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S06392 Summary:

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S06392 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         6392--A
            Cal. No. 23
 
                    IN SENATE
 
                                     January 8, 2016
                                       ___________
 
        Introduced  by  Sen.  LITTLE -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules -- reported  favora-
          bly  from said committee, ordered to a third reading, passed by Senate
          and delivered to the Assembly, recalled, vote  reconsidered,  restored
          to  third  reading, amended and ordered reprinted, retaining its place
          in the order of third reading
 
        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.  Paragraph  32  of  subsection  (i) of section 3216 of the
     2  insurance law, as added by a chapter of the laws of  2015  amending  the
     3  insurance  law,  the  social  services law and the workers' compensation
     4  law, relating to reimbursement for surgical first assistant services, as
     5  proposed in legislative bills numbers S.1233-A and A.1241-A, is  amended
     6  to read as follows:
     7    (32)  [Every]  No policy delivered or issued [pursuant to this section
     8  which] for delivery in this state that provides reimbursement  for  non-
     9  physician surgical first assistant services when [such] the services are
    10  provided by a non-physician surgical first assistant [who is employed by
    11  a  physician  and the physician bills for the services] shall [not deny]
    12  exclude such coverage [exclusively] on the basis that the  non-physician
    13  surgical  first  assistant services were performed by a registered nurse
    14  first assistant [who is certified in operating  room  nursing]  provided
    15  that:  (A)  [such]  the registered nurse first assistant is certified in
    16  operating room nursing; (B) the services are within the scope  of  prac-
    17  tice  of  a  non-physician  surgical  first assistant; and [(B)] (C) the
    18  terms and conditions of the [member contract] policy  otherwise  provide
    19  for the coverage of [such] the services. Nothing in this paragraph shall
    20  be  construed to[:] prevent the medical management or utilization review
    21  of [such] the services[;]  or  prevent  a  policy  from  requiring  that
    22  services are to be provided through a network of participating providers
    23  who  [shall]  meet  certain  requirements  for  participation, including
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03097-08-6
        S. 6392--A                          2
 
     1  provider credentialing[; or  prohibit  an  insurer  from,  in  its  sole
     2  discretion,  providing  a  global  or  capitated  payment or electing to
     3  directly reimburse a non-physician surgical  first  assistant  for  such
     4  services].
     5    §  2.  Paragraph 20 of subsection (k) of section 3221 of the insurance
     6  law, as added by a chapter of the laws of 2015  amending  the  insurance
     7  law,  the social services law and the workers' compensation law relating
     8  to reimbursement for surgical first assistant services, as  proposed  in
     9  legislative  bills  numbers S.1233-A and A.1241-A, is amended to read as
    10  follows:
    11    (20) [Every] No group or  blanket  policy  [issued  pursuant  to  this
    12  section  which]  delivered  or  issued  for  delivery in this state that
    13  provides  reimbursement  for  non-physician  surgical  first   assistant
    14  services when [such] the services are provided by a non-physician surgi-
    15  cal  first  assistant  [who is employed by a physician and the physician
    16  bills for the services] shall [not deny] exclude such  coverage  [exclu-
    17  sively]  on  the  basis  that the non-physician surgical first assistant
    18  services were performed by a registered nurse first  assistant  [who  is
    19  certified  in  operating  room  nursing]  provided  that: (A) [such] the
    20  registered nurse first assistant is certified in operating room nursing;
    21  (B) the services are within the scope of  practice  of  a  non-physician
    22  surgical  first assistant; and [(B)] (C) the terms and conditions of the
    23  [member contract] policy otherwise provide for the  coverage  of  [such]
    24  the services. Nothing in this paragraph shall be construed to[:] prevent
    25  the  medical  management or utilization review of [such] the services[;]
    26  or prevent a policy from requiring that  services  are  to  be  provided
    27  through  a  network  of participating providers who [shall] meet certain
    28  requirements for participation, including  provider  credentialing[;  or
    29  prohibit  an insurer from, in its sole discretion, providing a global or
    30  capitated payment or electing  to  directly  reimburse  a  non-physician
    31  surgical first assistant for such services].
    32    § 3. Subsection (pp) of section 4303 of the insurance law, as added by
    33  a  chapter  of  the  laws of 2015 amending the insurance law, the social
    34  services law and the workers' compensation law relating to reimbursement
    35  for surgical first assistant services, as proposed in legislative  bills
    36  numbers S.1233-A and A.1241-A, is amended to read as follows:
    37    (pp)  [Every] No contract issued by a medical expense indemnity corpo-
    38  ration, hospital service corporation, or health service corporation  [or
    39  a  medical  expense  indemnity  corporation  which]  that provides [for]
    40  reimbursement for non-physician surgical first assistant  services  when
    41  the  services  are  provided by a non-physician surgical first assistant
    42  shall [provide] exclude such coverage [for such services when  provided]
    43  on  the  basis  that the non-physician surgical first assistant services
    44  were performed by a registered nurse first assistant [who  is  certified
    45  in  operating  room  nursing]  provided  that: (1) [such] the registered
    46  nurse first assistant is certified in operating room  nursing;  (2)  the
    47  services  are  within  the scope of practice of a non-physician surgical
    48  first assistant; and [(2)] (3) the terms and conditions of the  [member]
    49  contract  otherwise  provide  for  the  coverage of [such] the services.
    50  Nothing in this subsection shall be construed to[:] prevent the  medical
    51  management  or utilization review of [such] the services[;] or prevent a
    52  policy from requiring that services are to be provided through a network
    53  of participating providers who [shall]  meet  certain  requirements  for
    54  participation, including provider credentialing[; or prohibit an insurer
    55  from, in its sole discretion, providing a global or capitated payment or
        S. 6392--A                          3

