Bill Text: NY A00405 | 2019-2020 | General Assembly | Introduced
Bill Title: Provides that no policy of group accident, group health or group accident and health shall impose copayments for physical or occupational therapy greater than the copay for similar services provided by a physician.
Spectrum: Moderate Partisan Bill (Democrat 46-14)
Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A00405 Detail]
Download: New_York-2019-A00405-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 405 2019-2020 Regular Sessions IN ASSEMBLY (Prefiled) January 9, 2019 ___________ Introduced by M. of A. CAHILL, BARRETT, BLANKENBUSH, DiPIETRO, FAHY, HUNTER, MALLIOTAKIS, B. MILLER, RIVERA, SANTABARBARA, STECK, WEPRIN -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN, COLTON, CRESPO, CROUCH, CUSICK, CYMBROWITZ, DINOWITZ, ENGLEBRIGHT, GALEF, GARBARINO, GIGLIO, GOTTFRIED, GUNTHER, HAWLEY, HEVESI, JAFFEE, LENTOL, LIFTON, LUPARDO, MAGNARELLI, McDONOUGH, MOSLEY, OTIS, PALMESANO, PAULIN, PEOPLES-STOKES, PERRY, PRETLOW, QUART, RAIA, RAMOS, L. ROSENTHAL, SIMON, STEC, STIRPE, THIELE, WOER- NER, ZEBROWSKI -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to physical therapy services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 23 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 593 of the laws of 2000, is amended 3 to read as follows: 4 (23) If a policy provides for reimbursement for physical and occupa- 5 tional therapy service which is within the lawful scope of practice of a 6 duly licensed physical or occupational therapist, an insured shall be 7 entitled to reimbursement for such service whether the said service is 8 performed by a physician or through a duly licensed physical or occupa- 9 tional therapist, provided however, that nothing contained herein shall 10 be construed to impair any terms of such policy including appropriate 11 utilization review and the requirement that said service be performed 12 pursuant to a medical order, or a similar or related service of a physi- 13 cian. An insurer shall not impose a copayment or coinsurance amount 14 charged to the insured for services rendered for each date of service by 15 a physical therapist licensed under article one hundred thirty-six of 16 the education law or an occupational therapist licensed under article 17 one hundred fifty-six of the education law that is greater than the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01964-01-9A. 405 2 1 copayment or coinsurance amount imposed on the insured for services 2 provided to the insured for an office visit for the service of a 3 licensed primary care physician or osteopath for the same or a similar 4 diagnosed condition even if a different nomenclature is used to describe 5 the condition for which the services are provided. 6 § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235 7 of the insurance law is amended by adding a new clause (iii) to read as 8 follows: 9 (iii) a policy shall not impose a copayment or coinsurance amount 10 charged to the insured for services rendered for each date of service by 11 a physical therapist licensed under article one hundred thirty-six of 12 the education law or an occupational therapist licensed under article 13 one hundred fifty-six of the education law that is greater than the 14 copayment or coinsurance amount imposed on the insured for services 15 provided to the insured for an office visit for the service of a 16 licensed primary care physician or osteopath for the same or a similar 17 diagnosed condition even if a different nomenclature is used to describe 18 the condition for which the services are provided. 19 § 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235 20 of the insurance law, as amended by chapter 593 of the laws of 2000, is 21 amended to read as follows: 22 (A) any physical and occupational therapy service which is within the 23 lawful scope of practice of a licensed physical and occupational thera- 24 pist, a subscriber to such policy shall be entitled to reimbursement for 25 such service, whether the said service is performed by a physician or 26 licensed physical and occupational therapist pursuant to prescription or 27 referral by a physician. A policy shall not impose a copayment or coin- 28 surance amount charged to the insured for services rendered for each 29 date of service by a physical therapist licensed under article one 30 hundred thirty-six of the education law or an occupational therapist 31 licensed under article one hundred fifty-six of the education law that 32 is greater than the copayment or coinsurance amount imposed on the 33 insured for services provided to the insured for an office visit for the 34 service of a licensed primary care physician or osteopath for the same 35 or a similar diagnosed condition even if a different nomenclature is 36 used to describe the condition for which the services are provided; 37 § 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301 38 of the insurance law, as amended by chapter 593 of the laws of 2000, is 39 amended to read as follows: 40 (G) physical and occupational therapy care provided through licensed 41 physical and occupational therapists upon the prescription of a physi- 42 cian, provided, however, that no copayment or coinsurance amount charged 43 to the insured for services rendered for each date of service by a phys- 44 ical therapist licensed under article one hundred thirty-six of the 45 education law or an occupational therapist licensed under article one 46 hundred fifty-six of the education law is greater than the copayment or 47 coinsurance amount imposed on the insured for services provided to the 48 insured for an office visit for the service of a licensed primary care 49 physician or osteopath for the same or a similar diagnosed condition 50 even if a different nomenclature is used to describe the condition for 51 which the services are provided, 52 § 5. Paragraph 13 of subsection (b) of section 4322 of the insurance 53 law, as added by chapter 504 of the laws of 1995, is amended to read as 54 follows: 55 (13) Outpatient physical therapy up to ninety visits per condition per 56 calendar year, provided, however, that no copayment or coinsuranceA. 405 3 1 amount charged to the insured for services rendered for each date of 2 service by a physical therapist licensed under article one hundred thir- 3 ty-six of the education law or an occupational therapist licensed under 4 article one hundred fifty-six of the education law is greater than the 5 copayment or coinsurance amount imposed on the insured for services 6 provided to the insured for an office visit for the service of a 7 licensed primary care physician or osteopath for the same or a similar 8 diagnosed condition even if a different nomenclature is used to describe 9 the condition for which the services are provided. 10 § 6. This act shall take effect on the one hundred eightieth day after 11 it shall have become a law.
