NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5301
SPONSOR: Morelle TITLE OF BILL: An act to amend the insurance law, in relation to
coverage of a nurse practitioner
PURPOSE: The purpose of this legislation is to make technical amend-
ments to Timothy's Law (Chapter 502 of the Laws of 2007).
SUMMARY OF PROVISIONS: Amends section 3221 (1) (5) (A) (ii) to add
"nurse practitioners" to this section that limits the coverage for
outpatient care provided by a psychiatrist or psychologist or a licensed
clinical social worker to policies that provide coverage for physician
services.
JUSTIFICATION: While referencing psychiatrists, psychologists and
licensed clinical social workers, the language excludes nurse practi-
tioners (NPs) and fails to recognize NPs as providers of services to
adults and children with biologically based mental illness, serious
emotional disturbances and other forms of mental, nervous or emotional
disorders or ailments.
In addition to the specialty of Psychiatric Nurse Practitioner (Psychia-
try), many NPs certified by the Education Department in other special-
ties such as Adult Health, College Health, Community Health, Family
Health, Gerontology, Holistic Nursing, Neonatology, Pediatrics, Pallia-
tive Care, Perinatology, School Health and Women's Health are educated,
trained, qualified and authorized by law to diagnose and treat mental
health conditions as well as prescribe psychotropic drugs.
As such, the bill makes the law "provider neutral" with respect to NPs
by adding language to include "nurse practitioners consistent with their
scope of practice."
LEGISLATIVE HISTORY: A9904 of 2007-2008 referred to insurance
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
5301
2009-2010 Regular Sessions
IN ASSEMBLY
February 11, 2009
___________
Introduced by M. of A. MORELLE -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to coverage of a nurse
practitioner
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Clause (ii) of subparagraph (A) of paragraph 5 of
2 subsection (l) of section 3221 of the insurance law, as amended by chap-
3 ter 502 of the laws of 2007, is amended to read as follows:
4 (ii) where the policy provides coverage for physician services, it
5 shall include benefits for outpatient care provided by a psychiatrist or
6 psychologist licensed to practice in this state, a nurse practitioner
7 consistent with his or her scope of practice, a licensed clinical social
8 worker who meets the requirements of subparagraph (D) of paragraph four
9 of this subsection, or a professional corporation or university faculty
10 practice corporation thereof. Such benefits may be limited to not less
11 than twenty visits in any contract year, plan year, or calendar year.
12 § 2. Paragraph 1 of subsection (h) of section 4303 of the insurance
13 law, as amended by chapter 502 of the laws of 2007, is amended to read
14 as follows:
15 (1) A medical expense indemnity corporation or a health service corpo-
16 ration, which provides group, group remittance or school blanket cover-
17 age for physician services, shall provide as part of its contract broad-
18 based coverage for the diagnosis and treatment of mental, nervous or
19 emotional disorders or ailments, however defined in such contract, at
20 least equal to the coverage provided for other health conditions and
21 shall include: benefits for outpatient care provided by a psychiatrist
22 or psychologist licensed to practice in this state, a nurse practitioner
23 consistent with his or her scope of practice, a licensed clinical social
24 worker who meets the requirements of subsection (n) of this section, or
25 a professional corporation or university faculty practice corporation
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD08485-01-9
A. 5301 2
1 thereof, which benefits may be limited to not less than twenty visits in
2 any contract year, plan year or calendar year. Such coverage may be
3 provided on a contract year, plan year or calendar year basis and shall
4 be consistent with the provision of other benefits under the contract.
5 Such coverage may be subject to annual deductibles, co-pays and coinsu-
6 rance as may be deemed appropriate by the superintendent and shall be
7 consistent with those imposed on other benefits under the contract. In
8 the event the group remittance group or contract holder is provided
9 coverage provided under this paragraph and under subparagraph (B) of
10 paragraph one of subsection (g) of this section from the same health
11 service corporation, or under a contract which is jointly underwritten
12 by two health service corporations or by a health service corporation
13 and a medical expense indemnity corporation, the aggregate of the bene-
14 fits for out-patient care obtained under subparagraph (B) of paragraph
15 one of subsection (g) of this section and this paragraph may be limited
16 to not less than twenty visits in any contract year, plan year or calen-
17 dar year.
18 § 3. This act shall take effect immediately; provided that the amend-
19 ments to paragraph 5 of subsection (l) of section 3221 and subsection
20 (h) of section 4303 of the insurance law made by sections one and two of
21 this act shall not affect the expiration of such provisions and shall be
22 deemed to expire therewith.
