S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    569
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2017
                                ___________
 
 Introduced  by  M.  of  A.  CAHILL,  SKOUFIS, BLANKENBUSH, RIVERA, FAHY,
   BARRETT, WEPRIN, TITONE, BRABENEC, MURRAY, SANTABARBARA, LALOR,  MOYA,
   HUNTER,  CASTORINA,  MALLIOTAKIS  --  Multi-Sponsored  by  -- M. of A.
   ABBATE, ABINANTI, ARROYO,  BENEDETTO,  BRAUNSTEIN,  BRINDISI,  COLTON,
   CRESPO,  CROUCH,  CUSICK,  CYMBROWITZ, DINOWITZ, ENGLEBRIGHT, FARRELL,
   GALEF, GARBARINO, GIGLIO, GOTTFRIED, GRAF,  GUNTHER,  HAWLEY,  HEVESI,
   HOOPER, JAFFEE, JENNE, KAVANAGH, LENTOL, LIFTON, LOPEZ, LUPARDO, LUPI-
   NACCI,  MAGEE,  MAGNARELLI, McDONALD, McDONOUGH, McKEVITT, McLAUGHLIN,
   MOSLEY, OTIS, PAULIN, PEOPLES-STOKES,  PERRY,  PRETLOW,  QUART,  RAIA,
   RAMOS,   ROSENTHAL,  SALADINO,  SEPULVEDA,  SIMANOWITZ,  STEC,  STECK,
   STIRPE, THIELE, WALTER, WOERNER, ZEBROWSKI -- read once  and  referred
   to the Committee on Insurance
 
 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 OR
 DIFFERENT DEDUCTIBLES, CO-PAYMENTS OR CO-INSURANCE AMOUNTS ON THE  BASIS
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01314-01-7

 A. 569                              2
 
 OF  THE  SETTING IN WHICH SUCH PHYSICAL THERAPY SERVICES ARE RENDERED OR
 WHETHER THE SERVICES ARE PERFORMED BY A PHYSICAL THERAPIST OR PHYSICIAN.
   § 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.
 § 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 OR DIFFERENT DEDUCTIBLES,
 CO-PAYMENTS OR CO-INSURANCE AMOUNTS ON THE BASIS OF THE SETTING IN WHICH
 SUCH PHYSICAL THERAPY SERVICES ARE RENDERED OR WHETHER THE SERVICES  ARE
 PERFORMED BY A PHYSICAL THERAPIST OR PHYSICIAN.
   § 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

 A. 569                              3
 
 CARE  OR  DIFFERENT  DEDUCTIBLES, CO-PAYMENTS OR CO-INSURANCE AMOUNTS ON
 THE BASIS OF THE SETTING IN WHICH SUCH  PHYSICAL  THERAPY  SERVICES  ARE
 RENDERED  OR  WHETHER THE SERVICES ARE PERFORMED BY A PHYSICAL THERAPIST
 OR PHYSICIAN;
   § 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:
   (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 OR DIFFERENT DEDUCTIBLES, CO-PAYMENTS  OR  CO-INSU-
 RANCE AMOUNTS ON THE BASIS OF THE SETTING IN WHICH SUCH PHYSICAL THERAPY
 SERVICES  ARE  RENDERED OR WHETHER THE SERVICES ARE PERFORMED BY A PHYS-
 ICAL THERAPIST OR PHYSICIAN,
   § 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  SUCH
 SERVICES  SHALL  NOT EXCEED TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO
 THE PROVIDER OF CARE OR DIFFERENT DEDUCTIBLES, CO-PAYMENTS  OR  CO-INSU-
 RANCE AMOUNTS ON THE BASIS OF THE SETTING IN WHICH SUCH PHYSICAL THERAPY
 SERVICES  ARE  RENDERED OR WHETHER THE SERVICES ARE PERFORMED BY A PHYS-
 ICAL THERAPIST OR PHYSICIAN.
   § 6. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.