Senate Bill S4491

2009-2010 Legislative Session

Requires health coverage plans to include in provider networks certified nurse practitioners as primary health care providers

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 25, 2010	print number 4491a
Feb 25, 2010	amend and recommit to health
Jan 06, 2010	referred to health
Apr 24, 2009	referred to health

Bill Amendments

Original

A (Active)

2009-S4491 - Details

See Assembly Version of this Bill:: A7877
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4403, Pub Health L; add §§3217-e & 4325-a, amd §§4235 & 4301, Ins L

2009-S4491 - Summary

Requires health coverage plans covering health-care services to include in the provider networks certified nurse practitioners as primary health care providers.

2009-S4491 - Sponsor Memo

                                 BILL NUMBER:  S4491

 TITLE OF BILL :
An act to amend the public health law and the insurance law, in
relation to nurse practitioner access


 PURPOSE OR GENERAL IDEA OF BILL :
To entitle people covered by health plans to choose a nurse
practitioner as their primary care or specialty provider and requires
reimbursement at negotiated or reasonable rates.

 SUMMARY OF SPECIFIC PROVISIONS :
Amends various provisions to require that health plans not
discriminate against nurse practitioners as a class of primary care or
specialty practice providers, and to provide that nurse practitioners
shall be paid by health plans for their services, and that such rate
should be negotiated. Where there is no negotiation, the insurer will
pay usual and customary charges.

 JUSTIFICATION :
Nurse practitioners are authorized to diagnose, treat and refer
patients in collaboration with a physician and in accordance with a
practice agreement (Education Law § 6902 (3) (a)) in seventeen
different specialties. Further, nurse practitioners are authorized to
prescribe and dispense drugs (Education Law §§ 6902(3) (b) and

6807(1)(b)).

Nurse practitioners are often the primary care and specialty providers
of medical treatment. Typically, the services of nurse practitioners
are reimbursed directly by Medicaid, Medicare and a number of private
health insurers. Because all health plans provide reimbursement to
nurse practitioners either directly or through billings generated by
the physician-employer of the nurse practitioner, this bill will
result in no additional costs to health insurers. The bill ensures
that health plans that provide reimbursement to subscribers for
certain physician services not exclude licensed and certified nurse
practitioners from their primary care and specialty provider networks
and must provide reasonable reimbursement to subscribers who choose to
receive such services from a nurse practitioner.

 PRIOR LEGISLATIVE HISTORY :
2006: A.10689 - passed Assembly; S.7733 (Volker) - referred to Health
2007-08: A.6342 - passed Assembly; S.3093 (Volker) - referred to
Health

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
Sixty days after it becomes law.

2009-S4491 - Bill Text download pdf

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

                                  4491

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 24, 2009
                               ___________

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

AN ACT to amend the public health law and the insurance law, in relation
  to nurse practitioner access

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

  Section  1.    Paragraph  (a)  of subdivision 5 of section 4403 of the
public health law, as amended by chapter 586 of the  laws  of  1998,  is
amended to read as follows:
  (a) The commissioner, at the time of initial licensure, at least every
three  years  thereafter,  and upon application for expansion of service
area, shall ensure that the health maintenance organization maintains  a
network  of  health  care  providers  adequate to meet the comprehensive
health needs of its enrollees and to provide an  appropriate  choice  of
providers   sufficient   to  provide  the  services  covered  under  its
enrollee's contracts by determining that  (i)  there  are  a  sufficient
number  of geographically accessible participating providers; (ii) there
are opportunities to select from at least three primary  care  providers
pursuant  to  travel  and  distance  time standards, providing that such
standards account for the conditions of  accessing  providers  in  rural
areas;  (iii)  there  are sufficient providers in each area of specialty
practice to meet the needs of the enrollment population; (iv)  there  is
no  exclusion of any appropriately licensed type of provider as a class;
[and] (v) THERE IS NO EXCLUSION OF APPROPRIATELY LICENSED AND  CERTIFIED
NURSE  PRACTITIONERS  AS  A  CLASS  OF  PRIMARY CARE PRACTITIONERS OR AS
PROVIDERS OF SPECIALTY PRACTICE AND (VI)  contracts  entered  into  with
health care providers neither transfer financial risk to providers, in a
manner  inconsistent with the provisions of paragraph (c) of subdivision
one of this section, nor penalize providers for unfavorable case mix  so
as  to  jeopardize  the  quality  of or enrollees' appropriate access to
medically necessary services; provided, however, that  payment  at  less

