NY State Senate Bill 2021-S3569

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
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Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 05, 2022	referred to insurance
Jan 30, 2021	referred to insurance

co-Sponsors

2021-S3569 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3235-a, 4235, 4301, 4322, 4803, 4901, 4902 & 4905, Ins L; amd §§4406-d, 4901, 4902 & 4905, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2017-2018: S2134
2019-2020: S964, S5760

2021-S3569 (ACTIVE) - Summary

Expands health insurance coverage of physical and occupational therapy services by limiting co-payments and regulating visit limitations; expands coverage of early intervention services; expands utilization review of health insurance coverage for medically necessary care.

2021-S3569 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S3569

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law, in relation to health insurance
coverage of physical and occupational therapy services and payment for
early intervention services; and to amend the insurance law and the
public health law, in relation to the provision of medically necessary
care and utilization review

 
PURPOSE OR GENERAL IDEA OF BILL:

To limit the imposition of co-payments for physical and occupational
therapy services to no more than twenty percent of the reimbursement to
the provider of care. Provides greater disclosure of utilization prac-
tices and to prohibit certain practices.

 
SUMMARY OF PROVISIONS:

Sections 1 through 5 prohibit payors from imposing higher co-pays on

consumers for physical and occupational therapy services on the basis of
provider or setting.

Sections 6 and 7 would prohibit health care plans from compensating
utilization review agents on a percentage basis or other method which
would provide a financial incentive to deny claims.

Sections 8 and 9 prohibit a health plan from terminating or refusing to
renew a contract on the basis that a provider offered or rendered
medically necessary care.

Sections 10 and 11 require utilization review agents to provide adverse
determinations to both the provider and the enrollee.

Sections 12 and 13 require utilization review agents to report to the
Department of Health and Department of Insurance respectively the clin-
ical review criteria and standards and the definition of medical neces-
sity used under the utilization plan. Sections 12 and 13 also require
utilization review agents to report any amendments to their utilization
review plan within thirty days of such amendment.

Sections 14 and 15 allow a health care provider to request clinical
review criteria and other clinical information which the health care
plan might consider in its utilization review.

Section 16. Effective Date.

 
JUSTIFICATION:

This bill will protect consumers by prohibiting plans from inappropri-
ately shifting the cost of therapy care to consumers. It limits co-pay-
ments to no more than 20 percent of the total reimbursement to the
provider of care. Under existing law, health plans must cover physical
and'occupational therapy services. Despite that requirement, health
plans have shifted the vast majority of the cost of physical and occupa-
tional therapy services by imposing increasingly high co-payments on
consumers. Under certain health plans, co-payments for therapy services
have exceeded the reimbursement, paid by the plan to the provider of
care. This cost shift has imposed a financial burden on consumers,
affected access to physical and occupational therapy services and
defeated the purpose of insurance coverage.

Consumers frequently cannot afford the cost imposed by these copayments
for medically necessary physical and occupational therapy care. Physical
and occupational therapy services generally require multiple visits over
the recovery process. For example, a co-payment of $50 for a occupa-
tional therapy plan of care at 3 times a week over one month will cost
the consumer $600 in out-of-pocket expenses which is beyond the means of
many consumers. As a result, New Yorkers are forgoing medically neces-
sary care running and the risk of partial recovery, worsening the under-
lying condition or risking re-injury.  This bill would reestablish the
obligation of health plans to cover the expense of physical and occupa-
tional therapy services by limiting co-payments to no more than twenty
percent of the total reimbursement to the provider of care. The 20
percent limitation will allow plans to require co-payments that discour-
age inappropriate care but will prohibit plans from inappropriately
shifting the cost cf physical and occupational therapy care to consum-
ers.  Managed care practices have become increasingly aggressive and
protections enacted in 1996 have eroded as payors have found ways to
implement policies consistent with the law but detrimental to health
care. This bill seeks to reestablish fair and appropriate utilization
practices consistent with the underlying purpose of the 1996 Managed
Care Reform Act.

