senate Bill S4138B

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

See Assembly Version of this Bill:
A10178
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

Sponsor Memo

BILL NUMBER:S4138B

TITLE OF BILL:
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

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 29.

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

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

Section 4 amends subdivision 2 of section 365-a of the social services
law by adding a new paragraph (aa).

Section 5 amends subparagraphs (xv) and (xvi) of paragraph (e) of subdi-
vision 1 of section 369-ee 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 contains 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 predomi-
nantly 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 assist-
ant, 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 func-
tions as a first assistant is already established as a cost saving meas-
ure.

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

LEGISLATIVE HISTORY:
2011: S.4138 Committed to Rules

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--B

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 21, 2011
                               ___________

Introduced  by  Sens. LITTLE, MAZIARZ -- read twice and ordered printed,
  and when printed to be committed to  the  Committee  on  Insurance  --
  recommitted  to  the  Committee on Insurance in accordance with Senate
  Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
  reprinted  as  amended  and recommitted to said committee -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

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 29 to read as follows:
  (29) 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01171-03-2

S. 4138--B                          2

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 18 to read as follows:
  (18)  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 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (ii) to read as follows:
  (II)  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 (aa) to read as follows:
  (AA)  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

S. 4138--B                          3

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
  (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

S. 4138--B                          4

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. 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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