Bill Text: NY A06345 | 2023-2024 | General Assembly | Introduced

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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: Slight Partisan Bill (Democrat 24-8)

Status: (Introduced) 2024-06-07 - substituted by s1470 [A06345 Detail]

Download: New_York-2023-A06345-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6345

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                      April 5, 2023
                                       ___________

        Introduced  by  M.  of  A. WEPRIN, BARRETT, BLANKENBUSH, DiPIETRO, FAHY,
          HUNTER, MILLER, RIVERA,  SANTABARBARA,  STECK,  CARROLL,  BUTTENSCHON,
          ZEBROWSKI, L. ROSENTHAL, WOERNER, THIELE, BRABENEC, STIRPE, LUPARDO --
          Multi-Sponsored  by  -- M. of A. BENEDETTO, BRAUNSTEIN, COLTON, DINOW-
          ITZ, J. M. GIGLIO -- read once and referred to the Committee on Insur-
          ance

        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
    18  copayment  or  coinsurance  amount  imposed  on the insured for services
    19  provided to the insured for  an  office  visit  for  the  service  of  a
    20  licensed  primary  care physician or osteopath for the same or a similar

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05304-01-3
        A. 6345                             2

     1  diagnosed condition even if a different nomenclature is used to describe
     2  the condition for which the services are provided.
     3    § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
     4  of  the insurance law is amended by adding a new clause (iii) to read as
     5  follows:
     6    (iii) a policy shall not impose  a  copayment  or  coinsurance  amount
     7  charged to the insured for services rendered for each date of service by
     8  a  physical  therapist  licensed under article one hundred thirty-six of
     9  the education law or an occupational therapist  licensed  under  article
    10  one  hundred  fifty-six  of  the  education law that is greater than the
    11  copayment or coinsurance amount imposed  on  the  insured  for  services
    12  provided  to  the  insured  for  an  office  visit  for the service of a
    13  licensed primary care physician or osteopath for the same or  a  similar
    14  diagnosed condition even if a different nomenclature is used to describe
    15  the condition for which the services are provided.
    16    § 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235
    17  of  the insurance law, as amended by chapter 593 of the laws of 2000, is
    18  amended to read as follows:
    19    (A) any physical and occupational therapy service which is within  the
    20  lawful  scope of practice of a licensed physical and occupational thera-
    21  pist, a subscriber to such policy shall be entitled to reimbursement for
    22  such service, whether the said service is performed by  a  physician  or
    23  licensed physical and occupational therapist pursuant to prescription or
    24  referral by a physician.  A policy shall not impose a copayment or coin-
    25  surance  amount  charged  to  the insured for services rendered for each
    26  date of service by a  physical  therapist  licensed  under  article  one
    27  hundred  thirty-six  of  the  education law or an occupational therapist
    28  licensed under article one hundred fifty-six of the education  law  that
    29  is  greater  than  the  copayment  or  coinsurance amount imposed on the
    30  insured for services provided to the insured for an office visit for the
    31  service of a licensed primary care physician or osteopath for  the  same
    32  or  a  similar  diagnosed  condition even if a different nomenclature is
    33  used to describe the condition for which the services are provided;
    34    § 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301
    35  of the insurance law, as amended by chapter 593 of the laws of 2000,  is
    36  amended to read as follows:
    37    (G)  physical  and occupational therapy care provided through licensed
    38  physical and occupational therapists upon the prescription of  a  physi-
    39  cian, provided, however, that no copayment or coinsurance amount charged
    40  to the insured for services rendered for each date of service by a phys-
    41  ical  therapist  licensed  under  article  one hundred thirty-six of the
    42  education law or an occupational therapist licensed  under  article  one
    43  hundred  fifty-six of the education law is greater than the copayment or
    44  coinsurance amount imposed on the insured for services provided  to  the
    45  insured  for  an office visit for the service of a licensed primary care
    46  physician or osteopath for the same or  a  similar  diagnosed  condition
    47  even  if  a different nomenclature is used to describe the condition for
    48  which the services are provided,
    49    § 5. Paragraph 13 of subsection (b) of section 4322 of  the  insurance
    50  law,  as added by chapter 504 of the laws of 1995, is amended to read as
    51  follows:
    52    (13) Outpatient physical therapy up to ninety visits per condition per
    53  calendar year, provided,  however,  that  no  copayment  or  coinsurance
    54  amount  charged  to  the  insured for services rendered for each date of
    55  service by a physical therapist licensed under article one hundred thir-
    56  ty-six of the education law or an occupational therapist licensed  under
        A. 6345                             3

     1  article  one  hundred fifty-six of the education law is greater than the
     2  copayment or coinsurance amount imposed  on  the  insured  for  services
     3  provided  to  the  insured  for  an  office  visit  for the service of a
     4  licensed  primary  care physician or osteopath for the same or a similar
     5  diagnosed condition even if a different nomenclature is used to describe
     6  the condition for which the services are provided.
     7    § 6. This act shall take effect on the one hundred eightieth day after
     8  it shall have become a law.