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01104-01-9

S. 4491                             2

than  prevailing fee for service rates or capitation shall not be deemed
or presumed prima facie to jeopardize quality or access.
  S  2.  The  insurance law is amended by adding a new section 3217-d to
read as follows:
  S 3217-D. NURSE PRACTITIONER SERVICE REIMBURSEMENT. NO INSURER SUBJECT
TO THIS ARTICLE THAT PROVIDES  COVERAGE  FOR  PHYSICIAN  SERVICES  SHALL
EXCLUDE  APPROPRIATELY  LICENSED  AND CERTIFIED NURSE PRACTITIONERS AS A
CLASS OF PRIMARY CARE PRACTITIONERS OR AS PROVIDERS OF  SPECIALTY  PRAC-
TICE.    AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE SERVICES
PRESCRIBED BY THIS SECTION AT RATES NEGOTIATED BETWEEN THE  INSURER  AND
THE  PROVIDER  OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON RATES, AN
INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL AND  CUSTOMARY  CHARGE,
WHICH SHALL NOT BE UNREASONABLE.
  S  3.  Subparagraphs (F), (G) and (H) of paragraph 4 of subsection (f)
of section 4235 of the insurance law,  subparagraph  (F)  as  added  and
subparagraphs  (G)  and  (H) as relettered by chapter 456 of the laws of
1993, are amended and a  new  subparagraph  (I)  is  added  to  read  as
follows:
  (F) any speech-language pathology or audiology service which is within
the lawful scope of practice of a duly licensed speech-language patholo-
gist  or  audiologist,  a subscriber to such policy shall be entitled to
reimbursement for such service whether the said service is performed  by
a physician or duly licensed speech-language pathologist or audiologist,
provided  however,  that  nothing contained herein shall be construed to
impair any terms of such policy which may require  said  service  to  be
performed  pursuant  to a medical order, or a similar or related service
of a physician, in which case coverage need  not  be  provided  for  any
tests,  evaluations or diagnoses if such tests, evaluations or diagnoses
have already been provided by  or  through  a  physician  within  twelve
months  of  the  referral  or order from the physician. However, nothing
herein shall be construed as preventing an insurer  from  covering  more
than one test or evaluation provided by a speech-language pathologist or
audiologist  within  a twelve-month period where such test or evaluation
is ordered by a physician as medically  necessary.  Nor  shall  anything
herein  be  construed  as  prohibiting  the limitation of such services,
where covered, to specified settings other than offices, such as  hospi-
tals  or  to  services  provided by such professionals as part of a home
care agency's services; and when such policy or any  certificate  issued
thereunder  is  delivered or issued for delivery without the state by an
authorized insurer, covered persons residing  in  this  state  shall  be
entitled  to  reimbursement  for  speech-language pathology or audiology
service as herein provided[.];
  (G) psychiatric or psychological services or  for  the  diagnosis  and
treatment of mental, nervous, or emotional disorders or ailments, howev-
er defined in such policy, a subscriber to such policy shall be entitled
to reimbursement for such psychiatric or psychological services or diag-
nosis  or  treatment whether performed by a physician, psychiatrist or a
certified and registered psychologist when  the  services  rendered  are
within  the  lawful scope of their practice, and when such policy or any
certificate issued thereunder is delivered or issued for delivery  with-
out  this  state  by  an authorized insurer, covered persons residing in
this state shall be entitled to reimbursement  for  such  diagnosis  and
treatment  by  a  physician,  psychiatrist or a certified and registered
psychologist as hereinabove provided; [and]
  (H) any service which is within the lawful  scope  of  practice  of  a
licensed  chiropractor, a subscriber to such policy shall be entitled to

