Relates to the registration of office-based surgery facilities and payments for the use thereof

Summary of provisions

Section 1 provides the legislative intent.

Section 2 adds office-based surgery facilities, certified or accredited pursuant to § 230d of the public health law, to clause (1) of subparagraph (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 Office-Based Surgery (OBS) facilities to obtain and maintain full accredited 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 legislation 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 lowercost 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; this despite the fact that accredited OBS facilities must shoulder the burden of significant costs not unlike those of the 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 nonpayment 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 accredited 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 providing OBS facilities with the same review procedures licensed facilities utilize when insurer deny these claims.

Legislative history

S.4597-B passed in 2011

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.