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

                                  4437

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            January 30, 2015
                               ___________

Introduced  by M. of A. SILVER, GOTTFRIED -- Multi-Sponsored by -- M. of
  A. BRAUNSTEIN, BRINDISI, DINOWITZ, HEVESI -- read once and referred to
  the Committee 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
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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06783-01-5
              

A. 4437                             2

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;
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, 2014.