S. 4491                             3

reimbursement for such service when  such  service  is  performed  by  a
licensed chiropractor[.]; AND
  (I)  ANY  SERVICE  WHICH  IS  WITHIN THE LAWFUL SCOPE OF PRACTICE OF A
CERTIFIED NURSE PRACTITIONER, A SUBSCRIBER TO SUCH POLICY SHALL BE ENTI-
TLED TO REIMBURSEMENT FOR SUCH SERVICE WHEN SAID SERVICE IS PERFORMED BY
A CERTIFIED NURSE PRACTITIONER.  AN INSURER SHALL PROVIDE  REIMBURSEMENT
FOR  THOSE  SERVICES PRESCRIBED BY THIS SUBPARAGRAPH AT RATES NEGOTIATED
BETWEEN THE INSURER AND THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF
AGREED UPON RATES, AN INSURER SHALL PAY FOR SUCH SERVICES AT  THE  USUAL
AND CUSTOMARY CHARGE, WHICH SHALL NOT BE UNREASONABLE.
  S 4. Subsection (b) of section 4301 of the insurance law, subparagraph
(G) of paragraph 1 and paragraph 3 as amended by chapter 593 of the laws
of  2000  and subparagraph (I) as added and subparagraphs (J) and (K) as
relettered by chapter 456 of the laws of 1993, is  amended  to  read  as
follows:
  (b) (1) Medical expense indemnity shall consist of reimbursement for:
  (A)  medical  care  provided  through licensed physicians OR CERTIFIED
NURSE PRACTITIONERS,
  (B) dental care provided through licensed dentists,
  (C) optometric care provided through licensed optometrists,
  (D) podiatrical care provided through licensed podiatrists,
  (E) chiropractic care provided through licensed chiropractors,
  (F) psychiatric or psychological services provided through physicians,
psychiatrists or certified and registered psychologists,
  (G) physical and occupational therapy care provided  through  licensed
physical  and  occupational therapists upon the prescription of a physi-
cian,
  (H) nursing service,
  (I) speech-language pathology or audiology services  provided  through
licensed speech-language pathologists or audiologists, provided however,
that  nothing contained herein shall be construed to prohibit a contract
from requiring said service from being performed pursuant to  a  medical
order   or   similar   or  related  service  of  a  physician  OR  NURSE
PRACTITIONER, in which case coverage need not be provided for any tests,
evaluations or diagnoses if such tests, evaluations  or  diagnoses  have
already  been provided by or through a physician within twelve months of
the referral or order from the physician OR NURSE PRACTITIONER.   Howev-
er,  nothing  herein shall be construed as preventing a corporation from
covering more than one test or evaluation provided by a  speech-language
pathologist or audiologist within a twelve-month period where such tests
or  evaluations  is  ordered  by  a  physician  OR NURSE PRACTITIONER as
medically necessary. Nor shall anything herein be construed as prohibit-
ing the  limitation  of  such  services,  where  covered,  to  specified
settings  other  than offices, such as hospitals or to services provided
by such professionals as part of a home care agency's services,
  (J) necessary appliances, drugs, medicines and supplies, and
  (K) bio-analytical or clinical  laboratory  examinations  and  reports
thereof  reported  to  a  physician  OR  NURSE  PRACTITIONER, osteopath,
dentist, optometrist, podiatrist,  chiropractor  or  physical  therapist
made by any privately operated bioanalytical or clinical laboratory.
  (2)  It  is  not mandatory that a contract issued by a medical expense
indemnity corporation provide for and offer all of the services hereina-
bove described, but when any service is provided which can be  performed
by more than one of the practitioners hereinbefore referred to, benefits
under  the  contract  shall be provided regardless of which practitioner
performed the service, provided that the performance of such service was

