A10178 Summary:

BILL NO    A10178 

SAME AS    SAME AS S04138-B

SPONSOR    Lavine

COSPNSR    Gunther, Rivera P

MLTSPNSR   Abinanti

Amd SS3216, 3221 & 4303, Ins L; amd SS365-a & 369-ee, Soc Serv L; amd S13, Work
Comp L

Requires reimbursement for surgical first assistant services.
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A10178 Actions:

BILL NO    A10178 

05/10/2012 referred to insurance
06/06/2012 reported referred to ways and means
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A10178 Text:

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

                                         10178

                                 I N  A S S E M B L Y

                                     May 10, 2012
                                      ___________

       Introduced by M. of A. LAVINE -- 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:

    1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
    2  amended by adding a new paragraph 29 to read as follows:
    3    (29)  EVERY  POLICY  ISSUED  PURSUANT  TO  THIS SECTION WHICH PROVIDES
    4  REIMBURSEMENT FOR NON-PHYSICIAN SURGICAL FIRST ASSISTANT  SERVICES  WHEN
    5  SUCH  SERVICES  ARE PROVIDED BY A NON-PHYSICIAN SURGICAL FIRST ASSISTANT
    6  WHO IS EMPLOYED BY A PHYSICIAN AND THE PHYSICIAN BILLS FOR THE  SERVICES
    7  SHALL  NOT DENY SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE NON-PHY-
    8  SICIAN SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A  REGISTERED
    9  NURSE  FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM NURSING
   10  PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE  OF  A
   11  NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
   12  OF  THE  MEMBER  CONTRACT  OTHERWISE  PROVIDE  FOR  THE COVERAGE OF SUCH
   13  SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT  THE
   14  MEDICAL  MANAGEMENT  OR  UTILIZATION  REVIEW OF SUCH SERVICES; PREVENT A
   15  POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
   16  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   17  ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
   18  DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
   19  DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
   20  SERVICES.
   21    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   22  adding a new paragraph 18 to read as follows:
   23    (18) EVERY POLICY ISSUED  PURSUANT  TO  THIS  SECTION  WHICH  PROVIDES
   24  REIMBURSEMENT  FOR  NON-PHYSICIAN SURGICAL FIRST ASSISTANT SERVICES WHEN
   25  SUCH SERVICES ARE PROVIDED BY A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT
   26  WHO  IS EMPLOYED BY A PHYSICIAN AND THE PHYSICIAN BILLS FOR THE SERVICES
   27  SHALL NOT DENY SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE  NON-PHY-

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD01171-04-2
       A. 10178                            2

    1  SICIAN  SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A REGISTERED
    2  NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
    3  PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A
    4  NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
    5  OF  THE  MEMBER  CONTRACT  OTHERWISE  PROVIDE  FOR  THE COVERAGE OF SUCH
    6  SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT  THE
    7  MEDICAL  MANAGEMENT  OR  UTILIZATION  REVIEW OF SUCH SERVICES; PREVENT A
    8  POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
    9  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   10  ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
   11  DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
   12  DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
   13  SERVICES.
   14    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
   15  subsection (ii) to read as follows:
   16    (II)  EVERY  CONTRACT  ISSUED  BY  A  HEALTH  SERVICE CORPORATION OR A
   17  MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES  FOR  REIMBURSEMENT
   18  FOR  SURGICAL  FIRST  ASSISTANT SERVICES SHALL PROVIDE COVERAGE FOR SUCH
   19  SERVICES WHEN PROVIDED BY A REGISTERED  NURSE  FIRST  ASSISTANT  WHO  IS
   20  CERTIFIED IN OPERATING ROOM NURSING PROVIDED THAT: (1) SUCH SERVICES ARE
   21  WITHIN  THE  SCOPE OF PRACTICE OF A NON-PHYSICIAN SURGICAL FIRST ASSIST-
   22  ANT; AND (2) THE TERMS AND CONDITIONS OF THE MEMBER  CONTRACT  OTHERWISE
   23  PROVIDE  FOR  THE  COVERAGE  OF SUCH SERVICES. NOTHING IN THIS PARAGRAPH
   24  SHALL BE CONSTRUED TO: PREVENT THE  MEDICAL  MANAGEMENT  OR  UTILIZATION
   25  REVIEW  OF  SUCH  SERVICES;  PREVENT  A  POLICY  FROM REQUIRING SERVICES
   26  THROUGH A NETWORK OF PARTICIPATING  PROVIDERS  WHO  SHALL  MEET  CERTAIN
   27  REQUIREMENTS  FOR  PARTICIPATION,  INCLUDING  PROVIDER CREDENTIALING; OR
   28  PROHIBIT AN INSURER FROM, IN ITS SOLE DISCRETION, PROVIDING A GLOBAL  OR
   29  CAPITATED  PAYMENT  OR  ELECTING  TO  DIRECTLY REIMBURSE A NON-PHYSICIAN
   30  SURGICAL FIRST ASSISTANT FOR SUCH SERVICES.
   31    S 4. Subdivision 2 of section 365-a of  the  social  services  law  is
   32  amended by adding a new paragraph (aa) to read as follows:
   33    (AA)  CARE AND SERVICES FOR SURGICAL FIRST ASSISTANT SERVICES PROVIDED
   34  BY A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM
   35  NURSING PROVIDED THAT: (I) SUCH SERVICES ARE WITHIN THE SCOPE  OF  PRAC-
   36  TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (II) THE TERMS AND
   37  CONDITIONS  OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF
   38  SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT
   39  THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES: PREVENT A
   40  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
   41  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   42  ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
   43  DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
   44  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
   45  SERVICES.
   46    S 5. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
   47  section  369-ee of the social services law, subparagraph (xv) as amended
   48  and subparagraph (xvi) as added by chapter 526 of the laws of 2002,  are
   49  amended and a new subparagraph (xvii) is added to read as follows:
   50    (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
   51  [and]
   52    (xvi) hospice services[.]; AND
   53    (XVII)  SURGICAL  FIRST  ASSISTANT  SERVICES PERFORMED BY A REGISTERED
   54  NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
   55  PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A
   56  NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
       A. 10178                            3

