Bill Text: NY S04138 | 2011-2012 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Requires reimbursement for surgical first assistant services.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2012-05-16 - PRINT NUMBER 4138B [S04138 Detail]
Download: New_York-2011-S04138-Amended.html
Bill Title: Requires reimbursement for surgical first assistant services.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2012-05-16 - PRINT NUMBER 4138B [S04138 Detail]
Download: New_York-2011-S04138-Amended.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 4138--A 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 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. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01171-02-2 S. 4138--A 2 1 S 2. Subsection (k) of section 3221 of the insurance law is amended by 2 adding a new paragraph 18 to read as follows: 3 (18) 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 3. Section 4303 of the insurance law is amended by adding a new 22 subsection (ii) to read as follows: 23 (II) EVERY CONTRACT ISSUED BY A HEALTH SERVICE CORPORATION OR A 24 MEDICAL EXPENSE INDEMNITY CORPORATION WHICH PROVIDES FOR REIMBURSEMENT 25 FOR SURGICAL FIRST ASSISTANT SERVICES SHALL PROVIDE COVERAGE FOR SUCH 26 SERVICES WHEN PROVIDED BY A REGISTERED NURSE FIRST ASSISTANT WHO IS 27 CERTIFIED IN OPERATING ROOM NURSING PROVIDED THAT: (1) SUCH SERVICES ARE 28 WITHIN THE SCOPE OF PRACTICE OF A NON-PHYSICIAN SURGICAL FIRST ASSIST- 29 ANT; AND (2) THE TERMS AND CONDITIONS OF THE MEMBER CONTRACT OTHERWISE 30 PROVIDE FOR THE COVERAGE OF SUCH SERVICES. NOTHING IN THIS PARAGRAPH 31 SHALL BE CONSTRUED TO: PREVENT THE MEDICAL MANAGEMENT OR UTILIZATION 32 REVIEW OF SUCH SERVICES; PREVENT A POLICY FROM REQUIRING SERVICES 33 THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO SHALL MEET CERTAIN 34 REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER CREDENTIALING; OR 35 PROHIBIT AN INSURER FROM, IN ITS SOLE DISCRETION, PROVIDING A GLOBAL OR 36 CAPITATED PAYMENT OR ELECTING TO DIRECTLY REIMBURSE A NON-PHYSICIAN 37 SURGICAL FIRST ASSISTANT FOR SUCH SERVICES. 38 S 4. Subdivision 2 of section 365-a of the social services law is 39 amended by adding a new paragraph (w) to read as follows: 40 (W) CARE AND SERVICES FOR SURGICAL FIRST ASSISTANT SERVICES PROVIDED 41 BY A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM 42 NURSING PROVIDED THAT: (I) SUCH SERVICES ARE WITHIN THE SCOPE OF PRAC- 43 TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (II) THE TERMS AND 44 CONDITIONS OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF 45 SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT 46 THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES: PREVENT A 47 POLICY FROM REQUIRING SERVICES THROUGH A NETWORK OF PARTICIPATING 48 PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD- 49 ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER FROM, IN ITS SOLE 50 DISCRETION, PROVIDING A GLOBAL OR CAPITATED PAYMENT OR ELECTING TO 51 DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL FIRST ASSISTANT FOR SUCH 52 SERVICES. 53 S 5. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of 54 section 369-ee of the social services law, subparagraph (xv) as amended 55 and subparagraph (xvi) as added by chapter 526 of the laws of 2002, are 56 amended and a new subparagraph (xvii) is added to read as follows: S. 4138--A 3 1 (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r); 2 [and] 3 (xvi) hospice services[.]; AND 4 (XVII) SURGICAL FIRST ASSISTANT SERVICES PERFORMED BY A REGISTERED 5 NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM NURSING 6 PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRACTICE OF A 7 NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND CONDITIONS 8 OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF SUCH 9 SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT THE 10 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. 17 S 6. The opening paragraph of subdivision (a) of section 13 of the 18 workers' compensation law, as amended by chapter 6 of the laws of 2007, 19 is amended to read as follows: 20 The employer shall promptly provide for an injured employee such 21 medical, dental, surgical, optometric or other attendance or treatment, 22 nurse and hospital service, medicine, optometric services, crutches, 23 eye-glasses, false teeth, artificial eyes, orthotics, prosthetic 24 devices, functional assistive and adaptive devices and apparatus for 25 such period as the nature of the injury or the process of recovery may 26 require. The employer shall be liable for the payment of the expenses of 27 medical, dental, surgical, optometric or other attendance or treatment, 28 nurse and hospital service, medicine, optometric services, crutches, 29 eye-glasses, false teeth, artificial eyes, orthotics, prosthetic 30 devices, functional assistive and adaptive devices and apparatus, as 31 well as artificial members of the body or other devices or appliances 32 necessary in the first instance to replace, support or relieve a portion 33 or part of the body resulting from and necessitated by the injury of an 34 employee, for such period as the nature of the injury or the process of 35 recovery may require, and the employer shall also be liable for replace- 36 ments or repairs of such artificial members of the body or such other 37 devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet- 38 ic devices, functional assistive and adaptive devices or appliances 39 necessitated by ordinary wear or loss or damage to a prosthesis, with or 40 without bodily injury to the employee. Damage to or loss of a prosthetic 41 device shall be deemed an injury except that no disability benefits 42 shall be payable with respect to such injury under section fifteen of 43 this article. Such a replacement or repair of artificial members of the 44 body or such other devices, eye-glasses, false teeth, artificial eyes, 45 orthotics, prosthetic devices, functional assistive and adaptive devices 46 or appliances or the providing of medical treatment and care as defined 47 herein shall not constitute the payment of compensation under section 48 twenty-five-a of this article. ALL SURGICAL SERVICES COVERED BY THIS 49 ARTICLE, INCLUDING COVERAGE FOR SURGICAL FIRST ASSISTANT SERVICES, SHALL 50 INCLUDE CARE AND SERVICES FURNISHED IN ALL COVERED SETTINGS PROVIDED BY 51 A REGISTERED NURSE FIRST ASSISTANT WHO IS CERTIFIED IN OPERATING ROOM 52 NURSING PROVIDED THAT: (A) SUCH SERVICES ARE WITHIN THE SCOPE OF PRAC- 53 TICE OF A NON-PHYSICIAN SURGICAL FIRST ASSISTANT; AND (B) THE TERMS AND 54 CONDITIONS OF THE MEMBER CONTRACT OTHERWISE PROVIDE FOR THE COVERAGE OF 55 SUCH SERVICES. NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO: PREVENT 56 THE MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF SUCH SERVICES; PREVENT A S. 4138--A 4 1 POLICY FROM REQUIRING SERVICES THROUGH A NETWORK OF PARTICIPATING 2 PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD- 3 ING PROVIDER CREDENTIALING; OR PROHIBIT AN INSURER FROM, IN ITS SOLE 4 DISCRETION, PROVIDING A GLOBAL OR CAPITATED PAYMENT OR ELECTING TO 5 DIRECTLY REIMBURSE A NON-PHYSICIAN SURGICAL FIRST ASSISTANT FOR SUCH 6 SERVICES. All fees and other charges for such treatment and services 7 shall be limited to such charges as prevail in the same community for 8 similar treatment of injured persons of a like standard of living. 9 S 7. This act shall take effect on the one hundred eightieth day after 10 it shall have become a law and shall apply to all policies and contracts 11 issued, renewed, modified, altered or amended on or after such effective 12 date.