Bill Text: NY A10178 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires reimbursement for surgical first assistant services.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2012-06-06 - reported referred to ways and means [A10178 Detail]
Download: New_York-2011-A10178-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
10178
I N A S S E M B L Y
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 S 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 S 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 S 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 S 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 S 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 S 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.
