Bill Text: NY S01470 | 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 8-5)

Status: (Engrossed) 2024-06-07 - returned to senate [S01470 Detail]

Download: New_York-2023-S01470-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          1470

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 12, 2023
                                       ___________

        Introduced  by  Sens. BRESLIN, COMRIE, GALLIVAN, HELMING, KENNEDY, MANN-
          ION, MAY, PARKER, SEPULVEDA, STEC -- read twice and  ordered  printed,
          and when printed to be committed 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
    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
    21  diagnosed condition even if a different nomenclature is used to describe
    22  the condition for which the services are provided.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05304-01-3
        S. 1470                             2

     1    § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
     2  of  the insurance law is amended by adding a new clause (iii) to read as
     3  follows:
     4    (iii)  a  policy  shall  not  impose a copayment or coinsurance amount
     5  charged to the insured for services rendered for each date of service by
     6  a physical therapist licensed under article one  hundred  thirty-six  of
     7  the  education  law  or an occupational therapist licensed under article
     8  one hundred fifty-six of the education law  that  is  greater  than  the
     9  copayment  or  coinsurance  amount  imposed  on the insured for services
    10  provided to the insured for  an  office  visit  for  the  service  of  a
    11  licensed  primary  care physician or osteopath for the same or a similar
    12  diagnosed condition even if a different nomenclature is used to describe
    13  the condition for which the services are provided.
    14    § 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235
    15  of the insurance law, as amended by chapter 593 of the laws of 2000,  is
    16  amended to read as follows:
    17    (A)  any physical and occupational therapy service which is within the
    18  lawful scope of practice of a licensed physical and occupational  thera-
    19  pist, a subscriber to such policy shall be entitled to reimbursement for
    20  such  service,  whether  the said service is performed by a physician or
    21  licensed physical and occupational therapist pursuant to prescription or
    22  referral by a physician.  A policy shall not impose a copayment or coin-
    23  surance amount charged to the insured for  services  rendered  for  each
    24  date  of  service  by  a  physical  therapist licensed under article one
    25  hundred thirty-six of the education law  or  an  occupational  therapist
    26  licensed  under  article one hundred fifty-six of the education law that
    27  is greater than the copayment  or  coinsurance  amount  imposed  on  the
    28  insured for services provided to the insured for an office visit for the
    29  service  of  a licensed primary care physician or osteopath for the same
    30  or a similar diagnosed condition even if  a  different  nomenclature  is
    31  used to describe the condition for which the services are provided;
    32    § 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301
    33  of  the insurance law, as amended by chapter 593 of the laws of 2000, is
    34  amended to read as follows:
    35    (G) physical and occupational therapy care provided  through  licensed
    36  physical  and  occupational therapists upon the prescription of a physi-
    37  cian, provided, however, that no copayment or coinsurance amount charged
    38  to the insured for services rendered for each date of service by a phys-
    39  ical therapist licensed under article  one  hundred  thirty-six  of  the
    40  education  law  or  an occupational therapist licensed under article one
    41  hundred fifty-six of the education law is greater than the copayment  or
    42  coinsurance  amount  imposed on the insured for services provided to the
    43  insured for an office visit for the service of a licensed  primary  care
    44  physician  or  osteopath  for  the same or a similar diagnosed condition
    45  even if a different nomenclature is used to describe the  condition  for
    46  which the services are provided,
    47    §  5.  Paragraph 13 of subsection (b) of section 4322 of the insurance
    48  law, as added by chapter 504 of the laws of 1995, is amended to read  as
    49  follows:
    50    (13) Outpatient physical therapy up to ninety visits per condition per
    51  calendar  year,  provided,  however,  that  no  copayment or coinsurance
    52  amount charged to the insured for services rendered  for  each  date  of
    53  service by a physical therapist licensed under article one hundred thir-
    54  ty-six  of the education law or an occupational therapist licensed under
    55  article one hundred fifty-six of the education law is greater  than  the
    56  copayment  or  coinsurance  amount  imposed  on the insured for services
        S. 1470                             3

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