S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3751
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             February 13, 2019
                                ___________
 
 Introduced  by Sens. BRESLIN, AMEDORE, HELMING, KENNEDY, PARKER, ROBACH,
   SEPULVEDA -- read twice and ordered printed, and when  printed  to  be
   committed 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.  AN INSURER SHALL NOT IMPOSE A  COPAYMENT  OR  COINSURANCE  AMOUNT
 CHARGED TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY
 A  PHYSICAL  THERAPIST  LICENSED UNDER ARTICLE ONE HUNDRED THIRTY-SIX OF
 THE EDUCATION LAW OR AN OCCUPATIONAL THERAPIST  LICENSED  UNDER  ARTICLE
 ONE  HUNDRED  FIFTY-SIX  OF  THE  EDUCATION LAW THAT IS GREATER THAN THE
 COPAYMENT OR COINSURANCE AMOUNT IMPOSED  ON  THE  INSURED  FOR  SERVICES
 PROVIDED  TO  THE  INSURED  FOR  AN  OFFICE  VISIT  FOR THE SERVICE OF A
 LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR  A  SIMILAR
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01964-01-9

              

 S. 3751                             2
 
   § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235
 of  the insurance law is amended by adding a new clause (iii) to read as
 follows:
   (III)  A  POLICY  SHALL  NOT  IMPOSE A COPAYMENT OR COINSURANCE AMOUNT
 CHARGED TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY
 A PHYSICAL THERAPIST LICENSED UNDER ARTICLE ONE  HUNDRED  THIRTY-SIX  OF
 THE  EDUCATION  LAW  OR AN OCCUPATIONAL THERAPIST LICENSED UNDER ARTICLE
 ONE HUNDRED FIFTY-SIX OF THE EDUCATION LAW  THAT  IS  GREATER  THAN  THE
 COPAYMENT  OR  COINSURANCE  AMOUNT  IMPOSED  ON THE INSURED FOR SERVICES
 PROVIDED TO THE INSURED FOR  AN  OFFICE  VISIT  FOR  THE  SERVICE  OF  A
 LICENSED  PRIMARY  CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR A SIMILAR
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.
   § 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.  A POLICY SHALL NOT IMPOSE A COPAYMENT OR COIN-
 SURANCE AMOUNT CHARGED TO THE INSURED FOR  SERVICES  RENDERED  FOR  EACH
 DATE  OF  SERVICE  BY  A  PHYSICAL  THERAPIST LICENSED UNDER ARTICLE ONE
 HUNDRED THIRTY-SIX OF THE EDUCATION LAW  OR  AN  OCCUPATIONAL  THERAPIST
 LICENSED  UNDER  ARTICLE ONE HUNDRED FIFTY-SIX OF THE EDUCATION LAW THAT
 IS GREATER THAN THE COPAYMENT  OR  COINSURANCE  AMOUNT  IMPOSED  ON  THE
 INSURED FOR SERVICES PROVIDED TO THE INSURED FOR AN OFFICE VISIT FOR THE
 SERVICE  OF  A LICENSED PRIMARY CARE PHYSICIAN OR OSTEOPATH FOR THE SAME
 OR A SIMILAR DIAGNOSED CONDITION EVEN IF  A  DIFFERENT  NOMENCLATURE  IS
 USED TO DESCRIBE THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED;
   § 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, PROVIDED, HOWEVER, THAT NO COPAYMENT OR COINSURANCE AMOUNT CHARGED
 TO THE INSURED FOR SERVICES RENDERED FOR EACH DATE OF SERVICE BY A PHYS-
 ICAL THERAPIST LICENSED UNDER ARTICLE  ONE  HUNDRED  THIRTY-SIX  OF  THE
 EDUCATION  LAW  OR  AN OCCUPATIONAL THERAPIST LICENSED UNDER ARTICLE ONE
 HUNDRED FIFTY-SIX OF THE EDUCATION LAW IS GREATER THAN THE COPAYMENT  OR
 COINSURANCE  AMOUNT  IMPOSED ON THE INSURED FOR SERVICES PROVIDED TO THE
 INSURED FOR AN OFFICE VISIT FOR THE SERVICE OF A LICENSED  PRIMARY  CARE
 PHYSICIAN  OR  OSTEOPATH  FOR  THE SAME OR A SIMILAR DIAGNOSED CONDITION
 EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE THE  CONDITION  FOR
 WHICH THE SERVICES ARE PROVIDED,
   §  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,  PROVIDED,  HOWEVER,  THAT  NO  COPAYMENT OR COINSURANCE
 AMOUNT CHARGED TO THE INSURED FOR SERVICES RENDERED  FOR  EACH  DATE  OF
 SERVICE BY A PHYSICAL THERAPIST LICENSED UNDER ARTICLE ONE HUNDRED THIR-
 TY-SIX  OF THE EDUCATION LAW OR AN OCCUPATIONAL THERAPIST LICENSED UNDER
 ARTICLE ONE HUNDRED FIFTY-SIX OF THE EDUCATION LAW IS GREATER  THAN  THE
 COPAYMENT  OR  COINSURANCE  AMOUNT  IMPOSED  ON THE INSURED FOR SERVICES

 S. 3751                             3
 
 PROVIDED TO THE INSURED FOR  AN  OFFICE  VISIT  FOR  THE  SERVICE  OF  A
 LICENSED  PRIMARY  CARE PHYSICIAN OR OSTEOPATH FOR THE SAME OR A SIMILAR
 DIAGNOSED CONDITION EVEN IF A DIFFERENT NOMENCLATURE IS USED TO DESCRIBE
 THE CONDITION FOR WHICH THE SERVICES ARE PROVIDED.
   § 6. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.