S. 4491                             4

within the scope of the license  of  such  practitioner.    Unless  such
contract  shall  otherwise  provide  there shall be no reimbursement for
ophthalmic materials, lenses, spectacles,  eyeglasses,  and/or  appurte-
nances thereto.
  (3)  Every  medical expense indemnity corporation shall be open to the
participation of licensed physicians, podiatrists, chiropractors,  opto-
metrists, physical and occupational therapists, speech-language patholo-
gists, audiologists, and dentists, CERTIFIED NURSE PRACTITIONERS, certi-
fied and registered psychologists without discrimination against schools
of  medical  practice, podiatry practice, chiropractic practice, optome-
tric practice, physical and occupational therapy practice, dental  prac-
tice, speech-language pathology practice (subject to the permitted limi-
tations  of  paragraph  one  of  this  subsection),  audiology  practice
(subject  to  the  permitted  limitations  of  paragraph  one  of   this
subsection), and psychological training as defined in the education law.
  S  5.  The  insurance law is amended by adding a new section 4325-a to
read as follows:
  S 4325-A. NURSE PRACTITIONER SERVICE REIMBURSEMENT. NO INSURER SUBJECT
TO THIS ARTICLE THAT PROVIDES  COVERAGE  FOR  PHYSICIAN  SERVICES  SHALL
EXCLUDE  APPROPRIATELY  LICENSED  AND CERTIFIED NURSE PRACTITIONERS AS A
CLASS OF PRIMARY CARE PRACTITIONERS OR AS PROVIDERS OF  SPECIALTY  PRAC-
TICE.    AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE SERVICES
PRESCRIBED BY THIS SECTION AT RATES NEGOTIATED BETWEEN THE  INSURER  AND
THE  PROVIDER  OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON RATES, AN
INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL AND  CUSTOMARY  CHARGE,
WHICH SHALL NOT BE UNREASONABLE.
  S  6.  This  act  shall take effect on the sixtieth 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 date.

2009-S4491A (ACTIVE) - Details

See Assembly Version of this Bill:: A7877
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §4403, Pub Health L; add §§3217-e & 4325-a, amd §§4235 & 4301, Ins L

2009-S4491A (ACTIVE) - Summary

Requires health coverage plans covering health-care services to include in the provider networks certified nurse practitioners as primary health care providers.

2009-S4491A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S4491A

 TITLE OF BILL :

An act to amend the public health law and the insurance law, in
relation to nurse practitioner access


 PURPOSE :

To entitle people covered by health plans to choose a nurse
practitioner as their primary care or specialty provider and requires
reimbursement at negotiated or reasonable rates.

 SUMMARY OF PROVISIONS :

Amends various provisions to require that health plans not
discriminate against nurse practitioners as a class of primary care or
specialty practice providers, and to provide that nurse practitioners
shall be paid by health plans for their services, and that such rate
should be negotiated. Where there is no negotiation, the insurer will
pay usual and customary charges.

 JUSTIFICATION :

Nurse practitioners are authorized to diagnose, treat and refer

patients in collaboration with a physician and in accordance with a
practice agreement (Education Law § 6902 (3) (a) in seventeen
different specialties. Further, nurse practitioners are authorized to
prescribe and dispense drugs (Education Law §§ 6902(3) (b) and
6807(1)(b)).

Nurse practitioners are often the primary care and specialty providers
of medical treatment.  Typically, the services of nurse practitioners
are reimbursed directly by Medicaid, Medicare and a number of private
health insurers.  Because all health plans provide reimbursement to
nurse practitioners either directly or through billings generated by
the physician-employer of the nurse practitioner, this bill will
result in no additional costs to health insurers. The bill ensures
that health plans that provide reimbursement to subscribers for
certain physician services not exclude licensed nurse practitioners
from their primary care and specialty provider networks and must
provide reasonable reimbursement to subscribers who choose to receive
such services from a nurse practitioner.

