A05357 Summary:

BILL NO    A05357 

SAME AS    SAME AS S06585

SPONSOR    Gottfried (MS)

COSPNSR    Weisenberg, Galef, Paulin, Cymbrowitz, Lavine, Jaffee, Montesano,
           Magnarelli

MLTSPNSR   Brennan, Clark, Corwin, Crouch, Magee

Amd S238-a, Pub Health L

Relates to referrals of patients for health related items or services that are
prohibited under law.
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A05357 Actions:

BILL NO    A05357 

02/25/2013 referred to health
01/08/2014 referred to health
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A05357 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         5357

                              2013-2014 Regular Sessions

                                 I N  A S S E M B L Y

                                   February 25, 2013
                                      ___________

       Introduced by M. of A. GOTTFRIED, WEISENBERG, GALEF, PAULIN, CYMBROWITZ,
         LAVINE,  JAFFEE,  MONTESANO, MAGNARELLI -- Multi-Sponsored by -- M. of
         A. BRENNAN, CLARK, CORWIN, CROUCH, MAGEE -- read once and referred  to
         the Committee 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:

    1    Section  1.  Paragraph  (g)  of  subdivision 2 of section 238-a of the
    2  public health law, as added by chapter 803  of  the  laws  of  1992,  is
    3  amended to read as follows:
    4    (g)  [in the case of any other financial relationship which the public
    5  health council determines  and  specifies  in  regulations,  subject  to
    6  approval  by the commissioner, does not pose a substantial risk of payor
    7  or patient abuse in relation to  patient  benefits  consistent,  to  the
    8  extent  practicable,  with  financial  relationships  specified in regu-
    9  lations adopted pursuant to  federal  law  applicable  to  reimbursement
   10  pursuant  to  title  XVIII of the federal social security act (medicare)
   11  for clinical laboratory services  provided  to  beneficiaries  of  title
   12  XVIII  of  the  federal  social security act (medicare)] ANY ARRANGEMENT
   13  THAT, UNDER THE FEDERAL STATUTORY PROHIBITION ON CERTAIN REFERRALS CODI-
   14  FIED AT 42 U.S.C. 1395NN AND REGULATIONS PROMULGATED  THEREUNDER,  WOULD
   15  BE  AN  ARRANGEMENT  BETWEEN A PRACTITIONER (OR IMMEDIATE FAMILY MEMBER)
   16  AND A HEALTH CARE PROVIDER THAT:
   17    (I) WOULD NOT BE A FINANCIAL RELATIONSHIP IF EXISTING BETWEEN A PHYSI-
   18  CIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED UNDER SUCH FEDERAL LAW  OR
   19  REGULATIONS; OR
   20    (II) WOULD SATISFY THE REQUIREMENTS OF AN EXCEPTION RELATING TO FINAN-
   21  CIAL  RELATIONSHIPS  PROVIDED  UNDER  SUCH FEDERAL LAW OR REGULATIONS IF
   22  EXISTING BETWEEN A PHYSICIAN AND AN ENTITY, AS SUCH  TERMS  ARE  DEFINED
   23  UNDER SUCH FEDERAL LAW OR REGULATIONS.

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD01597-01-3
       A. 5357                             2

    1    AN  ARRANGEMENT  SHALL NOT BE EXCEPTED UNDER THIS PARAGRAPH IF IT IS A
    2  PARTICULAR TYPE OF FINANCIAL RELATIONSHIP THAT WOULD POSE A  SUBSTANTIAL
    3  RISK  OF  PAYOR  OR  PATIENT  ABUSE,  AS DETERMINED AND SPECIFIED BY THE
    4  PUBLIC HEALTH AND HEALTH PLANNING COUNCIL  IN  REGULATIONS,  SUBJECT  TO
    5  APPROVAL BY THE COMMISSIONER.
    6    S  2.  Paragraph  (c)  of subdivision 6 of section 238-a of the public
    7  health law, as added by chapter 803 of the laws of 1992, is  amended  to
    8  read as follows:
    9    (c) provided further, however, that the following shall not constitute
   10  a referral by a referring practitioner:
   11    (i) a request by a practitioner for practitioners' services consisting
   12  solely of professional services to be furnished personally by that prac-
   13  titioner, or under that practitioner's supervision;
   14    (ii)  a  request  by  a pathologist for clinical diagnostic laboratory
   15  tests and  pathological  examination  services,  if  such  services  are
   16  furnished  by or under the supervision of such pathologist pursuant to a
   17  consultation requested by another practitioner; [and]
   18    (iii) a request by a  radiologist  for  diagnostic  x-ray  or  imaging
   19  services,  if such services are furnished by or under the supervision of
   20  such radiologist pursuant to a consultation requested by another practi-
   21  tioner[.]; AND
   22    (IV) A REFERRAL FOR ANY SERVICES EXCEPTED UNDER 42 U.S.C. S 1395NN AND
   23  REGULATIONS PROMULGATED THEREUNDER, UNLESS THE PUBLIC HEALTH AND  HEALTH
   24  PLANNING  COUNCIL  DETERMINES  AND  SPECIFIES IN REGULATIONS, SUBJECT TO
   25  APPROVAL BY THE COMMISSIONER, THAT A PARTICULAR TYPE OF  REFERRAL  WOULD
   26  POSE A SUBSTANTIAL RISK OF PAYOR OR PATIENT ABUSE IN RELATION TO PATIENT
   27  BENEFITS.
   28    S 3. This act shall take effect immediately.
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