

S3154-2013 Memo

BILL NUMBER:S3154

TITLE  OF BILL:  An act to amend the public health law, in relation to
payment for services performed in an office-based surgical facility

PURPOSE:  To require health plans to provide payment  to  a  physician
for  the  use of the office-based surgical facility in the performance
of medically necessary procedures performed in accredited office-based
practices.

SUMMARY OF PROVISIONS:  This bill amends Section 230-d of  the  public
health  law  to  require  a  health  plan  to provide reimbursement to
physician for  the  use  of  the  office-based  surgical  facility  in
addition  to  the  fee  charged  for  the  performance  of a medically
necessary procedure involving  a  health  plan  enrollee  or  insured,
provided   that  such  office-based  surgical  facility  has  achieved
accredited status as required by Section 230-d(2).

EXISTING LAW:   Current law  requires  physicians  in  whose  practice
office-based   surgery  is  performed  to  obtain  and  maintain  full
accredited  status  by  a  nationally-recognized   accredited   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 to require physicians who perform
office-based  surgery in their offices to obtain accreditation of such
office setting was passed by both  Houses  of  the  Legislature.  This
measure  was the culmination of the work of the Department of Health's
Committee on Quality Assurance in Office-Based Surgery. The  Committee
concluded  that  "the  New York State Department of Health should seek
the legislative authority to  require  accreditation  of  office-based
surgical  practices, including adverse event reporting" as outlined in
their report. The resulting legislation defined OBS as  "any  surgical
or   other   invasive  procedure  (excluding  minimal  procedures  and
procedures requiring minimal  sedation)  requiring  moderate  or  deep
sedation  or  general  anesthesia  and  unsupplemented  liposuction of
greater than 500cc." Exempt from the accreditation requirements of the
bill are practices that are limited  to  minor  procedures  (performed
with  local  or topical anesthesia or liposuction with removal of less
than  500  cc  of  fat  under  unsupplemented  local  anesthesia)   or
procedures  performed  using  minimal  sedation ("means a drug induced
state during which (i) patients respond normally to  verbal  commands;
(ii)  cognitive  function  and  coordination may be impaired and (iii)
ventilatory  and  cardiovascular  functions  are   unaffected").   The
accreditation  conferred  upon  these  office-based surgical practices
assures that these practices meet nationally recognized standard which
address the office-based surgery  practices  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. OBS
practices provide a higher quality of care at a lower cost  than  care
provided  in  more  costly ambulatory surgery centers and hospital out


patient departments.  Several  health  plans,  however,  fail  to  pay
physicians  with accredited office based surgical practices a facility
fee.  Payment of a facility fee in addition to the fee charged for the
performance  of  a  medically  necessary  procedure  will  assure  the
continued operation of these cost-efficient OBS practices.

FISCAL IMPLICATIONS:  None.

EFFECTIVE DATE: Immediately.

S3154-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    3154

                         2013-2014 Regular Sessions

                              I N  SENATE

                              January 30, 2013
                                 ___________

  Introduced  by  Sen. KRUEGER -- 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  payment  for
    services performed in an office-based surgical facility

    THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
  BLY, DO ENACT AS FOLLOWS:


    Section 1. Section 230-d of the public health law is amended by adding
  a new subdivision 6 to read as follows:

    6. ANY LICENSEE WHO OBTAINS ACCREDITED STATUS AS SET FORTH PURSUANT TO
  THIS SECTION SHALL RECEIVE PAYMENT FROM A HEALTH PLAN FOR THE USE OF THE
  OFFICE-BASED SURGICAL FACILITY IN ADDITION TO THE FEE  CHARGED  FOR  THE
  PERFORMANCE OF THE MEDICALLY NECESSARY PROCEDURE INVOLVING A HEALTH PLAN
  ENROLLEE  OR  INSURED.  FOR  THE PURPOSES OF THIS SECTION, "HEALTH PLAN"
  SHALL BE DEFINED AS AN INSURER THAT IS LICENSED UNDER THE INSURANCE  LAW
  TO  WRITE ACCIDENT AND HEALTH INSURANCE, OR THAT IS LICENSED PURSUANT TO
  ARTICLE FORTY-THREE OF THE INSURANCE LAW, OR IS  CERTIFIED  PURSUANT  TO
  ARTICLE FORTY-FOUR OF THIS CHAPTER.
    S 2. This act shall take effect immediately.





   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD06296-01-3