Senate Bill S2626

                                BILL NUMBER:S2626

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.