Relates to payment for services performed in an office-based surgical facility

BILL NUMBER:S8101

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 anesthesia) 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.

Legislative history

New Bill.

Fiscal implications

None.

Effective date

Immediately.