Legislative and Regulatory

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Representatives from NYOBS met with representatives of the Department of Financial Services as well as insurance company representatives in Albany in July.    DFS has regulatory authority over insurance companies. If you would like more information about the meeting, you need to become a member. We made great progress in our quest to have insurance companies reimburse for office based surgery facility fees.

For those of you who remain skeptical about whether we will be able to get reimbursement, the situation has changed dramatically recently.  As soon as there is more information about this it will be posted on this page, but you will need to be a member in order to be able to get the information.

You will also have access to information about the proper relationship of your OBS facility to anesthesiologists and outside surgeons.

In order to be able to see all of the content on this page, you need to become a member

If you were already a member of NYOBS and your membership has expired, please renew your membership now.[/nonmember]

[private_member]
This section is set up for members only. Please do not share this information, since we would like to encourage non-members to join in order to be able to have access to this valuable information.

On July 16, 2013, NYOBS met with the Department of Financial Services (DFS) and with representatives of the health insurance industry to discuss coverage of claims for office-based surgery facility costs. DFS is the state regulatory agency responsible for oversight of the health insurance industry.  DFS played an active role in the discussions, and questioned whether the insurers could point to an allowable subscriber contract exclusion to justify their denial of coverage for these claims on an out-of-network basis when they are paying a benefit on an in-network basis. The insurers objected, but in our view were unable to defend their position to the satisfaction of DFS during the meeting. While our meeting ended without a final resolution, a follow-up meeting will be scheduled that we hope will bring closure to this issue — both retrospectively and prospectively. We will continue to keep you apprised of developments.

We now await further action by DFS and will keep you informed.  You can’t send in claims yet and expect to be paid, but it should be soon. As members of NYOBS you will be in the best position to get claims paid. As soon as we have more information we will pass it on to you.

In the near future we will also post advance information about the proper relationship of anesthesiologists and outside surgeons to your OBS facility.  There are steps which you MUST take to be compliant.

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NYOBS  was  successful in having a bill passed by the New York State Senate in 2011 regarding reimbursement for a facility fee from insurance companies for office based surgery. We also had provisions introduced into an out of network bill in 2012.  The Governor’s office plans to enforce a provision regarding OBS reimbursement. We were responsible for most of the bill and the accompanying sponsors memorandum.  A bill was sponsored in 2013 in the Senate  by Kemp Hannon, the chair of the Health Committee and by Dan Quart this year in the Assembly.

The officers of NYOBS  traveled to Albany have traveled to Albany in 2013 and several times in 2012 meeting with many legislators. There have also been meetings with members of President Obama’s personal staff who were favorably impressed with office based surgery and thought that it had potential for Medicare reimbursement.

A proposal has also been submitted the Innovation Center for Medicare and Medicaid for a pilot project on reimbursement of OBS facility fees. This is a long process, but we are hopeful that this will eventually come about.

On Wednesday May 18th, 2011 Drs. Tichenor and Antell traveled to Albany to participate in a roundtable discussion chaired by Senator Hannon to discuss both the non-reimbursement of OBS facility fees and a bill requiring insurance companies to base reimbursement for out of network physicians on UCR fees.  We believe that the senators understood the issues and it was helpful for them. Although the insurance companies are still concerned that it will cost them more money if OBS facility fees are paid, a discussion was started.

On Wednesday March 16, 2011, Drs. Tichenor and Tehrani spent the day in  Albany and, along with our lobbyists  from Bogdan, Lasky and Kopley, discussed office based surgery issues with the chair of the Senate Health Committee, representatives from the Governors’ office, and representatives of the Chair of the Finance, Health and Insurance Committees.  All of them understood and were sympathetic to our problem.

We started with having the following resolution introduced into the Senate’s version of the budget bill, although it didn’t make it into the final budget bill:

It is the intent of the Senate to examine opportunities for potential modifications to the system of reimbursement for accredited office- based surgery facilities to include reimbursement for costs associated with facilities in addition to physician fees.

We originally proposed language which would have required payment from the insurance companies, but along the way it was changed to a resolution.

We are now on everyone’s radar.
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Page last modified on: August 10th, 2013