The provisions of the bill will protect consumers of physical therapy
services by prohibiting plans from inappropriately shifting the cost of
care onto enrollees by treating independently practicing physical thera-
pists as "specialists" triggering specialist level Co-payments.  The
application of specialist co-payments to physical therapy care is a
distortion of the concept of specialized care and has led to co-payments
of $40 more per visit.  The bill would also prohibit certain utilization
review practices detrimental to quality health care such as the termi-
nation of health care providers because they ordered medically necessary
care and the compensation of utilization review agents by health plans
on a basis which awards denial of care. The bill would also require
utilization review agents to disclose additional information to regula-
tory agencies, enrollees and participating providers.

 
PRIOR LEGISLATIVE HISTORY:

2019-2020 S.5760

2017,2013: S.2134 Referred to Insurance

2016: A.9384 Referred to Insurance

 
FISCAL IMPLICATIONS:

None to state.

 
EFFECTIVE DATE:
180 days after it shall have become a law.

2021-S3569 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3569
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 30, 2021
                                ___________
 
 Introduced  by  Sens.  BRESLIN,  ADDABBO, HARCKHAM, KAMINSKY, KENNEDY --
   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 health insurance
   coverage of physical and occupational therapy services and payment for
   early intervention services; and to amend the insurance  law  and  the
   public health law, in relation to the provision of medically necessary
   care and utilization review
 
   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, FURTHER, THAT SUCH TERMS SHALL NOT IMPOSE CO-PAYMENTS IN
 EXCESS OF TWENTY PERCENT OF THE TOTAL REIMBURSEMENT TO THE  PROVIDER  OF
 CARE.  VISIT LIMITS FOR PHYSICAL AND OCCUPATIONAL THERAPY SERVICES SHALL
 BE SUBJECT TO AN EXCEPTIONS PROCESS, THAT SHALL  INCLUDE  THE  INSURED'S
 PHYSICIAN  CERTIFYING  THAT  THE CESSATION OF SERVICES WOULD MOST LIKELY
 RESULT IN FURTHER DISABILITY OR HARM  TO  THE  INSURED.  ANY  EXCEPTIONS
 PROCESS SHALL BE FURTHER DETERMINED BY THE SUPERINTENDENT.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07595-01-1

 S. 3569                             2
 
   §  2.  Subsection (b) of section 3235-a of the insurance law, as added
 by section 3 of part C of chapter 1 of the laws of 2002, is  amended  to
 read as follows:
   (b)  Where  a  policy  of  accident  and health insurance, including a
 contract  issued  pursuant  to  article  forty-three  of  this  chapter,
 provides coverage for an early intervention program service, such cover-
 age shall not be applied against any maximum annual or lifetime monetary
 limits  set  forth  in  such  policy or contract. Visit limitations [and
 other terms and conditions of the policy]  will  continue  to  apply  to
 early  intervention  services. However, any visits used for early inter-
 vention program services shall not reduce the number of visits otherwise
 available under the policy or contract for such services.
   § 3. Clause (ii) of 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:
   (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] IN THIS
 CLAUSE.  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. VISIT LIMITS FOR  PHYS-
 ICAL  AND  OCCUPATIONAL SERVICES SHALL BE SUBJECT TO AN EXCEPTIONS PROC-
 ESS, THAT SHALL INCLUDE  AN  INSURED'S  PHYSICIAN  CERTIFYING  THAT  THE
 CESSATION  OF SERVICES WOULD MOST LIKELY RESULT IN FURTHER DISABILITY OR
 HARM TO THE INSURED. ANY EXCEPTIONS PROCESS SHALL BE FURTHER  DETERMINED
 BY THE SUPERINTENDENT.
   § 4. 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. 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.
 VISIT LIMITS FOR PHYSICAL AND OCCUPATIONAL  THERAPY  SERVICES  SHALL  BE
 SUBJECT TO AN EXCEPTIONS PROCESS, THAT SHALL INCLUDE AN INSURED'S PHYSI-
 CIAN  CERTIFYING THAT THE CESSATION OF SERVICES WOULD MOST LIKELY RESULT
 IN FURTHER DISABILITY OR HARM TO THE  INSURED.  ANY  EXCEPTIONS  PROCESS
 SHALL BE FURTHER DETERMINED BY THE SUPERINTENDENT;
   § 5. 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. CO-PAYMENTS RELATED TO REIMBURSEMENT FOR SUCH SERVICES  SHALL  NOT

