Bill Text: NJ S2779 | 2012-2013 | Regular Session | Chaptered
Bill Title: Allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met.
Spectrum: Slight Partisan Bill (Democrat 4-2)
Status: (Passed) 2014-01-13 - Approved P.L.2013, c.178. [S2779 Detail]
Download: New_Jersey-2012-S2779-Chaptered.html
§2 - Note to
45:9-22.5
An Act concerning certain health care service referrals and amending P.L.1989, c.19.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.1989, c.19 (C.45:9-22.5) is amended to read as follows:
2. a. A practitioner shall not refer a patient or direct an employee of the practitioner to refer a patient to a health care service in which the practitioner, or the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family has a significant beneficial interest; except that, in the case of a practitioner, a practitioner's immediate family, or a practitioner in combination with the practitioner's immediate family who had the significant beneficial interest prior to the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.), and in the case of a significant beneficial interest in a health care service that provides lithotripsy or radiation therapy pursuant to an oncological protocol that was held prior to the effective date of this section of P.L.2009, c.24, the practitioner may continue to refer a patient or direct an employee to do so if that practitioner discloses the significant beneficial interest to the patient.
b. If a practitioner is permitted to refer a patient to a health care service pursuant to this section, the practitioner shall provide the patient with a written disclosure form, prepared pursuant to section 3 of P.L.1989, c.19 (C.45:9-22.6), and post a copy of this disclosure form in a conspicuous public place in the practitioner's office.
c. The restrictions on referral of patients established in this section shall not apply to:
(1) medical treatment or a procedure that is provided at the practitioner's medical office and for which a bill is issued directly in the name of the practitioner or the practitioner's medical office;
(2) renal dialysis; and
(3) ambulatory surgery or procedures requiring anesthesia performed at a surgical practice registered with the Department of Health pursuant to subsection g. of section 12 of P.L.1971, c.136 (C.26:2H-12) or at an ambulatory care facility licensed by the Department of Health to perform surgical and related services or lithotripsy services, if the following conditions are met:
(a) the practitioner who provided the referral personally performs the procedure;
(b) the practitioner's remuneration as an owner of or investor in the practice or facility is directly proportional to the [practioner's] practitioner's ownership interest and not to the volume of patients the practitioner refers to the practice or facility;
(c) all clinically-related decisions at a facility owned in part by non-practitioners are made by practitioners and are in the best interests of the patient; and
(d) disclosure of the referring practitioner's significant beneficial interest in the practice or facility is made to the patient in writing, at or prior to the time that the referral is made, consistent with the provisions of section 3 of P.L.1989, c.19 (C.45:9-22.6).
(cf: P.L. 2012, c.17, s.410)
2. The State Board of Medical Examiners shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the provisions of this act.
3. This act shall take effect immediately.
STATEMENT
This bill amends section 2 of P.L.1989, C.19 (C.45:9-22.5) to eliminate the prohibition on certain patient referrals for lithotripsy, which is a procedure that uses shock waves to break up stones in the kidney, bladder, or ureter, after which pieces of the stones pass from the body. Lithotripsy procedures are provided in licensed ambulatory surgical facilities or in freestanding ambulatory care facilities licensed to provide lithotripsy, rather than in practitioners' medical offices.
Current law generally prohibits health care practitioners from referring patients to health care services in which the practitioner or his or her immediate family has a financial interest, but provides various exceptions to this general prohibition and sets forth certain conditions that must be met in order to qualify under an exception. With respect to referrals of patients for lithotripsy, current law allows a practitioner to refer patients to a health care service in which the practitioner has a financial interest if: (1) he or she held a financial interest in the health care service prior to the effective date of P.L.2009, c.24 and discloses the financial interest to the patient; or (2) he or she has a financial interest in an ambulatory surgical facility that provides lithotripsy services and the practitioner personally performs the procedure, the practitioner's remuneration is directly proportional to his or her ownership interest and not to the volume of patients referred by the practitioner, all clinically-related decisions are made by the facility's practitioners and are in the best interests of the patient, and the practitioner discloses the financial interest to the patient at or prior to the time the referral is made. Current law does not permit referrals by practitioners who invest in a licensed facility that provides lithotripsy if the practitioner obtained his or her financial interest in that facility after the effective date of P.L.2009, c.24. This bill would allow for such referrals, under the same conditions that apply to referrals to ambulatory surgical facilities.
Allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met.
