S04138 Summary:

BILL NO    S04138B

SAME AS    SAME AS A10178

SPONSOR    LITTLE

COSPNSR    MAZIARZ

MLTSPNSR   

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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S04138 Actions:

BILL NO    S04138B

03/21/2011 REFERRED TO INSURANCE
06/01/2011 1ST REPORT CAL.897
06/02/2011 2ND REPORT CAL.
06/06/2011 ADVANCED TO THIRD READING 
06/24/2011 COMMITTED TO RULES
01/04/2012 REFERRED TO INSURANCE
01/11/2012 AMEND AND RECOMMIT TO INSURANCE
01/11/2012 PRINT NUMBER 4138A
05/16/2012 AMEND AND RECOMMIT TO INSURANCE
05/16/2012 PRINT NUMBER 4138B
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S04138 Text:

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

                                        4138--B

                              2011-2012 Regular Sessions

                                   I N  S E N A T E

                                    March 21, 2011
                                      ___________

       Introduced  by  Sens. LITTLE, MAZIARZ -- read twice and ordered printed,
         and when printed to be committed to  the  Committee  on  Insurance  --
         recommitted  to  the  Committee on Insurance in accordance with Senate
         Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
         reprinted  as  amended  and recommitted to said committee -- committee
         discharged, bill amended, ordered reprinted as amended and recommitted
         to said committee

       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

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD01171-03-2
       S. 4138--B                          2

    1  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
    2  SERVICES.
    3    S 2. Subsection (k) of section 3221 of the insurance law is amended by
    4  adding a new paragraph 18 to read as follows:
    5    (18)  EVERY  POLICY  ISSUED  PURSUANT  TO  THIS SECTION WHICH PROVIDES
    6  REIMBURSEMENT FOR NON-PHYSICIAN SURGICAL FIRST ASSISTANT  SERVICES  WHEN
    7  SUCH  SERVICES  ARE PROVIDED BY A NON-PHYSICIAN SURGICAL FIRST ASSISTANT
    8  WHO IS EMPLOYED BY A PHYSICIAN AND THE PHYSICIAN BILLS FOR THE  SERVICES
    9  SHALL  NOT DENY SUCH COVERAGE EXCLUSIVELY ON THE BASIS THAT THE NON-PHY-
   10  SICIAN SURGICAL FIRST ASSISTANT SERVICES WERE PERFORMED BY A  REGISTERED
   11  NURSE  FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM NURSING
   12  PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE  OF  A
   13  NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
   14  OF  THE  MEMBER  CONTRACT  OTHERWISE  PROVIDE  FOR  THE COVERAGE OF SUCH
   15  SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT  THE
   16  MEDICAL  MANAGEMENT  OR  UTILIZATION  REVIEW OF SUCH SERVICES; PREVENT A
   17  POLICY FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF  PARTICIPATING
   18  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   19  ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
   20  DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
   21  DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
   22  SERVICES.
   23    S 3. Section 4303 of the insurance law is  amended  by  adding  a  new
   24  subsection (ii) to read as follows:
   25    (II)  EVERY  CONTRACT  ISSUED  BY  A  HEALTH  SERVICE CORPORATION OR A
   26  MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES  FOR  REIMBURSEMENT
   27  FOR  SURGICAL  FIRST  ASSISTANT SERVICES SHALL PROVIDE COVERAGE FOR SUCH
   28  SERVICES WHEN PROVIDED BY A REGISTERED  NURSE  FIRST  ASSISTANT  WHO  IS
   29  CERTIFIED IN OPERATING ROOM NURSING PROVIDED THAT: (1) SUCH SERVICES ARE
   30  WITHIN  THE  SCOPE OF PRACTICE OF A NON-PHYSICIAN SURGICAL FIRST ASSIST-
   31  ANT; AND (2) THE TERMS AND CONDITIONS OF THE MEMBER  CONTRACT  OTHERWISE
   32  PROVIDE  FOR  THE  COVERAGE  OF SUCH SERVICES. NOTHING IN THIS PARAGRAPH
   33  SHALL BE CONSTRUED TO: PREVENT THE  MEDICAL  MANAGEMENT  OR  UTILIZATION
   34  REVIEW  OF  SUCH  SERVICES;  PREVENT  A  POLICY  FROM REQUIRING SERVICES
   35  THROUGH A NETWORK OF PARTICIPATING  PROVIDERS  WHO  SHALL  MEET  CERTAIN
   36  REQUIREMENTS  FOR  PARTICIPATION,  INCLUDING  PROVIDER CREDENTIALING; OR
   37  PROHIBIT AN INSURER FROM, IN ITS SOLE DISCRETION, PROVIDING A GLOBAL  OR
   38  CAPITATED  PAYMENT  OR  ELECTING  TO  DIRECTLY REIMBURSE A NON-PHYSICIAN
   39  SURGICAL FIRST ASSISTANT FOR SUCH SERVICES.
   40    S 4. Subdivision 2 of section 365-a of  the  social  services  law  is
   41  amended by adding a new paragraph (aa) to read as follows:
   42    (AA)  CARE AND SERVICES FOR SURGICAL FIRST ASSISTANT SERVICES PROVIDED
   43  BY A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM
   44  NURSING PROVIDED THAT: (I) SUCH SERVICES ARE WITHIN THE SCOPE  OF  PRAC-
   45  TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (II) THE TERMS AND
   46  CONDITIONS  OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF
   47  SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT
   48  THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES: PREVENT A
   49  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
   50  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   51  ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
   52  DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
   53  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
   54  SERVICES.
   55    S 5. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
   56  section  369-ee of the social services law, subparagraph (xv) as amended
       S. 4138--B                          3