 LEGISLATIVE HISTORY :

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Sixty days after it becomes law.

2009-S4491A (ACTIVE) - Bill Text download pdf

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

                                 4491--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 24, 2009
                               ___________

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

AN ACT to amend the public health law and the insurance law, in relation
  to nurse practitioner access

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

  Section 1.  Paragraph (a) of subdivision 5  of  section  4403  of  the
public  health  law,  as  amended by chapter 586 of the laws of 1998, is
amended to read as follows:
  (a) The commissioner, at the time of initial licensure, at least every
three years thereafter, and upon application for  expansion  of  service
area,  shall ensure that the health maintenance organization maintains a
network of health care providers  adequate  to  meet  the  comprehensive
health  needs  of  its enrollees and to provide an appropriate choice of
providers  sufficient  to  provide  the  services  covered   under   its
enrollee's  contracts  by  determining  that  (i) there are a sufficient
number of geographically accessible participating providers; (ii)  there
are  opportunities  to select from at least three primary care providers
pursuant to travel and distance  time  standards,  providing  that  such
standards  account  for  the  conditions of accessing providers in rural
areas; (iii) there are sufficient providers in each  area  of  specialty
practice  to  meet the needs of the enrollment population; (iv) there is
no exclusion of any appropriately licensed type of provider as a  class;
[and]  (v) THERE IS NO EXCLUSION OF APPROPRIATELY LICENSED AND CERTIFIED
NURSE PRACTITIONERS AS A CLASS  OF  PRIMARY  CARE  PRACTITIONERS  OR  AS
PROVIDERS  OF  SPECIALTY  PRACTICE  AND (VI) contracts entered into with
health care providers neither transfer financial risk to providers, in a
manner inconsistent with the provisions of paragraph (c) of  subdivision

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01104-02-0

S. 4491--A                          2

one  of this section, nor penalize providers for unfavorable case mix so
as to jeopardize the quality of  or  enrollees'  appropriate  access  to
medically  necessary  services;  provided, however, that payment at less
than  prevailing fee for service rates or capitation shall not be deemed
or presumed prima facie to jeopardize quality or access.
  S 2. The insurance law is amended by adding a new  section  3217-e  to
read as follows:
  S 3217-E. NURSE PRACTITIONER SERVICE REIMBURSEMENT. NO INSURER SUBJECT
TO  THIS  ARTICLE  THAT  PROVIDES  COVERAGE FOR PHYSICIAN SERVICES SHALL
EXCLUDE APPROPRIATELY LICENSED AND CERTIFIED NURSE  PRACTITIONERS  AS  A
CLASS  OF  PRIMARY CARE PRACTITIONERS OR AS PROVIDERS OF SPECIALTY PRAC-
TICE.   AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE  SERVICES
PRESCRIBED  BY  THIS SECTION AT RATES NEGOTIATED BETWEEN THE INSURER AND
THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON  RATES,  AN
INSURER  SHALL  PAY FOR SUCH SERVICES AT THE USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE UNREASONABLE.
  S 3. Subparagraphs (F), (G) and (H) of paragraph 4 of  subsection  (f)
of  section  4235  of  the  insurance law, subparagraph (F) as added and
subparagraphs (G) and (H) as relettered by chapter 456 of  the  laws  of
1993,  are  amended  and  a  new  subparagraph  (I)  is added to read as
follows:
  (F) any speech-language pathology or audiology service which is within
the lawful scope of practice of a duly licensed speech-language patholo-
gist or audiologist, a subscriber to such policy shall  be  entitled  to
reimbursement  for such service whether the said service is performed by
a physician or duly licensed speech-language pathologist or audiologist,
provided however, that nothing contained herein shall  be  construed  to
impair  any  terms  of  such policy which may require said service to be
performed pursuant to a medical order, or a similar or  related  service
of  a  physician,  in  which  case coverage need not be provided for any
tests, evaluations or diagnoses if such tests, evaluations or  diagnoses
have  already  been  provided  by  or  through a physician within twelve
months of the referral or order from  the  physician.  However,  nothing
herein  shall  be  construed as preventing an insurer from covering more
than one test or evaluation provided by a speech-language pathologist or
audiologist within a twelve-month period where such test  or  evaluation
is  ordered  by  a  physician as medically necessary. Nor shall anything
herein be construed as prohibiting  the  limitation  of  such  services,
where  covered, to specified settings other than offices, such as hospi-
tals or to services provided by such professionals as  part  of  a  home
care  agency's  services; and when such policy or any certificate issued
thereunder is delivered or issued for delivery without the state  by  an
authorized  insurer,  covered  persons  residing  in this state shall be
entitled to reimbursement for  speech-language  pathology  or  audiology
service as herein provided[.];
  (G)  psychiatric  or  psychological  services or for the diagnosis and
treatment of mental, nervous, or emotional disorders or ailments, howev-
er defined in such policy, a subscriber to such policy shall be entitled
to reimbursement for such psychiatric or psychological services or diag-
nosis or treatment whether performed by a physician, psychiatrist  or  a
certified  and  registered  psychologist  when the services rendered are
within the lawful scope of their practice, and when such policy  or  any
certificate  issued thereunder is delivered or issued for delivery with-
out this state by an authorized insurer,  covered  persons  residing  in
this  state  shall  be  entitled to reimbursement for such diagnosis and