 S. 3569                             3
 
 EXCEED  TWENTY  PERCENT  OF  THE  TOTAL REIMBURSEMENT TO THE PROVIDER OF
 CARE. VISIT LIMITS FOR PHYSICAL AND OCCUPATIONAL THERAPY SERVICES  SHALL
 BE  SUBJECT  TO  AN  EXCEPTIONS  PROCESS, THAT SHALL INCLUDE THE COVERED
 PERSON'S  PHYSICIAN CERTIFYING THAT THE CESSATION OF SERVICES WOULD MOST
 LIKELY RESULT IN FURTHER DISABILITY OR HARM TO THE COVERED  PERSON.  ANY
 EXCEPTIONS PROCESS SHALL BE FURTHER DETERMINED BY THE SUPERINTENDENT,
   §  6.  Paragraph 13 of subsection (b) of section 4322 of the insurance
 law, as added by chapter 504 of the laws of 1995, is amended and  a  new
 paragraph 13-a is added to read as follows:
   (13) Outpatient physical therapy up to ninety visits per condition per
 calendar  year.  ANY  CO-PAYMENTS  RELATED TO REIMBURSEMENT FOR PHYSICAL
 THERAPY SERVICES SHALL NOT EXCEED TWENTY PERCENT OF THE TOTAL REIMBURSE-
 MENT TO THE PROVIDER OF CARE. VISIT LIMITS FOR PHYSICAL THERAPY SERVICES
 SHALL BE SUBJECT TO  AN  EXCEPTIONS  PROCESS,  THAT  SHALL  INCLUDE  THE
 COVERED  PERSON'S  PHYSICIAN  CERTIFYING  THAT THE CESSATION OF SERVICES
 WOULD MOST LIKELY RESULT IN FURTHER DISABILITY OR HARM  TO  THE  COVERED
 PERSON.    ANY  EXCEPTIONS  PROCESS  SHALL  BE FURTHER DETERMINED BY THE
 SUPERINTENDENT.
   (13-A) OUTPATIENT OCCUPATIONAL THERAPY UP TO NINETY VISITS PER  CONDI-
 TION  PER  CALENDAR  YEAR.  ANY CO-PAYMENTS RELATED TO REIMBURSEMENT FOR
 OCCUPATIONAL THERAPY SERVICES SHALL NOT EXCEED  TWENTY  PERCENT  OF  THE
 TOTAL  REIMBURSEMENT  TO  THE PROVIDER OF CARE. VISIT LIMITS FOR OCCUPA-
 TIONAL THERAPY SERVICES SHALL BE SUBJECT TO AN EXCEPTIONS PROCESS,  THAT
 SHALL INCLUDE THE COVERED PERSON'S PHYSICIAN CERTIFYING THAT SUCH CESSA-
 TION  OF SERVICES WOULD MOST LIKELY RESULT IN FURTHER DISABILITY OR HARM
 TO THE COVERED PERSON.  ANY EXCEPTIONS PROCESS SHALL BE  FURTHER  DETER-
 MINED BY THE SUPERINTENDENT.
   §  7. Subsection (e) of section 4803 of the insurance law, as added by
 chapter 705 of the laws of 1996, is amended and a new  subsection  (a-1)
 is added to read as follows:
   (A-1)  UPON  WRITTEN  REQUEST  BY  A PARTICIPATING HEALTH CARE PROFES-
 SIONAL, A HEALTH CARE  PLAN  SHALL  PROVIDE  SPECIFIC  WRITTEN  CLINICAL
 REVIEW  CRITERIA RELATING TO A PARTICULAR CONDITION, DISEASE, SERVICE OR
 PROCEDURE AND, WHERE APPROPRIATE, OTHER CLINICAL INFORMATION  WHICH  THE
 HEALTH  CARE  PLAN OR ITS UTILIZATION REVIEW AGENT MIGHT CONSIDER IN ITS
 UTILIZATION REVIEW AND THE HEALTH  CARE  PLAN  SHALL  INCLUDE  WITH  THE
 INFORMATION  A  DESCRIPTION  OF  HOW  IT WILL BE USED IN THE UTILIZATION
 REVIEW PROCESS; PROVIDED, HOWEVER, THAT TO THE EXTENT  SUCH  INFORMATION
 IS  PROPRIETARY  TO  THE HEALTH CARE PLAN, THE PARTICIPATING HEALTH CARE
 PROVIDER OR PROSPECTIVE HEALTH CARE PROVIDER SHALL ONLY USE THE INFORMA-
 TION FOR THE PURPOSES OF ASSISTING THE PARTICIPATING HEALTH CARE PROVID-
 ER IN EVALUATING COVERED  SERVICES  PROVIDED  BY  THE  ORGANIZATION,  AN
 ADVERSE DETERMINATION OR AN APPEAL OF ADVERSE DETERMINATION.
   (e)  No insurer shall terminate [or], THREATEN TO TERMINATE, refuse to
 renew OR THREATEN REFUSAL TO RENEW a contract for participation  in  the
 in-network  benefits  portion of an insurer's network for a managed care
 product [solely] because the health care professional has (1)  advocated
 on  behalf of an insured; (2) has filed a complaint against the insurer;
 (3) has appealed a decision of the insurer; (4) provided information  or
 filed  a  report  pursuant  to  section  forty-four hundred six-c of the
 public health law; [or] (5) requested a hearing or  review  pursuant  to
 this section; OR (6) ORDERED OR RENDERED MEDICALLY NECESSARY CARE.
   §  8.  Paragraph  1 of subsection (b) of section 4901 of the insurance
 law, as added by chapter 705 of the laws of 1996, is amended to read  as
 follows:

