A00405 Summary:

BILL NOA00405
 
SAME ASSAME AS S03751
 
SPONSORCahill (MS)
 
COSPNSRBarrett, Blankenbush, DiPietro, Fahy, Hunter, Malliotakis, Miller B, Rivera, Santabarbara, Steck, Weprin, Ortiz, Carroll, McDonald, Buttenschon, LiPetri, Montesano
 
MLTSPNSRAbbate, 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, Rosenthal L, Simon, Stec, Stirpe, Thiele, Woerner, Zebrowski
 
Amd §§3216, 4235, 4301 & 4322, Ins L
 
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.
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A00405 Committee Votes:

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A00405 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A405
 
SPONSOR: Cahill (MS)
  TITLE OF BILL: An act to amend the insurance law, in relation to physical therapy services   PURPOSE: To limit the imposition of co-payments for physical therapy services to no more than twenty percent of the reimbursement to the provider of care.   SUMMARY OF PROVISIONS: Sections 1 through 5 prohibit payors from imposing costs on insureds for the provision of physical therapy services in excess of 20 percent of the reimbursement to the provider of care. Section 6. Effective Date.   JUSTIFICATION: This bill will protect consumers by prohibiting plans from inappropri- ately shifting the cost of physical therapy care to consumers by limit- ing co-payments to no more than 20 percent of the total reimbursement to the provider of care. Under existing law, health plans must cover phys- ical therapy services. Despite that requirement, health plans have shifted the vast majority of the cost of physical therapy services by imposing increasingly high co-payments on consumers. Under certain health plans, co-payments for physical therapy services have exceeded the reimbursement paid by the plan to the provider of care. This cost shift has imposed a financial burden on consumers, and it has restricted access to physical therapy services. Consumers frequently cannot afford the cost imposed by these copayments for medically neces- sary physical therapy care. Physical therapy services generally require multiple visits over the healing process. A co-payment of $50 for a physical therapy plan of care of 3 times a week for a month will cost the consumer $600 in out-of-pocket expenses which is beyond the means of many consumers. As a result, New Yorkers are forgoing medically neces- sary care running the risk of worsening the underlying condition or risking re-injury. This bill would reestablish the obligation of health plans to cover the expense of physical therapy services by limiting co-payments to no more than twenty percent of the total reimbursement to the provider of care. The 20 percent limitation will allow plans to require co-payments that discourage inappropriate care but will prohibit plans from inappropri- ately shifting the cost of physical therapy care to consumers.   LEGISLATIVE HISTORY: 2017-2018: A.569A - Referred to Insurance 2015-2016: A.1063A Referred to Insurance 2009-2010: A.8171A Referred to Insurance 2011-2012: A.187A - Amend and Recommit to Insurance 2013-2014: A.1666A - Amend and Recommit to Insurance   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect on the one hundred eightieth day after it shall have become a law.
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A00405 Text:



 
                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.
                                                                   LBD01964-01-9

        A. 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  coinsurance

        A. 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.
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