NY State Senate Bill 2019-S467

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to health
Jan 09, 2019	referred to health

2019-S467 (ACTIVE) - Details

See Assembly Version of this Bill:: A2413
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §238-a, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S6955, A9933
2011-2012: S4660, A3551
2013-2014: S6585, A5357
2015-2016: S772, A7374
2017-2018: S156, A6171
2021-2022: S1171, A6781

2019-S467 (ACTIVE) - Summary

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

2019-S467 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S467               REVISED MEMO 02/06/19

SPONSOR: RIVERA
 
TITLE OF BILL:  An act to amend the public health law, in relation to
referrals of patients for health or health related items or services

 
PURPOSE OR GENERAL IDEA OF BILL:

To promote conformity between the federal Stark Law and New York's
Health Care Practitioner Referrals Statute.

 
SUMMARY OF PROVISIONS:

Amends Public Health Law § 238-a (2) (c) to provide that a referral or
arrangement that would be allowed under federal law, 42 U.S.C.  1395-nn
or its regulations would similarly be allowed under the New York law,
unless the Public Health and Health Planning Council declares a type of
arrangement to pose a substantial risk of payer or patient abuse, by
regulation approved by the Health Commissioner.

Amends the list of exemptions in Public Health Law § 238-a (6) (c) to

add any referral or arrangement allowed under federal law, unless the
state Public Health and Health Planning Council declares a type of
referral to pose a substantial risk of payer or patient abuse, by regu-
lation subject approval of the Health Commissioner.

 
JUSTIFICATION:

The federal Stark law (named for its congressional sponsor) establishes
complex rules on referrals from one health care provider to another and
the financial relationships between providers. The purpose is to avoid
kickback arrangements and conflicts of interest that cost patients and
third-party payers money and can lead to unnecessary and inappropriate
services. New York State's law is similar but not the same. So some
arrangements or referrals are permissible under the federal Stark law
but not under the New York statute. This can create difficulties for
health care providers.

For example, the New York statute does not contain exceptions for
providing electronic medical record systems, donations of items and
services to federally qualified health centers, and fair market value
arrangements. Also, the New York exception for in-office ancillary
services requires an employer/employee relationship, as compared to the
Stark exception, which permits an independent contractor relationship.

The bill would provide that arrangements or referrals that are allowed
under the federal law are also allowed under the New York law, unless
the Public Health and Health Planning Council and the Health Commission-
er designate particular types of arrangements or referrals that would
not be allowed because they pose a substantial risk of payer or patient
abuse. The bill was drafted in conjunction with the State Bar Associ-
ation's health law section and has broad provider support.

 
PRIOR LEGISLATIVE HISTORY:

2009-10: A.9933/S6955 Duane
2011-2012: A.3551-A/S4660 Hannon
2013-2014: S6585/ A5357 Gottfried
2015-2016: S772/ A 7374 Pichardo
2017-2018: S156/ A 6171 Pichardo

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.

2019-S467 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    467
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed 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:
 
   Section 1. Paragraph (g) of subdivision 2  of  section  238-a  of  the
 public  health  law,  as  added  by  chapter 803 of the laws of 1992, is
 amended to read as follows:
   (g) [in the case of any other financial relationship which the  public
 health  council  determines  and  specifies  in  regulations, subject to
 approval by the commissioner, does not pose a substantial risk of  payor
 or  patient  abuse  in  relation  to patient benefits consistent, to the
 extent practicable, with  financial  relationships  specified  in  regu-
 lations  adopted  pursuant  to  federal  law applicable to reimbursement
 pursuant to title XVIII of the federal social  security  act  (medicare)
 for  clinical  laboratory  services  provided  to beneficiaries of title
 XVIII of the federal social security  act  (medicare)]  ANY  ARRANGEMENT
 THAT, UNDER THE FEDERAL STATUTORY PROHIBITION ON CERTAIN REFERRALS CODI-
 FIED  AT  42 U.S.C. 1395NN AND REGULATIONS PROMULGATED THEREUNDER, WOULD
 BE AN ARRANGEMENT BETWEEN A PRACTITIONER (OR  IMMEDIATE  FAMILY  MEMBER)
 AND A HEALTH CARE PROVIDER THAT:
   (I) WOULD NOT BE A FINANCIAL RELATIONSHIP IF EXISTING BETWEEN A PHYSI-
 CIAN  AND AN ENTITY, AS SUCH TERMS ARE DEFINED UNDER SUCH FEDERAL LAW OR
 REGULATIONS; OR
   (II) WOULD SATISFY THE REQUIREMENTS OF AN EXCEPTION RELATING TO FINAN-
 CIAL RELATIONSHIPS PROVIDED UNDER SUCH FEDERAL  LAW  OR  REGULATIONS  IF
 EXISTING  BETWEEN  A  PHYSICIAN AND AN ENTITY, AS SUCH TERMS ARE DEFINED
 UNDER SUCH FEDERAL LAW OR REGULATIONS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD05451-01-9

 S. 467                              2
 
   AN ARRANGEMENT SHALL NOT BE EXCEPTED UNDER THIS PARAGRAPH IF IT  IS  A
 PARTICULAR  TYPE OF FINANCIAL RELATIONSHIP THAT WOULD POSE A SUBSTANTIAL
 RISK OF PAYOR OR PATIENT ABUSE,  AS  DETERMINED  AND  SPECIFIED  BY  THE
 PUBLIC  HEALTH  AND  HEALTH  PLANNING COUNCIL IN REGULATIONS, SUBJECT TO
 APPROVAL BY THE COMMISSIONER.
   §  2.  Paragraph  (c)  of subdivision 6 of section 238-a of the public
 health law, as added by chapter 803 of the laws of 1992, is  amended  to
 read as follows:
   (c) provided further, however, that the following shall not constitute
 a referral by a referring practitioner:
   (i) a request by a practitioner for practitioners' services consisting
 solely of professional services to be furnished personally by that prac-
 titioner, or under that practitioner's supervision;
   (ii)  a  request  by  a pathologist for clinical diagnostic laboratory
 tests and  pathological  examination  services,  if  such  services  are
 furnished  by or under the supervision of such pathologist pursuant to a
 consultation requested by another practitioner; [and]
   (iii) a request by a  radiologist  for  diagnostic  x-ray  or  imaging
 services,  if such services are furnished by or under the supervision of
 such radiologist pursuant to a consultation requested by another practi-
 tioner[.]; AND
   (IV) A REFERRAL FOR ANY SERVICES EXCEPTED UNDER 42 U.S.C. § 1395NN AND
 REGULATIONS PROMULGATED THEREUNDER, UNLESS THE PUBLIC HEALTH AND  HEALTH
 PLANNING  COUNCIL  DETERMINES  AND  SPECIFIES IN REGULATIONS, SUBJECT TO
 APPROVAL BY THE COMMISSIONER, THAT A PARTICULAR TYPE OF  REFERRAL  WOULD
 POSE A SUBSTANTIAL RISK OF PAYOR OR PATIENT ABUSE IN RELATION TO PATIENT
 BENEFITS.
   § 3. This act shall take effect immediately.

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Senate Bill S467

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

2019-S467 (ACTIVE) - Details

2019-S467 (ACTIVE) - Summary

2019-S467 (ACTIVE) - Sponsor Memo

2019-S467 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S467

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Sponsored By

Gustavo Rivera

Archive: Last Bill Status - In Senate Committee Health Committee

2019-S467 (ACTIVE) - Details

2019-S467 (ACTIVE) - Summary

2019-S467 (ACTIVE) - Sponsor Memo

2019-S467 (ACTIVE) - Bill Text download pdf

Comments