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. LBD05304-01-3A. 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 underA. 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.