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

                                  9198

                          I N  A S S E M B L Y

                            February 3, 2016
                               ___________

Introduced by M. of A. LAVINE -- read once and referred 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. Paragraph 32 of subsection  (i)  of  section  3216  of  the
insurance  law,  as  added by a chapter of the laws of 2015 amending the
insurance law, the social services law  and  the  workers'  compensation
law, relating to reimbursement for surgical first assistant services, as
proposed  in legislative bills numbers S.1233-A and A.1241-A, is amended
to read as follows:
  (32) [Every] NO policy DELIVERED OR issued [pursuant to  this  section
which]  FOR  DELIVERY IN THIS STATE THAT provides reimbursement for non-
physician surgical first assistant services when [such] THE 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]
EXCLUDE  such coverage [exclusively] on the basis that the non-physician
surgical first assistant services were performed by a  registered  nurse
first  assistant  [who  is certified in operating room nursing] provided
that: (A) [such] THE REGISTERED NURSE FIRST ASSISTANT  IS  CERTIFIED  IN
OPERATING  ROOM  NURSING; (B) THE services are within the scope of prac-
tice of a non-physician surgical first  assistant;  and  [(B)]  (C)  the
terms  and  conditions of the [member contract] POLICY otherwise provide
for the coverage of [such] THE services. Nothing in this paragraph shall
be construed to[:] prevent the medical management or utilization  review
of  [such]  THE  services[;]  OR  prevent  a  policy from requiring THAT
services ARE TO BE PROVIDED 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].

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

                                                           LBD03097-07-6

A. 9198                             2

  S 2. Paragraph 20 of subsection (k) of section 3221 of  the  insurance
law,  as  added  by a chapter of the laws of 2015 amending the insurance
law, the social services law and the workers' compensation law  relating
to  reimbursement  for surgical first assistant services, as proposed in
legislative  bills  numbers S.1233-A and A.1241-A, is amended to read as
follows:
  (20) [Every] NO GROUP OR  BLANKET  policy  [issued  pursuant  to  this
section  which]  DELIVERED  OR  ISSUED  FOR  DELIVERY IN THIS STATE THAT
provides  reimbursement  for  non-physician  surgical  first   assistant
services when [such] THE services are provided by a non-physician surgi-
cal  first  assistant  [who is employed by a physician and the physician
bills for the services] shall [not deny] EXCLUDE such  coverage  [exclu-
sively]  on  the  basis  that the non-physician surgical first assistant
services were performed by a registered nurse first  assistant  [who  is
certified  in  operating  room  nursing]  provided  that: (A) [such] THE
REGISTERED NURSE FIRST ASSISTANT IS CERTIFIED IN OPERATING ROOM NURSING;
(B) THE services are within the scope of  practice  of  a  non-physician
surgical  first assistant; and [(B)] (C) the terms and conditions of the
[member contract] POLICY otherwise provide for the  coverage  of  [such]
THE services. Nothing in this paragraph shall be construed to[:] prevent
the  medical  management or utilization review of [such] THE services[;]
OR prevent a policy from requiring THAT  services  ARE  TO  BE  PROVIDED
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 3. Subsection (pp) of section 4303 of the insurance law, as added by
a  chapter  of  the  laws of 2015 amending the insurance law, the social
services law and the workers' compensation law relating to reimbursement
for surgical first assistant services, as proposed in legislative  bills
numbers S.1233-A and A.1241-A, is amended to read as follows:
  (pp)  [Every] NO contract issued by a MEDICAL EXPENSE INDEMNITY CORPO-
RATION, HOSPITAL SERVICE CORPORATION, OR health service corporation  [or
a  medical  expense  indemnity  corporation  which]  THAT provides [for]
reimbursement for NON-PHYSICIAN surgical first assistant  services  WHEN
THE  SERVICES  ARE  PROVIDED BY A NON-PHYSICIAN SURGICAL FIRST ASSISTANT
shall [provide] EXCLUDE SUCH coverage [for such services when  provided]
ON  THE  BASIS  THAT THE NON-PHYSICIAN SURGICAL FIRST ASSISTANT SERVICES
WERE PERFORMED by a registered nurse first assistant [who  is  certified
in  operating  room  nursing]  provided  that: (1) [such] THE REGISTERED
NURSE FIRST ASSISTANT IS CERTIFIED IN OPERATING ROOM  NURSING;  (2)  THE
services  are  within  the scope of practice of a non-physician surgical
first assistant; and [(2)] (3) the terms and conditions of the  [member]
contract  otherwise  provide  for  the  coverage of [such] THE services.
Nothing in this subsection shall be construed to[:] prevent the  medical
management  or utilization review of [such] THE services[;] OR prevent a
policy from requiring THAT services ARE TO BE PROVIDED 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. Paragraph (cc) of subdivision 2 of section 365-a  of  the  social
services  law,  as  added  by a chapter of the laws of 2015 amending the
insurance law, the social services law and the workers' compensation law

A. 9198                             3

relating to reimbursement for  surgical  first  assistant  services,  as
proposed  in legislative bills numbers S.1233-A and A.1241-A, is amended
to read as follows:
  (cc)  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]  THE REGISTERED NURSE FIRST
ASSISTANT IS CERTIFIED IN OPERATING ROOM NURSING; (II) THE services  are
within  the  scope of practice of a non-physician surgical first assist-
ant; and [(ii)] (III) the terms and conditions of the [member] POLICY OR
contract otherwise provide for the  coverage  of  [such]  THE  services.
Nothing  in  this paragraph shall be construed to[:] prevent the medical
management or utilization review of [such] THE services; prevent a poli-
cy OR CONTRACT from requiring THAT services ARE TO BE PROVIDED 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] THE services, AS OTHERWISE PERMITTED BY LAW.
  S 5. The opening paragraph of subdivision (a) of  section  13  of  the
workers'  compensation  law, as amended by a chapter of the laws of 2015
amending the insurance law, the social services  law  and  the  workers'
compensation  law relating to reimbursement for surgical first assistant
services,  as  proposed  in  legislative  bills  numbers  S.1233-A   and
A.1241-A, 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

A. 9198                             4

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
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 6. This act shall take effect on the  same  date  and  in  the  same
manner  as a chapter of the laws of 2015 amending the insurance law, the
social services law  and  the  workers'  compensation  law  relating  to
reimbursement  for  surgical  first  assistant  services, as proposed in
legislative bills numbers S.1233-A and A.1241-A, takes effect.