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

                                  7944

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              June 11, 2013
                               ___________

Introduced  by M. of A. QUART -- read once and referred to the Committee
  on Insurance

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:

  Section 1. Legislative intent. The legislature hereby finds  that  New
York  state  is  home  to approximately 1,000 accredited physician-owned
ambulatory surgery facilities, referred to as Office-Based Surgery (OBS)
practices, currently providing patient access to virtually all types  of
covered  outpatient  surgical  procedures  safely  and  at  a lower cost
compared to other settings,  including  traditional  ambulatory  surgery
centers and hospitals.
  The  legislature  further  finds  that advances in medicine, including
surgical techniques, equipment and  improvements  in  anesthesia  enable
procedures to be performed safely, conveniently and at a much lower cost
in  an office-based setting. In fact, conservative estimates show physi-
cian-owned ambulatory surgery facilities can  achieve  cost  savings  of
30%-40%  as  compared with other settings. The enviable safety record of
the accredited OBS industry is also well established.
  The legislature also finds that like many states, New York is  experi-
encing  a  growing  physician  shortage.  The  problem is compounded for
accredited office-based surgery facilities and the patients  they  treat
by  the  recent  refusal on the part of many third party payers to reim-
burse facility costs for covered procedures. These expenses are substan-
tial and include capital costs, equipment usage, supplies and  overhead.
The  motives behind these denials are inexplicable given that this venue
represents the lowest-cost provider. In fact, it was not long  ago  that
insurers  were consistently reimbursing OBS practices for their facility
costs. Practitioners invested in  their  practices  dependent  on  these
established reimbursement practices.  Without the mechanism to negotiate
with the payers, these mostly small or solo practices lack the clout and
market  power to negotiate and convince insurers to reinstate reimburse-
ment.

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11385-01-3

A. 7944                             2

  The legislature also finds that lack of reimbursement has driven  many
physician  owned  ambulatory  surgery  practices out of the market. Many
more are likely to follow resulting in thousands of lost jobs, decreased
access to care and substantially higher costs to patients and the  over-
all healthcare delivery system.
  The  legislature  further  finds that while office-based surgery prac-
tices are recognized in statute pursuant to the  accreditation  require-
ments  in  section  230-d  of the public health law, there is nothing in
current law  or  regulations  that  specifically  identifies  accredited
office-based  surgery entities as facilities entitled to seek reimburse-
ment for facility related costs.
  Therefore, the legislature hereby declares that, due to  the  integral
role  that  accredited  office-based surgery practices play in the safe,
efficient and low-cost delivery of surgical services,  as  well  as  the
need to protect and enhance patient safety and access to affordable care
for  all  New Yorkers, it is in the interest of the people of this state
to further enhance recognition of accredited office-based surgery  prac-
tice  and protect and encourage a robust and successful industry in this
state.
  S 2. Clause (i) of subparagraph (A) of paragraph 1 of  subsection  (e)
and  subsection  (g) of section 4900 of the insurance law, as amended by
chapter 558 of the laws of 1999, are amended to read as follows:
  (i) provided by a facility licensed, CERTIFIED OR ACCREDITED  pursuant
to  SECTION  TWO  HUNDRED  THIRTY-D,  article  twenty-eight, thirty-six,
forty-four or forty-seven of the public health law or pursuant to  arti-
cle  nineteen,  [twenty-three,]  thirty-one  or thirty-two of the mental
hygiene law; or
  (g) "Health care provider" means  a  health  care  professional  or  a
facility  licensed,  CERTIFIED  OR  ACCREDITED  pursuant  to SECTION TWO
HUNDRED  THIRTY-D,  article  twenty-eight,  thirty-six,  forty-four   or
forty-seven of the public health law or a facility licensed OR CERTIFIED
pursuant  to  article nineteen, [twenty-three,] thirty-one or thirty-two
of the mental hygiene law.
  S 3. Paragraph 2 of subsection (b) of section 4901  of  the  insurance
law,  as added by chapter 705 of the laws of 1996, is amended to read as
follows:
  (2) Those circumstances, if any, under which utilization review may be
delegated to a  utilization  review  program  conducted  by  a  facility
licensed,  CERTIFIED OR ACCREDITED pursuant to SECTION TWO HUNDRED THIR-
TY-D OR article twenty-eight of the public health  law  or  pursuant  to
article thirty-one of the mental hygiene law;
  S  4. Subsection (b) of section 4906 of the insurance law, as added by
chapter 237 of the laws of 2009, is amended to read as follows:
  (b) Notwithstanding subsection (a) of this section,  in  lieu  of  the
external appeal process as set forth in this article, a health care plan
and a facility licensed, CERTIFIED OR ACCREDITED pursuant to SECTION TWO
HUNDRED  THIRTY-D  OR  article twenty-eight of the public health law may
agree to an alternative dispute resolution mechanism to resolve disputes
otherwise subject to this article.
  S 5. This act shall take effect immediately and  shall  be  deemed  to
have  been  in  full force and effect on and after January 18, 2009 with
respect to claims and appeals filed for health care services provided at
facilities subject to the provisions of  section  230-d  of  the  public
health  law during the period of time which such facilities remain fully
licensed, certified or accredited pursuant to such section.