     1  electing  to directly reimburse a non-physician surgical first assistant
     2  for such services].
     3    §  4.  Paragraph  (cc) of subdivision 2 of section 365-a of the social
     4  services law, as added by a chapter of the laws  of  2015  amending  the
     5  insurance law, the social services law and the workers' compensation law
     6  relating  to  reimbursement  for  surgical  first assistant services, as
     7  proposed in legislative bills numbers S.1233-A and A.1241-A, is  amended
     8  to read as follows:
     9    (cc)  care and services for surgical first assistant services provided
    10  by a registered nurse first assistant [who  is  certified  in  operating
    11  room  nursing]  provided  that:  (i)  [such]  the registered nurse first
    12  assistant is certified in operating room nursing; (ii) the services  are
    13  within  the  scope of practice of a non-physician surgical first assist-
    14  ant; and [(ii)] (iii) the terms and conditions of the [member] policy or
    15  contract otherwise provide for the  coverage  of  [such]  the  services.
    16  Nothing  in  this paragraph shall be construed to[:] prevent the medical
    17  management or utilization review of [such] the services; prevent a poli-
    18  cy or contract from requiring that services are to be provided through a
    19  network of participating providers who [shall] meet certain requirements
    20  for participation, including  provider  credentialing;  or  prohibit  an
    21  insurer  from[, in its sole discretion,] providing a global or capitated
    22  payment or electing to directly reimburse a non-physician surgical first
    23  assistant for [such] the services, as otherwise permitted by law.
    24    § 5. The opening paragraph of subdivision (a) of  section  13  of  the
    25  workers'  compensation  law, as amended by a chapter of the laws of 2015
    26  amending the insurance law, the social services  law  and  the  workers'
    27  compensation  law relating to reimbursement for surgical first assistant
    28  services,  as  proposed  in  legislative  bills  numbers  S.1233-A   and
    29  A.1241-A, is amended to read as follows:
    30    The  employer  shall  promptly  provide  for  an injured employee such
    31  medical, dental, surgical, optometric or other attendance or  treatment,
    32  nurse  and  hospital  service,  medicine, optometric services, crutches,
    33  eye-glasses,  false  teeth,  artificial  eyes,   orthotics,   prosthetic
    34  devices,  functional  assistive  and  adaptive devices and apparatus for
    35  such period as the nature of the injury or the process of  recovery  may
    36  require. The employer shall be liable for the payment of the expenses of
    37  medical,  dental, surgical, optometric or other attendance or treatment,
    38  nurse and hospital service,  medicine,  optometric  services,  crutches,
    39  eye-glasses,   false   teeth,  artificial  eyes,  orthotics,  prosthetic
    40  devices, functional assistive and adaptive  devices  and  apparatus,  as
    41  well  as  artificial  members of the body or other devices or appliances
    42  necessary in the first instance to replace, support or relieve a portion
    43  or part of the body resulting from and necessitated by the injury of  an
    44  employee,  for such period as the nature of the injury or the process of
    45  recovery may require, and the employer shall also be liable for replace-
    46  ments or repairs of such artificial members of the body  or  such  other
    47  devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet-
    48  ic  devices,  functional  assistive  and  adaptive devices or appliances
    49  necessitated by ordinary wear or loss or damage to a prosthesis, with or
    50  without bodily injury to the employee. Damage to or loss of a prosthetic
    51  device shall be deemed an injury  except  that  no  disability  benefits
    52  shall  be  payable  with respect to such injury under section fifteen of
    53  this article. Such a replacement or repair of artificial members of  the
    54  body  or  such other devices, eye-glasses, false teeth, artificial eyes,
    55  orthotics, prosthetic devices, functional assistive and adaptive devices
    56  or appliances or the providing of medical treatment and care as  defined
        S. 6392--A                          4

     1  herein  shall  not  constitute the payment of compensation under section
     2  twenty-five-a of this article.  [All surgical services covered  by  this
     3  article, including coverage for surgical first assistant services, shall
     4  include  care and services furnished in all covered settings provided by
     5  a registered nurse first assistant who is certified  in  operating  room
     6  nursing  provided that:  (A) such services are within the scope of prac-
     7  tice of a non-physician surgical first assistant; and (B) the terms  and
     8  conditions  of the member contract otherwise provide for the coverage of
     9  such services. Nothing in this paragraph shall be construed to:  prevent
    10  the medical management or utilization review of such services; prevent a
    11  policy  from  requiring  services  through  a  network  of participating
    12  providers who shall meet certain requirements for participation, includ-
    13  ing provider credentialing; or prohibit an insurer  from,  in  its  sole
    14  discretion,  providing  a  global  or  capitated  payment or electing to
    15  directly reimburse a non-physician surgical  first  assistant  for  such
    16  services.]  All  fees  and other charges for such treatment and services
    17  shall be limited to such charges as prevail in the  same  community  for
    18  similar treatment of injured persons of a like standard of living.
    19    §  6.  This  act  shall  take  effect on the same date and in the same
    20  manner as a chapter of the laws of 2015 amending the insurance law,  the
    21  social  services  law  and  the  workers'  compensation  law relating to
    22  reimbursement for surgical first  assistant  services,  as  proposed  in
    23  legislative bills numbers S.1233-A and A.1241-A, takes effect.