2. The disclosure shall provide notice of any such financial relationship and shall also inform the patient of his or her right to utilize a specifically identified alternative health care provider if any such alternative is reasonably available, and shall be provided in a brief and reasonable form and manner specified in regulations proposed by the commissioner in consultation with consumer and physician organizations and adopted by the public health council, subject to approval by the commissioner. 3. Disclosure pursuant to this section shall not be required pursuant to this section for a referral for the furnishing of any health or health related services under circumstances for which a referral of clinical laboratory services or x-ray or imaging services would not be prohibited pursuant to section two hundred thirty-eight-a of this title, provided that any disclosure required by section two hundred thirtyeight-a of this title remains applicable. §238-e. Study of referrals by practitioners. 1. The commissioner may conduct a study of the ownership of or financial interests in health care providers by referring practitioners. Such study shall investigate: (a) the types of such ownership arrangements and types of services offered under such arrangements; (b) the effect of such arrangements on the utilization of health or health related items and services; and (c) the effect of such arrangements on independent providers of similar services. of 2. For the purposes of the study authorized by this section, the commissioner is authorized to request and any health care provider or practitioner shall provide, such information regarding those matters which the commissioner is authorized to study pursuant to subdivision one this section in such form as may be prescribed by the commissioner. 3. Patient and practitioner identifying information collected pursuant to this section shall be confidential and not subject to disclosure. § 2. The insurance law is amended by adding a new section 3231 to read as follows: § 3231. Health insurance policies and subscriber contracts; prohibited claims. (a) For the purposes of this section the terms health care provider, practitioner, clinical laboratory services or x-ray or imaging services shall have the same meanings as are set forth in section two hundred thirty-eight of the public health law. (b) No health care provider or practitioner may demand or request any payment for clinical laboratory services or x-ray or imaging services furnished pursuant to a referral prohibited by subdivision one of section two hundred thirty-eight-a of the public health law. (c) No insurer shall be required to pay any claim, bill or other demand or request for payment by a health care provider for clinical laboratory services or x-ray or imaging services furnished pursuant to a referral prohibited by subdivision one of section two hundred thirtyeight-a of the public health law. or (d) Every policy of accident or health insurance issued by a commercial insurer and every subscriber contract issued by a hospital service corporation, health service corporation or medical expense indemnity corporation which provides coverage for clinical laboratory services x-ray or imaging services shall include a provision excluding payment of any claim, bill or other demand or request for payment for such services furnished pursuant to a referral prohibited by subdivision one of section two hundred thirty-eight-a of the public health law. (e) Every insurer subject to the provisions of this section shall report to the commissioner of health any pattern of submission of claims, bills or other demands or requests for payment submitted in violation of subsection (b) of this section, within thirty days after such insurer has knowledge of such pattern. (f) Notwithstanding the requirements of subsections (c), (d) and (e) of this section, an insurer reimbursing for clinical laboratory services or x-ray or imaging services is not required to audit or investigate any claim, bill or other demand or request for payment for such items or services furnished pursuant to a referral. § 3. Paragraph (g) of subdivision 1 of section 577 of the public health law, as added by chapter 217 of the laws of 1964 and relettered by chapter 858 of the laws of 1966, is amended to read as follows: EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law (g) has violated or aided and abetted in the violation of any provision of this title, title six of this article, or the rules and regulations promulgated [thereunder] pursuant to such titles, or the state sanitary code or a violation of title eleven of article five of the social services law or the rules and regulations promulgated thereunder related to laboratory services. § 4. Subdivision 1 of section 578 of the public health law, as added by chapter 217 of the laws of 1964, is amended to read as follows: 1. (a) A person who owns or operates a laboratory after July first, nineteen hundred sixty-five, and who does not hold a valid laboratory permit issued pursuant to [or otherwise complies with] the provisions of this title or the New York city health code, as the case may be,] or who otherwise does not comply with this title or the New York city health code is guilty of a misdemeanor, punishable by imprisonment not more than one year, or by a fine of not more than [five hundred] two thousand dollars, or by both such fine and imprisonment. For any subsequent offense, the penalty shall be both such fine and imprisonment. for (b) A person who owns or operates a laboratory and willfully misreports laboratory results or otherwise fails to comply with the provisions of this title or the New York city health code, as the case may be, is guilty of a class A misdemeanor, punishable by imprisonment for not more than one year, or by a fine of not more than one thousand dollars, or by both such fine and imprisonment. § 5. Article 5 of the public health law is amended by adding a new title 6 to read as follows: TITLE VI LABORATORY BUSINESS PRACTICES Section 585. Definitions. 586. Payment for services. § 585. Definitions. Whenever used in this title: any 1. "Health services purveyor" means any person, firm, partnership, group, association, corporation or professional corporation, or agent, employee, fiduciary, employer or representative thereof, including but not limited to a physician, dentist, podiatrist or chiropractor, either in individual practice, group practice or employed in a facility owned by any person, group, association, firm, partnership or corporation hiring any of the aforementioned practitioners, who provide health or health related services. 2. "Clinical laboratory" shall have the same meaning as is set forth in subdivision one of section five hundred seventy-one of this article. § 586. Payment for services. 