BILL NUMBER:  S5810A

 TITLE OF BILL :

An act to amend the public health law, in relation to authorizing
certain office-based surgery practices to seek payment for the use of
their facilities

 PURPOSE :

Authorize accredited office-based surgery practices to seek payment
from health care plans for the use of the surgery location or setting.

 SUMMARY OF PROVISIONS :

Section one amends Public Health Law § 230-d to authorize every
office-based surgery practice established prior to the effective date
of this subdivision to seek payment from insurers for the costs
related to the use of the surgery location or setting of such
practice, provided the health plan also reimburses such costs for the
same covered procedure performed at a hospital or ambulatory surgery
center. This fee is in addition to the fee charged by the licensee for
the performance of the surgery. When calculating the rate, the plan
may also take into consideration certain comparable and non-comparable
costs and obligation of ambulatory surgery centers and hospitals and
adjust rates accordingly.
              

Section two provides the act shall take effect immediately.

 JUSTIFICATION :

In 2007, as culmination of the work of the Department of Health
Committee on Quality Assurance in Office Based Surgery (OBS), the
legislature enacted measures 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. The accreditation conferred
upon these OBS facilities assures that these practices meet nationally
recognized standards for patient safety and quality care.  Provisions
of this legislation became effective on January 14, 2008 and on July
14, 2009.

OBS facilities are often a cost efficient, quality option for
patients. However, despite increased accreditation requirements, many
health plans refuse to reimburse these facilities a facility fee, even
if they may reimburse such a fee if the procedure were performed in an
ambulatory surgery center or hospital. Since the enactment of the 2007
law, most third party payers have not recognized facility and
compliance costs when negotiating with OBS providers, and in cases
where such fees were once reimbursed by third parties, they no longer
are in most instances.

This legislation amends Public Health Law to explicitly provide
existing accredited OBS facilities with the authority to seek
reimbursement for a facility fee. There are a number of reasons
currently accredited OBS facilities may not be able to apply to become
article 28 facilities. This change will level the playing field and,
in turn, enable consumer choice by leaving the decision to the patient
and doctors as to which facility can provide the best care for that
patient.

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.