    1  and subparagraph (xvi) as added by chapter 526 of the laws of 2002,  are
    2  amended and a new subparagraph (xvii) is added to read as follows:
    3    (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
    4  [and]
    5    (xvi) hospice services[.]; AND
    6    (XVII)  SURGICAL  FIRST  ASSISTANT  SERVICES PERFORMED BY A REGISTERED
    7  NURSE FIRST  ASSISTANT  WHO  IS  CERTIFIED  IN  OPERATING  ROOM  NURSING
    8  PROVIDED  THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A
    9  NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS
   10  OF THE MEMBER CONTRACT  OTHERWISE  PROVIDE  FOR  THE  COVERAGE  OF  SUCH
   11  SERVICES.  NOTHING  IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT THE
   12  MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF  SUCH  SERVICES;  PREVENT  A
   13  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
   14  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
   15  ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER  FROM,  IN  ITS  SOLE
   16  DISCRETION,  PROVIDING  A  GLOBAL  OR  CAPITATED  PAYMENT OR ELECTING TO
   17  DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL  FIRST  ASSISTANT  FOR  SUCH
   18  SERVICES.
   19    S  6.  The  opening  paragraph of subdivision (a) of section 13 of the
   20  workers' compensation law, as amended by chapter 6 of the laws of  2007,
   21  is amended to read as follows:
   22    The  employer  shall  promptly  provide  for  an injured employee such
   23  medical, dental, surgical, optometric or other attendance or  treatment,
   24  nurse  and  hospital  service,  medicine, optometric services, crutches,
   25  eye-glasses,  false  teeth,  artificial  eyes,   orthotics,   prosthetic
   26  devices,  functional  assistive  and  adaptive devices and apparatus for
   27  such period as the nature of the injury or the process of  recovery  may
   28  require. The employer shall be liable for the payment of the expenses of
   29  medical,  dental, surgical, optometric or other attendance or treatment,
   30  nurse and hospital service,  medicine,  optometric  services,  crutches,
   31  eye-glasses,   false   teeth,  artificial  eyes,  orthotics,  prosthetic
   32  devices, functional assistive and adaptive  devices  and  apparatus,  as
   33  well  as  artificial  members of the body or other devices or appliances
   34  necessary in the first instance to replace, support or relieve a portion
   35  or part of the body resulting from and necessitated by the injury of  an
   36  employee,  for such period as the nature of the injury or the process of
   37  recovery may require, and the employer shall also be liable for replace-
   38  ments or repairs of such artificial members of the body  or  such  other
   39  devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
   40  ic  devices,  functional  assistive  and  adaptive devices or appliances
   41  necessitated by ordinary wear or loss or damage to a prosthesis, with or
   42  without bodily injury to the employee. Damage to or loss of a prosthetic
   43  device shall be deemed an injury  except  that  no  disability  benefits
   44  shall  be  payable  with respect to such injury under section fifteen of
   45  this article. Such a replacement or repair of artificial members of  the
   46  body  or  such other devices, eye-glasses, false teeth, artificial eyes,
   47  orthotics, prosthetic devices, functional assistive and adaptive devices
   48  or appliances or the providing of medical treatment and care as  defined
   49  herein  shall  not  constitute the payment of compensation under section
   50  twenty-five-a of this article.  ALL SURGICAL SERVICES  COVERED  BY  THIS
   51  ARTICLE, INCLUDING COVERAGE FOR SURGICAL FIRST ASSISTANT SERVICES, SHALL
   52  INCLUDE  CARE AND SERVICES FURNISHED IN ALL COVERED SETTINGS PROVIDED BY
   53  A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED  IN  OPERATING  ROOM
   54  NURSING  PROVIDED THAT:  (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRAC-
   55  TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS  AND
   56  CONDITIONS  OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF
       S. 4138--B                          4

    1  SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO:  PREVENT
    2  THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES; PREVENT A
    3  POLICY  FROM  REQUIRING  SERVICES  THROUGH  A  NETWORK  OF PARTICIPATING
    4  PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
    5  ING  PROVIDER  CREDENTIALING;  OR  PROHIBIT AN INSURER FROM, IN ITS SOLE
    6  DISCRETION, PROVIDING A GLOBAL  OR  CAPITATED  PAYMENT  OR  ELECTING  TO
    7  DIRECTLY  REIMBURSE  A  NON-PHYSICIAN  SURGICAL FIRST ASSISTANT FOR SUCH
    8  SERVICES. All fees and other charges for  such  treatment  and  services
    9  shall  be  limited  to such charges as prevail in the same community for
   10  similar treatment of injured persons of a like standard of living.
   11    S 7. This act shall take effect on the one hundred eightieth day after
   12  it shall have become a law and shall apply to all policies and contracts
   13  issued, renewed, modified, altered or amended on or after such effective
   14  date.
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