Requires reimbursement for surgical first assistant services

SUMMARY OF PROVISIONS:; Section 1 amends Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 27

Section 2 amends subsection (k) of section 3221 of the insurance law

Section 3 adds a new subsection (gg) to section 4303 of the insurance law

Section 4 amends subdivision 2 of section 365-a of the social services law by adding a new paragraph (v)

Section 5 amends subparagraphs (xv) and (xvi) of paragraph (e) of subdi- vision 1 of section 369-ee of the social services law and adds a new subparagraph (xvii)

Section 6 amends the opening paragraph of subdivision (a) of section 13 of the workers' compensation law

Section 7 sets the effective date

Justification

Registered professional nurses are authorized to diagnose and treat patients through such services as case-finding, health teach- ing, health counseling, and provision of care supportive to or restora- tive of life and well-being.

The registered nurse first assistant is a registered professional nurse who provide s supportive and restorative patient care by performing as a first assistant at surgery under the direction of a licensed physician or legally authorized licensed health care provider under State Educa- tion Law and in accordance with scope of practice qualifications.

The extraordinary capabilities of those nurses providing such services, and their invaluable contributions to New York's health care delivery system are a matter of fact. These learned professionals work predomi- nantly in sensitive pre-operative, intra-operative and postoperative environments and are a vital liaison between surgeon and patient. The diminishment of surgical resident availability has enhanced the need for the registered nurse first assistant to function as a vital link in the provision of quality patient care

Typically, first assistant at surgery services are routinely reimbursed by health insurers for the services of other non physician, licensed professionals, who, within their scope of practice, perform, as first assistants at surgery. However, the first assistant at surgery services provided by the qualified registered nurse are not routinely reimbursed by insurers. This bill will rectify that disparity. It will ensure that first assistant at surgery services, provided by a registered nurse first assistant, will be routinely reimbursed by insurers.

DIRECT REIMBURSEMENT TO A REGISTERED NURSE FIRST ASSISTANT WHO BILLS FOR SUCH SERVICES.MAY OCCUR FOR SITUATIONS SUCH AS SERVICE AGREEMENT RELATIONSHIPS BETWEEN A PHYSICIAN AND A REGISTERED NURSE FIRST ASSIST- ANT, WHEN AN INSURANCE POLICY ALLOWS SUCH REIMBURSEMENT DIRECTLY TO THE REGISTERED NURSE FIRST ASSISTANT PROVIDER.

This bill ensures the equitability of the provision and distribution of reimbursement for services already designated as reimbursable.

As a matter of fact, this bill describes a cost-effective approach since the reimbursement for a non-physician, licensed professional who func- tions as a first assistant is already established as a cost saving meas- ure.

Additionally, this bill also serves as an incentive for retention and recruitment of nursing professionals.

Prior legislative history

A7894 of 2007-2008 referred to Insurance; A6167A of 2006; referred to Insurance A.6187 of 2005; referred to Insur- ance Committee A.9143 of 2003-2004; referred to Insurance Committee A.6315 of 2001 - 2002; referred to Insurance Committee

Effective date

This act shall take effect on the one hundred and eight- ieth day after it shall have become law and shall apply to all policies and contracts issued, renewed, modified, altered or amended after such a date.