Assembly Bill A6484A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6484
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 5, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- 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.  AN INSURER SHALL NOT IMPOSE A  COPAYMENT  OR  COINSURANCE  AMOUNT
 CHARGED TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY
 A  PHYSICAL  THERAPIST  LICENSED UNDER ARTICLE ONE HUNDRED THIRTY-SIX OF
 THE EDUCATION LAW OR AN OCCUPATIONAL THERAPIST  LICENSED  UNDER  ARTICLE
 ONE  HUNDRED  FIFTY-SIX  OF  THE  EDUCATION LAW THAT IS GREATER THAN THE
 COPAYMENT OR COINSURANCE AMOUNT IMPOSED  ON  THE  INSURED  FOR  SERVICES
 PROVIDED  TO  THE  INSURED  FOR  AN  OFFICE  VISIT  FOR THE SERVICE OF A
 LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.
   § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
 of  the insurance law is amended by adding a new clause (iii) to read as
 follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09380-01-5
              

 A. 6484                             2
 
   (III) A POLICY SHALL NOT IMPOSE  A  COPAYMENT  OR  COINSURANCE  AMOUNT
 CHARGED TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY
 A  PHYSICAL  THERAPIST  LICENSED UNDER ARTICLE ONE HUNDRED THIRTY-SIX OF
 THE EDUCATION LAW OR AN OCCUPATIONAL THERAPIST  LICENSED  UNDER  ARTICLE
 ONE  HUNDRED  FIFTY-SIX  OF  THE  EDUCATION LAW THAT IS GREATER THAN THE
 COPAYMENT OR COINSURANCE AMOUNT IMPOSED  ON  THE  INSURED  FOR  SERVICES
 PROVIDED  TO  THE  INSURED  FOR  AN  OFFICE  VISIT  FOR THE SERVICE OF A
 LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.
   § 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.  A POLICY SHALL NOT IMPOSE A COPAYMENT OR COIN-
 SURANCE  AMOUNT  CHARGED  TO  THE INSURED FOR SERVICES RENDERED FOR EACH
 DATE OF SERVICE BY A  PHYSICAL  THERAPIST  LICENSED  UNDER  ARTICLE  ONE
 HUNDRED  THIRTY-SIX  OF  THE  EDUCATION LAW OR AN OCCUPATIONAL THERAPIST
 LICENSED UNDER ARTICLE ONE HUNDRED FIFTY-SIX OF THE EDUCATION  LAW  THAT
 IS  GREATER  THAN  THE  COPAYMENT  OR  COINSURANCE AMOUNT IMPOSED ON THE
 INSURED FOR SERVICES PROVIDED TO THE INSURED FOR AN OFFICE VISIT FOR THE
 SERVICE OF A LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR  THE  SAME
 OR  A  SIMILAR  DIAGNOSED  CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS
 USED TO DESCRIBE THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED;
   § 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, PROVIDED, HOWEVER, THAT NO COPAYMENT OR COINSURANCE AMOUNT CHARGED
 TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY A PHYS-
 ICAL  THERAPIST  LICENSED  UNDER  ARTICLE  ONE HUNDRED THIRTY-SIX OF THE
 EDUCATION LAW OR AN OCCUPATIONAL THERAPIST LICENSED  UNDER  ARTICLE  ONE
 HUNDRED  FIFTY-SIX OF THE EDUCATION LAW IS GREATER THAN THE COPAYMENT OR
 COINSURANCE AMOUNT IMPOSED ON THE INSURED FOR SERVICES PROVIDED  TO  THE
 INSURED  FOR  AN OFFICE VISIT FOR THE SERVICE OF A LICENSED PRIMARY CARE
 PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR  DIAGNOSED  CONDITION
 EVEN  IF  A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE THE CONDITION FOR
 WHICH THE SERVICES ARE PROVIDED,
   § 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, PROVIDED,  HOWEVER,  THAT  NO  COPAYMENT  OR  COINSURANCE
 AMOUNT  CHARGED  TO  THE  INSURED FOR SERVICES RENDERED FOR EACH DATE OF
 SERVICE BY A PHYSICAL THERAPIST LICENSED UNDER ARTICLE ONE HUNDRED THIR-
 TY-SIX OF THE EDUCATION LAW OR AN OCCUPATIONAL THERAPIST LICENSED  UNDER
 ARTICLE  ONE  HUNDRED FIFTY-SIX OF THE EDUCATION LAW IS GREATER THAN THE
 COPAYMENT OR COINSURANCE AMOUNT IMPOSED  ON  THE  INSURED  FOR  SERVICES
 PROVIDED  TO  THE  INSURED  FOR  AN  OFFICE  VISIT  FOR THE SERVICE OF A
 LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR
 A. 6484                             3
 
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.
   § 6. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.