S. 4491--A                          3

treatment by a physician, psychiatrist or  a  certified  and  registered
psychologist as hereinabove provided; [and]
  (H)  any  service  which  is  within the lawful scope of practice of a
licensed chiropractor, a subscriber to such policy shall be entitled  to
reimbursement  for  such  service  when  such  service is performed by a
licensed chiropractor[.]; AND
  (I) ANY SERVICE WHICH IS WITHIN THE LAWFUL  SCOPE  OF  PRACTICE  OF  A
CERTIFIED NURSE PRACTITIONER, A SUBSCRIBER TO SUCH POLICY SHALL BE ENTI-
TLED TO REIMBURSEMENT FOR SUCH SERVICE WHEN SAID SERVICE IS PERFORMED BY
A  CERTIFIED NURSE PRACTITIONER.  AN INSURER SHALL PROVIDE REIMBURSEMENT
FOR THOSE SERVICES PRESCRIBED BY THIS SUBPARAGRAPH AT  RATES  NEGOTIATED
BETWEEN THE INSURER AND THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF
AGREED  UPON  RATES, AN INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL
AND CUSTOMARY CHARGE, WHICH SHALL NOT BE UNREASONABLE.
  S 4. Subsection (b) of section 4301 of the insurance law, subparagraph
(G) of paragraph 1 and paragraph 3 as amended by chapter 593 of the laws
of 2000 and subparagraph (I) of paragraph 1 as added  and  subparagraphs
(J)  and  (K) of paragraph 1 as relettered by chapter 456 of the laws of
1993, is amended to read as follows:
  (b) (1) Medical expense indemnity shall consist of reimbursement for:
  (A) medical care provided through  licensed  physicians  OR  CERTIFIED
NURSE PRACTITIONERS,
  (B) dental care provided through licensed dentists,
  (C) optometric care provided through licensed optometrists,
  (D) podiatrical care provided through licensed podiatrists,
  (E) chiropractic care provided through licensed chiropractors,
  (F) psychiatric or psychological services provided through physicians,
psychiatrists or certified and registered psychologists,
  (G)  physical  and occupational therapy care provided through licensed
physical and occupational therapists upon the prescription of  a  physi-
cian,
  (H) nursing service,
  (I)  speech-language  pathology or audiology services provided through
licensed speech-language pathologists or audiologists, provided however,
that nothing contained herein shall be construed to prohibit a  contract
from  requiring  said service from being performed pursuant to a medical
order  or  similar  or  related  service  of  a   physician   OR   NURSE
PRACTITIONER, in which case coverage need not be provided for any tests,
evaluations  or  diagnoses  if such tests, evaluations or diagnoses have
already been provided by or through a physician within twelve months  of
the  referral or order from the physician OR NURSE PRACTITIONER.  Howev-
er, nothing herein shall be construed as preventing a  corporation  from
covering  more than one test or evaluation provided by a speech-language
pathologist or audiologist within a twelve-month period where such tests
or evaluations is ordered  by  a  physician  OR  NURSE  PRACTITIONER  as
medically necessary. Nor shall anything herein be construed as prohibit-
ing  the  limitation  of  such  services,  where  covered,  to specified
settings other than offices, such as hospitals or to  services  provided
by such professionals as part of a home care agency's services,
  (J) necessary appliances, drugs, medicines and supplies, and
  (K)  bio-analytical  or  clinical  laboratory examinations and reports
thereof reported  to  a  physician  OR  NURSE  PRACTITIONER,  osteopath,
dentist,  optometrist,  podiatrist,  chiropractor  or physical therapist
made by any privately operated bioanalytical or clinical laboratory.
  (2) It is not mandatory that a contract issued by  a  medical  expense
indemnity corporation provide for and offer all of the services hereina-

