This bill has been amended

Bill S3056-2013

Requires reimbursement for surgical first assistant services

Requires reimbursement for surgical first assistant services.

Details

Actions

  • Jan 8, 2014: REFERRED TO INSURANCE
  • Jun 3, 2013: REPORTED AND COMMITTED TO FINANCE
  • Jan 29, 2013: REFERRED TO INSURANCE

Votes

VOTE: COMMITTEE VOTE: - Insurance - Jun 3, 2013
Ayes (17): Seward, Carlucci, Flanagan, Golden, Grisanti, Lanza, Larkin, Martins, O'Mara, Valesky, Young, Breslin, Espaillat, Kennedy, Parker, Stavisky, O'Brien
Ayes W/R (2): LaValle, Peralta

Memo

BILL NUMBER:S3056

TITLE OF BILL: An act to amend the insurance law, the social services law and the workers' 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 30.

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 subdivision 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 predominantly 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 assistant, 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 functions as a first assistant is already established as a cost saving measure.

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.


Text

STATE OF NEW YORK ________________________________________________________________________ 3056 2013-2014 Regular Sessions IN SENATE January 29, 2013 ___________
Introduced by Sen. LITTLE -- read twice and ordered printed, and when printed to be committed 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 30 to read as follows: (30) 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 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) 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 (jj) to read as follows: (JJ) 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 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 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.

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