S T A T E O F N E W Y O R K
________________________________________________________________________
9198
I N A S S E M B L Y
February 3, 2016
___________
Introduced by M. of A. LAVINE -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, the social services law and the work-
ers' compensation law, in relation to reimbursement for surgical first
assistant services
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 32 of subsection (i) of section 3216 of the
insurance law, as added by a chapter of the laws of 2015 amending the
insurance law, the social services law and the workers' compensation
law, relating to reimbursement for surgical first assistant services, as
proposed in legislative bills numbers S.1233-A and A.1241-A, is amended
to read as follows:
(32) [Every] NO policy DELIVERED OR issued [pursuant to this section
which] FOR DELIVERY IN THIS STATE THAT provides reimbursement for non-
physician surgical first assistant services when [such] THE services are
provided by a non-physician surgical first assistant [who is employed by
a physician and the physician bills for the services] shall [not deny]
EXCLUDE such coverage [exclusively] on the basis that the non-physician
surgical first assistant services were performed by a registered nurse
first assistant [who is certified in operating room nursing] provided
that: (A) [such] THE REGISTERED NURSE FIRST ASSISTANT IS CERTIFIED IN
OPERATING ROOM NURSING; (B) THE services are within the scope of prac-
tice of a non-physician surgical first assistant; and [(B)] (C) the
terms and conditions of the [member contract] POLICY otherwise provide
for the coverage of [such] THE services. Nothing in this paragraph shall
be construed to[:] prevent the medical management or utilization review
of [such] THE services[;] OR prevent a policy from requiring THAT
services ARE TO BE PROVIDED through a network of participating providers
who [shall] meet certain requirements for participation, including
provider credentialing[; or prohibit an insurer from, in its sole
discretion, providing a global or capitated payment or electing to
directly reimburse a non-physician surgical first assistant for such
services].
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03097-07-6
A. 9198 2
S 2. Paragraph 20 of subsection (k) of section 3221 of the insurance
law, as added by a chapter of the laws of 2015 amending the insurance
law, the social services law and the workers' compensation law relating
to reimbursement for surgical first assistant services, as proposed in
legislative bills numbers S.1233-A and A.1241-A, is amended to read as
follows:
(20) [Every] NO GROUP OR BLANKET policy [issued pursuant to this
section which] DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
provides reimbursement for non-physician surgical first assistant
services when [such] THE services are provided by a non-physician surgi-
cal first assistant [who is employed by a physician and the physician
bills for the services] shall [not deny] EXCLUDE such coverage [exclu-
sively] on the basis that the non-physician surgical first assistant
services were performed by a registered nurse first assistant [who is
certified in operating room nursing] provided that: (A) [such] THE
REGISTERED NURSE FIRST ASSISTANT IS CERTIFIED IN OPERATING ROOM NURSING;
(B) THE services are within the scope of practice of a non-physician
surgical first assistant; and [(B)] (C) the terms and conditions of the
[member contract] POLICY otherwise provide for the coverage of [such]
THE services. Nothing in this paragraph shall be construed to[:] prevent
the medical management or utilization review of [such] THE services[;]
OR prevent a policy from requiring THAT services ARE TO BE PROVIDED
through a network of participating providers who [shall] meet certain
requirements for participation, including provider credentialing[; or
prohibit an insurer from, in its sole discretion, providing a global or
capitated payment or electing to directly reimburse a non-physician
surgical first assistant for such services].
S 3. Subsection (pp) of section 4303 of the insurance law, as added by
a chapter of the laws of 2015 amending the insurance law, the social
services law and the workers' compensation law relating to reimbursement
for surgical first assistant services, as proposed in legislative bills
numbers S.1233-A and A.1241-A, is amended to read as follows:
(pp) [Every] NO contract issued by a MEDICAL EXPENSE INDEMNITY CORPO-
RATION, HOSPITAL SERVICE CORPORATION, OR health service corporation [or
a medical expense indemnity corporation which] THAT provides [for]
reimbursement for NON-PHYSICIAN surgical first assistant services WHEN
THE SERVICES ARE PROVIDED BY A NON-PHYSICIAN SURGICAL FIRST ASSISTANT
shall [provide] EXCLUDE SUCH coverage [for such services when provided]
ON THE BASIS THAT THE NON-PHYSICIAN SURGICAL FIRST ASSISTANT SERVICES
WERE PERFORMED by a registered nurse first assistant [who is certified
in operating room nursing] provided that: (1) [such] THE REGISTERED
NURSE FIRST ASSISTANT IS CERTIFIED IN OPERATING ROOM NURSING; (2) THE
services are within the scope of practice of a non-physician surgical
first assistant; and [(2)] (3) the terms and conditions of the [member]
contract otherwise provide for the coverage of [such] THE services.
