Assembly Bill A9392

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

                                  9392

                          I N  A S S E M B L Y

                            February 29, 2016
                               ___________

Introduced  by M. of A. RUSSELL -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance law and the workers' compensation law,  in
  relation to coverage of health care services by means of telehealth

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

  Section 1. Paragraph 1 of subsection (a) of section 5102 of the insur-
ance law, as amended by chapter 298 of the laws of 2006, is  amended  to
read as follows:
  (1)  All  necessary  expenses  incurred  for:  (i)  medical,  hospital
(including services rendered in compliance with article forty-one of the
public health law, whether or not such services are rendered directly by
a hospital), surgical, nursing, dental, ambulance,  x-ray,  prescription
drug   and  prosthetic  services;  (ii)  psychiatric,  physical  therapy
(provided that treatment is rendered pursuant to a referral) and occupa-
tional therapy and rehabilitation; (iii) ANY HEALTH CARE SERVICES DELIV-
ERED BY MEANS OF TELEHEALTH, AS DEFINED IN  SUBSECTION  (B)  OF  SECTION
THREE  THOUSAND  TWO  HUNDRED SEVENTEEN-H OF THIS CHAPTER; (IV) any non-
medical remedial care and treatment rendered in accordance with a  reli-
gious method of healing recognized by the laws of this state; and [(iv)]
(V) any other professional health services; all without limitation as to
time, provided that within one year after the date of the accident caus-
ing the injury it is ascertainable that further expenses may be incurred
as a result of the injury. For the purpose of determining basic economic
loss,  the expenses incurred under this paragraph shall be in accordance
with the limitations of section five thousand one hundred eight of  this
article.
  S  2.  The  opening  paragraph of subdivision (a) of section 13 of the
workers' compensation law, as amended by chapter  536  of  the  laws  of
2015, 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

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

                                                           LBD13523-02-6

A. 9392                             2

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, ANY HEALTH CARE SERVICES DELIVERED BY  MEANS
OF  TELEHEALTH,  AS  DEFINED IN SUBSECTION (B) OF SECTION THREE THOUSAND
TWO HUNDRED SEVENTEEN-H  OF  THE  INSURANCE  LAW,  medicine,  optometric
services,  crutches,  eye-glasses, false teeth, artificial eyes, orthot-
ics, 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 replacements or repairs of such  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 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 artifi-
cial members of the body  or  such  other  devices,  eye-glasses,  false
teeth, artificial eyes, orthotics, prosthetic devices, functional assis-
tive  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 practice of a non-physician surgical  first  assist-
ant;  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,  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.  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 3. This act shall take effect on the first of January next  succeed-
ing  the  date  on  which it shall have become a law; provided, however,
that if chapter 536 of the laws of 2015 shall not have taken  effect  on
or before such effective date, section two of this act shall take effect
on  the  same  date and in the same manner as chapter 536 of the laws of
2015, takes effect.