Authorizes certified or registered dietitians and certified nutritionists as providers for direct reimbursement when a policy provides coverage for nutrition and dietetic services and such services are provided pursuant to a physician's order.
STATE OF NEW YORK
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3404
2011-2012 Regular Sessions
IN ASSEMBLY
January 25, 2011
___________
Introduced by M. of A. PRETLOW -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to reimbursement for
nutrition and dietetic services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraphs (F), (G) and (H) of paragraph 4 of subsection
2 (f) of section 4235 of the insurance law, subparagraph (F) as added and
3 subparagraphs (G) and (H) as relettered by chapter 456 of the laws of
4 1993, are amended and a new subparagraph (I) is added to read as
5 follows:
6 (F) any speech-language pathology or audiology service which is within
7 the lawful scope of practice of a duly licensed speech-language patholo-
8 gist or audiologist, a subscriber to such policy shall be entitled to
9 reimbursement for such service whether the said service is performed by
10 a physician or duly licensed speech-language pathologist or audiologist,
11 provided however, that nothing contained herein shall be construed to
12 impair any terms of such policy which may require said service to be
13 performed pursuant to a medical order, or a similar or related service
14 of a physician, in which case coverage need not be provided for any
15 tests, evaluations or diagnoses if such tests, evaluations or diagnoses
16 have already been provided by or through a physician within twelve
17 months of the referral or order from the physician. However, nothing
18 herein shall be construed as preventing an insurer from covering more
19 than one test or evaluation provided by a speech-language pathologist or
20 audiologist within a twelve-month period where such test or evaluation
21 is ordered by a physician as medically necessary. Nor shall anything
22 herein be construed as prohibiting the limitation of such services,
23 where covered, to specified settings other than offices, such as hospi-
24 tals or to services provided by such professionals as part of a home
25 care agency's services; and when such policy or any certificate issued
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02460-01-1
A. 3404 2
1 thereunder is delivered or issued for delivery without the state by an
2 authorized insurer, covered persons residing in this state shall be
3 entitled to reimbursement for speech-language pathology or audiology
4 service as herein provided[.];
5 (G) psychiatric or psychological services or for the diagnosis and
6 treatment of mental, nervous, or emotional disorders or ailments, howev-
7 er defined in such policy, a subscriber to such policy shall be entitled
8 to reimbursement for such psychiatric or psychological services or diag-
9 nosis or treatment whether performed by a physician, psychiatrist or a
10 certified and registered psychologist when the services rendered are
11 within the lawful scope of their practice, and when such policy or any
12 certificate issued thereunder is delivered or issued for delivery with-
13 out this state by an authorized insurer, covered persons residing in
14 this state shall be entitled to reimbursement for such diagnosis and
15 treatment by a physician, psychiatrist or a certified and registered
16 psychologist as hereinabove provided; [and]
17 (H) any service which is within the lawful scope of practice of a
18 licensed chiropractor, a subscriber to such policy shall be entitled to
19 reimbursement for such service when such service is performed by a
20 licensed chiropractor[.]; and
21 (I) any nutrition or dietetic service which is within the lawful scope
22 of practice of a duly certified nutritionist, certified dietitian, or
23 registered dietitian, a subscriber to such policy shall be entitled to
24 reimbursement for such service whether such service is performed by a
25 physician or duly certified nutritionist, certified dietitian, or regis-
26 tered dietitian, provided however, that such service, when rendered by a
27 certified nutritionist, certified dietitian, or registered dietitian,
28 shall be performed pursuant to a medical order or referral of a physi-
29 cian, and when such policy or any certificate issued thereunder is
30 delivered or issued for delivery without the state by an authorized
31 insurer, covered persons residing in this state shall be entitled to
32 reimbursement for nutrition or dietetic service as provided in this
33 subparagraph.
34 § 2. Subparagraphs (J) and (K) of paragraph 1 of subsection (b) of
35 section 4301 of the insurance law, as relettered by chapter 456 of the
36 laws of 1993, are relettered subparagraphs (K) and (L) and a new subpar-
37 agraph (J) is added to read as follows:
38 (J) nutrition or dietetic services provided through certified nutri-
39 tionists, certified dietitians or registered dietitians, provided howev-
40 er, that said service, when rendered by a certified nutritionist, certi-
41 fied dietitian, or registered dietitian, shall be performed pursuant to
42 a medical order or referral of a physician,
43 § 3. Paragraph 3 of subsection (b) of section 4301 of the insurance
44 law, as amended by chapter 593 of the laws of 2000, is amended to read
45 as follows:
46 (3) Every medical expense indemnity corporation shall be open to the
47 participation of licensed physicians, podiatrists, chiropractors, opto-
48 metrists, physical and occupational therapists, certified nutritionists,
49 certified dietitians, registered dietitians, speech-language patholo-
50 gists, audiologists, and dentists, certified and registered psychol-
51 ogists without discrimination against schools of medical practice,
52 podiatry practice, chiropractic practice, optometric practice, physical
53 and occupational therapy practice, dental practice, speech-language
54 pathology practice (subject to the permitted limitations of paragraph
55 one of this subsection), audiology practice (subject to the permitted
A. 3404 3
1 limitations of paragraph one of this subsection), and psychological
2 training as defined in the education law.
3 § 4. This act shall take effect on the first of September next
4 succeeding the date on which it shall have become a law and shall apply
5 to all policies and contracts issued, renewed, modified, altered or
6 amended on or after such date.