    1  OF THE MEMBER CONTRACT  OTHERWISE  PROVIDE  FOR  THE  COVERAGE  OF  SUCH
    2  SERVICES.  NOTHING  IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT THE
    3  MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF  SUCH  SERVICES;  PREVENT  A
    4  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
    5  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
    6  ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
    7  DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
    8  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
    9  SERVICES.
   10    S  6.  The  opening  paragraph of subdivision (a) of section 13 of the
   11  workers' compensation law, as amended by chapter 6 of the laws of  2007,
   12  is amended to read as follows:
   13    The  employer  shall  promptly  provide  for  an injured employee such
   14  medical, dental, surgical, optometric or other attendance or  treatment,
   15  nurse  and  hospital  service,  medicine, optometric services, crutches,
   16  eye-glasses,  false  teeth,  artificial  eyes,   orthotics,   prosthetic
   17  devices,  functional  assistive  and  adaptive devices and apparatus for
   18  such period as the nature of the injury or the process of  recovery  may
   19  require. The employer shall be liable for the payment of the expenses of
   20  medical,  dental, surgical, optometric or other attendance or treatment,
   21  nurse and hospital service,  medicine,  optometric  services,  crutches,
   22  eye-glasses,   false   teeth,  artificial  eyes,  orthotics,  prosthetic
   23  devices, functional assistive and adaptive  devices  and  apparatus,  as
   24  well  as  artificial  members of the body or other devices or appliances
   25  necessary in the first instance to replace, support or relieve a portion
   26  or part of the body resulting from and necessitated by the injury of  an
   27  employee,  for such period as the nature of the injury or the process of
   28  recovery may require, and the employer shall also be liable for replace-
   29  ments or repairs of such artificial members of the body  or  such  other
   30  devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
   31  ic  devices,  functional  assistive  and  adaptive devices or appliances
   32  necessitated by ordinary wear or loss or damage to a prosthesis, with or
   33  without bodily injury to the employee. Damage to or loss of a prosthetic
   34  device shall be deemed an injury  except  that  no  disability  benefits
   35  shall  be  payable  with respect to such injury under section fifteen of
   36  this article. Such a replacement or repair of artificial members of  the
   37  body  or  such other devices, eye-glasses, false teeth, artificial eyes,
   38  orthotics, prosthetic devices, functional assistive and adaptive devices
   39  or appliances or the providing of medical treatment and care as  defined
   40  herein  shall  not  constitute the payment of compensation under section
   41  twenty-five-a of this article.  ALL SURGICAL SERVICES  COVERED  BY  THIS
   42  ARTICLE, INCLUDING COVERAGE FOR SURGICAL FIRST ASSISTANT SERVICES, SHALL
   43  INCLUDE  CARE AND SERVICES FURNISHED IN ALL COVERED SETTINGS PROVIDED BY
   44  A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED  IN  OPERATING  ROOM
   45  NURSING  PROVIDED THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRAC-
   46  TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS  AND
   47  CONDITIONS  OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF
   48  SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT
   49  THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES; PREVENT A
   50  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
   51  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   52  ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
   53  DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
   54  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
   55  SERVICES.  All  fees  and  other charges for such treatment and services
       A. 10178                            4

    1  shall be limited to such charges as prevail in the  same  community  for
    2  similar treatment of injured persons of a like standard of living.
    3    S 7. This act shall take effect on the one hundred eightieth day after
    4  it shall have become a law and shall apply to all policies and contracts
    5  issued, renewed, modified, altered or amended on or after such effective
    6  date.
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