S. 4491--A                          4

bove  described, but when any service is provided which can be performed
by more than one of the practitioners hereinbefore referred to, benefits
under the contract shall be provided regardless  of  which  practitioner
performed the service, provided that the performance of such service was
within  the  scope  of  the  license of such practitioner.   Unless such
contract shall otherwise provide there shall  be  no  reimbursement  for
ophthalmic  materials,  lenses,  spectacles, eyeglasses, and/or appurte-
nances thereto.
  (3) Every medical expense indemnity corporation shall be open  to  the
participation  of licensed physicians, podiatrists, chiropractors, opto-
metrists, physical and occupational therapists, speech-language patholo-
gists, audiologists, and dentists, CERTIFIED NURSE PRACTITIONERS, certi-
fied and registered psychologists without discrimination against schools
of medical practice, podiatry practice, chiropractic  practice,  optome-
tric  practice, physical and occupational therapy practice, dental prac-
tice, speech-language pathology practice (subject to the permitted limi-
tations  of  paragraph  one  of  this  subsection),  audiology  practice
(subject   to  the  permitted  limitations  of  paragraph  one  of  this
subsection), and psychological training as defined in the education law.
  S 5. The insurance law is amended by adding a new  section  4325-a  to
read as follows:
  S 4325-A. NURSE PRACTITIONER SERVICE REIMBURSEMENT. NO INSURER SUBJECT
TO  THIS  ARTICLE  THAT  PROVIDES  COVERAGE FOR PHYSICIAN SERVICES SHALL
EXCLUDE APPROPRIATELY LICENSED AND CERTIFIED NURSE  PRACTITIONERS  AS  A
CLASS  OF  PRIMARY CARE PRACTITIONERS OR AS PROVIDERS OF SPECIALTY PRAC-
TICE.   AN  INSURER  SHALL  PROVIDE  REIMBURSEMENT  FOR  THOSE  SERVICES
PRESCRIBED  BY  THIS SECTION AT RATES NEGOTIATED BETWEEN THE INSURER AND
THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON  RATES,  AN
INSURER  SHALL  PAY FOR SUCH SERVICES AT THE USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE UNREASONABLE.
  S 6. This act shall take effect on the sixtieth  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 date.

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Senate Bill S4491

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Sponsored By

Thomas K. Duane

Archive: Last Bill Status - In Senate Committee Health Committee

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