senate Bill S4138

Amended

Requires reimbursement for surgical first assistant services

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 21 / Mar / 2011
    • REFERRED TO INSURANCE
  • 01 / Jun / 2011
    • 1ST REPORT CAL.897
  • 02 / Jun / 2011
    • 2ND REPORT CAL.
  • 06 / Jun / 2011
    • ADVANCED TO THIRD READING
  • 24 / Jun / 2011
    • COMMITTED TO RULES
  • 04 / Jan / 2012
    • REFERRED TO INSURANCE
  • 11 / Jan / 2012
    • AMEND AND RECOMMIT TO INSURANCE
  • 11 / Jan / 2012
    • PRINT NUMBER 4138A
  • 16 / May / 2012
    • AMEND AND RECOMMIT TO INSURANCE
  • 16 / May / 2012
    • PRINT NUMBER 4138B

Summary

Requires reimbursement for surgical first assistant services.

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Bill Details

Versions:
S4138
S4138A
S4138B
Legislative Cycle:
2011-2012
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L; amd §§365-a & 369-ee, Soc Serv L; amd §13, Work Comp L
Versions Introduced in Previous Legislative Cycles:
2011-2012: A10178
2009-2010: A5720C
2007-2008: A7894

Votes

15
0
15
Aye
0
Nay
2
aye with reservations
1
absent
0
excused
0
abstained
show Insurance committee vote details

Sponsor Memo

BILL NUMBER:S4138

TITLE OF BILL:
An act
to amend the insurance law, the social services law and the workers'
compensation law, in relation to reimbursement for surgical first
assistant
services

PURPOSE:
Provides for coverage for surgical first assistant services performed
by a registered nurse first assistant who is certified in operating
room nursing and who performs surgical first assistant services
within his or her scope of practice in every policy of insurance in
instances in which reimbursement for surgical first assistant
services is provided.

SUMMARY OF PROVISIONS:
Section 1 amends subsection (i) of section 3216 of the insurance law
is amended by adding a new paragraph 27

Section 2 amends subsection (k) of section 3221 of the insurance law.

Section 3 adds a new subsection (gg) to section 4303 of the insurance
law.

Section 4 amends subdivision 3 of section 365-a of the social services
law by adding a new paragraph (v)

Section 5 amends subparagraphs (xv) and (xvi) of paragraph (e) of
subdivision I of section 369ee of the social services law and adds a
new subparagraph (xvii)

Section 6 amends the opening paragraph of subdivision (a) of section
13 of the workers' compensation law

Section 7 sets the effective date.

JUSTIFICATION:
Registered professional nurses are authorized to diagnose and treat
patients through such services as case-finding, health teaching,
health counseling, and provision of care supportive to or restorative
of life and well-being.

The registered nurse first assistant is a registered professional
nurse who provides supportive and restorative patient care by
performing as a first assistant at surgery under the direction of a
licensed physician or legally authorized licensed healthcare provider
under State Education Law and in accordance with scope of practice
qualifications.

The extraordinary capabilities of those nurse providing such services,
and their invaluable contributions to New York's healthcare delivery
system are a matter of fact. These learned professionals work
predominantly in sensitive pre-operative and post-operative
environments and are a vital liaison between surgeon and patient. The


diminishment of surgical resident availability has enhanced the need
for the registered nurse first assistant to function as a vital link
in the provision of quality patient care

Typically, first assistant at surgery services are routinely
reimbursed by health insurers for the services of other
non-physician, licensed professionals, who, within their scope of
practice, perform, as first assistants at surgery. However, the first
assistant at surgery services provided by the qualified registered
nurse are not routinely reimbursed by insurers. This bill will
rectify that disparity. It will ensure that first assistant at
surgery services, provided by a registered nurse first assistant,
will be routinely reimbursed by insurers.

Direct reimbursement to a registered nurse first assistant who bills
for such services may occur for situations such as service agreement
relationships between a physician and a registered nurse first
assistant, when an insurance policy allows such reimbursement
directly to the registered nurse first assistant provider.

This bill ensures the equitability of the provision and the
distribution of reimbursement for services already designated as
reimbursable.

As a matter of fact, this bill describes a cost-effective approach
since the reimbursement for a non-physician, licensed professional
who functions as a first assistant is already established as a cost
saving measure.

