S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5045--A
     Cal. No. 584
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 18, 2025
                                ___________
 
 Introduced  by  Sens.  BAILEY, ASHBY, COMRIE, GALLIVAN, GRIFFO, HELMING,
   MAY, PARKER, SEPULVEDA, STEC -- read twice and  ordered  printed,  and
   when printed to be committed to the Committee on Insurance -- reported
   favorably  from  said  committee,  ordered to first and second report,
   ordered to a third reading, amended and ordered  reprinted,  retaining
   its place in the order of third reading
 
 AN  ACT  to amend the insurance law, in relation to physical and occupa-
   tional 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.  ANY COPAYMENT OR COINSURANCE AMOUNT CHARGED BY AN INSURER TO  THE
 INSURED  FOR  SERVICES  RENDERED  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 SHALL NOT BE MORE THAN TWENTY-FIVE PERCENT GREATER THAN  THE  COPAY-
 MENT  OR  COINSURANCE  AMOUNT  IMPOSED FOR AN OFFICE VISIT TO A LICENSED
 PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR A SIMILAR  DIAGNOSED
 CONDITION.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09380-03-5
              
             
                          
                 S. 5045--A                          2
 
   § 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:
   (III)  A  POLICY  SHALL  NOT  IMPOSE A COPAYMENT OR COINSURANCE AMOUNT
 CHARGED TO THE INSURED FOR SERVICES RENDERED  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 MORE THAN TWENTY-FIVE PERCENT GREATER THAN THE
 COPAYMENT OR COINSURANCE  AMOUNT  IMPOSED  FOR  AN  OFFICE  VISIT  TO  A
 LICENSED  PRIMARY  CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR A SIMILAR
 DIAGNOSED CONDITION.
   § 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 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 THAT IS MORE THAN TWENTY-FIVE
 PERCENT GREATER THAN THE COPAYMENT OR COINSURANCE AMOUNT IMPOSED FOR  AN
 OFFICE  VISIT  TO A LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE
 SAME OR A SIMILAR DIAGNOSED CONDITION;
   § 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 BY A PHYSICAL THERAPIST LICENSED
 UNDER ARTICLE ONE HUNDRED THIRTY-SIX OF THE EDUCATION LAW OR AN  OCCUPA-
 TIONAL  THERAPIST  LICENSED  UNDER  ARTICLE ONE HUNDRED FIFTY-SIX OF THE
 EDUCATION LAW SHALL BE MORE THAN TWENTY-FIVE PERCENT  GREATER  THAN  THE
 COPAYMENT  OR  COINSURANCE  AMOUNT  IMPOSED  FOR  AN  OFFICE  VISIT TO A
 LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR
 DIAGNOSED CONDITION,
   §  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 BY A PHYSICAL THERA-
 PIST 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 SHALL BE MORE THAN TWENTY-FIVE PERCENT  GREATER
 THAN  THE COPAYMENT OR COINSURANCE AMOUNT IMPOSED FOR AN OFFICE VISIT TO
 A LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR A SIMILAR
 DIAGNOSED CONDITION.
   § 6. This act shall take effect January 1, 2027.