MEMORANDUM IN OPPOSITION
FOR IMMEDIATE RELEASE: MAY 19, 2015
Re: A.2061 (Quart) AN ACT to amend the insurance law, in relation to the registration of office-based surgery facilities and payments for the use thereof.
The New York Health Plan Association (HPA) opposes this legislation, which purports to create appeal rights and rights to external appeals for office-based surgery practices. This legislation is unnecessary since Article 49 of the Insurance Law already establishes appeal rights for certain certified or licensed health care facilities and professionals. Physicians are expressly included in the list of individuals who can file such appeals.
When the Public Health Law was amended to add Section 230-d, it was done expressly to establish accreditation requirements for office-based surgery practices. Accreditation of the practice established standards of safety and care and provided a mechanism to report adverse events. Nothing in that section establishes “certification” status for these practices, nor the physicians within the practice. In fact, there is no basis to use the term “certified,” which does not appear in section 230-d.
Despite the fact that all physicians already have a right to file appeals, the legislation seeks to add a redundant set of physicians—i.e. those who are accredited to perform office-based surgery—to the list of those entities and individuals authorized to bring appeals. It is clear from the Legislative Intent section that this effort to create redundant appeal rights is actually little more than a veiled attempt of certain office- based surgery practices to bootstrap themselves into higher payments through additional facility fees. This will only hurt employers and consumers trying to afford health insurance coverage, with no guarantee of higher quality or better outcomes.
This legislation refers to physician practices as “certified”—when they are not—and then seeks to create appeal rights that already exist and its only impact will result in unjustified higher health care costs to the consumer. It is simply an effort to create the illusion that such physician practices are entitled to payment of a facility fee.
According to the bill these new appeal rights would be deemed to have been in effect since January 18, 2009 when the original Section 230-d was enacted. This would make any and all claims processed over the intervening six and a half years subject to retroactive appeals. It is unnecessary to allow service appeals to be retroactive, unless the intent as expressed by the legislative intent is to allow physician office-based surgery practices to retroactively bill for facility fees. These office-based surgery sites are not licensed Article 28 entities, but seek the same financial benefits without meeting State patient safety and quality standards.
For the reasons set forth above, HPA encourages the Legislature to reject this legislation.