S T A T E   O F   N E W   Y O R K
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                                 1063--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 8, 2015
                               ___________

Introduced  by M. of A. CAHILL -- Multi-Sponsored by -- M. of A. ABBATE,
  ABINANTI, ARROYO, BENEDETTO, BORELLI, BRAUNSTEIN,  BRENNAN,  BRINDISI,
  BROOK-KRASNY,  CERETTO, CLARK, COLTON, CORWIN, CRESPO, CROUCH, CUSICK,
  CYMBROWITZ, ENGLEBRIGHT, FARRELL, GALEF, GARBARINO, GIGLIO, GOTTFRIED,
  GRAF, GUNTHER,  HAWLEY,  HEVESI,  HOOPER,  JAFFEE,  KAVANAGH,  LAVINE,
  LENTOL,  LIFTON,  LUPARDO, LUPINACCI, MAGEE, MAGNARELLI, MARKEY, McDO-
  NALD, McDONOUGH, McKEVITT, McLAUGHLIN, MOSLEY, OTIS, PAULIN,  PEOPLES-
  STOKES,  PERRY,  PRETLOW,  QUART,  RAMOS, ROBERTS, ROSENTHAL, RUSSELL,
  SALADINO, SIMANOWITZ, STEC, STECK,  STIRPE,  TENNEY,  THIELE,  WRIGHT,
  ZEBROWSKI  --  read once and referred to the Committee on Insurance --
  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
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 OR
DIFFERENT DEDUCTIBLES, CO-PAYMENTS OR CO-INSURANCE AMOUNTS ON THE  BASIS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01104-03-5
              

A. 1063--A                          2

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. 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 OR 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 CO-PAYMENTS IN
EXCESS OF TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO THE  PROVIDER  OF

A. 1063--A                          3

CARE  OR  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 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 OR DIFFERENT DEDUCTIBLES, CO-PAYMENTS  OR  CO-INSU-
RANCE AMOUNTS ON THE BASIS OF THE SETTING IN WHICH SUCH PHYSICAL THERAPY
SERVICES  ARE  RENDERED OR WHETHER THE SERVICES ARE PERFORMED BY A PHYS-
ICAL 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  RELATED  TO  REIMBURSEMENT  FOR  SUCH
SERVICES  SHALL  NOT EXCEED TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO
THE PROVIDER OF CARE OR DIFFERENT DEDUCTIBLES, CO-PAYMENTS  OR  CO-INSU-
RANCE AMOUNTS ON THE BASIS OF THE SETTING IN WHICH SUCH PHYSICAL THERAPY
SERVICES  ARE  RENDERED OR WHETHER THE SERVICES ARE PERFORMED BY A PHYS-
ICAL THERAPIST OR PHYSICIAN.
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.