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

                                  7838

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              June 5, 2013
                               ___________

Introduced  by  M.  of  A. SILVER, GOTTFRIED, MILLMAN, MORELLE, FARRELL,
  JACOBS -- Multi-Sponsored by -- M. of A. BRAUNSTEIN,  BRINDISI,  BRON-
  SON,  CLARK,  DINOWITZ,  GOLDFEDER, HENNESSEY, HEVESI, LAVINE, LIFTON,
  PAULIN,  ROBERTS,  ROBINSON,  ROSA,  RUSSELL,  SANTABARBARA,  SKOUFIS,
  STIRPE, WEINSTEIN, WEISENBERG -- read once and referred to the Commit-
  tee on Health

AN  ACT to amend the public health law, in relation to prohibiting Medi-
  care charges by healthcare providers in excess  of  statutory  limita-
  tions

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

  Section 1. Section 19 of the public health law, as  added  by  chapter
572 of the laws of 1990, is amended to read as follows:
  S 19. Reasonable charges for medicare beneficiaries.  1. No [physician
licensed  under  article  one  hundred  thirty-one of the education law]
HEALTHCARE PROVIDER shall charge from a beneficiary of health  insurance
under  title  XVIII  of  the  federal social security act (medicare) any
amount in excess of ONE HUNDRED AND FIVE PERCENT OF the [following limi-
tations:
  (a) Effective January first, nineteen  hundred  ninety-one,  a  physi-
cian's  charge  shall  not  exceed  one  hundred  fifteen percent of the
reasonable charge for that service as determined by  the  United  States
secretary for health and human services.
  (b)  Beginning  January first, nineteen hundred ninety-three, a physi-
cian's charge shall not exceed one hundred ten percent of the reasonable
charge] ESTABLISHED MEDICARE PAYMENT RATE,  INCLUDING  ANY  DEDUCTIBLES,
COINSURANCE  OR  COPAYMENTS for that service as determined by the United
States secretary for health and human services[, provided however,  that
if the statewide percentage of medicare part B claims billed at or below
the  reasonable  charge as determined by the United States secretary for
health and human services  for  federal  fiscal  year  nineteen  hundred

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11143-05-3
              

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eighty-nine  fails  to  increase  by  five percentage points for federal
fiscal year nineteen hundred ninety-two, such physician's charge  shall,
thereafter, not exceed one hundred five percent of the reasonable charge
as  determined  by  the  United  States  secretary  for health and human
services. If, in any subsequent  federal  fiscal  year,  such  statewide
percentage  of medicare part B claims billed at or below such reasonable
charge fails to maintain such five  percentage  point  increase,  physi-
cian's  charge  shall  thereafter not exceed one hundred five percent of
the reasonable charge as determined by the United States  secretary  for
health and human services].
  1-A.  IN THE EVENT A BENEFICIARY OF MEDICARE EXHAUSTS ANY CAPPED BENE-
FIT FOR HEALTH CARE SERVICES, INCLUDING, BUT NOT LIMITED  TO,  REHABILI-
TATION  SERVICES,  THE CHARGE LIMITATION SET FORTH IN SUBDIVISION ONE OF
THIS SECTION SHALL CONTINUE TO APPLY, PROVIDED THAT  SUCH  SERVICES  ARE
DETERMINED TO BE MEDICALLY NECESSARY.
  2.  The charge limitation set forth in subdivision one of this section
shall not apply if the service which such beneficiary is to be billed is
either an office or home visit as set forth  in  procedure  codes  90000
through  90170  in  the  Physician  Current  Procedural  Terminology 4th
Edition 1989.
  3. [The state office for  the  aging  shall,  through  agreement  with
carriers and/or intermediaries contracted with by the federal government
in this state pursuant to title XVIII of the federal social security act
(medicare),  obtain the percentages of physician's bills submitted at or
below the reasonable charge as established by the United  States  secre-
tary for health and human services, and shall issue a report by December
first, nineteen hundred ninety-two and every December first, thereafter,
stating  whether  the  percentage  of  bills  submitted at or below such
reasonable charge for federal fiscal year  nineteen  hundred  ninety-two
increased  by  five  percentage  points over the statewide percentage of
bills submitted at or below such reasonable charge  for  federal  fiscal
year  nineteen  hundred eighty-nine and whether such percentage has been
maintained for  each  successive  federal  fiscal  year  after  nineteen
hundred ninety-two.
  4.]  Notwithstanding  any  inconsistent  provision  of this chapter, a
[physician] HEALTHCARE PROVIDER who is determined, after opportunity for
a hearing, to have violated the provisions  of  this  section  shall  be
subject  for the first violation to a fine of not more than one thousand
dollars nor less than the greater of three times the  amount  collected,
or,  if  not collected, three times the amount charged, in excess of the
limitations set forth in subdivision one of this section, and, for  each
additional violation committed within five years of the date of an imme-
diately  preceding violation of this section, to a fine of not more than
five thousand dollars nor less than the greater of one thousand  dollars
or  three  times the amount collected, or, if not collected, three times
the amount charged, in excess of the limitations set forth  in  subdivi-
sion  one of this section; provided, however, that in no event shall the
fine for an individual violation of this section be  greater  than  five
thousand dollars. In addition, where the provisions of this section have
been  violated,  the [physician] HEALTHCARE PROVIDER shall refund to the
beneficiary the amount collected in excess of the limitations set  forth
in subdivision one of this section.
  4.  FOR PURPOSES OF THIS SECTION, A "HEALTHCARE PROVIDER" SHALL MEAN A
HEALTHCARE PRACTITIONER LICENSED OR CERTIFIED UNDER TITLE EIGHT  OF  THE
EDUCATION  LAW OR A LAWFUL COMBINATION OF SUCH HEALTHCARE PRACTITIONERS;

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AND AN ENTITY LICENSED OR CERTIFIED UNDER ARTICLE TWENTY-EIGHT OR  THIR-
TY-SIX OF THIS CHAPTER.
  S  2.  This  act  shall take effect immediately and shall apply to all
charges incurred on and after January 1, 2012.