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

                                  8171

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                               May 6, 2009
                               ___________

Introduced by M. of A. CAHILL -- 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  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.
  S 2. Paragraph 1 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:
  (1) 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, his

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11213-01-9
              

A. 8171                             2

spouse, his child or children, or other persons chiefly  dependent  upon
him  for  support  and  maintenance;  provided that a policy under which
coverage of a dependent of an employee or other member  of  the  insured
group  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 dependent
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 dependent remains in
such condition, if the insured employee or member has within  thirty-one
days  of  such  dependent's  attainment of the termination age submitted
proof of such dependent's incapacity as described herein. NO  POLICY  OF
GROUP  ACCIDENT,  GROUP  HEALTH  OR  GROUP ACCIDENT AND HEALTH INSURANCE
SHALL IMPOSE 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.
  S 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 DIFFERENT DEDUCT-
IBLES, 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.
  S 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, DEDUCTIBLES, OR CO-INSURANCE AMOUNTS RELATED
TO REIMBURSEMENT FOR PHYSICAL THERAPY SERVICES SHALL NOT DIFFER  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,
  S  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, DEDUCTIBLES OR CO-INSURANCE AMOUNTS
RELATED TO REIMBURSEMENT OF PHYSICAL THERAPY SERVICES SHALL  NOT  DIFFER
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.
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.