|SAME AS||No Same As|
|Amd §§4900, 4901 & 4906, Ins L|
|Relates to the registration of office-based surgery facilities and payments for the use thereof.|
|02/01/2017||referred to insurance|
|01/03/2018||referred to insurance|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4226 SPONSOR: Quart
TITLE OF BILL: An act to amend the insurance law, in relation to registration of office-based surgery facilities and payments for the use thereof   PURPOSE OR GENERAL IDEA OF BILL: To ensure that office-based surgery facilities, certified or accredited pursuant to § 230d of the public health law 'are permitted to seek reimbursement from health plans for a facility fee.   SUMMARY OF SPECIFIC PROVISIONS: Section 2 adds office-based surgery facilities, certified or accredited pursuant to § 230d of the public health law, to clause (1) of subpara- graph (A) of paragraph 1 of subsection (e) and subsection (g) of section 4900 of the insurance law. Section 3 adds office-based surgery facilities, certified or accredited pursuant to § 230d of the public health law, to paragraph 2 of subsection (b) of section 4901 of the insurance law. Section 4 adds office-based surgery facilities, certified or accredited pursuant to § 230d of the public health law, to subsection (b) of section 4906 of the insurance law. Section 5 includes the effective date.   EXISTING LAW: Current law requires OBS facilities to obtain and maintain full accred- ited status by a nationally-recognized accrediting 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 was enacted 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. Sections of this legis- lation became effective on January 14, 2008 and on July 14, 2009. This measure was the culmination of the work of the Department of Health's Committee on Quality Assurance in Office-Based Surgery. The accreditation conferred upon these OBS facilities assures that these practices meet nationally recognized standards for patient safety and quality care and 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. Accredited OBS facilities provide quality care at a lower cost than care provided in more costly Article 28 Ambulatory Surgery Centers (ASCs) and hospitals. In fact, for thousands of New Yorkers, these facilities represent critical access points for vital, affordable health care services. However, many health plans refuse to pay OBS facilities a facility fee, even though accredited OBS facilities must shoulder the burden of significant costs just like ASCs and hospitals. Unfortunately, there has been a lack of recognition of these costs on the part of third party payors. More importantly, insurance companies have also failed to recognize that the impact of non-payment of these fees has been to drive procedures from the low cost OBS locations into the much more expensive hospital and other Article 28 facilities. This inevitable shift will dramatically drive up the cost of medical care. Sadly, numerous accred- ited OBS facilities have already started to close and move procedures to more expensive Article 28 facilities and hospitals. Inexplicably, since the enactment of the OBS accreditation process, third party payors have cited the fact that OBS facilities are not licensed as a basis for denial of claims. This bill addresses that by establishing a registration and certification process to provide OBS facilities with an added level of recognition to better enable them to seek reimbursement for facility fees from third party payors. In addition, those few third party payors who have reimbursed OBS facil- ities have done so only for in-network facilities. To make matters worse, payors will often refuse to reimburse for out-of-network facili- ties, even in cases where the insureds have contracted and paid for out-of-network coverage. For the most part, OBS facilities have been denied access to the health plans' network further hindering their abil- ity to seek reimbursement and negatively impacting their patients' choice and access and to low cost, quality care. This bill would correct such inequity by providing accredited office-based surgery facilities with a mechanism to obtain a formal recognition through a certificate of registration. Specifically, the bill would authorize accredited OBS facilities to seek reimbursement for a facility fee if the health plan currently reimburses for the use of the facility charged in connection with the same covered procedure performed at an ASC or hospital, provided however, that when calculating the appropriate rate of OBS facility fees, the health plans may take into consideration certain comparable and non-comparable costs and obligations of ASCs and hospi- tals. This recognition under the law and ability to seek certain reimbursements will assure the continued operation of these safe and cost-effective OBS practices thereby maintaining access to affordable, quality care for thousands of patients.   PRIOR LEGISLATIVE HISTORY: 2015-2016: A2061 died in Insurance Committee 2013-2014: A7944 died in Insurance Committee 2011: A7431B died in Health Committee.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: Immediately; provided, subdivision 6 of section 230-d of the public health law shall be deemed to have been in full force and effect on and after January 18, 2009.