 S. 3569                             4
 
   (1)  The  utilization  review  plan,  INCLUDING BUT NOT LIMITED TO THE
 CLINICAL REVIEW CRITERIA AND STANDARDS AND THE  DEFINITION/STANDARDS  OF
 MEDICAL  NECESSITY USED UNDER THE UTILIZATION REVIEW PLAN. A UTILIZATION
 REVIEW AGENT SHALL REPORT ANY AMENDMENT OR CHANGES  TO  THE  UTILIZATION
 REVIEW  PLAN  TO  THE  SUPERINTENDENT  WITHIN THIRTY DAYS OF MAKING SUCH
 AMENDMENT OR CHANGE;
   § 9. Paragraph 4 of subsection (a) of section 4902  of  the  insurance
 law,  as added by chapter 705 of the laws of 1996, is amended to read as
 follows:
   (4) Establishment of a process for rendering utilization review deter-
 minations which shall, at a  minimum,  include:  written  procedures  to
 assure  that utilization reviews and determinations are conducted within
 the timeframes established herein; procedures to notify an  insured,  an
 insured's  designee  [and/or]  AND  an insured's health care provider of
 adverse determinations; and procedures for appeal  of  adverse  determi-
 nations  including the establishment of an expedited appeals process for
 denials of continued inpatient care or where there is imminent or  seri-
 ous threat to the health of the insured;
   §  10.  The opening paragraph of subsection (d) of section 4905 of the
 insurance law, as added by chapter 705 of the laws of 1996,  is  amended
 to read as follows:
   A utilization review agent OR THE HEALTH CARE PLAN FOR WHICH THE AGENT
 PROVIDES  UTILIZATION  REVIEW  shall  not,  with  respect to utilization
 review activities, permit or provide compensation or anything  of  value
 to its employees, agents, or contractors based on:
   §  11.  Subdivision  5  of section 4406-d of the public health law, as
 added by chapter 705 of the laws of 1996, is amended and a new  subdivi-
 sion 1-a is added to read as follows:
   1-A. UPON WRITTEN REQUEST BY A PARTICIPATING HEALTH CARE PROFESSIONAL,
 A HEALTH CARE PLAN SHALL PROVIDE SPECIFIC WRITTEN CLINICAL REVIEW CRITE-
 RIA  RELATING  TO  A PARTICULAR CONDITION, DISEASE, SERVICE OR PROCEDURE
 AND, WHERE APPROPRIATE, OTHER CLINICAL INFORMATION WHICH THE HEALTH CARE
 PLAN OR ITS UTILIZATION REVIEW AGENT MIGHT CONSIDER IN  ITS  UTILIZATION
 REVIEW  AND  THE  HEALTH  CARE PLAN SHALL INCLUDE WITH THE INFORMATION A
 DESCRIPTION OF HOW IT WILL BE USED IN THE  UTILIZATION  REVIEW  PROCESS;
 PROVIDED, HOWEVER, THAT TO THE EXTENT SUCH INFORMATION IS PROPRIETARY TO
 THE HEALTH CARE PLAN, THE PARTICIPATING HEALTH CARE PROVIDER OR PROSPEC-
 TIVE  HEALTH  CARE  PROVIDER  SHALL  ONLY  USE  THE  INFORMATION FOR THE
 PURPOSES OF ASSISTING THE PARTICIPATING HEALTH CARE PROVIDER IN EVALUAT-
 ING COVERED SERVICES PROVIDED BY THE ORGANIZATION, AN  ADVERSE  DETERMI-
 NATION OR AN APPEAL OF ADVERSE DETERMINATION.
   5.  No  health  care  plan shall terminate, OR THREATEN TO TERMINATE a
 contract or employment, [or] refuse to renew,  OR  THREATEN  REFUSAL  TO
 RENEW a contract, [solely] because a health care provider has:
   (a) advocated on behalf of an enrollee;
   (b) filed a complaint against the health care plan;
   (c) appealed a decision of the health care plan;
   (d)  provided information or filed a report pursuant to section forty-
 four hundred six-c of this article; [or]
   (e) requested a hearing or review pursuant to this section; OR
   (F) ORDERED OR RENDERED MEDICALLY NECESSARY CARE.
   § 12. Paragraph (a) of subdivision 2 of section  4901  of  the  public
 health  law,  as added by chapter 705 of the laws of 1996, is amended to
 read as follows:
   (a) The utilization review plan, INCLUDING  BUT  NOT  LIMITED  TO  THE
 CLINICAL  REVIEW  CRITERIA AND STANDARDS AND THE DEFINITION/STANDARDS OF

