S4660-2011 - NY Senate Open Legislation - Relates to referrals of patients for health related items or services

Relates to referrals of patients for health related items or services.

Sponsor: HANNON / Co-sponsor(s): KRUEGER
Law Section: Public Health Law / Law: Amd S238-a, Pub Health L

S4660-2011 Actions

Jun 12, 2012: SUBSTITUTED BY A3551A
May 21, 2012: ADVANCED TO THIRD READING
May 16, 2012: 2ND REPORT CAL.
May 15, 2012: 1ST REPORT CAL.814
Jan 4, 2012: REFERRED TO HEALTH
Apr 14, 2011: REFERRED TO HEALTH

S4660-2011 Meetings

Health: May 15, 2012

S4660-2011 Calendars

Active List: Jun 12, 2012 , Floor Calendar: May 16, 2012 , Floor Calendar: May 21, 2012 , Floor Calendar: May 22, 2012 , Floor Calendar: May 23, 2012 , Floor Calendar: May 30, 2012 , Floor Calendar: May 31, 2012 , Floor Calendar: Jun 4, 2012 , Floor Calendar: Jun 5, 2012 , Floor Calendar: Jun 6, 2012 , Floor Calendar: Jun 11, 2012 , Floor Calendar: Jun 12, 2012

S4660-2011 Votes

VOTE: COMMITTEE VOTE: - Health - May 15, 2012

Ayes (14): Hannon, Ball, Farley, Fuschillo, Golden, Larkin, McDonald, Seward, Young, Adams, Montgomery, Rivera, Smith, Stewart-Cousins
Ayes W/R (3): Duane, Gianaris, Peralta

S4660-2011 Memo

BILL NUMBER:S4660

TITLE OF BILL:
An act
to amend the public health law, in relation to referrals of patients for
health or health related items or services

PURPOSE OR GENERAL IDEA OF BILL:
To promote conformity between the
federal Stark Law and New York's Health Care Practitioner Referrals
Statute.

SUMMARY OF PROVISIONS:
Amends Public Health Law �238-a (2) (g) to
provide that a referral or arrangement that would be allowed under
federal law, 42 D.S.C. 1395nn or its regulations would similarly be
allowed under the New York law, unless the Public Health and Health
Planning Council declares a type of arrangement to pose a substantial
risk of payor or patient abuse, by regulation approved by the Health
Commissioner.

Amends the list of exemptions in Public Health Law � 238-a (6) (c) to
add any referral or arrangement allowed under federal law, unless the
state Public Health and Health Planning Council declares a type of
referral to pose a substantial risk of payor or patient abuse, by
regulation subject approval of the Health Commissioner.

JUSTIFICATION:
This bill is being introduced in order to determine
what effect the federal Stark law (named for its congressional
sponsor) establishes complex rules on referrals from one health care
provider to another and the financial relationships between providers.
The purpose is to avoid kickback arrangements and conflicts of
interest that cost patients and third-party payers money and can lead
to unnecessary and inappropriate services. New York State's law is
similar but not the same. So some arrangements or referrals are
permissible under the federal Stark law but not under the New York
statute. This can create difficulties for health care providers.

For example, the New York statute does not contain exceptions for
providing electronic medical record systems, donations of items and
services to federally qualified health centers, and fair market value
arrangements. Also, the New York exception for in-office ancillary
services requires an employer/employee relationship, as compared to
the Stark exception, which permits an independent contractor
relationship.

The bill would provide that arrangements or referrals that are allowed
under the federal law are also allowed under the New York law, unless
the Public Health and Health Planning Council and the Health
Commissioner designate particular types of arrangements or referrals
that would not be allowed because they pose a substantial risk of
payor or patient abuse. The bill was drafted in conjunction with
the State Bar Association's health law section and has broad
provider support.


The bill is being introduced in order to determine what practical
effect making NYS' law uniform with the federal Stark law would have
on business practices and consumer care.

PRIOR LEGISLATIVE HISTORY:
2009-10:   A.9933 - Passed Assembly.
           S.6955/A.9933 of 2010

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
Immediately.

