S T A T E   O F   N E W   Y O R K
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                                 1666--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  M.  of  A. CAHILL, BENEDETTO, PERRY, CAMARA, WEISENBERG,
  SCHIMEL, JAFFEE, GUNTHER, LIFTON, ENGLEBRIGHT, GALEF, RAMOS,  CYMBROW-
  ITZ,  KELLNER,  SCARBOROUGH,  RUSSELL,  ROSENTHAL,  WEPRIN,  KAVANAGH,
  MARKEY, BRINDISI, ABINANTI, QUART, CRESPO, BORELLI, GRAF,  MAGNARELLI,
  STECK,  COLTON, OTIS, ROBERTS, CLARK -- Multi-Sponsored by -- M. of A.
  ABBATE, ARROYO, BRAUNSTEIN, BRENNAN,  BROOK-KRASNY,  CERETTO,  CORWIN,
  CROUCH, CUSICK, FARRELL, GARBARINO, GIGLIO, GOTTFRIED, HAWLEY, HEVESI,
  HOOPER,  JACOBS,  LAVINE, LENTOL, LUPARDO, LUPINACCI, MAGEE, McDONALD,
  McDONOUGH,   McKEVITT,   McLAUGHLIN,    MILLMAN,    MOSLEY,    PAULIN,
  PEOPLES-STOKES,  PRETLOW,  RAIA,  RYAN,  SALADINO,  SIMANOWITZ,  STEC,
  STIRPE, SWEENEY, TENNEY, THIELE, WRIGHT, ZEBROWSKI --  read  once  and
  referred to the Committee on Insurance -- recommitted to the Committee
  on  Insurance  in accordance with Assembly Rule 3, sec. 2 -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

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

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

                                                           LBD03730-02-4

A. 1666--A                          2

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.
  S 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.
S 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.
  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 CO-PAYMENTS IN
EXCESS OF TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO THE  PROVIDER  OF
CARE;

A. 1666--A                          3

  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 RELATED TO REIMBURSEMENT FOR PHYSICAL THERAPY
SERVICES SHALL NOT EXCEED TWENTY PERCENT OF THE TOTAL  REIMBURSEMENT  TO
THE PROVIDER OF CARE,
  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  RELATED TO REIMBURSEMENT FOR SUCH
SERVICES SHALL NOT EXCEED TWENTY PERCENT OF THE TOTAL  REIMBURSEMENT  TO
THE PROVIDER OF CARE.
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.