A178-2011 Actions

• Jun 29, 2011: enacting clause stricken
• Mar 2, 2011: reported referred to ways and means
• Jan 5, 2011: referred to insurance

A178-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                          178
 2011-2012 Regular Sessions
 I N  ASSEMBLY
 (PREFILED)
 January 5, 2011
 
 Introduced  by  M.  of  A. CAHILL, GUNTHER, CYMBROWITZ, N. RIVERA, COOK,
 BENEDETTO, COLTON, JAFFEE -- Multi-Sponsored by  --  M.  of  A.  BING,
 BOYLAND,  GOTTFRIED, LATIMER, LIFTON, McENENY, PAULIN, PHEFFER, REILLY
 -- 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 28 to read as follows:

 (28) 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.
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD01171-01-1
 
       A. 178                              2
 

S 2. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 17 to read as follows:

 (17)  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 (hh) to read as follows:

 (HH)  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 (w) to read as follows:

 (W)  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:

 
       A. 178                              3
 (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
 SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT
 THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES; PREVENT A
 
       A. 178                              4
 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.

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