INS-02-08-00005-P Charges for Professional Health Services

1/9/08 N.Y. St. Reg. INS-02-08-00005-P

NEW YORK STATE REGISTER

VOLUME XXX, ISSUE 2

January 09, 2008

RULE MAKING ACTIVITIES

INSURANCE DEPARTMENT

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

 

I.D No. INS-02-08-00005-P

Charges for Professional Health Services

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed action:

This is a consensus rule making to amend Part 68 (Regulation 83) of Title 11 NYCRR.

Statutory authority:

Insurance Law, sections 201, 301, 2601, 5221 and art. 51

Subject:

Charges for professional health services.

Purpose:

To repeal the fee schedules previously established by the Insurance Department for prescription drugs, durable medical equipment, medical/surgical supplies, orthopedic footwear, and orthotic and prosthetic appliances that are now covered by the two fee schedules established by the Workers' Compensation Board, clarifies that a pharmacy is deemed to be a provider of health services for purposes of eligibility of direct payments pursuant to Regulation 68-C.

Text of proposed rule:

Section 68.1(b) (3) of Part 68 is hereby amended to read as follows:

(3) A “licensed health provider” means a licensed healthcare professional acting within the scope of his or her licensure or an entity, including a pharmacy, properly formed in accordance with applicable law and acting within the scope of its license.

Part E of Appendix 17-C to Part 68 is repealed.

Part F of Appendix 17-C to Part 68 is repealed.

Parts G, H, I, J, K of Appendix 17-C to Part 68-C are relettered Parts E, F, G, H and I.

Text of proposed rule and any required statements and analyses may be obtained from:

Andrew Mais, Insurance Department, 25 Beaver St., New York, NY 10004, [phone], e-mail: [e-mail]

Data, views or arguments may be submitted to:

Buffy Cheung, Insurance Department, 25 Beaver St., New York, NY 10004, [phone], e-mail: [e-mail]

Public comment will be received until:

45 days after publication of this notice.

Consensus Rule Making Determination

Sections 201, 301, 2601, 5221, 5108 and Article 51 of the Insurance Law establish the Superintendent's authority to promulgate regulations governing charges for professional health services under No-fault.

Chapter 892 of the Laws of 1977 recognized the necessity of establishing schedules of maximum permissible charges, for professional health services payable as no-fault insurance benefits, in order to contain the costs of no-fault insurance. In order to contain costs, the Superintendent is required to adopt those fee schedules that are promulgated by the Chairman of the Workers' Compensation Board. Effective July 11, 2007, the Workers' Compensation Board issued two new fee schedules, one for prescription drugs and the other for durable medical equipment, medical/surgical supplies, orthopedic footwear, and orthotic and prosthetic appliances.

No person is likely to object to the rule. The rule repeals the fee schedules previously established by the Insurance Department for prescription drugs, durable medical equipment, medical/surgical supplies, orthopedic footwear, and orthotic and prosthetic appliances. The charges for these goods and services are now covered by two fee schedules established by the Workers' Compensation Board. In addition, the proposed rule clarifies that a pharmacy is deemed to be a provider of health services for purposes of eligibility for direct payments pursuant to Regulation 68-C.

Job Impact Statement

Nature of Impact:

The Insurance Department finds that this rule will have little or no impact on jobs and employment opportunities. The proposed amendment, which is required by statute, repeals the fee schedules previously established by the Insurance Department for prescription drugs, durable medical equipment, medical/surgical supplies, orthopedic footwear, and orthotic and prosthetic appliances and replaces those schedules with the same schedules implemented by the Workers' Compensation Board. These services are now covered by two fee schedules established by the Workers' Compensation Board. The rule also clarifies that a pharmacy is deemed to be a provider of health services for purposes of eligibility for direct payments pursuant to Regulation 68-C.

Categories and number affected:

No categories of jobs or number of jobs will be affected.

Regions of adverse impact:

This rule applies to all property/casualty insurance companies authorized to do business in New York State, self-insurers, health care providers and medical supply companies. There would be no region in New York which would experience an adverse impact on jobs and employment opportunities.

Minimizing adverse impact:

No measures would need to be taken by the Department to minimize adverse impacts.

Self-employment opportunities:

This rule would not have a measurable impact on self-employment opportunities.