S4138B-2011 Actions

• May 16, 2012: PRINT NUMBER 4138B
• May 16, 2012: AMEND AND RECOMMIT TO INSURANCE
• Jan 11, 2012: PRINT NUMBER 4138A
• Jan 11, 2012: AMEND AND RECOMMIT TO INSURANCE
• Jan 4, 2012: REFERRED TO INSURANCE
• Jun 24, 2011: COMMITTED TO RULES
• Jun 6, 2011: ADVANCED TO THIRD READING
• Jun 2, 2011: 2ND REPORT CAL.
• Jun 1, 2011: 1ST REPORT CAL.897
• Mar 21, 2011: REFERRED TO INSURANCE

S4138B-2011 Votes

S4138B-2011 Memo

BILL NUMBER:S4138B

TITLE OF BILL:
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

PURPOSE:
Provides for coverage for surgical first assistant services performed by
a registered nurse first assistant who is certified in operating room
nursing and who performs surgical first assistant services within his or
her scope of practice in every policy of insurance in instances in which
reimbursement for surgical first assistant services is provided.

SUMMARY OF PROVISIONS:
Section 1 amends subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 29.

Section 2 amends subsection (k) of section 3221 of the insurance law.

Section 3 adds a new subsection (ii) to section 4303 of the insurance
law.

Section 4 amends subdivision 2 of section 365-a of the social services
law by adding a new paragraph (aa).

Section 5 amends subparagraphs (xv) and (xvi) of paragraph (e) of subdi-
vision 1 of section 369-ee of the social services law and adds a new
subparagraph (xvii).

Section 6 amends the opening paragraph of subdivision (a) of section 13
of the workers' compensation law.

Section 7 contains the effective date.

JUSTIFICATION:
Registered professional nurses are authorized to diagnose and treat
patients through such services as case-finding, health teaching, health
counseling, and provision of care supportive to or restorative of life
and well-being.

The registered nurse first assistant is a registered professional nurse
who provides supportive and restorative patient care by performing as a
first assistant at surgery under the direction of a licensed physician
or legally authorized licensed healthcare provider under State Education
Law and in accordance with scope of practice qualifications.

The extraordinary capabilities of those nurse providing such services,
and their invaluable contributions to New York's healthcare delivery
system are a matter of fact. These learned professionals work predomi-
nantly in sensitive pre-operative and post-operative environments and

are a vital liaison between surgeon and patient. The diminishment of
surgical resident availability has enhanced the need for the registered
nurse first assistant to function as a vital link in the provision of
quality patient care.

Typically, first assistant at surgery services are routinely reimbursed
by health insurers for the services of other non-physician, licensed
professionals, who, within their scope of practice, perform, as first
assistants at surgery. However, the first assistant at surgery services
provided by the qualified registered nurse are not routinely reimbursed
by insurers. This bill will rectify that disparity. It will ensure that
first assistant at surgery services, provided by a registered nurse
first assistant, will be routinely reimbursed by insurers.

Direct reimbursement to a registered nurse first assistant who bills for
such services may occur for situations such as service agreement
relationships between a physician and a registered nurse first assist-
ant, when an insurance policy allows such reimbursement directly to the
registered nurse first assistant provider.

This bill ensures the equitability of the provision and the distribution
of reimbursement for services already designated as reimbursable.

As a matter of fact, this bill describes a cost-effective approach since
the reimbursement for a non-physician, licensed professional who func-
tions as a first assistant is already established as a cost saving meas-
ure.

Additionally, this bill also serves as an incentive for retention and
recruitment of nursing professionals

LEGISLATIVE HISTORY:
2011: S.4138 Committed to Rules

FISCAL IMPLICATIONS:
None to the State.

EFFECTIVE DATE:
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.

S4138B-2011 Text

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

                                   4138--B

                         2011-2012 Regular Sessions

                              I N  SENATE

                               March 21, 2011
                                 ___________

  Introduced  by  Sens. LITTLE, MAZIARZ -- read twice and ordered printed,
    and when printed to be committed to  the  Committee  on  Insurance  --
    recommitted  to  the  Committee on Insurance in accordance with Senate
    Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
    reprinted  as  amended  and recommitted to said committee -- committee
    discharged, bill amended, ordered reprinted as amended and recommitted
    to said committee

  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 29 to read as follows:

    (29) 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

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD01171-03-2

 S. 4138--B                          2

  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 18 to read as follows:

    (18)  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 (ii) to read as follows:

    (II)  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 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,  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 (aa) to read as follows:

    (AA)  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

 S. 4138--B                          3

  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]
    (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 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  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

 S. 4138--B                          4

  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. 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.