STATE OF NEW YORK ________________________________________________________________________ 569--A 2017-2018 Regular Sessions IN ASSEMBLY January 9, 2017 ___________ Introduced by M. of A. CAHILL, SKOUFIS, BLANKENBUSH, RIVERA, FAHY, BARRETT, WEPRIN, TITONE, BRABENEC, MURRAY, SANTABARBARA, LALOR, MOYA, HUNTER, CASTORINA, MALLIOTAKIS -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN, BRINDISI, COLTON, CRESPO, CROUCH, CUSICK, CYMBROWITZ, DINOWITZ, ENGLEBRIGHT, FARRELL, GALEF, GARBARINO, GIGLIO, GOTTFRIED, GRAF, GUNTHER, HAWLEY, HEVESI, HOOPER, JAFFEE, JENNE, KAVANAGH, LENTOL, LIFTON, LOPEZ, LUPARDO, LUPI- NACCI, MAGEE, MAGNARELLI, McDONALD, McDONOUGH, McKEVITT, McLAUGHLIN, MOSLEY, OTIS, PAULIN, PEOPLES-STOKES, PERRY, PRETLOW, QUART, RAIA, RAMOS, ROSENTHAL, SEPULVEDA, SIMANOWITZ, SIMON, STEC, STECK, STIRPE, THIELE, WALTER, WOERNER, 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: 1 Section 1. Paragraph 23 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 593 of the laws of 2000, is amended 3 to read as follows: 4 (23) If a policy provides for reimbursement for physical and occupa- 5 tional therapy service which is within the lawful scope of practice of a 6 duly licensed physical or occupational therapist, an insured shall be 7 entitled to reimbursement for such service whether the said service is 8 performed by a physician or through a duly licensed physical or occupa- 9 tional therapist, provided however, that nothing contained herein shall 10 be construed to impair any terms of such policy including appropriate 11 utilization review and the requirement that said service be performed 12 pursuant to a medical order, or a similar or related service of a physi- 13 cian. An insurer shall not impose a copayment or coinsurance amount 14 charged to the insured for services rendered for each date of service by EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01314-03-7

A. 569--A 2 1 a physical therapist licensed under article one hundred thirty-six of 2 the education law or an occupational therapist licensed under article 3 one hundred fifty-six of the education law that is greater than the 4 copayment or coinsurance amount imposed on the insured for services 5 provided to the insured for an office visit for the service of a 6 licensed primary care physician or osteopath for the same or a similar 7 diagnosed condition even if a different nomenclature is used to describe 8 the condition for which the services are provided. 9 § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235 10 of the insurance law is amended by adding a new clause (iii) to read as 11 follows: 12 (iii) a policy shall not impose a copayment or coinsurance amount 13 charged to the insured for services rendered for each date of service by 14 a physical therapist licensed under article one hundred thirty-six of 15 the education law or an occupational therapist licensed under article 16 one hundred fifty-six of the education law that is greater than the 17 copayment or coinsurance amount imposed on the insured for services 18 provided to the insured for an office visit for the service of a 19 licensed primary care physician or osteopath for the same or a similar 20 diagnosed condition even if a different nomenclature is used to describe 21 the condition for which the services are provided. 22 § 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235 23 of the insurance law, as amended by chapter 593 of the laws of 2000, is 24 amended to read as follows: 25 (A) any physical and occupational therapy service which is within the 26 lawful scope of practice of a licensed physical and occupational thera- 27 pist, a subscriber to such policy shall be entitled to reimbursement for 28 such service, whether the said service is performed by a physician or 29 licensed physical and occupational therapist pursuant to prescription or 30 referral by a physician. A policy shall not impose a copayment or coin- 31 surance amount charged to the insured for services rendered for each 32 date of service by a physical therapist licensed under article one 33 hundred thirty-six of the education law or an occupational therapist 34 licensed under article one hundred fifty-six of the education law that 35 is greater than the copayment or coinsurance amount imposed on the 36 insured for services provided to the insured for an office visit for the 37 service of a licensed primary care physician or osteopath for the same 38 or a similar diagnosed condition even if a different nomenclature is 39 used to describe the condition for which the services are provided; 40 § 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301 41 of the insurance law, as amended by chapter 593 of the laws of 2000, is 42 amended to read as follows: 43 (G) physical and occupational therapy care provided through licensed 44 physical and occupational therapists upon the prescription of a physi- 45 cian, provided, however, that no copayment or coinsurance amount charged 46 to the insured for services rendered for each date of service by a phys- 47 ical therapist licensed under article one hundred thirty-six of the 48 education law or an occupational therapist licensed under article one 49 hundred fifty-six of the education law is greater than the copayment or 50 coinsurance amount imposed on the insured for services provided to the 51 insured for an office visit for the service of a licensed primary care 52 physician or osteopath for the same or a similar diagnosed condition 53 even if a different nomenclature is used to describe the condition for 54 which the services are provided,

A. 569--A 3 1 § 5. Paragraph 13 of subsection (b) of section 4322 of the insurance 2 law, as added by chapter 504 of the laws of 1995, is amended to read as 3 follows: 4 (13) Outpatient physical therapy up to ninety visits per condition per 5 calendar year, provided, however, that no copayment or coinsurance 6 amount charged to the insured for services rendered for each date of 7 service by a physical therapist licensed under article one hundred thir- 8 ty-six of the education law or an occupational therapist licensed under 9 article one hundred fifty-six of the education law is greater than the 10 copayment or coinsurance amount imposed on the insured for services 11 provided to the insured for an office visit for the service of a 12 licensed primary care physician or osteopath for the same or a similar 13 diagnosed condition even if a different nomenclature is used to describe 14 the condition for which the services are provided. 15 § 6. This act shall take effect on the one hundred eightieth day after 16 it shall have become a law.