BILL NUMBER:  S3997

 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 anes- thesia) 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.