Authorizes accredited office-based surgery practices to seek payment from health care plans for the use of the surgery location or setting of such practice, in addition to payment for services performed

Title of bill

An act to amend the public health law, in relation to authorizing certain office-based surgery practices to seek payment for the use of their facilities

Purpose

Authorize accredited office-based surgery practices to seek payment from health care plans for the use of the surgery location or setting.

Summary of provisions

Section one amends Public Health Law § 230-d to authorize every office-based surgery practice established prior to the effective date of this subdivision to seek payment from insurers for the costs related to the use of the surgery location or setting of such practice, provided the health plan also reimburses such costs for the same covered procedure performed at a hospital or ambulatory surgery center. This fee is in addition to the fee charged by the licensee for the performance of the surgery. When calculating the rate, the plan may also take into consideration certain comparable and non-comparable costs and obligation of ambulatory surgery centers and hospitals and adjust rates accordingly.

Section two provides the act shall take effect immediately.

Justification

In 2007, as culmination of the work of the Department of Health Committee on Quality Assurance in Office Based Surgery (OBS), the legislature enacted measures 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. The accreditation conferred upon these OBS facilities assures that these practices meet nationally recognized standards for patient safety and quality care. Provisions of this legislation became effective on January 14, 2008 and on July 14, 2009.

OBS facilities are often a cost efficient, quality option for patients. However, despite increased accreditation requirements, many health plans refuse to reimburse these facilities a facility fee, even if they may reimburse such a fee if the procedure were performed in an ambulatory surgery center or hospital. Since the enactment of the 2007 law, most third party payers have not recognized facility and compliance costs when negotiating with OBS providers, and in cases where such fees were once reimbursed by third parties, they no longer are in most instances.

This legislation amends Public Health Law to explicitly provide existing accredited OBS facilities with the authority to seek reimbursement for a facility fee. There are a number of reasons currently accredited OBS facilities may not be able to apply to become article 28 facilities. This change will level the playing field and, in turn, enable consumer choice by leaving the decision to the patient and doctors as to which facility can provide the best care for that patient.

Legislative history

New bill.

Fiscal implications

None.

Effective date

Immediately.