Bill Text: NY S04138 | 2011-2012 | General Assembly | Amended
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--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.