Requires health coverage plans to include in provider networks certified nurse practitioners as primary health care providers

Title of bill

An act to amend the public health law and the insurance law, in relation to nurse practitioner access

Purpose

To entitle people covered by health plans to choose a nurse practitioner as their primary care or specialty provider and requires reimbursement at negotiated or reasonable rates.

Summary of provisions

Amends various provisions to require that health plans not discriminate against nurse practitioners as a class of primary care or specialty practice providers, and to provide that nurse practitioners shall be paid by health plans for their services, and that such rate should be negotiated. Where there is no negotiation, the insurer will pay usual and customary charges.

Justification

Nurse practitioners are authorized to diagnose, treat and refer patients in collaboration with a physician and in accordance with a practice agreement (Education Law § 6902 (3) (a) in seventeen different specialties. Further, nurse practitioners are authorized to prescribe and dispense drugs (Education Law §§ 6902(3) (b) and 6807(1)(b)).

Nurse practitioners are often the primary care and specialty providers of medical treatment. Typically, the services of nurse practitioners are reimbursed directly by Medicaid, Medicare and a number of private health insurers. Because all health plans provide reimbursement to nurse practitioners either directly or through billings generated by the physician-employer of the nurse practitioner, this bill will result in no additional costs to health insurers. The bill ensures that health plans that provide reimbursement to subscribers for certain physician services not exclude licensed nurse practitioners from their primary care and specialty provider networks and must provide reasonable reimbursement to subscribers who choose to receive such services from a nurse practitioner.

Fiscal implications

None.

Effective date

Sixty days after it becomes law.