 S. 3569                             5
 
 MEDICAL NECESSITY USED UNDER THE UTILIZATION REVIEW PLAN. A  UTILIZATION
 REVIEW  AGENT  SHALL  REPORT ANY AMENDMENT OR CHANGES TO THE UTILIZATION
 REVIEW PLAN TO THE COMMISSIONER WITHIN THIRTY DAYS OF MAKING SUCH AMEND-
 MENT OR CHANGE;
   §  13.  Paragraph  (d)  of subdivision 1 of section 4902 of the public
 health law, as added by chapter 705 of the laws of 1996, is  amended  to
 read as follows:
   (d) Establishment of a process for rendering utilization review deter-
 minations  which  shall,  at  a  minimum, include: written procedures to
 assure that utilization reviews and determinations are conducted  within
 the  timeframes established herein; procedures to notify an enrollee, an
 enrollee's designee [and/or] AND an enrollee's health care  provider  of
 adverse  determinations;  and  procedures for appeal of adverse determi-
 nations including the establishment of an expedited appeals process  for
 denials  of continued inpatient care or where there is imminent or seri-
 ous threat to the health of the enrollee;
   § 14. The opening paragraph of subdivision 4 of section  4905  of  the
 public  health  law,  as  added  by  chapter 705 of the laws of 1996, is
 amended to read as follows:
   A utilization review agent OR THE HEALTH CARE PLAN FOR WHICH THE AGENT
 PROVIDES UTILIZATION REVIEW  shall  not,  with  respect  to  utilization
 review  activities,  permit or provide compensation or anything of value
 to its employees, agents, or contractors based on:
   § 15. This act shall take effect on  the  one  hundred  eightieth  day
 after it shall have become a law.

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Senate Bill S3569

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

co-Sponsors

2021-S3569 (ACTIVE) - Details

2021-S3569 (ACTIVE) - Summary

2021-S3569 (ACTIVE) - Sponsor Memo

2021-S3569 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S3569

Share this bill

Sponsored By

Neil D. Breslin

Archive: Last Bill Status - In Senate Committee Insurance Committee

co-Sponsors

Joseph P. Addabbo Jr.

Pete Harckham

Todd Kaminsky

Timothy M. Kennedy

2021-S3569 (ACTIVE) - Details

2021-S3569 (ACTIVE) - Summary

2021-S3569 (ACTIVE) - Sponsor Memo

2021-S3569 (ACTIVE) - Bill Text download pdf

Comments