senate Bill S2944

Amended

Relates to the registration of office-based surgery facilities and payments for the use thereof

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 25 / Jan / 2013
    • REFERRED TO HEALTH
  • 12 / Jun / 2013
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 12 / Jun / 2013
    • PRINT NUMBER 2944A
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Relates to the registration of office-based surgery facilities and payments for the use thereof.

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Bill Details

See Assembly Version of this Bill:
A6702
Versions:
S2944
S2944A
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §230-d, Pub Health L
Versions Introduced in Previous Legislative Cycles:
2013-2014: A7944
2011-2012: S4597B, A7431B

Sponsor Memo

BILL NUMBER:S2944

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 nation-
ally-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 main-
tain full accredited status by a nationally-recognized accrediting agen-
cy 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, insur-
ance companies have also failed to recognize that the impact of non-pay-
ment 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 facil-
ities 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 facil-
ities have done so only for in-network facilities. To make matters
worse, payors will often refuse to reimburse for out-of-network facili-
ties, 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 abil-
ity 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 hospi-
tals. 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.

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

                                  2944

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            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.

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