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STATE OF NEW YORK ________________________________________________________________________ 4226 2017-2018 Regular Sessions IN ASSEMBLY February 1, 2017 ___________ Introduced by M. of A. QUART -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to registration of office-based surgery facilities and payments for the use thereof The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Legislative intent. The legislature hereby finds that New 2 York state is home to approximately 1,000 accredited physician-owned 3 ambulatory surgery facilities, referred to as Office-Based Surgery (OBS) 4 practices, currently providing patient access to virtually all types of 5 covered outpatient surgical procedures safely and at a lower cost 6 compared to other settings, including traditional ambulatory surgery 7 centers and hospitals. 8 The legislature further finds that advances in medicine, including 9 surgical techniques, equipment and improvements in anesthesia enable 10 procedures to be performed safely, conveniently and at a much lower cost 11 in an office-based setting. In fact, conservative estimates show physi- 12 cian-owned ambulatory surgery facilities can achieve cost savings of 13 30%-40% as compared with other settings. The enviable safety record of 14 the accredited OBS industry is also well established. 15 The legislature also finds that like many states, New York is experi- 16 encing a growing physician shortage. The problem is compounded for 17 accredited office-based surgery facilities and the patients they treat 18 by the recent refusal on the part of many third party payers to reim- 19 burse facility costs for covered procedures. These expenses are substan- 20 tial and include capital costs, equipment usage, supplies and overhead. 21 The motives behind these denials are inexplicable given that this venue 22 represents the lowest-cost provider. In fact, it was not long ago that 23 insurers were consistently reimbursing OBS practices for their facility 24 costs. Practitioners invested in their practices dependent on these 25 established reimbursement practices. Without the mechanism to negotiate 26 with the payers, these mostly small or solo practices lack the clout and 27 market power to negotiate and convince insurers to reinstate reimburse- 28 ment. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08898-01-7A. 4226 2 1 The legislature also finds that lack of reimbursement has driven many 2 physician owned ambulatory surgery practices out of the market. Many 3 more are likely to follow resulting in thousands of lost jobs, decreased 4 access to care and substantially higher costs to patients and the over- 5 all healthcare delivery system. 6 The legislature further finds that while office-based surgery prac- 7 tices are recognized in statute pursuant to the accreditation require- 8 ments in section 230-d of the public health law, there is nothing in 9 current law or regulations that specifically identifies accredited 10 office-based surgery entities as facilities entitled to seek reimburse- 11 ment for facility related costs. 12 Therefore, the legislature hereby declares that, due to the integral 13 role that accredited office-based surgery practices play in the safe, 14 efficient and low-cost delivery of surgical services, as well as the 15 need to protect and enhance patient safety and access to affordable care 16 for all New Yorkers, it is in the interest of the people of this state 17 to further enhance recognition of accredited office-based surgery prac- 18 tice and protect and encourage a robust and successful industry in this 19 state. 20 § 2. Clause (i) of subparagraph (A) of paragraph 1 of subsection (e) 21 and subsection (g) of section 4900 of the insurance law, as amended by 22 chapter 558 of the laws of 1999, are amended to read as follows: 23 (i) provided by a facility licensed, certified or accredited pursuant 24 to section two hundred thirty-d, article twenty-eight, thirty-six, 25 forty-four or forty-seven of the public health law or pursuant to arti- 26 cle nineteen, [ twenty-three,] thirty-one or thirty-two of the mental 27 hygiene law; or 28 (g) "Health care provider" means a health care professional or a 29 facility licensed, certified or accredited pursuant to section two 30 hundred thirty-d, article twenty-eight, thirty-six, forty-four or 31 forty-seven of the public health law or a facility licensed or certified 32 pursuant to article nineteen, [ twenty-three,] thirty-one or thirty-two 33 of the mental hygiene law. 34 § 3. Paragraph 2 of subsection (b) of section 4901 of the insurance 35 law, as added by chapter 705 of the laws of 1996, is amended to read as 36 follows: 37 (2) Those circumstances, if any, under which utilization review may be 38 delegated to a utilization review program conducted by a facility 39 licensed, certified or accredited pursuant to section two hundred thir- 40 ty-d or article twenty-eight of the public health law or pursuant to 41 article thirty-one of the mental hygiene law; 42 § 4. Subsection (b) of section 4906 of the insurance law, as added by 43 chapter 237 of the laws of 2009, is amended to read as follows: 44 (b) Notwithstanding subsection (a) of this section, in lieu of the 45 external appeal process as set forth in this article, a health care plan 46 and a facility licensed, certified or accredited pursuant to section two 47 hundred thirty-d or article twenty-eight of the public health law may 48 agree to an alternative dispute resolution mechanism to resolve disputes 49 otherwise subject to this article. 50 § 5. This act shall take effect immediately and shall be deemed to 51 have been in full force and effect on and after January 18, 2009 with 52 respect to claims and appeals filed for health care services provided at 53 facilities subject to the provisions of section 230-d of the public 54 health law during the period of time which such facilities remain fully 55 licensed, certified or accredited pursuant to such section.