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:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          10178
 
                   IN ASSEMBLY
 
                                      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    § 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    § 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    § 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    § 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    §  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    § 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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