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 29.

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

Section 3 adds a new subsection (ii) 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 (aa).

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 contains the effective date.

Justification

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

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

The extraordinary capabilities of those nurse providing such services, and their invaluable contributions to New York's healthcare delivery system are a matter of fact. These learned professionals work predomi- nantly in sensitive pre-operative and post-operative 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 the 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

Legislative history

2011: S.4138 Committed to Rules

Fiscal implications

None to the State.

Effective date

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