Additionally, this bill also serves as an incentive for retention and
recruitment of nursing professionals.

LEGISLATIVE HISTORY:
2010 A.5720-C Reported to Ways and Means
2009 A.5720-C Referred to Insurance
2007-08 A.7894 Referred to Insurance
2006 A.6167A Referred to Insurance
2005 A.6167 Referred to Insurance Committee
2003-04 A.9143 Referred to Insurance Committee
2001-02 A.6315 Referred to Insurance Committee

FISCAL IMPLICATIONS:
None to the State.

EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law and shall apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such
effective date.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4138

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 21, 2011
                               ___________

Introduced  by  Sen.  LITTLE -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, the social services law and the work-
  ers' compensation law, in relation to reimbursement for surgical first
  assistant services

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 28 to read as follows:
  (28) EVERY POLICY ISSUED  PURSUANT  TO  THIS  SECTION  WHICH  PROVIDES
REIMBURSEMENT  FOR  NON-PHYSICIAN SURGICAL FIRST ASSISTANT SERVICES WHEN
SUCH SERVICES ARE PROVIDED BY A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT
WHO  IS EMPLOYED BY A PHYSICIAN AND THE PHYSICIAN BILLS FOR THE SERVICES
SHALL NOT DENY SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE  NON-PHY-
SICIAN  SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A REGISTERED
NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A
NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
OF THE MEMBER CONTRACT  OTHERWISE  PROVIDE  FOR  THE  COVERAGE  OF  SUCH
SERVICES.  NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT THE
MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF  SUCH  SERVICES;  PREVENT  A
POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
SERVICES.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 17 to read as follows:
  (17)  EVERY  POLICY  ISSUED  PURSUANT  TO  THIS SECTION WHICH PROVIDES
REIMBURSEMENT FOR NON-PHYSICIAN SURGICAL FIRST ASSISTANT  SERVICES  WHEN

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01171-01-1

S. 4138                             2

SUCH  SERVICES  ARE PROVIDED BY A NON-PHYSICIAN SURGICAL FIRST ASSISTANT
WHO IS EMPLOYED BY A PHYSICIAN AND THE PHYSICIAN BILLS FOR THE  SERVICES
SHALL  NOT DENY SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE NON-PHY-
SICIAN  SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A REGISTERED
NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A
NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
OF THE MEMBER CONTRACT  OTHERWISE  PROVIDE  FOR  THE  COVERAGE  OF  SUCH
SERVICES.  NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT THE
MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF  SUCH  SERVICES;  PREVENT  A
POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
SERVICES.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (hh) to read as follows:
  (HH) EVERY CONTRACT ISSUED  BY  A  HEALTH  SERVICE  CORPORATION  OR  A
MEDICAL  EXPENSE  INDEMNITY CORPORATION WHICH PROVIDES FOR REIMBURSEMENT
FOR SURGICAL FIRST ASSISTANT SERVICES SHALL PROVIDE  COVERAGE  FOR  SUCH
SERVICES  WHEN  PROVIDED  BY  A  REGISTERED NURSE FIRST ASSISTANT WHO IS
CERTIFIED IN OPERATING ROOM NURSING PROVIDED THAT: (1) SUCH SERVICES ARE
WITHIN THE SCOPE OF PRACTICE OF A NON-PHYSICIAN SURGICAL  FIRST  ASSIST-
ANT;  AND  (2) THE TERMS AND CONDITIONS OF THE MEMBER CONTRACT OTHERWISE
PROVIDE FOR THE COVERAGE OF SUCH SERVICES.  NOTHING  IN  THIS  PARAGRAPH
SHALL  BE  CONSTRUED  TO:  PREVENT THE MEDICAL MANAGEMENT OR UTILIZATION
REVIEW OF SUCH  SERVICES;  PREVENT  A  POLICY  FROM  REQUIRING  SERVICES
THROUGH  A  NETWORK  OF  PARTICIPATING  PROVIDERS WHO SHALL MEET CERTAIN
REQUIREMENTS FOR PARTICIPATION,  INCLUDING  PROVIDER  CREDENTIALING;  OR
PROHIBIT  AN INSURER FROM, IN ITS SOLE DISCRETION, PROVIDING A GLOBAL OR
CAPITATED PAYMENT OR ELECTING  TO  DIRECTLY  REIMBURSE  A  NON-PHYSICIAN
SURGICAL FIRST ASSISTANT FOR SUCH SERVICES.
  S  4.  Subdivision  2  of  section 365-a of the social services law is
amended by adding a new paragraph (w) to read as follows:
  (W) CARE AND SERVICES FOR SURGICAL FIRST ASSISTANT  SERVICES  PROVIDED
BY A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM
NURSING  PROVIDED  THAT: (I) SUCH SERVICES ARE WITHIN THE SCOPE OF PRAC-
TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (II) THE TERMS AND
CONDITIONS OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE  OF
SUCH  SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT
THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES: PREVENT A
POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
SERVICES.
  S 5. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
section 369-ee of the social services law, subparagraph (xv) as  amended
and  subparagraph (xvi) as added by chapter 526 of the laws of 2002, are
amended and a new subparagraph (xvii) is added to read as follows:
  (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
[and]
  (xvi) hospice services[.]; AND