Nothing in this subsection shall be construed to[:] prevent the medical
management or utilization review of [such] THE services[;] OR prevent a
policy from requiring THAT services ARE TO BE PROVIDED through a network
of participating providers who [shall] meet certain requirements for
participation, including provider credentialing[; or prohibit an insurer
from, in its sole discretion, providing a global or capitated payment or
electing to directly reimburse a non-physician surgical first assistant
for such services].
S 4. Paragraph (cc) of subdivision 2 of section 365-a of the social
services law, as added by a chapter of the laws of 2015 amending the
insurance law, the social services law and the workers' compensation law
A. 9198 3
relating to reimbursement for surgical first assistant services, as
proposed in legislative bills numbers S.1233-A and A.1241-A, is amended
to read as follows:
(cc) care and services for surgical first assistant services provided
by a registered nurse first assistant [who is certified in operating
room nursing] provided that: (i) [such] THE REGISTERED NURSE FIRST
ASSISTANT IS CERTIFIED IN OPERATING ROOM NURSING; (II) THE services are
within the scope of practice of a non-physician surgical first assist-
ant; and [(ii)] (III) the terms and conditions of the [member] POLICY OR
contract otherwise provide for the coverage of [such] THE services.
Nothing in this paragraph shall be construed to[:] prevent the medical
management or utilization review of [such] THE services; prevent a poli-
cy OR CONTRACT from requiring THAT services ARE TO BE PROVIDED through a
network of participating providers who [shall] meet certain requirements
for participation, including provider credentialing; or prohibit an
insurer from[, in its sole discretion,] providing a global or capitated
payment or electing to directly reimburse a non-physician surgical first
assistant for [such] THE services, AS OTHERWISE PERMITTED BY LAW.
S 5. The opening paragraph of subdivision (a) of section 13 of the
workers' compensation law, as amended by a chapter of the laws of 2015
amending the insurance law, the social services law and the workers'
compensation law relating to reimbursement for surgical first assistant
services, as proposed in legislative bills numbers S.1233-A and
A.1241-A, is amended to read as follows:
The employer shall promptly provide for an injured employee such
medical, dental, surgical, optometric or other attendance or treatment,
nurse and hospital service, medicine, optometric services, crutches,
eye-glasses, false teeth, artificial eyes, orthotics, prosthetic
devices, functional assistive and adaptive devices and apparatus for
such period as the nature of the injury or the process of recovery may
require. The employer shall be liable for the payment of the expenses of
medical, dental, surgical, optometric or other attendance or treatment,
nurse and hospital service, medicine, optometric services, crutches,
eye-glasses, false teeth, artificial eyes, orthotics, prosthetic
devices, functional assistive and adaptive devices and apparatus, as
well as artificial members of the body or other devices or appliances
necessary in the first instance to replace, support or relieve a portion
or part of the body resulting from and necessitated by the injury of an
employee, for such period as the nature of the injury or the process of
recovery may require, and the employer shall also be liable for replace-
ments or repairs of such artificial members of the body or such other
devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
ic devices, functional assistive and adaptive devices or appliances
necessitated by ordinary wear or loss or damage to a prosthesis, with or
without bodily injury to the employee. Damage to or loss of a prosthetic
device shall be deemed an injury except that no disability benefits
shall be payable with respect to such injury under section fifteen of
this article. Such a replacement or repair of artificial members of the
body or such other devices, eye-glasses, false teeth, artificial eyes,
orthotics, prosthetic devices, functional assistive and adaptive devices
or appliances or the providing of medical treatment and care as defined
herein shall not constitute the payment of compensation under section
twenty-five-a of this article. [All surgical services covered by this
article, including coverage for surgical first assistant services, shall
include care and services furnished in all covered settings provided by
a registered nurse first assistant who is certified in operating room
A. 9198 4
nursing provided that: (A) such services are within the scope of prac-
tice of a non-physician surgical first assistant; and (B) the terms and
conditions of the member contract otherwise provide for the coverage of
such services. Nothing in this paragraph shall be construed to: prevent
the medical management or utilization review of such services; prevent a
policy from requiring services through a network of participating
providers who shall meet certain requirements for participation, includ-
ing provider credentialing; or prohibit an insurer from, in its sole
discretion, providing a global or capitated payment or electing to
directly reimburse a non-physician surgical first assistant for such
services.] All fees and other charges for such treatment and services
shall be limited to such charges as prevail in the same community for
similar treatment of injured persons of a like standard of living.
S 6. This act shall take effect on the same date and in the same
manner as a chapter of the laws of 2015 amending the insurance law, the
social services law and the workers' compensation law relating to
reimbursement for surgical first assistant services, as proposed in
legislative bills numbers S.1233-A and A.1241-A, takes effect.