S T A T E O F N E W Y O R K
________________________________________________________________________
187--A
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. CAHILL, BENEDETTO, PERRY, CAMARA, WEISENBERG,
GABRYSZAK, SCHIMEL, JAFFEE, GUNTHER, LIFTON, ENGLEBRIGHT, GALEF,
RAMOS, CYMBROWITZ, KELLNER, P. RIVERA, SCARBOROUGH, RUSSELL, ROSEN-
THAL, REILLY, BOYLAND, WEPRIN, KAVANAGH, BARRON -- Multi-Sponsored by
-- M. of A. ABBATE, ABINANTI, BOYLE, BRENNAN, BROOK-KRASNY, BURLING,
CERETTO, COLTON, CORWIN, CUSICK, HAWLEY, HEVESI, JACOBS, LATIMER,
LAVINE, LENTOL, LUPARDO, MARKEY, McDONOUGH, McENENY, PAULIN, PRETLOW,
RAIA, SAYWARD, SWEENEY, ZEBROWSKI -- read once and referred to the
Committee on Insurance -- recommitted to the Committee on Insurance in
accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
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:
Section 1. Paragraph 23 of subsection (i) of section 3216 of the
insurance law, as added by chapter 593 of the laws of 2000, is amended
to read as follows:
(23) If a policy provides for reimbursement for physical and occupa-
tional therapy service which is within the lawful scope of practice of a
duly licensed physical or occupational therapist, an insured shall be
entitled to reimbursement for such service whether the said service is
performed by a physician or through a duly licensed physical or occupa-
tional therapist, provided however, that nothing contained herein shall
be construed to impair any terms of such policy including appropriate
utilization review and the requirement that said service be performed
pursuant to a medical order, or a similar or related service of a physi-
cian PROVIDED THAT SUCH TERMS SHALL NOT IMPOSE CO-PAYMENTS IN EXCESS OF
TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO THE PROVIDER OF CARE.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00680-03-2
A. 187--A 2
S 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
of the insurance law, as amended by chapter 219 of the laws of 2011, is
amended to read as follows:
(A) Any policy of group accident, group health or group accident and
health insurance may include provisions for the payment by the insurer
of benefits for expenses incurred on account of hospital, medical or
surgical care or physical and occupational therapy by licensed physical
and occupational therapists upon the prescription or referral of a
physician for the employee or other member of the insured group, the
employee's or member's spouse, the employee's or member's child or chil-
dren, or other persons chiefly dependent upon the employee or member for
support and maintenance; provided that:
(i) a policy of hospital, medical, surgical, or prescription drug
expense insurance that provides coverage for children shall provide such
coverage to a married or unmarried child until attainment of age twen-
ty-six, without regard to financial dependence, residency with the
employee or member, student status, or employment, except a policy that
is a grandfathered health plan may, for plan years beginning before
January first, two thousand fourteen, exclude coverage of an adult child
under age twenty-six who is eligible to enroll in an employer-sponsored
health plan other than a group health plan of a parent. For purposes of
this item, "grandfathered health plan" means coverage provided by an
insurer in which an individual was enrolled on March twenty-third, two
thousand ten for as long as the coverage maintains grandfathered status
in accordance with section 1251(e) of the Affordable Care Act, 42 U.S.C.
S 18011(e); and
(ii) a policy under which coverage terminates at a specified age shall
not so terminate with respect to an unmarried child who is incapable of
self-sustaining employment by reason of mental illness, developmental
disability, mental retardation, as defined in the mental hygiene law, or
physical handicap and who became so incapable prior to attainment of the
age at which coverage would otherwise terminate and who is chiefly
dependent upon such employee or member for support and maintenance,
while the insurance of the employee or member remains in force and the
child remains in such condition, if the insured employee or member has
within thirty-one days of such child's attainment of the termination age
submitted proof of such child's incapacity as described herein. NO
POLICY OF GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCIDENT AND HEALTH
INSURANCE SHALL IMPOSE CO-PAYMENTS IN EXCESS OF TWENTY PERCENT OF THE
TOTAL REIMBURSEMENT TO THE PROVIDER OF CARE.
S 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235
of the insurance law, as amended by chapter 593 of the laws of 2000, is
amended to read as follows:
(A) any physical and occupational therapy service which is within the
lawful scope of practice of a licensed physical and occupational thera-
pist, a subscriber to such policy shall be entitled to reimbursement for
such service, whether the said service is performed by a physician or
licensed physical and occupational therapist pursuant to prescription or
referral by a physician; AND A POLICY OF GROUP ACCIDENT, GROUP HEALTH OR
GROUP ACCIDENT AND HEALTH INSURANCE SHALL NOT IMPOSE CO-PAYMENTS IN
EXCESS OF TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO THE PROVIDER OF
CARE;
S 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301
of the insurance law, as amended by chapter 593 of the laws of 2000, is
amended to read as follows:
A. 187--A 3
(G) physical and occupational therapy care provided through licensed
physical and occupational therapists upon the prescription of a physi-
cian AND ANY CO-PAYMENTS RELATED TO REIMBURSEMENT FOR PHYSICAL THERAPY
SERVICES SHALL NOT EXCEED TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO
THE PROVIDER OF CARE,
S 5. Paragraph 13 of subsection (b) of section 4322 of the insurance
law, as added by chapter 504 of the laws of 1995, is amended to read as
follows:
(13) Outpatient physical therapy up to ninety visits per condition per
calendar year AND ANY CO-PAYMENTS RELATED TO REIMBURSEMENT FOR PHYSICAL
THERAPY SERVICES SHALL NOT EXCEED TWENTY PERCENT OF THE TOTAL REIMBURSE-
MENT TO THE PROVIDER OF CARE.
S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.