Title: Section 58-3.1 - Definitions

Section 58-3.1 Definitions.

(a) Gross annual receipts for clinical laboratories able to segregate income. For independent laboratories or laboratories operated within facilities which can segregate their laboratory income from total facility income, gross annual receipts shall mean the total income of the laboratory from all sources for all clinical laboratory tests performed pursuant to its permit, less any amounts paid to reference laboratories for such tests which are referred.

(b) Gross annual receipts for clinical laboratories unable to segregate laboratory income.

(1) For laboratories operated by health maintenance organizations, facilities with operating certificates issued pursuant to section 2805 of the Public Health Law, and other similar facilities which are reimbursed by third-party payors for laboratory services as part of an all inclusive facility per diem rate and which cannot segregate laboratory income from total facility income, gross annual receipts shall mean the amount computed by multiplying the total annual cost of the laboratory, by a fraction, the numerator of which is the gross revenue of the facility and the denominator of which is the gross cost of operating the facility. This amount must be further adjusted by subtracting any amounts paid to reference laboratories for such tests which are referred. Laboratories must obtain prior department approval to use this method by documenting that they are unable to segregate income.

(2) For all other clinical laboratories unable to segregate their annual income from tests performed pursuant to their New York State permit, gross annual receipts shall mean the amount the laboratory would have received had it billed the prevailing rate for these services. The prevailing rate shall mean the fee schedule for clinical laboratory services as listed on pages 5-1 through 5-14 of the Medicaid Management Information System Provider Manual for Laboratories, March 1982 edition, as published by the New York State Department of Social Services. Copies of this publication are available from the Department of Social Services, 40 North Pearl Street, Albany, NY 12243, and a copy is available for inspection and copying from the records access officer of the Department of Health, Corning Tower, Empire State Plaza, Albany, NY 12237. Laboratories must obtain prior department approval to use this method by documenting that they are unable to identify laboratory income.

(c) Inspection and reference fee shall mean the fee charged to a clinical laboratory calculated by multiplying the total operating expenses of the clinical laboratory evaluation program of the Department of Health by a fraction, the numerator of which is the gross annual receipts of such laboratory and the denominator of which is the total gross annual receipts of all laboratories issued permits.

(d) Permit year shall mean July 1st to June 30th.