Current through Register Vol. 46, No. 12, March 20, 2024
(a) Expenditures by social services districts
for their payments to a physician for services rendered to a hospitalized
patient shall be subject to State reimbursement as follows:
(1) when the physician has the responsibility
for the care of the patient; or
(2)
when the physician's services were rendered as a consultant, surgical
assistant, or for a special service at the request of the physician responsible
for the care of the patient.
(b) State reimbursement shall not be
available:
(1) for compensation paid to a
physician for the care of hospitalized patients when such compensation has been
included as an element of costs reflected in a hospital rate approved by the
State Director of the Budget pursuant to section
2807 of the Public Health Law;
(2) for services provided by a physician or
physician's associate or a registered specialist's assistant employed by the
physician to patients other than those determined in accordance with Part 505
of this Subchapter by the Commissioner of Health or his designee.
(c) Maximum reimbursable fee
schedule for physician provided inpatient care at hospitals with approved
training programs.
(1) Conditions for
payment:
(i) Individual private practitioner.
Qualified physicians may be paid on a fee-for-service basis for direct care of
hospital inpatients when their hospital salary is not paid for purposes of
providing direct patient care; i.e., when the salary is paid exclusively for
hospital activities such as teaching, various administrative duties (department
heads, etc.) or for research.
(ii)
Group practice. Payments for physicians' services on a group care basis may
begin September 1, 1968, provided that the State Department of Health has
approved a plan submitted in accordance with section
405.22
of 10 NYCRR, by the hospital describing how the group care will function, or is
already functioning, how the requirements of such section are being met, and to
which services it will apply.
(2) Conditions barring payment. Payment on a
fee-for-service basis to a salaried hospital physician may not be made when:
(i) any portion of the salary paid by the
hospital to such salaried physicians is for direct care of hospital inpatients
or outpatients; or
(ii) there is
any prohibition for such payment in law, in the rules of particular hospital or
in the contractual arrangement with the salaried physician or group.
(3) Medicine (effective April 1,
1974).
9020 First visit, history, examination and treatment
............$6.50
9021 Subsequent visit, including treatment ............
5.00
During the first week of care, payments for no more than
one visit daily shall be subject to reimbursement. Thereafter, payment for no
more than three visits weekly shall be subject to reimbursement.
(4) Surgery. Reimbursement for
inpatient surgical care shall be limited to 80 percent of the maximum
reimbursable allowances as set out in section
533.5 of
this Part when after-care is provided in the outpatient department. Payment for
such after-care shall be made made on a per-visit basis to the hospital and the
outpatient physician in accordance with prescribed procedures.
(d) State reimbursement for
payment to physicians providing emergency services under contract with certain
hospitals. Maximum reimbursable fees for payments made to physicians providing
emergency services under contract with a hospital, effective April 1, 1974,
shall be as follows:
(1) Reimbursement for
inpatient emergency care shall be limited to 70 percent of the maximum
reimbursable allowances set out in section
533.4 of this
Part.
(2) Reimbursement for
outpatient emergency care shall be limited to 70 percent of the maximum
reimbursable allowances set out in section
533.4 of this
Part.
(3) If the contract with
physicians either individually, or as a group includes the provision that the
hospital will pay to such physicians or physician group an amount equal to the
difference between the billings for physicians' services and an established
guaranteed amount, the hospitals may include, as an allowable hospital cost for
outpatient rate determination purposes, either the amount paid under the
guarantee or 15 percent of the guaranteed amount, whichever is less. Such
amount shall not be included in determination of the inpatient rate.
(4) Salaries of physicians employed by a
hospital to provide patient care are included as hospital costs in determining
inpatient and outpatient reimbursement rates and therefore, no separate
payments shall be made to such salaried physicians.
