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The Health Care Authoritie's diagnostic center rule has been amended by the House Judiciary Committee. The committee met on Tuesday afternoon and took up the rule and amended it with language that was agreed upon by the WVSMA, the Health Care Authority the Hospital Association and the Governor's Office.
The rule will now be on second reading on the floor of the House today where this committee amendment will be adopted. The rule will then go back to the Senate for that body to concur.
Though the WVSMA did agree to amendments we are not taking the position that we support the rule in any way. The amendments simply make a bad rule less bad but they don't address all the potential concerns the physician community might have with the rule. Faced with the reality that there was not enough support by the Legislature or the Governor's office to either pull the entire rule or modify it in a way to address all the physician's concerns the WVSMA chose to agree to amendments that make the rule less onerous. The amendments only address the following two areas: modifying the grandfather clause and modifying the referral section.
Grandfather Clause:
The grandfather clause has been modified to clarify that physician practices currently offering lab or imaging services shall NOT be deemed a diagnostic center if:
2.1.g.1. Such lab or imaging services were offered in a manner that did not constitute a diagnostic center as it existed at such time the lab or imaging services were first offered; OR
2.1.g.2 Such lab or imaging services were offered in compliance with any certificate of need or any ruling of non-reviewability received by the Health care Authority; OR
2.1.g1.3 Such laboratory or imaging services were offered by the private office practice on the effective date of this rule; provided however, that the number of laboratory or imaging procedures performed on patients who are sent to the private office practice subsequent to the effective date of this rule for the sole purpose of obtaining laboratory or imaging services must remain at or below the level performed on such patients in 2006, or the level established by calculating an annual average based upon calendar years 2004 through 2006, inclusive.
There was a question raised by a physician practice yesterday regarding whether a practice would be required to meet one or all three of the above to be "grandfathered" so the WVSMA has worked to ensure the amendment approved today on the House floor will include the "OR" after sections one and two. This ensures that a practice will only must fall under one of the three to not be considered a diagnostic center.
Referral Section:
The referral section has been modified to allow practices to take up to 25% of the procedures they do on referral only for the sole purpose of doing that lab or imaging service. This clarifies that any referrals accepted by a practice where the physician sees the patient as their own will not be considered under that 25%. The following is the specific language that replaces section 2.1.c of the rule:
"Any facility owned or operated by one or more health professionals licensed, authorized, or organized pursuant to Chapter 30 of the West Virginia Code which offers laboratory or imaging services to patients that are sent by other licensed health care professionals for the sole purpose of obtaining the laboratory or imaging services, regardless of the cost associated with the proposal. A facility shall not be deemed a diagnostic center under subsection 2.1.c. if the proportion of laboratory procedures performed on such patients does not exceed 25% of the total laboratory procedures performed by the facility, and the proportion of imaging procedures performed on such patients does not exceed 25% of the total imaging procedures performed by the facility."
Click here to read the entire rule. (Note that the two amendments above are not included in this document.) |
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March 08, 2007
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