S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2413
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 22, 2019
                                ___________
 
 Introduced by M. of A. PICHARDO -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend  the  public  health law, in relation to referrals of
   patients for health or health related items or services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Paragraph  (g)  of  subdivision 2 of section 238-a of the
 public health law, as added by chapter 803  of  the  laws  of  1992,  is
 amended to read as follows:
   (g)  [in the case of any other financial relationship which the public
 health council determines  and  specifies  in  regulations,  subject  to
 approval  by the commissioner, does not pose a substantial risk of payor
 or patient abuse in relation to  patient  benefits  consistent,  to  the
 extent  practicable,  with  financial  relationships  specified in regu-
 lations adopted pursuant to  federal  law  applicable  to  reimbursement
 pursuant  to  title  XVIII of the federal social security act (medicare)
 for clinical laboratory services  provided  to  beneficiaries  of  title
 XVIII  of  the  federal  social security act (medicare)] ANY ARRANGEMENT
 THAT, UNDER THE FEDERAL STATUTORY PROHIBITION ON CERTAIN REFERRALS CODI-
 FIED AT 42 U.S.C. 1395NN AND REGULATIONS PROMULGATED  THEREUNDER,  WOULD
 BE  AN  ARRANGEMENT  BETWEEN A PRACTITIONER (OR IMMEDIATE FAMILY MEMBER)
 AND A HEALTH CARE PROVIDER THAT:
   (I) WOULD NOT BE A FINANCIAL RELATIONSHIP IF EXISTING BETWEEN A PHYSI-
 CIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED UNDER SUCH FEDERAL LAW  OR
 REGULATIONS; OR
   (II) WOULD SATISFY THE REQUIREMENTS OF AN EXCEPTION RELATING TO FINAN-
 CIAL  RELATIONSHIPS  PROVIDED  UNDER  SUCH FEDERAL LAW OR REGULATIONS IF
 EXISTING BETWEEN A PHYSICIAN AND AN ENTITY, AS SUCH  TERMS  ARE  DEFINED
 UNDER SUCH FEDERAL LAW OR REGULATIONS.
   AN  ARRANGEMENT  SHALL NOT BE EXCEPTED UNDER THIS PARAGRAPH IF IT IS A
 PARTICULAR TYPE OF FINANCIAL RELATIONSHIP THAT WOULD POSE A  SUBSTANTIAL
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD05451-01-9

 A. 2413                             2
 
 RISK  OF  PAYOR  OR  PATIENT  ABUSE,  AS DETERMINED AND SPECIFIED BY THE
 PUBLIC HEALTH AND HEALTH PLANNING COUNCIL  IN  REGULATIONS,  SUBJECT  TO
 APPROVAL BY THE COMMISSIONER.
   §  2.  Paragraph  (c)  of subdivision 6 of section 238-a of the public
 health law, as added by chapter 803 of the laws of 1992, is  amended  to
 read as follows:
   (c) provided further, however, that the following shall not constitute
 a referral by a referring practitioner:
   (i) a request by a practitioner for practitioners' services consisting
 solely of professional services to be furnished personally by that prac-
 titioner, or under that practitioner's supervision;
   (ii)  a  request  by  a pathologist for clinical diagnostic laboratory
 tests and  pathological  examination  services,  if  such  services  are
 furnished  by or under the supervision of such pathologist pursuant to a
 consultation requested by another practitioner; [and]
   (iii) a request by a  radiologist  for  diagnostic  x-ray  or  imaging
 services,  if such services are furnished by or under the supervision of
 such radiologist pursuant to a consultation requested by another practi-
 tioner[.]; AND
   (IV) A REFERRAL FOR ANY SERVICES EXCEPTED UNDER 42 U.S.C. § 1395NN AND
 REGULATIONS PROMULGATED THEREUNDER, UNLESS THE PUBLIC HEALTH AND  HEALTH
 PLANNING  COUNCIL  DETERMINES  AND  SPECIFIES IN REGULATIONS, SUBJECT TO
 APPROVAL BY THE COMMISSIONER, THAT A PARTICULAR TYPE OF  REFERRAL  WOULD
 POSE A SUBSTANTIAL RISK OF PAYOR OR PATIENT ABUSE IN RELATION TO PATIENT
 BENEFITS.
   § 3. This act shall take effect immediately.