1. It shall be unlawful for any purveyor of clinical laboratory services, directly or indirectly, through any person, firm, corporation or association or its officers or agents, to bill or receive payment, reimbursement, compensation or fee from any person other than the recipient of the services, such recipient being the person upon whom the clinical services have been or will be rendered. 2. The provisions of subdivision one of this section shall be inapplicable to services rendered by a clinical laboratory operated by the state of New York; and to payment by: (a) A legal relative of the recipient of the services; (b) An insurance carrier designated by the recipient of the services; (c) A hospital as defined in article twenty-eight of this chapter on behalf of an in-patient or out-patient of such hospital having been the recipient of the services; (d) One purveyor to another purveyor for actual services rendered; (e) An industrial firm only for its own employees; (f) A trade union health facility only for its registered patients; (g) Governmental agencies and/or their specified public or private agent, agency or organization on behalf of the recipient of the services; (h) A substance abuse program which has been approved to operate by the office of alcoholism and substance abuse services pursuant to the provision of section 23.01 of the mental hygiene law on behalf of clients of such a program having been the recipient of the services; and (1) A health maintenance organization operating in accordance with article forty-three of the insurance law or article forty-four of this chapter. 3. The public health council shall adopt and amend rules and regulations, subject to approval by the commissioner, to effectuate the provisions and purposes of this section. or § 587. Prohibited practices. 1. No health services purveyor shall solicit, receive, accept or agree to receive or accept any payment other consideration in any form to the extent such payment or other consideration is given for the referral of services or participate in the division, transference, assignment, rebate, splitting of fees, with any clinical laboratory or its agent, employee or fiduciary, or with another health services purveyor in relation to clinical laboratory services. Specifically prohibited practices shall include, without limiting thereto, the following: (a) Acceptance of payments for rental of space for more than the fair market value or where the rental amount is affected by test ordering volume or value. (b) Acceptance of rental payments for storage space for any supplies provided by any clinical laboratory or its agent, employee or fiduciary. (c) Acceptance of payments for filling proper information on laboratory request forms for tests. in (d) Receipt or acceptance of employees, agents or other fiduciaries of any clinical laboratory to perform any duties in the facility of any health services purveyor provided, however, that nothing in this subdívision shall prohibit a hospital as defined in article twenty-eight of this chapter or a health maintenance organization operating in accordance with article forty-three of the insurance law or article forty four of this chapter and a clinical laboratory from contracting for laboratory management services including the provision of technical services and employees for the performance of functions directly related to clinical laboratory operations. (e) Receipt or acceptance of equipment, supplies or services provided by any clinical laboratory or its agent, employee or fiduciary for less than fair market value or when the purchase price or rental payment is in any way related to the reference of patients or specimens to any clinical laboratory. (f) Receipt or acceptance of any monies or other consideration from any clinical laboratory or its agent, employee or fiduciary as a bonus, commission or fee in the form of a fixed or percentage return for the number or dollar value of laboratory tests performed or to be performed by any clinical laboratory to which patients or specimens are referred or for the number of patients or specimens referred. (g) The purchase of prepayment coupons, tickets, booklets or any variation of such prepayment instruments as advance payments by purveyors of health services for clinical laboratory services to be rendered by any clinical laboratory. (h) To accept payment of money or other consideration from anyone for any clinical laboratory tests rendered or to be rendered on any specimen for transference of the money or other consideration in whole or in part to any clinical laboratory or to actually be kept by the health services purveyor. (1) To accept or use directly any instrument or any clinical laboratory form marked "Invoice", "Receipt", "Payment Received" or any other variation for issuance to patients as if the patient had been billed and paid the clinical laboratory. (j) Receipt or acceptance of any monies or other consideration from any clinical laboratory or its agent, employee or fiduciary for influencing any person to refrain from using or utilizing any other clinical laboratory. 2. No clinical laboratory or its agent, employee or fiduciary shall make, offer, give, or agree to make, offer, or give any payment or other consideration in any form to the extent such payment or other consideration is given for the referral of services or participate in the division, transference, assignment rebate, splitting of fees, with any health services purveyor, or with another' clinical laboratory. SpecifiEXPLANATION-Matter in italics is new; matter in brackets [ ] is old law cally prohibited practices shall include, without limiting thereto, the following: (a) To offer or agree to give or give any payments for rental of space for more than the fair market value or where the rental amount is affected by test ordering volume or value. (b) To offer or agree to give or give rental payments for storage space for any supplies provided to any health services purveyor. (c) To offer or agree to give or give any payments for filling in proper information on laboratory request forms for tests. (d) To supply employees, agents or other fiduciaries of any clinical laboratory to perform any duties in the facility of any health services purveyor provided, however, that nothing in this subdivision shall prohibit a hospital as defined in article twenty-eight of this chapter or a health maintenance organization operating in accordance with article forty-three of the insurance law or article forty-four of this chapter and a clinical laboratory from contracting for laboratory management services, including the provision of technical services and employees for the performance of functions directly related to clinical laboratory operations. (e) To offer or agree to give or give any equipment, supplies or services to any health services