S4660-2011 Text

 S T A T E   O F   N E W   Y O R K
 
                                          4660
 2011-2012 Regular Sessions
 I N  SENATE
 April 14, 2011
 
 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  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:

 

Section 1. Paragraph (g) of subdivision 2  of  section  238-a  of  the
 public  health  law,  as  added  by  chapter 803 of the laws of 1992, is
 amended to read as follows:

 (g) [in the case of any other financial relationship which the  public
 health  council  determines  and  specifies  in  regulations, subject to
 approval by the commissioner, does not pose a substantial risk of  payor
 or  patient  abuse  in  relation  to patient benefits consistent, to the
 extent practicable, with  financial  relationships  specified  in  regu-
 lations  adopted  pursuant  to  federal  law applicable to reimbursement
 pursuant to title XVIII of the federal social  security  act  (medicare)
 for  clinical  laboratory  services  provided  to beneficiaries of title
 XVIII of the federal social security  act  (medicare)]  ANY  ARRANGEMENT
 THAT, UNDER THE FEDERAL STATUTORY PROHIBITION ON CERTAIN REFERRALS CODI
 FIED  AT  42 U.S.C. 1395NN AND REGULATIONS PROMULGATED THEREUNDER, WOULD
 BE AN ARRANGEMENT BETWEEN A PRACTITIONER (OR  IMMEDIATE  FAMILY  MEMBER)
 AND A HEALTH CARE PROVIDER THAT:

 (I) WOULD NOT BE A FINANCIAL RELATIONSHIP IF EXISTING BETWEEN A PHYSI
 CIAN  AND AN ENTITY, AS SUCH TERMS ARE DEFINED UNDER SUCH FEDERAL LAW OR
 REGULATIONS; OR
 (II) WOULD SATISFY THE REQUIREMENTS OF AN EXCEPTION RELATING TO FINAN
 CIAL RELATIONSHIPS PROVIDED UNDER SUCH FEDERAL  LAW  OR  REGULATIONS  IF
 EXISTING  BETWEEN  A  PHYSICIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED
 UNDER SUCH FEDERAL LAW OR REGULATIONS.
 AN ARRANGEMENT SHALL NOT BE EXCEPTED UNDER THIS PARAGRAPH IF IT  IS  A
 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.
 LBD02276-02-1
        S. 4660                             2
 RISK OF PAYOR OR PATIENT ABUSE,  AS  DETERMINED  AND  SPECIFIED  BY  THE
 PUBLIC  HEALTH  AND  HEALTH  PLANNING COUNCIL IN REGULATIONS, SUBJECT TO
 APPROVAL BY THE COMMISSIONER.
 

S  2.  Paragraph  (c)  of subdivision 6 of section 238-a of the public
 health law, as added by chapter 803 of the laws of 1992, is  amended  to
 read as follows:

 (c) provided further, however, that the following shall not constitute
 a referral by a referring practitioner:

 (i) a request by a practitioner for practitioners' services consisting
 solely of professional services to be furnished personally by that prac
 titioner, or under that practitioner's supervision;
 (ii)  a  request  by  a pathologist for clinical diagnostic laboratory
 tests and  pathological  examination  services,  if  such  services  are
 furnished  by or under the supervision of such pathologist pursuant to a
 consultation requested by another practitioner; [and]
 (iii) a request by a  radiologist  for  diagnostic  x-ray  or  imaging
 services,  if such services are furnished by or under the supervision of
 such radiologist pursuant to a consultation requested by another practi
 tioner[.]; AND
 (IV) A REFERRAL FOR ANY SERVICES EXCEPTED UNDER 42 U.S.C.

S 1395NN AND
 REGULATIONS PROMULGATED THEREUNDER, UNLESS THE PUBLIC HEALTH AND  HEALTH
 PLANNING  COUNCIL  DETERMINES  AND  SPECIFIES IN REGULATIONS, SUBJECT TO
 APPROVAL BY THE COMMISSIONER, THAT A PARTICULAR TYPE OF  REFERRAL  WOULD
 POSE A SUBSTANTIAL RISK OF PAYOR OR PATIENT ABUSE IN RELATION TO PATIENT
 BENEFITS.
 

S 3. This act shall take effect immediately.

S4660-2011: Relates to referrals of patients for health related items or services