Section 34-2.12 - Waiver of co-payments, co-insurance, deductibles and fees

34-2.12 Waiver of co-payments, co-insurance, deductibles and fees.

(a) Routine waiver by a clinical laboratory of co-payments, co-insurance, or deductibles for clinical laboratory services performed for recipients of such services who are patients of a referring health services purveyor shall be deemed consideration given for referral of specimens for performance of clinical laboratory services, and is prohibited.

(b) Waiver of fees for clinical laboratory services for the patients of a referring health services purveyor who are enrolled in an HMO by a clinical laboratory which is not a participating laboratory of the HMO, where such waiver results in consideration being received by the referring health services purveyor, shall be deemed consideration given for referral of specimens for performance of clinical laboratory services, and is prohibited.

(c) Nothing in Public Health Law section 587 or in this Subpart shall be construed to prohibit a clinical laboratory from:

(1) waiving a co-payment, co-insurance, deductible, or fee for a particular patient based on the patient's inability to pay, in which case the clinical laboratory shall maintain a record documenting the patient's inability to pay; or

(2) waiving a co-payment, co-insurance, deductible or fee, if the cost of collection is greater than the amount to be collected.

(d) Nothing in Public Health Law section 587 or in this Subpart shall be construed to prohibit a clinical laboratory from offering a discount to a referring health services purveyor provided that:

(1) the health services purveyor appropriately reflects the discount on any costs or charges reported and/or claimed by the health services purveyor under any third party reimbursement program; and

(2) the discounted price is consistent with fair market value; or

(3) the discounted price reflects a volume discount, whereby the amount of the discount is reasonably related to costs saved by the clinical laboratory.

Effective Date: 
Wednesday, December 26, 2001
Doc Status: 
Complete