purveyor for less than fair market value or when the purchase price or rental payment is in any way related to the reference of patient's or specimens to any clinical laboratory. (f) To offer or agree to give or give any monies or other consideration to any health services purveyor as a bonus, commission or fee the in form of a fixed or percentage return for the number or dollar value of laboratory tests performed or to be performed by any clinical laboratory to which patients or specimens are referred or for the number of patients or specimens referred. (8) To sell any prepayment coupons, tickets, booklets or any variation of such prepayment instrument as advance payments by purveyors of health services for clinical laboratory services. (h) To send a bill to or receive payment from any health services purveyor for clinical laboratory services rendered to any patient, where such bill is sent in code on blank paper, without name and address of the clinical laboratory, without name or address of the addressee, without name or other identifying information of the person who was the recipient of the laboratory service or in any other falsified manner. or (i) To utilize any health services purveyor or anyone else not authorized by law to collect money or other consideration from anyone for any clinical laboratory tests rendered or to be rendered on any specimen for transference of the money or other consideration in whole or in part to the clinical laboratory or to be actually kept by the health services purveyor. (j) To supply to any health services purveyor any printed form of a clinical laboratory marked "Invoice", "Receipt", "Payment Received", or any other variation for use by any health services purveyor issuing same to patients as if the patient had paid the clinical laboratory. (k) To offer or agree to give or give any monies or other consideration for influencing any person to refrain from using or utilizing any other clinical laboratory. 3. This section shall not apply to any: (a) legally established hospital group purchasing program approved by the commissioner, or (b) any arrangement between a clinical laboratory and health maintenance organization operating in accordance with article forty-three of the insurance law or article forty-four of this chapter approved by the commissioner. 4. Any transaction excluded from the prohibition of section five hundred eighty-six of this title relating to payment for services rendered by clinical laboratories shall be deemed to be similarly excluded from the application of this section. 5. No clinical laboratory or its agent, employee or fiduciary shall make, offer, give or agree to make, offer or give to any person, partnership, corporation or other entity any payment or other consideration in any form as a bonus, commission or fee for securing referrals of ser vices to the clinical laboratory except for payments made to a person who is an employee of the clinical laboratory. 6. The public health council shall adopt and amend rules and regulations, subject to approval by the commissioner, to effectuate the provisions and purposes of this section. § 588. Violations and penalties. 1. Any health services purveyor, clinical laboratory, or any agent, employee or fiduciary of a health services purveyor or clinical laboratory who violates the provisions of section five hundred eighty-six of this title, or any rule or regulation adopted pursuant thereto, is guilty of a class A misdemeanor and shall be punishable in accordance with the provisions of the penal law. 2. Any health services purveyor, clinical laboratory, or any agent, employee or fiduciary of a health services purveyor or clinical laboratory who violates the provisions of section five hundred eighty-seven of this title, or any rule or regulation adopted pursuant thereto, is guilty of a misdemeanor and shall be punishable by: (a) a term of imprisonment in accordance with the penal law; or (b) a fine of not less than five hundred dollars nor more than ten thousand dollars; or (c) if the defendant has gained money or property through a violation of the provisions of this section, a fine in an amount, fixed by the court, not to exceed double the amount of the defendant's gain from a violation of such provisions. In such event, the provisions of subdivision three of section 80.00 of the penal law shall be applicable to the sentence; or (d) both the imprisonment and the fine. § 6. Section 394-e of the general business law, as added by chapter 971 of the laws of 1970, is repealed. § 7. Article 38 of the general business law is repealed. § 8. The provisions of this act do not apply to or govern the construction of and punishment for any offense committed prior to the effective date of this act, or the construction and application of any defense to a prosecution for such an offense. Such an offense must be construed and punished according to the provisions of law existing at the time of the commission thereof in the same manner as if this act had not been enacted. $ 9. This act shall take effect immediately; except that: (a) sections 238-a, 238-b, 238-c and 238-d of the public health law as added by section one of this act shall take effect March 1, 1993, except that with respect to a financial interest held by a health care provider, as such terms are defined in section 238 of the public health law added by section one of this act, and acquired prior to July 1, 1992, subdivision 1 of section 238-a of such law shall not apply to referrals occurring prior to July 1, 1995 for clinical laboratory services or x-ray or imaging services; provided, however, that the public health council and the commissioner of health are authorized to adopt such regulations and to take such steps as may be appropriate prior to such effective date; (b) section 3231 of the insurance law, as added by section two of this act, shall take effect March 1, 1993, and subsection (d) of said section 3231 of the insurance law shall apply to all policies, contracts and certificates delivered or issued for delivery on or after such date and, as to those policies, contracts and certificates delivered or issued for delivery prior to such date, on the date such policies, contracts or certificates are renewed, modified, altered or amended; (c) the superintendent of insurance is authorized to adopt such regulations and to take such steps as may be appropriate to assure implementation of the provisions of section two of this act prior to March 1, 1993; and (d) sections three, four, five, six, seven and eight of this act shall take effect on November 1, 1992, provided however that the department of health is authorized to take any steps prior to such effective date necessary for the full implementation of these sections on such date. EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law |
