S T A T E   O F   N E W   Y O R K
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                                  1241

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             January 8, 2015
                               ___________

Introduced  by  M.  of  A. LAVINE, MORELLE, SKOUFIS, WEPRIN, CYMBROWITZ,
  WALTER -- Multi-Sponsored by -- M. of  A.  CORWIN  --  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. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 32 to read as follows:
  (32)  EVERY  POLICY  ISSUED  PURSUANT  TO  THIS SECTION WHICH PROVIDES
REIMBURSEMENT FOR NON-PHYSICIAN SURGICAL FIRST ASSISTANT  SERVICES  WHEN
SUCH  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 SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE NON-PHY-
SICIAN SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A  REGISTERED
NURSE  FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM NURSING
PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE  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.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 20 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03097-02-5

              

A. 1241                             2

  (20) EVERY POLICY ISSUED  PURSUANT  TO  THIS  SECTION  WHICH  PROVIDES
REIMBURSEMENT  FOR  NON-PHYSICIAN SURGICAL FIRST ASSISTANT SERVICES WHEN
SUCH 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 SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE NON-PHY-
SICIAN SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A  REGISTERED
NURSE  FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM NURSING
PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE  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.
  S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection (pp) to read as follows:
  (PP)  EVERY  CONTRACT  ISSUED  BY  A  HEALTH  SERVICE CORPORATION OR A
MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES  FOR  REIMBURSEMENT
FOR  SURGICAL  FIRST  ASSISTANT SERVICES SHALL PROVIDE COVERAGE FOR SUCH
SERVICES WHEN PROVIDED BY A REGISTERED  NURSE  FIRST  ASSISTANT  WHO  IS
CERTIFIED IN OPERATING ROOM NURSING PROVIDED THAT: (1) SUCH SERVICES ARE
WITHIN  THE  SCOPE OF PRACTICE OF A NON-PHYSICIAN SURGICAL FIRST ASSIST-
ANT; AND (2) THE TERMS AND CONDITIONS OF THE MEMBER  CONTRACT  OTHERWISE
PROVIDE  FOR  THE  COVERAGE OF SUCH SERVICES. NOTHING IN THIS SUBSECTION
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,  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. Subdivision 2 of section 365-a of  the  social  services  law  is
amended by adding a new paragraph (cc) 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 SERVICES ARE WITHIN THE SCOPE  OF  PRAC-
TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (II) 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.
  S 5. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
section  369-ee of the social services law, subparagraph (xv) as amended
and subparagraph (xvi) as added by chapter 526 of the laws of 2002,  are
amended and a new subparagraph (xvii) is added to read as follows:
  (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
[and]

A. 1241                             3

  (xvi) hospice services[.]; AND
  (XVII)  SURGICAL  FIRST  ASSISTANT  SERVICES PERFORMED BY A REGISTERED
NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE 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 SUBPARAGRAPH 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.
  S 6. The opening paragraph of subdivision (a) of  section  13  of  the
workers'  compensation law, as amended by chapter 6 of the laws of 2007,
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
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-

A. 1241                             4

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 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law and shall apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such effective
date;  provided,  however, that the amendments made to section 369-ee of
the social services law by section five of this act shall not affect the
repeal of such section and shall be deemed to be repealed therewith.