S. 4138                             3

  (XVII) SURGICAL FIRST ASSISTANT SERVICES  PERFORMED  BY  A  REGISTERED
NURSE  FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM NURSING
PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE  OF  A
NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
OF  THE  MEMBER  CONTRACT  OTHERWISE  PROVIDE  FOR  THE COVERAGE OF SUCH
SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT  THE
MEDICAL  MANAGEMENT  OR  UTILIZATION  REVIEW OF SUCH SERVICES; PREVENT A
POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
SERVICES.
  S 6. The opening paragraph of subdivision (a) of  section  13  of  the
workers'  compensation law, as amended by chapter 6 of the laws of 2007,
is amended to read as follows:
  The employer shall promptly  provide  for  an  injured  employee  such
medical,  dental, surgical, optometric or other attendance or treatment,
nurse and hospital service,  medicine,  optometric  services,  crutches,
eye-glasses,   false   teeth,  artificial  eyes,  orthotics,  prosthetic
devices, functional assistive and adaptive  devices  and  apparatus  for
such  period  as the nature of the injury or the process of recovery may
require. The employer shall be liable for the payment of the expenses of
medical, dental, surgical, optometric or other attendance or  treatment,
nurse  and  hospital  service,  medicine, optometric services, crutches,
eye-glasses,  false  teeth,  artificial  eyes,   orthotics,   prosthetic
devices,  functional  assistive  and  adaptive devices and apparatus, as
well as artificial members of the body or other  devices  or  appliances
necessary in the first instance to replace, support or relieve a portion
or  part of the body resulting from and necessitated by the injury of an
employee, for such period as the nature of the injury or the process  of
recovery may require, and the employer shall also be liable for replace-
ments  or  repairs  of such artificial members of the body or such other
devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
ic devices, functional assistive  and  adaptive  devices  or  appliances
necessitated by ordinary wear or loss or damage to a prosthesis, with or
without bodily injury to the employee. Damage to or loss of a prosthetic
device  shall  be  deemed  an  injury except that no disability benefits
shall be payable with respect to such injury under  section  fifteen  of
this  article. Such a replacement or repair of artificial members of the
body or such other devices, eye-glasses, false teeth,  artificial  eyes,
orthotics, prosthetic devices, functional assistive and adaptive devices
or  appliances or the providing of medical treatment and care as defined
herein shall not constitute the payment of  compensation  under  section
twenty-five-a  of  this article.   ALL SURGICAL SERVICES COVERED BY THIS
ARTICLE, INCLUDING COVERAGE FOR SURGICAL FIRST ASSISTANT SERVICES, SHALL
INCLUDE CARE AND SERVICES FURNISHED IN ALL COVERED SETTINGS PROVIDED  BY
A  REGISTERED  NURSE  FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM
NURSING PROVIDED THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF  PRAC-
TICE  OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND
CONDITIONS OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE  OF
SUCH  SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT
THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES; PREVENT A
POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE

S. 4138                             4

DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
SERVICES. All fees and other charges for  such  treatment  and  services
shall  be  limited  to such charges as prevail in the same community for
similar treatment of injured persons of a like standard of living.
  S 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law and shall apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such effective
date.

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